Nursing Lecture Safety Infection Control
Transcript of Nursing Lecture Safety Infection Control
-
8/8/2019 Nursing Lecture Safety Infection Control
1/15
-
8/8/2019 Nursing Lecture Safety Infection Control
2/15
C) Standard precautions
* D) Contact isolation
Review Information: The correct answer is:
D) Contact isolation.
Contact or Body Substance Isolation (BSI) involves the use of barrier
protection (e.g. gloves, mask, gown, or protective eyewear as
appropriate) whenever direct contact with any body fluid is expected.When determining the type of isolation to use, one must consider the
mode of transmission. The hands of personnel continues to be theprincipal mode of transmission for methicillin resistant staphylococcus
aureus (MRSA). Because the organism is limited to the sputum in thisexample, precautions are taken if contact with the patient''s sputum is
expected. A private room and BSI, along with good hand washingtechniques, are the best defense against the spread of MRSA
pneumonia.
Ewald, G.A., & McKenzie, C.R. (Eds.) (1995).The Washington Manual, 28th Edition.
Boston: Little Brown.
Morita, M. (1993).
Methicillin resistant staphylococcus aureus, past, present and future.Nursing Clinics of North America, 28(3), 625-637.
Question 3
Several clients are admitted to an adult
medical unit. The nurse would ensure airborneprecautions for a client with which of the
following medical conditions?
A)A diagnosis of AIDS and
cytomegalovirus
* B)A positive PPD with an abnormal chestx-ray
C) A tentative diagnosis of viral pneumoniaD) Advanced carcinoma of the lung
AnswersCorrect B
Student'sC
Review Information: The correct answer is:B) A positive PPD with an abnormal chest x-ray.
The client who must be placed in airborne precautions is the client with
a positive PPD (purified protein derivative) who has a positive x-ray
-
8/8/2019 Nursing Lecture Safety Infection Control
3/15
for a suspicious tuberculin lesion.
Black, J., Matassarin-Jacobs, E. (1997).
Medical-Surgical Nursing: Clinical Management for Continuity ofCare (5th ed.).
Philadelphia: Saunders.
Lewis, S., Collier, I., & Heitkemper, M. (1996).
Medical-Surgical nursing: Assessment and management of clinicalproblems. (4th ed).
St. Louis: Mosby
Question 4
Which of the following is the FIRST priority
in preventing infections when providing carefor a client?
* A) Handwashing
B) Wearing gloves
C)Using a barrier between client's furnitureand nurse's bag
D) Wearing gowns and goggles
AnswersCorrect A
Student'sA
Review Information: The correct answer is:A) Handwashing.
Handwashing remains the most effective way to avoid spreading
infection. However, too often nurses do not practice good handwashingtechniques and do not teach families to do so. Nurses need to wash
their hands before and after touching the client and before entering thenursing bag.
Nelson, M. (1996, December).It''s As Easy As Washing Your Hands.Home Health FOCUS, 3(7), 51.
Miranda, G. (1997).Universal Precautions. In KS Martin, BJ Larson, LA Gorski, and DM
Hayko (Eds.)
-
8/8/2019 Nursing Lecture Safety Infection Control
4/15
Question 5
When a client is diagnosed with tuberculosis,the nurse notifies the public health department
because
A) Disease statistics must be maintained
* B) Disease contacts need to be traced
C) Incidence of tuberculosis is on the rise
D) Additional tests must be done
AnswersCorrect B
Student'sB
Review Information: The correct answer is:B) Disease contacts need to be traced.
Tuberculosis is a reportable disease because persons who had contact
with the client must be traced.
Ashwill, J. W., and Droske, S. C. (1997)
Nursing care of children: Principles and practice.Philadelphia: W. B. Saunders. pp. 898-899.
Question 6
The school nurse is teaching the faculty the
most effective methods to prevent the spreadof lice in the school. The MOST appropriate
information would be
A)The classroom should be sprayed withan insecticide at the end of each day
B)The transmission can be prevented by
personal cleanliness
* C)Lice can be transmitted by hats andcombs
D) Lice are carried by household pets
AnswersCorrect C
Student'sC
Review Information: The correct answer is:C) Lice can be transmitted by hats and combs.
Head lice live only on human beings and can be spread easily by
sharing hats, combs, scarves, coats and other items of clothing thattouch the hair.
