1Infection
The entry and multiplication of an infectious agent in the tissues of a host
2Colonization vs. Infection
C: pathogen is present but no symptoms
I: pathogen present and symptoms
3Endogenous
From microbial life harbored on inidividual
4Exogenous
Caused by organisms not normally present or from others
5Iatrogenic
Infection from treatment or procedure
6Endemic
Of disease or condition found among particular people or area
8Pandemic
World-wide empidemic
9Nurses must understand the __________________, recognize the _______________, and be able to institue appropriate _________ and _________ measures.
nature of infection, source of infection, protective, restorative
10The Infection Cycle (6)
Infectious agent
Reservior
Portal of exit
Means of transmission
Portal of entry
Susceptible host
11Infectious Agent
pathogen causing a disease
12Reservior
source of infection
13Portal of Exit
any body opening on an infected person that allows pathogens to leave
14Means of Transmission
how infectious microorganisms move to another location
15The Nature of Infection
the body must protect itself from the constant attack of foreign substances
16Portal of Entry
any body opening on an uninfected person that allows pathogens to enter
17Susceptible Host
a person likely to get an infection or disease, usually because body defenses are weak
18Control/Elimination of Pathogens (3)
antimicrobial therapy, disinfection/sterilization, refrigeration
19Control Portals of Exit (4)
masks, transmission precautions, dry/intact dressings, sneeze/cough hygiene
20Control Portals of Entry (3)
maintain intact skin, ER& sterile technique invasive lines, pericare/hygiene
21Control of Transmission (4)
handwashing, standard precautions, insecticides, PPE
22Protecting Susceptible Host
immunizations, isolationarrier precautions, protecting patient defenses
23Infection Control Practices
disrupt the infection cycle or break the chain of infection
24Pathogen
agents which cause infection
25Examples of Pathogens
bacteria, viruses, fungi (molds or yeasts), prions, parasites/protozoa
26Factors Affecting a Pathogens Potential to Produce Disease (4)
number of organisms, virulence, competence of person's immune system, length and intimacy of contact between person and microorganism
27Pathogenesis (virulence)
a pathogen's ability to invade and injure tissues of a host and to produce "pathologic" effects. It is indicated by the severity of disease produced
28Factors Affecting Host Susceptibility (14)
Age, sex, race, hereditary factors, intact skin and mucous membranes, normal pH levels and body temperature, body's white blood cells, immunization-natural or acquired, fatigue, climate, nutritional and health status, stress, use invasive or indwelling medical devices, medications that predispose by altering immunity
29Age Related Changes (9)
Slower response to antibiotics, decreased inflammatory and immune response, thinner skin, decreased subcutaneous tissue, decreased vascularity-poorer wound healing, decreased coughag, increased chronic illness, decreased mobility, atypical symptoms-confusion/agitation
30Localized Infection
infection limited to a certain area of the body
31Systemic Infection
infection that spreads to different parts and/or entire body
32Stages of Infection (4)
Incubation
Prodromal
Illness
Convalescence
33Incubation Period
pathogen entry and multiplication, no symptoms
34Prodromal Period
non-specific symptoms, highly contageous
35Illness Stage
specific signs and symptoms of infectious agent
36Convalescence
return to pre-illness state
37The ______ stage is the most infectious stage.
prodromal
38Types of body defences against infection (2)
specific
nonspecific
39Nonspecific Defences (3)
Normal flora
Individual organody system defences
Inflammatory response
40Specific Defences (2)
Cell mediated immunity
Humoral immunity
41Cell Mediated Immunity
cellular destruction of neutralization antigen
42Humoral Immunity
antigen/antibody complex
43Transient
attached loosely on skin, removed with relative ease. Can adjust to environment and become resident
44Resident
found in creases of skin, requires friction with brush to remove
45Opportunistic
bacteria (normal flora) that normally don't cause a problem, but under certain conditions in susceptible host can be harmful
46Body System Defenses (9)
skin, oropharynx (humidity, warmth, cilia), mucociliary clearance, cough reflex, sneeze, acidic GI pH, peristalsis, urinary stream and pH, body temperature, etc.
47Inflammatory Response
protective response of the tissues of the body to injury or infetion
48Types of Inflammatory Responses
Vascular and cellular responses
Formation of exudate
Regeneration
49Vascular and Cellular Responses
physical, chemical, or biological agents trigger tissues to release inflammatory mediators, produce local vasodilation and increase blood vessel permeability which causes plasma to escape into the tissues, which carries white blood cells.
