Fundamentals Nur 112 Test 2

Infectious Agent of Pathogen

(bacteria, virus, fungi, protozoa)

Contact

(direct contact with patient or environment). Multidrug resistant organisms such as VRE & MRSA, C-Diff, Herpes simplex, Scabies, Shingles. *private room or cohort, gloves, gown.

Droplet

(larger than 5 microns; being within 3 feet of patient) Diptheria (pharyngeal), Pertussis, Rubella, Streptococcal Pharyngitis, Pneumonia or Scarlet fever in infants and children, Mumps, mycoplasma pneumonia or sepsis, pneumonic plague, Influenza (Flu) *Private room or cohort, Mask

Immunization

- process by which resistance to infectious disease is produced or augmented

Sulfonamides

-Achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, sulfamethoxazole/trimethoprim is often used in the treatment of UTIs. -Sulfamethoxazole/trimethoprim is also used for respiratory tract infections.

4. Macrolides

-Are bacteriostatic and inhibit protein synthesis of susceptible microorganisms -Often used to treat respiratory and GI infections as well as the STIs gonorrhea and Chlamydia

Heat and cold therapy

-Assessment for temperature tolerance -Bodily responses to heat and cold -Factors influencing heat and cold tolerance -Education have to have a order for ice packs and heating pads.

Appropriate Documentation

-Behavior of client -Procedure used for restraining (Initial documentation) -Time applied -Every assessment including condition of body part restrained -Releasing times (water, elimination, nutrition needs) -Evaluation of Patient response -Continuous evaluation for reapplication or removal -

Medical Aseptic Procedures

-Hand Hygiene -Alcohol-based waterless antiseptic -Clean dressing procedures -Standard precautions

Risk Management Nurse

-Identify possible risks -Analyze the risk -Act to reduce the risk -Evaluate the steps taken -Accurately document assessments and findings -Report significant changes in client's condition

Obtaining a Wound Culture

-Irrigate the wound with NS -Remove gloves and wash hands -Reapply clean gloves -Open culture kit paying close attention not to touch anything with the tips of the culture -Roll the cotton tips in the bed of the wound and reapply tips inside the culture medium -Label and place in biohazard bag, send to lab -Redress wound

Obtaining a wound culture

-Remove old dressing -Wipe away excess drainage off wound -Irrigate with normal saline -Use this time for patient education such as: -Nutrition -Proper Hygiene -Keeping the wound clean and dry -Signs and symptoms of infection *Normal saline- is a isotonic solution and the best thing to irrigate with.

Cephalosporins (Beta-Lactam group of antibiotics)

-Semisynthetic antibiotic that is structurally and pharmacologically related to the penicillins. -Work by interfering with bacterial cell wall synthesis -Those with hives or anaphylaxis from PCN should NOT receive cephalosporins

Erythrocyte Sedimentation Rate (ESR)

-Up to 15 mm/hr (Men) -Up to 20 mm/hr (Women) -increase with inflammatory process

Active Immunity

A. acquired active immunity Attained by an injection of a small amount of attenuated (weakened) or dead organisms or modified toxins from the organism (toxoids) into the body. B. natural active immunity obtained from having an illness (lifelong, active infection)

Collagen

A collagen dressing can be used for chronic or stalled wounds, ulcers, bed sores, transplant sites, surgical wounds, second degree or higher burns and wounds with large surface areas. collagen- dressing- form of collagen that aids in body healing process and has structual proteins in it. Types of wounds that requires this on chronic or wounds that are not healing on its own (pressure ulcers)

Professional Nursing Code of Ethics

A set of guiding principles that all members of a profession accept Helps professional groups settle questions about practice or behavior Includes advocacy, responsibility, accountability, and confidentiality

Risk Management

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Incident report or occurrence report is one tool used in risk management

Tetracyclines

ADEVERSE EFFECTS: Discoloration of permanent teeth Photosensitivity (must use sunscreen) C Diff Associated Diarrhea (report to HCP) Diarrhea N/V Rash (Report to HCP) Vaginal yeast infection

Aminoglycosides

ADVERSE EFFECTS: 1. Nephrotoxicity Evidenced by cast in urine, increased Creatinine and BUN 2. Ototoxicity Dizziness, tinnitus, fullness in ears and hearing loss