Wong, D. (1999)
-
8/8/2019 Nursing Lecture Safety Infection Control
5/15
Whaley and wong''s nursing care of infants and children (5th ed.)
St. Louis: Mosby. pp. 783-785.
Ball J. and Bindler, R. (1995).Pediatric nursing: Caring for children.
Norwalk, CN: Appleton and Lange.p. 698.
Question 7
A client is scheduled to receive an oral
solution of radioactive iodine. In order toreduce hazards, the nurse should instruct the
client that
* A)Urine and saliva will be radioactive for
24 hoursB) No solid food may be eaten for 24 hours
C) No precautions will be necessary
D) No visitors will be allowed
AnswersCorrect A
Student'sA
Review Information: The correct answer is:
A) Urine and saliva will be radioactive for 24 hours.
The client''s urine and saliva are radioactive for 24 hours after
ingestion, and vomitus is radioactive for 6-8 hours. The client should
void into a lead-lined container, use disposable utensils, and avoid
close contact with children and pregnant women for 48 hours afteringestion.
Nettina, Sandra (2000).The Lippincott Manual of Nursing Practice. Sixth Edition.
Lippincott. Philadelphia - New York. 1966. Page 112.
Luckmann, Joan.
Saunders Manual of Nursing Care.W.B.Saunders Company. Philadelphia. 1997. Page 1397.
Question 8
Which of the following nursing diagnosis
would place an 86 year-old client atGREATEST risk for falls?
AnswersCorrect D
Student'sA
-
8/8/2019 Nursing Lecture Safety Infection Control
6/15
A)Sensory perceptual alterations related todecreased vision
B) Alteration in mobility related to fatigue
C)Impaired gas exchange related to
retained secretions
* D)Altered patterns of urinary eliminationrelated to nocturia
Review Information: The correct answer is:
D) Altered patterns of urinary elimination related to nocturia.
Nocturia is especially problematic because many elders fall when they
rush to reach the bathroom at night. They may be confused or not fullyalert. Inadequate lighting can increase their chances of stumbling and
they may fall over furniture or carpets.
Sloan, H. (1997).Preventing Falls among the Elderly. In KS Martin, BJ Larson, LA
Gorski, and DM Hayko (Eds.), Mosby''s Home Health Client TeachingGuides: Rx for Teaching, IV G 1-8.
St. Louis: Mosby.
Question 9
A ten year-old child has a history of tonic-
clonic seizures. The school nurse shouldinstruct the classroom teacher that if the child
experiences a seizure in the classroom, theMOST important action would be to
A)Insert a plastic airway to maintainrespirations
B) Restrain the child to prevent self-injury
C)Provide privacy to prevent
embarrassment
* D) Protect the child from injury
AnswersCorrect D
Student'sD
Review Information: The correct answer is:D) Protect the child from injury.
The child must be protected from injury during a seizure. Place apillow, folded blanket or your hands under the child''s head to prevent
harm.
-
8/8/2019 Nursing Lecture Safety Infection Control
7/15
Wong, D. (1999).
Whaley & Wong''s Nursing Care of Infants and Children..St. Louis: Mosby. Pages 1722.
Ball, J.& Bindler, R. (1995).
Pediatric nursing: Caring for children.Norwalk: Appleton & Lange. Page 444
Question 10
A child has been admitted after swallowing ahousehold cleaner. Which of the following
assessments suggests to the nurse that thepoison is a corrosive?
* A) Burning mouth and throat painB) Bradycardia and orthopnea
C) Oliguria and cyanosis
D) Diarrhea and vomiting
AnswersCorrect A
Student'sA
Review Information: The correct answer is:
A) Burning mouth and throat pain.
Local irritation of tissues points to corrosive poisoning.
Wong, D (1995).
Whaley and Wong''s Nursing care of infants and children.St. Louis: Mosby. page 691.
Ashwill, J & Droske, S (1997).
Nursing care of children.Philadelphia: Saunders. page 337.
Question 11
The nurse assigned to the emergency roomunderstands that syrup of ipecac iscontraindicated in which of the following?
* A)An infant has ingested a mouthful ofgasoline
B)A toddler ate a number of ibuprofen
tablets
AnswersCorrectA
Student'sA
-
8/8/2019 Nursing Lecture Safety Infection Control
8/15
C)A preschooler swallowed powderedplant food
D)A school aged child took a handful of
vitamins
Review Information: The correct answer is:A) An infant has ingested a mouthful of gasoline.