50Inflammatory Mediators (4)
Histamine
Bradykinin
Prostaglandin
Serotonin
51White Blood Cells
attacks and phagocytize the pathogens (ex. neutrophils, monocytes, and some macrophages)
52Signs and symptoms of a localized inflammatory response (6)
Fever
Leukocytosis
Malaise
Anorexia
Nausea and vomiting
Lymphadenopathy
53Leukocytosis
increased white blood cell production
54Lymphadenopathy
swelling of lymph nodes
55SIRS
Systemic Inflammatory Response Syndrome
56Inflammatory Exudates
formed from the accumulation of fluid, dead (necrotic) tissue and cells, and white blood cells
57Serous
clear, yellow, pale: plasma
58Serosanguinous
pink, clear, watery: plasma and red blood cells
59Sanguineous
red, thicker: blood and red blood cells
60Purulent (pus)
contains white blood cells, bacteria, cellular debris
61Tissue Repair
through the body's healing processes, damaged cells replaced with healthy new ones
62Immune Response
specific response of the body to antigens or other foreign materials
63Cell-Mediated Immunity
activated t cells (thymus), divides rapidly into sensitized cells, lymphokines travel to affected area attract macrophages, antigen is destroyed, neutralized, or eliminated
64Humoral Immunity
B cells (B lymphocytes), in response to an antigen, production of specific antibodies, provides specific resistance
655 Classes of Antibodies
IgG, IgM, IgA, IgD, IgE (GMADE)
66Immunocompetent
having a normal immune response
67Immunosuppressed
immune response is inadequate
68Immunocompromised
having an impaired immune system
694 most common categories of health-care associated infections
UTI's
Bloodstream infections
Pneumonia
Surgical site infections
70MRSA
Methicillin resistant Staphylococcus aureus
71VRE
Vancomycin resistant enterococci
72CDI
Clostridium Difficile
73Risk Factors for VRE (5)
compromised immune systems, recent abdominal or chest surgery, presence of a urinary or central IV catheter, prolonged antibiotic use, lengthy hospital stay
74CDC recommendations to prevent CDI (4)
prescribe antibiotics carefully, contact precautions (gloves and gown), effective use of hand hygiene and cleansing with soap and water, clean equipment with bleach
75Factors of assessments for identifying people at risk
status of defense mechanisms, client susceptibility, clinical appearance, and lab data
76WBC and diff
measures white blood cell count, what types of white blood cells, how many of each kind are present, and whether there are bands and sigs
77Erythrocyte sedimentation rate
ESR, normal is 2mm/hr
78C-reactive protein
CRP, normal is <3 mg/l, Moderate infection is 10-100, Severe infection is >100
79Culture and Sensitivity
C&S, indicates which organisms are present as well as antibiotics to which the organism of sensitive
80Normal white blood cell count is ______ to ________/mm3.
5000, 10000
81Differential
measures numbers of neutrophils, basophils, eosinophils
82Favors viral infection if ______ are increased.
basophils
83Favors inflammatory and allergic responses if ______ are increased.
eosinophils
84Favors bacterial infection if ______ are increased.
neutrophils
85Leukopenia
WBC count under 5000, usually cancer related
86Leukocytosis
WBC count over 10000, indicates inflammatory response
87Bands and segs
precursors to making neutrophils, like "baby" neutrophils
88"Shift to the left"
looking at whether the neutrophils present in the blood are mature cells, or bands and segs (if they are present it indicates a very bad infection)
89Elevated ______ indicates sedimentation, clumping, indicates strong inflammatory response
ESR
90At first, you start with a __________ spectrum antibiotic, and the second you get the sensitivity back from the lab, switch to a more _____________ antibiotic.
broad, specific (narrow spectrum?)
91Cultures
tissue cells differentiated from microorganisms, gram stains identify the broad class, ID over 24-48 hours
92T/F. You can start antibiotics before you draw cultures.
False (different in emergency situations e.g. septic shock)
93Preliminary results usually within ______.
24 hours
94Specific pathogen identification in cultures may take _______.