Penicillins (beta lactam group of antibiotics)

ALLERGY **Patients allergic to PCNs have ↑ risk for allergy to other beta-lactam antibiotics and cephalosporins** **Those with HIVES from PCN should NOT receive cephalosporins** DRUG INTERACTIONS

Restraints Alternatives

ALTERNATIVES MUST BE TRIED BEFORE RETRAINTS. MUST DOCUMENT ALTERNATIVES ATTEMPTED -Modification of environment -Bed alarms -Encourage family to stay at bedside -Trained sitters -Diversionary Activities -Music -Folding bedding -Playing with doll -Etc. -Reorientation (pictures of family, clocks) -Removal of unnecessary medical equipment (Camouflage lines with clothing, drsg) -Place client in room near nurse's station -Relaxation techniques -Scheduled toileting, nutrition -Evaluate all meds (cause of confusion/pain uncontrolled) -Assess for abnormal labs (low sodium, low H&H, etc.)

Ethical Dilemmas-Beginning of Life

Abortion Impaired Newborn Adoption/surrogacy Reproductive technology Human Genetics and Genomics Saviour siblings Embryo Research

Dilemmas at the End Of Life

Access to Hospice Care Nutrition and Hydration Pain Management Withholding and withdrawing medical treatment Resuscitation Medical Futility Advance Directives Terminal Sedation

Assessment

Accurate history and physical exam of: -Skin -Presence of ulcers -Mobility -Nutrition and fluid status Pain -Existing wounds, appearance, character Wound culture

Culturally Competent Care: End-of-Life Decisions

Acknowledgment of and respect for cultural differences Willingness to negotiate and compromise when world views differ Being aware of one's own values and biases Using communication skills that enhance empathy Knowing cultural practices of patient groups regularly seen Understanding that all patients are individuals who may not share the same views as others within their own ethnic group

Control of Physical Hazards (Hospital, Home, Workplace, etc.)

Adequate lighting - night lights Obstacles-remove small rugs, cords secure & out of walk way Bathroom hazards-grab bars, non slip tape in tubs, elevated toilet seat, turn down setting on H2O heater Security system- evaluate doors, windows, locks Smoke detectors- check batteries, multipurpose fire extinguisher near kitchen Keep meds labeled & out of reach , child resist caps, flush out of date meds

Fidelity

Agreement to keep promises.

Airborne

Airborne (droplet less than 5 microns). Measles, Chickenpox (varicella) Tb, Shingles . Barrier Protection-private room, Negative pressure room, N95 Mask.

alginate

Alginate dressings are used for moderate to high amounts of wound drainage, venous ulcers, packing wounds and pressure ulcers in stage III or IV. dries when they are placed. Become larger and more gel like the more fluid drawn in them . Purpose is to help clean out the wound. Stay on 1 to 3 days before removal

Latex Allergy Interventions

Allergy noted within client chart and Allergy Band placed on client. Read packaging on medical equipment to determine if it is Latex Free. Know and Remove common medical equipment that contains latex: Gloves IV tubing Syringes Rubber stoppers on bottles Adhesive tape

Protective

Allogenic hematopoietic Stem Cell transplants Private room Positive airflow with HEPA filtration. Patient to wear mask when out of room.

Common Drug Classifications for Treating Infections

Antibiotic Having the ability to destroy or interfere with the development of a living organism. May reduce the efficacy of oral contraceptives. Teach patient to take additional precautions to prevent pregnancy Always assess ALLERGIES before giving and antibiotic Results of cultures and sensitivity testing determine which antibiotic is best to utilize. Get culture BEFORE starting antibiotic Always check the culture and sensitivity results when antibiotics are prescribed. -Antibiotics are classified into broad categories based on their chemical structure.

Common Drug Classifications for Treating Infections

Antibiotic Categories: 1. Sulfonamides -CONTRAINDICATED when allergic to "Sulfa" drugs (Sulfonamides) -Do not destroy bacteria but rather inhibit their growth therefore are considered a bacteriostatic antibiotic -Although there are many compounds in the sulfonamide family, only sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic), known as Bactrim, Septra, or co-trimoxazole and often abbreviated as SMZ-TMP, is used commonly in clinical practice.

Tetracyclines

Are bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome.

