When the presence of a pathogen leads to a chain of events - all components of the chain must be present for infection to occur
What are the components of the chain of infection?
Infectious agent
Reservoir
Exit portal
Means of transmission
Entry portal
Susceptible host
What are some examples of infectious agents?
Bacteria
Fungus
Virus
Protozoa
What are some examples of reservoirs where infections can grow?
Wound drainage
Food
Oxygen tubing
What are some exit portals for infectious agents?
Skin
Respiratory
GI tract
What are some means of transmission for infectious agents?
Droplet
Person-to-person contact
Touching contaminated items
The most common risks of infection are
Inadequate handwashing
Compromised health or defenses against infection
Poor medical or surgical asepsis by caregivers
Client with poor personal hygiene, poor nutrition
Stressed client
Older adult client
Clients making poor lifestyle choices
Clients recently exposed to poor sanitation, presence of mosquito-borne or parasitic diseases, or diseases endemic to the area visited but not in client's home country
Who are some of the individuals that have compromised health or defenses against infection?
Immunocompromised
Post-surgical
Indwelling devices
Break in the skin
Poor oxygenation
Impaired circulation
Chronic or acute disease
What are some poor lifestyle choices that put individuals at risk for infection?
IV drugs and sharing needles
Unprotected sex
What is a nosocomial (hospital acquired) infection?
An infection acquired while the client is in the health care system
The best way to prevent nosocomial infections?
Hand washing
What is the most common site of nosocomial infections?
Urinary tract
What are the most common causative agents of nosocomial infections?
Escherichia coli and Staphylococcus aureus
Signs and symptoms of a generalized or systemic infection?
Fever
Increased pulse and respiratory rate
Malaise
Anorexia, nausea and/or vomiting
Enlarged lymph nodes
Signs and symptoms of localized infection?
Redness
Edema
Pain or tenderness
Presence of exudates
Warmth of area on palpation
Loss of use of the affected part
What laboratory results indicate infection?
Leukocytosis (WBCs > 11,000/uL)
Increases in the specific types of WBCs on differential
Elevated erythrocyte sedimentation rate (ESR)
Presence of microorganism on culture of the specific fluid/area
What are some nursing diagnoses for infection?
Impaired tissue integrity
Risk for infection
Risk for social isolation
Risk for impaired tissue integrity
What education should be provided to clients and their families to prevent infection?
Handwashing
Required and recommended immunizations
Good oral hygiene
Adequate amount of fluids
Pulmonary hygiene
How does good oral hygiene prevent infection?
Decreases the protein in the oral cavity which decreases the growth of microorganisms that can migrate through breaks in the oral mucosa
How does adequate fluid intake prevent infection?
Prevents the stasis of urine by flushing the urinary tract and decreasing the growth of microorganisms
Keeps the skin from breaking down
How does good pulmonary hygiene prevent infection?
Decreases the growth of microorganisms and development of pneumonia by prevention of stasis of pulmonary excretions, stimulation of ciliary movement and clearance, and expansion of the lungs
What are isolation guidelines?
A group of actions that include hand hygiene and the use of barrier precautions, which are intended to reduce the transmission of infectious organisms
When is personal protective equipment changed?
After contact with each client
Between procedures with the same client if in contact with large amounts of blood and body fluids
What do standard precautions apply to?
Apply to all body fluids, nonintact skin, or mucous membranes
What precaution requires gloves to be worn when touching anything that has the potential to contaminate the hands?
Standard precautions
In standard precautions, when are masks, eye protection, or face shields required?
When care may cause splashing or spraying of body fluids
When are gowns worn on standard precautions?
If the caregiver's clothes may be soiled during care
What are the three types of transmission precautions?
Airborne
Droplet
Contact
Which transmission precaution is to protect against droplet infections smaller than 5 um?
Airborne
What are some airborne transmitted infections?
Measles
Vericella
Pulmonary TB
Laryngeal TB
Which transmission precaution requires a private room, mask/respiratory protection device for caregivers and visitors, and negative pressure airflow exchange in the room of at least six exchanges per hour
Which transmission precaution is to protect against droplets larger than 5 um?
Droplet
What are some droplet transmitted infections?
Streptococcal pharyngitis or pneumonia
Meningococcal pneumonia/sepsis
Scarlet fever
Rubella
Pertussis
Mumps
Mycoplasma pneumonia
Pneumonic plague
Which transmission precaution requires a private room or a room with other clients with the same infectious disease and a mask for providers and visitors?
Droplet
Which transmission precaution is to protect visitors and caregivers against direct client/environmental infections?
Contact
What are some direct contact transmitted infections?
RSV
Shigella
Enteric diseases
Wound infections
Herpes simplex
Scabies
Varicella zoster
Multi-drug resistant organisms
Which transmission precaution requires a private room or room with other clients with the same infection, gloves and gowns worn by the caregivers and visitors, and disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag?
Contact
What are the guidelines for cleaning contaminated equipment?