48-72 hours
95Blood Culture
detects presence of bacteria in the blood, must prep the skin to avoid contamination
96Sputum Culture
detects pathogenic bacteria from respiratory infections, the patient must cough up from their lungs, you want to avoid contamination of spit and saliva
97Throat Culture
Detects pathogenic organisms in the oropharynx, want to avoid contamination from the mouth and teeth
98Urine Culture
used to diagnose a UTI and detect bacteria in the urinary tract (since urine is sterile), want to avoid contamination from stool and vaginal secretions can collect midstream, from a straight cath, from a foley, or suprapubic aspiration, but NEVER from a bedpan
99Wound Culture
used when signs of infection in wounds or soft tissue, want to avoid contamination with skin
100Stool Culture
detects pathogenic bacteria in the bowel, want to avoid contamination of urine
101Aseptic Technique
includes all activites to prevent or break the chain of infection
102Midical Asepsis
clean technique, reduction of organisms
103Surgical Asepsis
sterile technique, removal of organisms
104When to use medical asepsis (3)
feeding patients, NG tube insertion, administration of enema
105When to use surgical asepsis (4)
IV insertion, injections, catheter insertion, endotracheal suctioning
106Are the oral cavity and GI tract sterile?
no
107Is blood and the trachea sterile?
yes
108T/F. The majority of organisms causing HAI are found in the colonized body substances of the patients themselves (feces, saliva, mucous, blood, and wound drainage).
True
109__________ protection should be used with all clients.
Barrier
110Standard Precautions
Tier 1: Used in the care of all hospitalized patients regardless of their diagnosis or possible infection status.
111Standard precautions are used with blood, mucous membranes, non-intact skin, and all bodily fluids, secretions, and excretions except ___________.
sweat
112PPE that can be used in standard precautions (5)
hand hygiene, gloves, gowns, masks, protective eyewear
113You should wear gloves whenever coming in contact with (3)
bodily fluids, non-intact skin, mucous membranes
114You should wear a gown to prevent soiling clothing when coming in contact with ________.
bodily fluids
115You should wear a mask to avoid inhaling __________.
large particles
116You should wear protective eyewear when there's risk for contamination with the eye's __________.
mucous membranes
117Other parts of standard precautions include ____________, ___________________, ____________.
sharps management, infectious waste disposal, handling laundry
118T/F. Gloves can be re-worn.
False
119T/F. Wearing gloves does not replace handwashing, hands must be washed meticulously after removing gloves.
True
120T/F. Gowns should be donned before entering the room.
True
121T/F. Gowns should be doffed after exiting the room.
False
122T/F. Masks filter expired air only.
True
123Respirators (ex. N95)
special type of mask that must be used for airborne precautions that filters inspired air
124T/F. Regular glasses are sufficient for protective eyewear.
False
125Personal protective equipment and supplies (10)
gowns, respiratory masks, eye protection, gloves, specimen collection, bagging trash and linen, protective barriers, hand washing before and after entering room, proper disposal of contaminated supplies/equipment, transport precautions
126Order for donning PPE
1. gown
2. mask
3. protective eyewear
4. gloves
127Order for doffing PPE
1. gloves
2. protective eyewear
3. gown
4. mask
128Transmission based precautions
Teir 2: Based on patient's diagnosed infectious agent or suspected infectious agent. It is determined by the mode of transmission of the agent
129T/F. Transmission based precautions should always be used in conjunction with standard precautions.
True
130Types of transmission based precautions
airborne, droplet, contact
131Airborne precautions
patient requires a private room with a closed door, negative/pressure outflow with change 6-12 hr (airborne isolation room), mask for provider (N98, HEPA, face shield), and a mask on the patient if transported outside of the room
132What type of precautions should be used for agents < 5 mmc?
airborne
133What type of precautions should be used for TB, Varicella, and Rubeola?
airborne
134Rubeola
regular measles
136________ precautions should be used for Influenza, mumps, pertussis, rubella, and pneumonia?
Droplet
137Droplet precautions
patient requires a private or cohort room, but the door may be left open. Surgical mask required for provider before entering the room and for patient whenever transported outside of room. Recommendation of 6-10 feet distancing
138Contact precautions
patient requires and private or cohort room with specific equipment dedicated to that room. Gown and gloves must be worn by provider prior to entry. The infected area must be covered when transporting the patient, and all equipment and surfaces must be carefully disinfected
139_________ precautions should be used for VRE, shigellosis, Hepatitis A, and impetigo?