5. Quinolones AKA Fluoroquinolones

Are very potent bactericidal broad-spectrum antibiotics. -Destroy bacteria by altering the bacteria's DNA

Access to Care

As a nurse, you will certainly deal with ethical issues related to access to care.

Nonmaleficence

Avoidance of Harm or Hurt

Justice

Being Fair

Portal of exit

Blood, Skin, mm,resp tract, Gi tract.

Sulfonamides Adverse Reactions

Blood: Agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia (monitor CBC results for ↓ WBC count, ↓ Hgb & Hct, ↓ low platelets) IV Site: Phlebitis Gastrointestinal: Nausea, vomiting, diarrhea, pancreatitis, hepatotoxicity (monitor serum bilirubin & alkaline phosphatase) Monitor Bowel Function: Diarrhea, abd cramping, fever, bloody stools should be reported to HCP as a sign of C-Diff diarrhea (May begin up to several weeks following therapy) Integumentary: Epidermal necrolysis, exfoliative dermatitis, Stevens-Johnson syndrome, photosensitivity (Report RASH immediately to HCP).

5. Quinolones

Body system and adverse effects. Central Nervous - headahce, dizziness, insominia, depression, restlessness, seizures, neuropathy. Gastrointestinal Nausea, constipation, Hepatotoxicity, flatulence, heartburn, vomiting, C-Diff Associated Diarrhea, oral candidiasis Integumentary- Rash Other Ruptured tendons and tendonitis fever, chills, blurred vision, tinnitus

Penicillins (Beta-Lactam group of antibiotic

CONTRAINDICATIONS -Known drug allergy to PCN ADVERSE EFFECTS Body system: Central Nervous System -Gastrointestinal Candidiasis (yeast) -Hematologic Granulocytipenia -Metabolic -skin See slide 79

Aminoglycosides

CONTRAINDICATIONS: Allergy to medication Pregnancy Breast feeding

Tetracyclines

CONTRAINDICATIONS: The only contraindication is a known drug allergy

Quinolones

CONTRAINDICATIONS: The only usual contraindication is known Quinolone allergy

4. Macrolides

CONTRAINDICATIONS: The only usual contraindication is known macrolide allergy

Signs and Symptoms of Anaphylaxis

Causes: Latex Allergy Insect Stings (bee, wasps, ant) Food Allergy Rapid Onset Dyspnea- tight throat, bronchospasm, Laryngeal Edema. Feelings of Apprehension Tingling and swelling in mouth, face, throat, and tongue. Itching, decresed BP, Tachycardia, loss of consciousness.

Cultures & Gram Stain of wound, sputum and throat

No WBCs on gram stain. Infectious microorganism growth and WBCs on gram stain

Basic Skin Cleaning

Clean in a direction from the least contaminated area such as from a wound or incision to the surrounding skin or from an isolated drain site to the surrounding skin. -Use gentle friction when applying solutions locally to the skin -When irrigating, allow the solution to follow from the least to most contaminated area

Clean technique Continued

Clean means free of dirt, marks, or stains Clean technique involves strategies used in patient care to reduce the overall number of microorganisms or to prevent or reduce the risk of transmission of microorganisms from one person to another or from one place to another.

Clean technique 3

Clean technique involves meticulous handwashing, maintaining a clean environment by preparing a clean field, using clean gloves and sterile instruments, and preventing direct contamination of materials and supplies. This technique may also be referred to as non-sterile.

Clean technique 4

Clean technique is considered most appropriate for long-term care, home care, and some clinic settings; for patients who are not at high risk for infection; and for patients receiving routine dressings for chronic wounds such as venous ulcers, or wounds healing by secondary intention with granulation tissue. -Clean in a direction from the least contaminated area such as from a wound or incision to the surrounding skin or from an isolated drain site to the surrounding skin.

Autonomy

Commitment to include patients in decisions, also refers to commitment to the patient and protecting the patients independence.

Nurses Collaborate With Other Professionals

Consensus building: an act of discovery in which "collective wisdom" guides a group to the best possible decision A nurse's point of view offers a unique voice in the resolution of ethical dilemmas

Mode of Transmission

Contact, airborne, droplet, vehicles, vectors.

Genetic Screening

What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available?