Always wear gloves
Rinse first in cold water
Wast the article in hot water with soap
Use a brush or abrasive to clean corners or hard-to-reach areas
Rinse well in warm or hot water
Dry the article
Clean the equipment used in cleaning and the sink
Remove gloves and wash hands
There are more than 60 communicable diseases that must be reported to the public health departments. What do the reports allow officials to do?
Ensure appropriate medical treatment of diseases
Monitor for common-source out breaks
Plan and evaluate control and prevention plans
Identify outbreaks and epidemics
Determine public health priorities based on trends
Match the component of the chain of infection with the example of each component
1. Infectious agent
2. Reservoir
3. Means of transmission
4. Exit and entry portal
5. Host
A. Client
B. Bacteria, virus, fungi, protozoa
C. Wound drainage, food, oxygen tubing
D. Person-to-person contact
E. Skin, respiratory, and GI tracts
1 - B
2 - C
3 - D
4 - E
5 - A
Which of the following are reasons health care professionals are required to report communicable/infectious diseases? (select all that apply)
- Planning and evaluating of control and prevention plans
- Determining public health priorities
- Ensuring proper medical treatment
- Identifying endemic disease
- Monitoring for common-source outbreaks
- Planning and evaluating of control and prevention plans
- Determining public health priorities
- Ensuring proper medical treatment
- Monitoring for common-source outbreaks
What is the purpose of bathing?
To cleanse the body, relax it and enhance healing
What assessments should be performed when bathing a client?
Skin assessment
Wound assessment and wound care
When are complete baths given?
When the client is able to tolerate it and the client's hygiene needs warrant it (usually reserved for debilitated clients)
When are partial baths given?
When the client needs to only have odorous or uncomfortable areas cleansed or can perform part of the bath himself
Why is foot care given?
To prevent skin breakdown, pain and infection
What clients is foot care extremely important for?
Diabetic clients - must be done by a trained professional
Why is perineal care important?
To maintain skin integrity, relieve discomfort, and prevent transmission of infection
Allowing the client to have as much control as possible over her hygiene does what for her psychologically?
Shows respect for her dignity
What are special considerations for older adult clients when giving hygiene care?
They have drier and thinner skin and may not tolerate as much bathing as a younger adult
They have a higher incidence of infection and periodontal disease
Dentures and partials must be fitted correctly
Dentures are a client's personal property and should never be left on a meal tray or in a place where they could be damaged
Dry mouth is common
May have poor nutritional status
Why is dry mouth common in older adults?
Due to decreased saliva production and medications used by this population
What is poor nutritional status in the older adult often due to?
Dental problems
Socioeconomic status
Decrease in the ability to prepare healthy foods
To understand how the client conducts hygiene at home and where the nurse will need to provide education and extra care, what needs to be assessed?
Hygiene preferences
What are some nursing diagnoses related to hygiene?
Risk for injury
Risk for infection
Bathing/self-care deficit
Dressing/grooming deficit
What part of the client's body should be washed first when giving a bath?
The face
How should a bath be given?
Systematically, staring with the client's upper body and continuing on to the lower extremities
When performing perineum care, should the water be changed to fresh water?
Yes
After giving a client a bath, what needs to be documented?
Skin assessment
Type of bath
Client response
How do you change and occupied bed?
- Roll the old bottom linens up in the bottom sheet or mattress pad under the client who is turned on his side, facing the opposite direction
- Apply clean bottom linens to the bed and smooth to the middle of the bed with the remainder of the linen fan folded underneath the client
- The client should roll over the linens and face the opposite direction while the nurse removes the old linens and applies the new linens
- Apply upper sheet and blanket
- Remove the pillow case by inserting the hand into the opening, grabbing the pillow and turning the pillowcase inside out
- Apply the clean pillow case by grasping the center of the closed end, turning the case inside out, fitting the pillow into the corner of the case adn pulling the case until it is right side out over the pillow
What clients require gentle brushing and flossing when performing oral hygiene?
Clients who have fragile oral mucosa
How do you perform denture care for a client who is unable to do it himself?
- Remove the dentures with a gloved hand, pulling down and out at the front of the upper denture, and lifting up and out at the front of the lower denture
- Place dentures in a denture cup or emesis basin
- Brush them with a soft brush and denture cleaner
- Rinse them in water
- Store the dentures, or assist the client with reinserting them
What instructions/education should be given to clients at risk for poor foot hygiene?
- Inspect feet daily, paying special attention to between the toes
- Use lukewarm water and dry the feet thoroughly
- Apply moisturizer to the feet but avoid applying it between the toes
- Avoid OTC products that contain alcohol or other strong chemicals
- Wear clean cotton socks daily
- Check shoes for any objects that may cause injury
- Cut nails straight across and use emery board to file edges
- Avoid self-treating corns or calluses
- Buy and wear comfortable shoes that do not cut off circulation
- Avoid using heat applications
- Contact PCP if any signs of infection or inflammation appear
What are the principles of perineal care?