Contact
140___________ precautions should be use whenever there is fecal incontinence or excessive drainage?
Contact
141Bundles
sets of evidence-based practices that have proven positive outcomes when implemented together to prevent infection
142VAP Bundle
HOB 30-45 degree angle, sedative interruption, early weaning assessment, PUD and DVT prophylaxis
143Latex sensitivity affects _______ of health care workers.
2-17%
144Latex sensitivity affects ____ of the general population.
<1%
145Repeated exposure to latex causes a _________.
sensitivity
146Sensitivity and additional exposure causes an _______.
allergy
147Anaphylaxis
Severe allergic reaction that involves 2 or more body systems. It is characterized by the release of histamine and can be life-threatening. Airways can close up, hives can form, and angioedema can happen.
148Andgioedema
really bad swelling in the subcutaneous tissue, dangerous when it blocks airways
149T/F. There is no cure for a latex allergy.
True
150T/F. Hospitals achieve a latex free environment.
False
151Safety
protection against physical or psychosocial hurt, injury, loss, danger, or risk of harm
152Physical hazards
agents, factors, or circumstances that can cause harm to people through contact
153Individual risk factors
characteristics or conditions that increase the likelihood of developing a disease or experiencing a negative outcome
154Developmental risk factors
events, circumstances, or properties that increase the likelihood of a problem occurring later in one's life
155Fall risk assessment
a medical test that evaluates how likely someone is to fal
156Safe environment
where basic needs are met, physical hazards are reduced, transmission of pathogens is diminished, sanitation is maintained, and pollution is controlled
157Sentinel event
unexpected occurrence involving death or serious physiological or psychological injury, or risk there of
158Health care setting risk factors
biological hazards, exposure to chemicals and drugs, etc.
159Never event
particularly "shocking" medical errors that should never occur, and serious (result in death or disability), unambiguous (clearly identifiable and measurable) adverse events, which are usually preventable
160Client inherent accidents
client is the primary factor which poses risk of injury. Can be accidental or intentional
161Procedure related risks
risks that have to do with procedures (doing correctly, sterility, etc.)
162Equipment related risks
from the malfunction, disrepair, or misuse of equipment
163QSEN
Quality Safety Education for Nursing
164Any error in any phase of clinical patient care. Does not include" near misses or unreported incidents are called ___________?
medical errors
165Giving the wrong patient the wrong procedure is an example of a _______.
sentinel event
166Giving a patient surgery on the wrong side is an example of a ________.
never event
167RCA
Root Cause Analysis
168Examples of never events (7)
surgical events, product or device events, patient protection events, care management events, environment events, radiological events, and criminal events
169Every time you initiate care for a patient, you must assess for any and all _____________________.
safety risks
170Quality safety education for nursing (6)
goal is person-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics
171KSAs
Knowledge, skills, and attitude
172QSEN wants to prepare future nurse who will have the _______ necessary to continuously improve the quality and safety of the healthcare systems within which they work.
KSAs
173(KSA) Knowledge
discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences
174(KSA) Skill
consult with clinical experts before deciding to deviate from evidence-based protocols
175(KSA) Attitude
Acknowledge one's own limitations in knowledge, and clinical expertise before determining when to deviate from evidence-based best practices.
176What you need for a risk or safety assessment (3)
nursing history, physical assessment, and risk assessment tools
1775 steps of the nursing process
ADPIE
178(ADPIE) Assessment
ID patient risk factors and environmental factors
179(ADPIE) Diagnosis
formulate safety or risk for nursing diagnoses
180(ADPIE) Planning
ID goals, outcomes, and interventions
181(ADPIE) Implementation
take appropriate preventative or restorative actions and education of the patient and others
182(ADPIE) Evaluation
determine how well the plan is working or if revisions are needed
183Create a culture of ______________________________ to avoid errors.
checks and balances
184What is a time out?
everyone stops what they are doing, designated professional checks ID of patient, procedure checked against consent, and other safety checks are preformed by entire team per strict protocol
185Always need __ forms of identification for every patient.
2
186Environmental risks
Clutter, temperature, hazards, etc.