4. Macrolides

DRUG INTERACTIONS The macrolides possess two properties that can cause drug interactions: they are highly protein bound, and they are metabolized in the liver. For drugs metabolized in the liver, drug interactions arise from competition between the different drugs for metabolic enzymes, specifically the enzymes known as the cytochrome P-450 complex. The result is a delay in the metabolic clearance of one or more interacting drugs and thus a prolonged and possibly toxic drug effect. -Examples of some especially common drugs that compete for hepatic metabolism with the macrolides are: carbamazepine (anti-seizure med), cyclosporine (immunosuppressant), theophylline (bronchodilator), and warfarin (anticoagulant). Macrolides can also reduce the efficacy of oral contraceptives.

Deontology

Defines actions as right or wrong based on the right making characteristics such as promised truthfulness and justice.

Personal Protective Equipment (PPE)

Donning (putting on) order: -Gown -Mask -Eyewear (if needed) -Gloves Way to Remember order: -First you put on your dress (Gown), then you put on your lipstick (mask), then your Shades (googles) and lastly your drive (gloves) to wherever you're going. -GMEG put your PPE on!

Personal Protective Equipment (PPE)

Donning (putting on): Make sure gown covers all clothing and is tied x 2 Make sure mask is fitted properly Ensure glove cuffs are over the gown sleeves

4. Macrolides

EXAMPLES Note "mycin" in the generic name. -Azithromycin (Zithromax) Clarithromycin (Biaxin) Erythromycin (E-mycin, EryPed)

Tetracyclines

EXAMPLES (Note "cycline" at the end of generic name) -demeclocycline -oxytetracycline -tetracycline -doxycycline -minocycline -tigecycline

2. Penicillins (Beta-Lactam group of antib

EXAMPLES: -Natural Penicillins Penicillin G & Penicillin V -Extended Spectrum Penicillins Ticarcillin (Timentin) Piperacillin/Tazobactam (Zosyn) Aminopenicillins Amoxicillin Ampicillin NOTE: Generic name identifies "cillin" and Brand name does not. To prevent giving penicillin to client with allergy to PCN be sure to always review generic name.

3. Cephalosporins (Beta-Lactam group of antibiotics)

EXAMPLES: notice "cef", "zil" & "ceph" in generic name

Surgical (sterile)

Eliminates all Microorganisms

Ethics of Care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives

Range of motion, Flexibility, and strength decrease.

Encourage supervised exercise classes for older adults and teach them to seek assistance with household tasks as needed. Safety features such as grab bars in the bathroom are often necessary.

Health Care Agency(Falls/ Accidents)

Environmental safety Medical errors-3rd leading cause of death -Most med errors are due to lack of knowledge about drug or pt & failure to follow policy -overwork & fatigue causes errors Errors due to system failures Material Safety Data Sheets (MSDS)- provide detailed info about chemical spills Incident report- confidential document, describes accident, not part of medical record

Community Ethics

Ethic of community is defined as the moral responsibility to engage in communal processes as educators pursue the moral purposes of their work and address the ongoing challenges of daily life and work in schools. It is ethical to act in the best interests of the community, and it is unethical to act against the best interests of the community.

Nursing and Values

Ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Sometimes people have such strong values that they consider them to be facts, not just opinions. Sometimes people are so passionate about their values that they provoke judgmental attitudes during conflict.

Institutional Resources

Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee.

Feminist Ethics

Focuses on the inequality between people and usually its between sex, Can be between race. Looks at the nature relationships

Process

For abrasions, minor lacerations, and small puncture wounds: -First rinse the wound with normal saline -Lightly cover the area with a dressing. -Application of moist saline dressing applied over minor wounds prevents entrance of microorganisms.

Hydrocolloid

Hydrocolloid dressings are used on burns, light to moderately draining wounds, necrotic wounds, under compression wraps, pressure ulcers and venous ulcers. self adhesives. usually contain a gel forming agent. Aim to provide moist healing environment while using the patient owns moisture to aid in proper healing. Varies in sizes.

