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Fundamentals-precautions-Becky
Nursing Fundamentals
27
Nursing
Undergraduate 3
07/11/2013

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Term
airborne precaution
Definition
disease than be spread through the air, client needs to be in private room with negative air pressure. Wear respirator mask visitor, pt, and nurse
Term
What kind of precaution should you take with TB, Varicella, Rubeola, SARS
Definition
airborne precaution
Term
what type of prevention is promotion
Definition
Primary prevention
Term
what type of prevention emphasizes early detection of disease, prompt intervention, and health maintenance.
Definition
Secondary prevention
Term
what type of prevention begins after an illness and helps to rehabilitate individuals or restore them to an optimum level?
Definition
Tertiary prevention
Term
when you are wearing ppe which object is the most soiled?
Definition
gloves
Term
PPE removal order
Definition
gloves, hand hygiene, eyewear, gown, mask
Term
PPE order
Definition
hand hygiene, gown, mask, eyewear, gloves
Term
Mumps Pneumonia,pertussis streptococcal pharyngitis scarlet fever rubella diptheria and adenovirus are need what kind of precaution?
Definition
Droplet precaution
Term
Tuberculosis vanilla rubeola and SARS require what type of precaution precaution?
Definition
airborne precaution
Term
C. Diff ,shigella , hepatitis A require what type of precaution ?
Definition
contact precaution
Term
what is surgical asepsis and sterile technique
Definition
practices that keep an area or object free of all microorganisms; includes practices that destroy all microorganisms and spores.
Term
what is medical asepsis?
Definition
includes all practices intended to confine a specific microorganism to a specific area, limiting the number of growth and transmission of microorganism. objects are referred to as clean (absence of almost all microorganisms) or dirty (soiled, contaminated)
Term
when is surgical asepsis used?
Definition
for all procedures involving the sterile areas of the body.
Term
Components of the infection chain
Definition
  1. an infectious agent
  2. a reservoir where the infectious agent grows
  3. an exit portal of the infectious agent
  4. a meas of transmission (e.g., droplet, contact, touching contaminated items)
  5. entry portal to a susceptible host (same as exit)
  6. a host that must be susceptible to the infectious agent
Term
Risks of infection
Definition
Nurse should assess each client for the risks of infection specific to the client, the disease or injury, and the environment
Term
Nosocomial infections
Definition
  • an infection that is acquired while the client is in the HC system
  • nosocomial infection can come from exogenous source (outside the pt) or endogenous (altered normal flora)
  • best way to prevent is through frequent hand washing!!
  • most common site: urinary tract; most common causative agents: E. coli and S. aureus
Term
signs and symptoms of generalized or systemic infection:
Definition
  • fever
  • increase pulse and resp rate (response to high fever)
  • malaise
  • anorexia, nausea, and/or vomiting
  • enlarged lymph nodes (repository for "waste")
Term
signs and symptoms of a localized infection:
Definition
  • redness (from dilation of arterioles bringing blood to the area)
  • edema
  • pain or tenderness
  • presence of exudates (dead phagocytes and tissue cells that leak from the vessels)
  • warmth of are on palpation
  • loss of use of affected part
Term
Lab results indicating infection
Definition
  • Laukocytosis (WBC's over 11,000 uL)
  • increases in specific types of WBCs on differential (left shift=an increase in neutrophils)
  • elevated erythrocyte sedimentation rate (ESR)
  • presence of micro-organism on culture of specific fluid/ area
Term
NSNDA Nursing Dx
Definition

impaired tissue integrity

risk for infection

risk for social isolation

risk for impaired tissue integrity

Term

Nursing Interventions 

(general guidelines)

Definition
  • frequent and effective handwashing (most important!!)
  • required and recommended immunizations
  • good oral hygiene
  • adequate amount of fluids
  • pulmonary hygiene (turning, coughing or deep breathing; make sure it is done every 2 hours in immobile clients or as ordered by physician)
  • aseptic technique and proper PPE
Term
Standard Precautions (tier one)
Definition
applies to all body fluids, nonintact skin, or mucous membranes
Term
Transmission Precautions (Tier Two)
Definition

Airborne precautions

droplet precautions

contact precautions

Term
Airborne Precaustions
Definition
  • to protect against droplet infections smaller then 5um (measles, varicella, TB)
  • require: a private room, mask/ respiratory protection device for caregivers and visitors, negative pressure airflow exchange in the room of at least 6 exchanges per hour
Term
Droplet precautions
Definition
  • protect against droplets larger than 5um (streptococcal pharyngitis or pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasm pheumonia, meningococcal pneumonia/ sepsis or pneumonic plague)
  • Require: private room or w/ other w/ same disease, mask for providers and visitors
Term
Contact Precautions
Definition
  • protect the visitors and caregivers against direct client/ environmental contact infections (e.g., respiratory syncytial virus, shigella, enteric diseases caused by micro-organisma, wound infections, herpes simplex, scabies, varicella zoster and multidrug-resistant organisms)
  • Require: private room or w/ client w/ same infection, gloves and gowns, disposal of infectious dressing material into a single, nonporous bag w/o touching the outside of the bag
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