There is a risk of aspiration pneumonia if fumes from hydrocarbons are
inhaled during vomiting. The poison control center should be contacted
and the infant should be rushed to the emergency room.
Wong, D (1995).Whaley and Wong''s nursing care of infants and children. (5th ed).
St. Louis: Mosby page 688.
Ashwill, J & Droske, S (1997).Nursing care of children.Philadelphia: Saunders, page 340.
Question 12
In caring for a client with salmonella infection,
the PRIMARY nursing intervention to limittransmission is
* A) Wash hands thoroughly before and afterclient contact
B)Wear gloves when in contact with body
secretions
C)Double glove when in contact with fecesor vomitus
D)Wear gloves when disposing of
contaminated linens
AnswersCorrect A
Student'sA
Review Information: The correct answer is:
A) Wash hands thoroughly before and after client contact.
Gram-negative bacilli cause Salmonella infection. Two million new
cases appear each year. Lack of sanitation is the primary means of
contamination. Thorough handwashing can prevent the spread ofsalmonella.
Springhouse.Handbook of Medical-Surgical Nursing. Second Edition.
-
8/8/2019 Nursing Lecture Safety Infection Control
9/15
Springhouse Corporation, Springhouse, PA. 1998. Pages 830-833.
Question 13
The mother of an infant who is being treatedfor pesticide poisoning asks why activated
charcoal is the treatment. What is the nurse'sBEST response?
A)"Activated charcoal stimulates bowelevacuation, thus decreasing systemic
absorption of the poison."
* B)"The charcoal absorbs the poison andforms a compound that doesn't hurt your
child."
C)"This liquid causes vomiting whicheliminates the poison from the body."
D)"When it is absorbed from her veins,activated charcoal neutralizes the
poison."
AnswersCorrect B
Student'sB
Review Information: The correct answer is:
B) "The charcoal absorbs the poison and forms a compound thatdoesn''t hurt your child.".
This response is accurate information about the effectiveness of
activated charcoal. Language is appropriate for a parent''s
understanding.
Wong, D (1995).
Whaley and Wong''s Nursing care of infants and children.St. Louis: Mosby. page 682.
Hodgson, B & Kizior, R (1998).Saunders nursing drug handbook 2001.Philadelphia: Saunders. .
Question 14
-
8/8/2019 Nursing Lecture Safety Infection Control
10/15
The nurse is caring for a newly admitted adultclient with a diagnosis of Hepatitis A. The
MOST significant routine infection controlstrategy, in addition to handwashing, is
A) Implementing a ventilation flow
B) Wearing a mask during care
C) Using a gown to change linens
* D) Gloving while handling bedpans
AnswersCorrect D
Student'sD
Review Information: The correct answer is:
D) Gloving while handling bedpans.
The specific measure to prevent the spread of hepatitis A is careful
handling and protection while handling fecal material.
Potter, P. & Perry, A. (2000).Fundamentals of Nursing: Concepts, Process and Practice.
St. Louis: Mosby.
Thompson, J., McFarland, G., Hirsch, J., & Tucker, S. (1993).Mosby''s Clinical Nursing. (3rd ed.).
St. Louis: Mosby.
Question 15
The nurse is caring for a client with active
tuberculosis. Which of the following protocolswould be ESSENTIAL for the nurse to
implement?
A)
Place client in a room with another
client with tuberculosis and staff shouldwear masks
B)Place client in a negative pressure room
and staff uses mask and gloves
C)Place client in a private room and staffwears masks, gloves and gowns
* D)Place client in a negative pressure room
and staff uses masks
AnswersCorrect D
Student'sD
Review Information: The correct answer is:
D) Place client in a negative pressure room and staff uses masks.
-
8/8/2019 Nursing Lecture Safety Infection Control
11/15
A client with active tuberculosis should be hospitalized in a negative
pressure room to prevent respiratory droplets from leaving the room
when the door is opened.
Nettina, Sandra (2000).The Lippincott Manual of Nursing Practice. Sixth Edition.Lippincott. Philadelphia-New York. 1996. Page 224.
Luckmann, Joan.