Aminoglycosides

INDICATIONS The toxicity associated with aminoglycosides limits their use to treatment of serious gram-negative infections and specific conditions involving gram-positive cocci, in which case gentamicin is usually given in combination with a penicillin. Gram-negative infections commonly treated with aminoglycosides include those caused by Pseudomonas species (spp.), Escherichia coli, Proteus spp., Klebsiella spp., Serratia spp., and acinetobacter spp. Gram-positive infections treated with aminoglycosides may include infections due to Enterococcus spp. and S. aureus, and bacterial endocarditis, which is usually streptococcal in origin

Tetracyclines

INDICATIONS Traditionally used to treat acne in adolescents and adults, they are also considered the drugs of choice for the treatment of the following infections caused by susceptible organisms: • Chlamydia: lymphogranuloma venereum, psittacosis, and nonspecific endocervical, rectal, and urethral infections • Mycoplasma: Mycoplasma pneumonia • Rickettsia: Q fever, rickettsial pox, Rocky Mountain spotted fever, and typhus Other bacteria: Lyme disease, H. pylori infections associated with peptic ulcer disease syphilis (used as an alternative drug to treat patients with penicillin allergy); tetracyclines are now unreliable in treating gonorrhea due to the development of resistant bacterial strains • Protozoa: balantidiasis

Fall Prevention Strategies

Identify those at risk Fall Risk Assessment on admission and when there is a change in client condition Yellow Arm Band Check client frequently Keep door open Side rails up x 3 Call light in reach Bed in lowest position with wheels locked Remove clutter from room

Procedure Related Accidents

Occur during a therapy Medication and fluid administration errors Preventive measures: -Follow policy & procedure for meds administration -Maintain surgical asepsis for sterile dressings -Correct use of body mechanics

The infectious Process

Localized-(ex. wound infection) client may experience localized symptoms such as pain & tenderness at the wound site Systemic-(ex. sepsis) affects the entire body instead of just a single organ. Can be fatal

Document wound care

Location Size Depth Wound depth appearance Exudate/Drainage Appearance of surrounding skin

3. Cephalosporins (Beta-Lactam group of antibiotics)

MOST COMMON ADVERSE EFFECTS: Diarrhea (C-Diff Associated Diarrhea), abdominal cramps, rash, pruritus, redness, and edema.

State guidelines

Make sure all alternatives are implemented -Physicians order -Secure with quick release tie (NEVER KNOT!!) Text page 391 DO NOT ATTACH to SIDE RAILS!!! -Insert two fingers under secured restraint -Proper placement, skin integrity, pulses, temperature, color, and sensation should be assessed every 2 hours

Environmental Hazard of Bioterrorism

May initially resemble a natural outbreak Anthrax- infected through skin, inhalation, ingestion - Flu like symptoms -Abd pain -NV -Bloody diarrhea -Itching Skin lesions Smallpox-airborne, **single case is public health emergency -flu like symptoms, skin lesions

Risks in the Health Care Agency

Medical errors TJC and CMS "Speak Up" campaign National Quality Forum mission Environmental risks: Chemicals found in some medications (e.g., chemotherapy), anesthetic gases, cleaning solutions, and disinfectants are potentially toxic if ingested, absorbed into the skin, or inhaled. Material safety data sheets (MSDSs) are required resources available in any health care agency.

Moral Distress

Moral distress describes the anguish experienced when a person feels unable to act according to closely held core values. Because moral distress is a shared experience, efforts to alleviate distress are most successful when they are also shared

Aminoglycosides

Most commonly, dosing is adjusted to the patient's level of renal function, based on estimates of creatinine clearance calculated from serum creatinine values (must assess creatinine clearance lab result). This task is often carried out by a hospital pharmacist, consulting for the prescriber. Not only are serum levels measured to prevent toxicity, but it has been shown that for the aminoglycosides to be effective, the serum level needs to be at least eight times higher than the minimum inhibitory concentration (MIC). The MIC for any antibiotic is a measure of the lowest concentration of drug needed to kill a certain standard amount of bacteria

Cultures of Urine and Blood

No microorganism, growth of microorganism.

Quinolones Examples (note "acin" in generic name

Norfloxacin (noroxine)- UTIs, Prostatitis, STIs Ciprofloxacin (Cipro)-Anthrax, UTIs, Respiratory & Skin infections, Bone & Joint infections, Typhoid fever, GI infections, some healthcare acquired pneumonias Levofloxacin (Levaquin)-Respiratory and UTI infections Moxifloxacin (Avelox)-Respiratory & Skin Infections, Community Acquired pneumonia Gemifloxacin (Factive)-Community Acquired Pneumonia (CAP) Exacerbation of COPD

White blood cell (WBC)

Normal count- 5000-10,000 mm3/ indication of Infection: Increase in acute inflammation, decrease in some viral illness and overwhelming infection.