- Providing privacy
- Maintaining a professional demeanor
- Removing fecal material away from the skin if present
- Cleansing the client from front to back
- Drying thoroughly
- Retracting the foreskin in male clients to wash the tip of the penis, then replace the foreskin
What is done when providing nail care?
Assess the client's nails for size, shape, and condition of nail beds
Assess for cracking, clubbing or any fungus that may be present
Use caution and have proper training when cutting nails
Who can trim the nails and provide foot care for diabetic clients?
Only the PCP or trained specialist
What type of razor should clients prone to bleeding or receiving anticoagulants use?
Electric razor
When shaving a client with a razor blade, what does the nurse do?
Apply soap or shaving cream to warm, moist skin
Move the razor over the skin the direction of hair growth using short strokes
A client is transferred from a long-term care facility to an acute care setting. An indwelling Foley catheter was inserted just prior to transfer. Which of the following tasks will help prevent the development of a nosocomial infection?
B. Frequently cleaning the client's perineal area and properly caring for the catheter
Which of the following are appropriate teaching measures related to care of the feet for a client with diabetes mellitus? (select all that apply)
- inspect feet daily
- use moisturizing lotions on feet
- wash with warm water and let air dry
- use OTC products to treat abrasions
- check shoes for any foreign objects
- inspect feet daily
- use moisturizing lotions on feet
- check shoes for any foreign objects
A client is in balanced suspension traction following a motor vehicle crash. He is unable to perform his own personal hygiene and must have it performed by the nurse. Which of the following factors will have the most influence on his comfort level?
B. attitude of the nurse
A client experiences dyspnea and reports feeling tired after completing her morning care. Which of the following should the nurse include in the client's plan of care for the next day?
D. plan for several rest periods during morning care
What clients are at risk from heat/cold applications?
Very young
Fair skinned
Older adults
Immobile
Impaired sensory perceptions
Why should long applications of either heat or cold be avoided?
They will result in the opposite reaction from the desired response
When using heat, why do bony prominences need to be monitored carefully?
They are more sensitive to heat applications
Why should heat applications be avoided over metal devices (pacemakers; artificial joints)?
To prevent deep tissue burns
Why should heat not be applied to the abdomen of a pregnant woman?
To avoid harm to the baby
Should a heat application be placed under an immobile client?
No because it may increase the risk of burns
When are cold applications inappropriate?
For clients with cold intolerance, vascular insufficiency, and conditions aggravated by cold (Raynaud's phenomenon)
The order for heat/cold applications must include?
Location
Duration and frequency
Specific type
Temperature to use
What are some nursing diagnoses related to heat/cold therapy?
Acute/chronic pain
Risk for injury
Risk for impaired skin integrity
What are the types of heat applications?
Moist
Dry
What are the types of moist heat applications?
Hot compresses
Hot soaks
Sitz baths
What are the types of dry heat applications?
Hot pack
Aquathermia pad
Warming blanket
What are the supplies needed for a hot compress?
Towel
Bath thermometer
Hot water
Plastic covering
Hot pack or aquathermia pad
Tape
What are the supplies needed for hot soaks?
Water
Bath thermometer
Basin
Waterproof pads
What are the supplies needed for a sitz bath?
Sitz bath (disposable or built in)
Bath thermometer
Bath blanket
Towels
What are the two types of cold applications?
Moist
Dry
What supplies are needed for a moist cold application?
Large basin of ice
Cold water
Cold pack to be used in place of ice
What supplies are need for a dry cold application?
Ice bag, ice collar, ice glove or a cold pack
Cooling blanket
When giving cold/heat applications, the site needs to be assessed every __ to ___ min
5; 10
When assessing sites undergoing heat/cold therapy what needs to be assessed for and what should be done if any of these are found?
Redness or pallor
Pain or burning
Numbness
Shivering
Blisters
Decreased sensations
Cyanosis
Discontinue the application if any of the above occur
What needs to be documented for heat/cold applications?
Location, type and length of application
Condition of the skin prior to and after the application
The client's ability to tolerate the application
Which of the following clients would benefit from the application of cold? (select all that apply)
- a 45 y/o client with a sprained ankle
- a 27 y/o client with Raynaud's phenomenon
- a 62 y/o client who just had a knee replacement surgery
- a 35 y/o client with a toothache
- a 10 y/o client with a nosebleed
- a 45 y/o client with a sprained ankle
- a 62 y/o client who just had a knee replacement surgery
- a 35 y/o client with a toothache
- a 10 y/o client with a nosebleed
A nurse is conducting morning rounds and notices an immobile client lying on an aquathermia pad. Which of the following nursing interventions is the most important for the nurse to include in the morning assessment?
B. a thorough skin assessment to check for skin damage
True or false: moist cold compresses are left in place for at least 45 min
False: heat and cold applications are kept in place for 15 to 20 min
True or false: cyanosis is a complication of cold applications
True
True or false: heat applications increase muscle tension