187Interventions may be ____________________ or _______________________.
preventative, restorative
188Pre-existing risk factors for falls (9)
very young, very old, history, sensory/mobility impaired, confused/disoriented, postural hypotension/vertigo, sedation, medications (especially diuretics), unfamiliar environments
189Falls make up ____ of all reported incidents in hospitals.
90%
190Preventative interventions for falls (12)
support and secure patients, side rails, bed in the low position, grip footwear, wipe up spills, clear obstacles, have enough help, make sure items are in reach, lock wheels, sittings, restraints, safety devices and alarms
191Client inherent risks (5)
seizure disorder, alcohol/drug impairment, severe mental illness, neurological disorder (impaired mobility), homicidal/suicidal
192Preventative interventions for client inherent risks (7)
good body mechanics, seizure precautions, suicide precautions, sitters, security, surveillance, restraints
193Procedure related events
poisonings, radiation, HAI, sharps/sticks, med errors, improper applications, excess heat or cold
194You can prevent ______________________________ events by knowing what you are doing and following standard practices
procedure related
195Equipment related events (2)
fires, electrocution
196Environmental changes to prevent equipment related events (6)
no smoking, reducing sparks, three prong devices, grounding, safety alarms, regular engineering checks
197Environmental related risks
cold, heat, toxic substances (radiation/chemo), obstacles, electrical, psychological stressors, infectious agents, fires
198___________________ can help prevent environmental related events from occuring.
Awareness
199RACE (fire)
Rescue
Alarm/Alert
Contain/Confine
Evacuate/Extinguish
200A _________ is a short, multidisciplinary briefings focused on exchange of information about potential or existing safety risks which may affect patients, staff, and any person accessing that particular health care environment. They are intended to mitigate clinical safety risks and are part of guidelines from the Clinical Excellence Commission.
safety huddle
2013 key elements of safety huddles
perception, comprehension, projection
202Safety huddles promote _________________.
situational awareness
203A ___________________________ is a confidential document (that doesn't go in the patient's chart) that completely and objectively describes any client accident occurring on the premises of a health care agency. Must be completed immediately following the event. It documents the accident/event details, the client assessment, all interventions carried out for the client, and the client's response to the interventions.
safety event (incident) report
204Canthus
the inner or outer corners of the eye where the eyelids meet
205Perineal
between anus and external genitalia
207caries
decay in the teeth
208Neuropathy
disease that occurs where the nerves are damaged
209Suprapubic
above the pubic bone
210___________ can be compromised when skin becomes irritated and inflammed.
Skin integrity
211Stomatitis
inflammation of the mucosa of the mouth
212Effleurage
massage technique that involves gliding, stroking or circular movements, utilizing a light, slow consistent motion with either light or no pressure
213Petrissage
massage technique that involves kneading, lifting or grasping movement
214Nasolacrimal duct
passageway for tears from the lacrimal sac into the nose
215perineum
the area of skin and tissue between the anus and genitals
216Maceration
a softening and breaking down of skin resulting from prolonged exposure to moisture
217Paresis
partial paralysis
218Hemiparesis
minor loss of strength in the face or upper or lower extremity on one side of the body
220Hemiplegia
Paralysis that affects one side of the body
221Aspiration
breathing fluid, food, vomitus, or an object into the lungs
222NAP
Nursing Assistive Personnel
223UAP
Unlicensed Assistive Personnel
224LPN
Licensed Practical Nurse
225A ___________ is done on a patient who cannot or should not engage in independent activity, and those who can tolerate it and whose hygiene warrants it.
full bath
226A _____________ is done on a patient needing only partial hygiene, whose able to do some self-care but unable to reach all body parts, cannot tolerate a full bed-bath, and who needs particular cleansing.
partial bath
227A __________ helps decrease gram-negative organisms and cleanses, moisturizes, and conditions the skin.
bag bath
228A bed bath is completed from ____ to ____.
head, toe
229Eyes are washed from _______ to _______ canthus.
inner, outer
230Extremities are washed from _______ to ________.
distal, proximal
2315 types of bathing
full, partial, tub, shower, bed
232For impaired oral care, patients should be put on their ________________ side.
affected
233For female peri care, you should wipe from ___________ to ____________.
front, back
234For male peri care, you need to pay attention to the _______________ and _______________.
foreskin, scrotum
235The benefits of a __________________ are that it stimulates circulation, promotes lymphatic drainage, promotes relaxation, rapport, and touch.
backrub