Legal Requirements

Nurse must know agency policy and procedures for appropriate use and monitoring -Use of restraint must be clinically justified -Physicians order is required, based on face to face assessment of client Order must state: -Type of restraint -Location -and specific client behaviors for which restraints are to be used

Disasters: Internal Disasters

Nurse protects client from immediate injury Code Red Setting priorities in case of fire using RACE mnemonic R-rescue & remove all clients in immediate danger A-activate the alarm C-confine the fire E - extinguish the fire

Evaluation

Nursing interventions for reducing and treating pressure ulcers need to be evaluated to determine if the client has met the identified outcomes or goals.

Physiological Changes of Aging and Effect on Patient Safety

Older adults experience visual and hearing alterations. Encourage annual vision and hearing examinations and frequent cleaning of glasses and hearing aids as a means of preventing falls and burns. •Some older adults have slowed reaction time. Teach patients safety tips for avoiding automobile accidents. Sometimes driving needs to be restricted to daylight hours or temporarily or permanently suspended.

Ethical Issues on Aging

Older people usually are not as familiar with the concept of autonomy as are people from younger generations. As people age, they develop clinical conditions that affect the communication process. Some patients become incapacitated by stroke or disease. Most older adults take multiple medications, some of which affect cognitive skills in subtle ways. Consensus about medical goals for the older adult is hard to achieve.

Sulfonamides Adverse Reactions

Other: -Convulsions -Crystalluria (to prevent must drink 1200-1500 mL fluid daily) -↑ Potassium level (Monitor serum K+ and if above 5.0 notify HCP) Hypoglycemia (Potentiates the hypoglycemic effects of sulfonylureas taken by diabetics) Examples of sulfonylureas Glimepiride (Amaryl) GlipiZIDE (Glucotrol) GlyBURIED (DiaBeta) Potentiates Toxic Effects of Phenytoin and Warfarin (Can result in hemorrhage/↓ platelets)

Fire Extinguisher Use

PASS P = pull pin A = aim low at base of fire S = squeeze handle S = sweep side to side

Caring for a patient in Isolation

PPE determined by type of isolation Equipment/supplies are not taken out of the room (Example VS machine, BP cuff, etc.) Sign for type of Isolation on patient door Isolation supplies in box or cart outside the patient's door Be sure to review Box 29-11 for procedural guidelines for Caring for a Patient on Isolation Precautions

Transmission of Pathogens

Pathogen-any microorganism capable of producing an illness ****Hand washing is most effective way for limiting transmission of pathogens Standard Precautions utilized on ALL Patients Guidelines recommended by the CDC for reducing the risk of transmission of blood-borne and other pathogens in hospitals. The precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes. Standard precautions apply to contact with blood, body fluid, nonintact skin, and mucous membranes from all patients. These precautions protect patients and provide protection for health care workers.

Memory is Sometimes impaired

Patients need to use medication organizers, which can be purchased at any drugstore at a very reasonable cost. Fill these dispensers once a week with the proper medications to be taken at a specific time during the day.

Values

Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior.

Basic Needs For Safe Environment

Physical hazards reduced. Transmission of pathogens reduced. Sanitation is maintained. Pollution is controlled. Threat of attack prevented.

Reservoir

Place where pathogen can survive, human body is most common.

Utilitarianism

Proposes that the value of something is determined by its usefulness also known as consequences

Purpose of Dressings

Protects a wound from microorganism contamination -Aids in hemostasis -Promotes healing by absorbing drainage and debriding a wound -Supports or splints a wound site -Promotes thermal insulation of a wound surface -Provides a moist environment

Reflexes are slowed, and the ability to respond to multiple stimuli is reduced.

Provide adequate, meaningful stimuli but prevent sensory overload.