Saunders Manual of Nursing Care.W.B.Saunders Company. Philadelphia. 1997. Page 949-951
SAFETY AND INFECTION CONTROL
Fire Extinguishers
Types Use
1. Carbon dioxide grease, electrical
2. Soda and acid paper and rubbish
3. Dry Chemical rubbish, electrical
4. Antifreeze or water rubbish, grease, wood
1. In a fire, the nurse acts in PRC order:A. Protects clients from injuryB. Reports the fireC. Contains the fire
Get a clue
Remember the kinds of Infection Control by remembering which link
they attack:
Six Links Five Control Mechanisms: AXIPPI
Pathogen Anti-drugs: Kill or weaken pathogens
Reservoir Host X-terminators: Kill nonhuman reservoirs & vectors
Port of Exit Isolation &Precautions
-
8/8/2019 Nursing Lecture Safety Infection Control
12/15
Transmission Precautions
Port of Entry Precautions
Susceptible Host Immunization
Strict Isolation
1. Designed for highly contagious infections that are spread by airborne dropletnuclei and contact transmission
2. Required in these diseases (among others):A. Varicella-zoster (chicken pox)B. Pharyngeal diphtheriaC. Herpes zoster (shingles)D. Viral hemorrhagic fevers
3. Strict Isolation requires two techniques: PAN+MGA. Private room with Negative AirflowB. Everyone who enters the room must wear Mask, Gown and Gloves.
Contact Isolation
1. Prevents highly transmissible infections that are not spread by airborne dropletnuclei, but are transmitted mainly by close and direct contact
-
8/8/2019 Nursing Lecture Safety Infection Control
13/15
2. Required in (for example):A. Viral respiratory infections in children (such as respiratory syncytial virus--
RSV)B. Vancomycin-resistant enterococcusC. Disseminated herpes simplexD. Scabies
E. Pediculosis (lice)F. Methicillin-resistant staphylococcus aureus
3. Contact Isolation Involves: PMG A. Private room,B. Masks for anyone providing close, direct care to the client,C. Gowns if soiling is likely, andD. Gloves for touching infective material
Respiratory Isolation
1. Prevents transmission of diseases that spread short distances via the air (droplettransmission)
2. Required in (for example): A. MeaslesB. Meningococcal meningitisC. PneumoniaD. MumpsE. Pertussis (whooping cough)
3. Respiratory Isolation Involves: P (or C) +MA. Private room or cohorting clients with the same pathogen, andB. Masks for everyone providing close, direct care to the client
Drainage/Secretions Precautions
1. Prevents infections transmitted by direct or indirect contact with pus or otherdrainage from an infected body site
2. Used in, for example:A. Skin infectionB. Minor abscess
C. Conjunctivitis3. Drainage/Secretion Precautions Involve: G; Gowns and gloves if contact withinfective material is likely
Tuberculosis/Acid-Fast Bacillus
(AFB Isolation)Used for clients with pulmonary or pharyngeal tuberculosis
1. AFB Isolation involves: PAN, M, G
-
8/8/2019 Nursing Lecture Safety Infection Control
14/15
-
8/8/2019 Nursing Lecture Safety Infection Control
15/15
y Sterile touching questionable is contaminated.y Only sterile objects may be placed on a sterile field.
2. A sterile object or field out of range of vision, or an object held below aperson's waist, is contaminated.
3. Never turn your back on a sterile field.
4. A sterile object or field becomes contaminated5. by prolonged exposure to air.6. When a sterile surface comes in contact with a wet, contaminated surface,
the object or field becomes contaminated by capillary action.7. Always hold your hands above the level of your elbows.8. The edges of a sterile field or container are considered contaminated.
Safety
y Know your institution's plan for fire drills and evacuation.y Know the emergency phone number for reporting fire.y
Know locations of all fire alarms, exits, and extinguishers.y PRC: first protect people, then report fire, then try to contain it.y In a fire, never use an elevator.y Turn off all oxygen supplies in the area of the fire.y In a fire, close all doors and windows.y In a power failure, only certain electrical outlets access the emergency
generators, know which ones they are.
Poisons
y Never induce vomiting for these poisons: Iye, household cleaners,
petroleum products, and furniture polish.y If you suspect someone has taken poison, save any vomitus and take it
with the victim to an emergency room.
Infection
y A pathogen cannot infect if you break even one of the six links in the chainof transmission.
y Clients at high risk for infection get prophylactic antibiotics before surgicalprocedures.
y The major sites fornosocomial infections are urinary and respiratorytracts, blood, and wounds.
y All nosocomial infections that occur in hospitals must be tracked andrecorded.
y The single most effective preventer of infection is hand washing.