REEDA

Redness, Edema, Erythema, discharge, Approximation

Reasons for Use

Reduce the risk of client injury from repeated falls -Prevent interruption/removal of therapy/medical devices such as traction, IV infusions, NG tube feedings, or Foley catheter -Prevent confused or combative client from removing life support equipment Reduce risk of injury to others by client **RESTRAINTS ARE NOT A SOLUTION TO A PROBLEM** They are temporary means to maintain safety

Warfarin

Reduced Vit K gut flora. Result- enhanced anticoagulant effect

Nurse Advocacy

Release and reassessment every 2 hours -Nutrition, toileting needs -Proper documentation -Safety PROPER DELEGATION: -Restraint application can be delegated to NAP AFTER the nurse appropriately assesses the patient -Assessment while the restraint is in place CAN NOT be delegated to NAP -The nurse instructs the NAP: Reviewing correct placement of restrain When and how to change pt position When to notify nurse if there is a change in skin integrity, circulation or pt breathing When to provide: ROM, nutrition, skin care, toileting, socialization opportunities

Personal Protective Equipment (PPE) (removal)

Removal order: -Gloves -Eyewear -Gown -Mask Way to Remember: -First you turn off your car (gloves), -then you take of your shades (googles) because you are indoors, -you take off your dress (gown) -and finally you wipe off your lipstick (Mask)

Latex Allergy

Routes of Exposure and Reactions to Latex Latex allergy usually occurs when latex-containing products (especially powdered gloves) come in direct contact with the skin, mucous membranes (eyes, mouth, vagina, and rectum), or the bloodstream. The powder in gloves can absorb latex proteins and then become an airborne carrier. Individuals may develop allergic reactions through merely inhaling latex-containing dust. Many medical devices/equipment contain LATEX and must be removed from the environment and replaced with LATEX FREE items.

Latex Allergy Interventions

Screen for other allergies that ↑ possibility of latex allergy. For Example: Allergies to High possibility of latex allergy Banana, Avocado, Chestnut, Kiwi Moderate possibility of latex allergy Apple, Carrot, Celery, Papaya, Potato, Tomato, Melon

Provide Seizure Safety

Seizure-hyper-excitation and disorderly discharge of neurons in brain leading to involuntary muscle contractions Seizure Precautions- **Assess ABCs bed in lowest position pad side rails side-lying position guide to floor cradle head into lap **never restrain pt during seizure ** Never put anything into mouth while seizing

acute and restorative Care

Side rails -Increase patient mobility and/or stability -Most commonly used as restraint (up x4 equals restraint) -Can cause falls or death

Portal of entry

Site where Microorganism find their way onto new host (ex) break in skin. (wound)

Susceptible Host

Someone who diminished defense mechanism.

How to Process an Ethical Dilemma

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Step 7: Evaluate the plan.

Beneficence

Taking positive actions to help others

Aminoglycosides

The aminoglycosides are a group of natural and semisynthetic antibiotics that are classified as bactericidal drugs. Prevent protein synthesis in bacteria They are potent antibiotics, which makes aminoglycosides the drugs of choice for the treatment of particularly virulent infections.

Nursing Diagnosis and Planning

The assessment will reveal important information regarding the client's status. Use NANDA-I-approved diagnoses. Don't forget to add the Related to (R/T) part. Example: Impaired skin integrity R/T poor nutritional status Write client goals and outcomes specific to the client's needs.

National Statistics RT Latex Allergy.

The current statistics for people sensitized to natural rubber latex are broken down by risk groups and are as follows: 8-17% of health care workers Up to 68% of children with spina bifida (related to frequent surgeries - anyone who has multiple surgeries is at risk) Less than 1% of the general population in the U.S. (about 3 million people)

Falls

The leading cause of fatal and nonfatal injuries in adults 65 and older! Falls- 90% of reported incidents in hospitals Increase in elderly due to age, gait problems Bed to toilet transfers Drug and drug interactions Hip fractures-most serious, 1/3 of pts. will die with in 1 yr due to complications of immobility

Process of cleaning a wound

The process of cleaning a wound includes selecting the appropriate -Cleaning solution -Use of mechanical means of delivery that solution without causing injury to the healing tissue -Gently cleaning a wound removes contaminants that serve as sources of infection

Concept of Safety Defined

The protection of clients and health care personnel from health and environmental hazards

Ethics

The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large.

Aminoglycosides

The three aminoglycosides most commonly used for the treatment of systemic infections are amikacin, gentamicin, and tobramycin. Serum levels of these drugs are routinely monitored in patients' blood samples. Dosages are adjusted to maintain known optimal levels that maximize drug efficacy and minimize the risk for toxicity. This process is known as therapeutic drug monitoring. Aminoglycoside therapy is monitored in this way due to the nephrotoxicity (kidney damage) and ototoxicity (hearing loss) associated with these drugs.

Restraints (continued)

The use of restraints is associated with serious complications resulting from immobilization such as pressure ulcers, pneumonia, constipation, and incontinence. -In some cases death has resulted because of restricted breathing and circulation. -Patients have been strangled while trying to get out of bed while restrained in a jacket or vest restraint. Many health care facilities have eliminated the use of the jacket (vest) restraint -Regulatory agencies such as TJC and the CMS enforce standards for the safe use of restraint devices. The optimal goal for all patients is a restraint-free environment.

Hydrogel

This type of dressing is for wounds with little to no excess fluid, painful wounds, necrotic wounds, pressure ulcers, donor sites, second degree or higher burns and infected wounds. -hydroGels are 90 % water in a gel base and help monitor fluid exchange inside the wound.

Standard Precautions

Tier one: -Hands are washed -Gloves are worn when touching body fluids -Masks are worn for splash occurrences -Gowns are worn if soiling of clothing is likely -Equipment is cleaned properly -Discard sharps instruments properly -No artificial nails -Respiratory hygiene/cough etiquette -Cover nose/mouth -Use of tissues -3 feet away from others if coughing

Patient Rights

Treatment without discrimination Respect, Confidentiality and Personal Dignity Information you can understand Participation in decisions about your care Care that supports you and your family Access to your billing and Medical Records Patient's Responsibilities Right to Complain Right to choose advocate and visitors

Oral Contraceptives

Uncertain result may decrease effectiveness of oral contraceptives.

Standard Precautions

Utilized to protect the patient AND health care provider (HCP) from infection pathogens regardless of suspected or confirmed infection. Utilized with EVERY patient!!! Examples: Hand hygiene Wearing gloves and other Personal Protective Equipment (PPE)

Environmental Hazard: Latex Allergy

What is latex allergy? Is a reaction to certain proteins in latex rubber. Increasing the exposure to latex proteins increases the risk of developing allergic symptoms Groups at High Risk for LATEX allergy: Healthcare workers who frequently wear latex gloves Children with spina bifida, spinal cord trauma, and urogenital malformations who may have had repeated exposure to latex products because of multiple surgeries.

Antibiotic Categories: 2. Penicillins (Beta-Lactam group of antibiotics)

Works by: inhibiting the synthesis of the bacterial cell wall -The microorganisms most commonly destroyed by penicillins are gram-positive bacteria, including Streptococcus, Enterococcus, and Staphylococcus. -Most natural penicillins have little if any ability to kill gram-negative bacteria. However, the extended-spectrum penicillins (i.e., piperacillin/tazobactam [Zosyn]) have excellent gram-positive, gram-negative, and anaerobic coverage. Because of this, the extended-spectrum penicillins are used to treat many health care-associated infections, including pneumonia, intraabdominal infections, and sepsis.

Chemical Restraints

are medications such as anxiolytics and sedatives used to manage a patient's behavior and are not a standard treatment or dosage for the patient's condition. Restraints are NOT a usual part of treatment plans

Quality of Life

central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNR

Nocturia and Incontinence are more frequent

in older adults. Institute a regular toileting schedule for the patient. A recommended frequency is every 3 hours. Give diuretics in the morning. Provide assistance, along with adequate lighting, to patients who need to go to the bathroom at night.

Medical (clean) Technique

includes procedures to reduce and prevent the spread of microorganisms

Care at the end of life

interventions unlikely to produce benefit for the patient

physical Restraints

is any manual method or physical or mechanical device (such as full set of side rails), material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely

Asepsis

is the absence of pathogenic microorganisms

Clean Technique

refers to the use of routine hand washing, hand drying and use of non-sterile gloves

Passive Immunity

occurs when antibodies produced by other persons or animals are introduced into a person's bloodstream for protection against a pathogen. A. natural (mother to baby) B. acquired (immune serum {ex hep B immune globulin}, is temporary)