Health Assessment Chapter 3 Techniques, Safety, Infection Control

Safety Precautions to Prevent Infection

Essential to follow infection control principles, includes current standard precautions, which include diligent hand hygiene and use of gloves and masks

Standard Precautions

1. Perform hand hygiene

2. Use PPE whenever there is an expectation of possible exposure

3. Properly clean and disinfect patient care equipment

4. Handle textiles and laundry carefully

5. Ensure proper handling of needles and other sharps

6. Follow transmission-based precautions

Transmission-Based Precautions

1. Source control

2. Social distancing

3. Respiratory hygiene/cough etiquette

4. Ensuring appropriate patient placement

Health Care Task Risk Levels

1. Lower Risk Level (Caution)

2. Medium Risk Level

3. High Risk Level

4. Very High Risk Level

Lower Risk Level (Caution)

Performing administrative duties in nonpublic areas of healthcare facilities, away from other staff members

Medium Risk Level

1. Providing care to the general public who are not known or suspected COVID-19 patients

2. Working at busy staff work areas within a healthcare facility

High Risk Level

1. Entering a known or suspected COVID-19 patients room

2. Providing care for a known or suspected COVID-19 patient not involving aerosol-generating procedures

Very High Risk Level

1. Performing aerosol-generating procedures on known suspected COVID-19 patients

2. Collecting or handling specimens from known or suspected COVID-19 patients

Hand Hygiene implemented when

1. Immediately before touching a patient

2. Before performing an aseptic task

3. Before moving from work on a soiled body site to a clean body site on the same patient

4. After touching a patient or the patients immediate environment

5. After contact with blood, body fluids, or contaminated surfaces

6. Immediately after glove removal

When using alcohol-based hand sanitizer

1. Put products on hands and rub hands together

2. Cover all surfaces until hands feel dry

3. This should take around 20 seconds

Handwashing with soap and water is necessary when

1. Hands are visible soiled with blood or body fluids

2. After caring for a person with infectious diarrhea

3. After known or suspected exposure to spores (C. difficile)

Personal Protective Equipment (PPE)

When selecting PPE consider 3 things

1. Anticipated exposure (touch, splash/sprays, blood)

2. Durability/Appropriateness of PPE for the task

3. Must properly fit individual

When do you put on PPE?

Before you have any contact with the patient, generally before entering the room

When you have completed your tasks

Remove the PPE carefully and discard it in the receptacles provided

After taking off PPE

Immediately perform hand hygiene before going onto the next patient

Gloves

Worn to

1. Reduce risk of acquiring infections from patients

2. To prevent transmission of flora from healthcare workers to patients

3. Reduce transient contamination of the hands of personnel by flora transmitted from one patient to another

When to change gloves

1. Between tasks and procedures on the same patient after contact with a material that contains a high concentration of microorganisms

2. When going from a contaminated to a cleaner area

Latex Allergy

Usually results from repeated exposures to proteins in natural rubber latex through skin contact or inhalation

Cough Etiquette

Turn the head, cough into inner aspect of the elbow

Respiratory Precautions

1. Wearing masks

2. Practicing social distancing

3. Turn head and cover mouth and nose with a tissue when coughing, EVEN WHEN MASKED!!

Source Control

Includes use of well-fitted cloth masks, face masks, or respirators to cover mouth and nose ( prevents spread of respiratory secretions )

Chain of Infection

1. Infectious agent

2. Reservoir

3. Portal of exit

4. Mode of transmission

5. Portal of entry

6. Susceptible host

Contact Precautions

For patients with known or suspected infections that represent an increased risk for contract transmission

1. Ensure appropriate patient placement

2. Use PPE

3. Limit transport and movement of patients

4. Use disposable or dedicated patient care equipment

5. Prioritize cleaning and disinfection of the rooms of patients on contact precautions

Droplet Precautions

Used for patients with known or suspected to be infected pathogens transmitted by respiratory droplets (coughing, sneezing, talking)

Airborne Precautions

Used for patients with known or suspected to be infected with pathogens transmitted by the airborne route (tuberculosis, measles, chickenpox)

Techniques

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

Inspection

Observation of the patient including general appearance

Palpation

Involves use of the hands to feel the firmness of body parts, such as the abdomen

Percussion

Tapping motions of the nurse’s hands on the patients body to produce sounds that indicate solid or air-filled spaces over the lungs and other areas

Auscultation

In which movements of air or fluid are heard over the lungs, heart and abdomen

First technique of the overall general survey

Inspection

Light Palpation

Begin with this to allow the patient to become accustomed to your gentle touch. Appropriate for assessment of surface characteristics (texture, surface lesions/lumps, inflamed areas of skin)

Moderate Palpation

Used to assess the size, shape, and consistency of abdominal organs.

Bimanual Deep Palpation

When fingers of the nondominant hand are over the dominant hand to use the pressure of both hands

Direct Percussion

Tap with your fingers directly on the patients skin

Indirect Percussion

When the nondominant hand acts as a barrier between the dominant hand and the patient. Easiest to hear different between resonant and dull.

Percussion Tones in the body

1. Flat

2. Dull

3. Resonant

4. Tympanic

(Percussion) In addition to intensity or loudness,

listen to the pitch, duration, and quality of sound

Intensity or loudness

Refers to how soft or loud the sound is

Pitch or Frequency

Depends on how quickly the vibration oscillates

Hyper resonant

Intensity: Very loud

Pitch: Low

Duration: Long

Quality: Booming

Location: Emphysematous lungs

Resonant

Intensity: Loud

Pitch: Low

Duration: Long

Quality: Hollow

Location: Healthy lungs

Tympanic

Intensity: Loud

Pitch: High

Duration: Moderate

Quality: Drumlike

Location: Gastric bubble

Dull

Intensity: Moderate

Pitch: High

Duration: Moderate

Quality: Thud

Location: Liver

Flat

Intensity: Soft

Pitch: High

Duration: Short

Quality: Dull

Location: Bone

Auscultation

Descriptors vary depending on the body part auscultated. Sound

Stethoscope

Includes

1. Ear tips

2. Ear piece

3. Flexible tubing

4. Chest piece

5. Diaphragm

6. Bell

Bell

Low frequency sounds

Diaphragm

High frequency sounds

and just used more in general

Advanced Techniques and Special Equipment

1. Ophthalmoscope

2. Otoscope

3. Tuning Fork

4. Flex Hammer

Opthalmoscope

Handheld system of lenses, lights, and mirrors that enables visualization of the interior structures of the eye

Otoscope

Directs light into the ear to visualize the ear canal and tympanic membrane

Tuning Fork

Create vibrations that produce sound waves of low-pitched or high-pitched frequencies

To check for hearing loss

Tuning Forks are used during

1. Neuromuscular assessment

2. To determine vibration sense

3. During assessment of hearing

4. Determine conductive versus sensorineural hearing loss

Reflex Hammer

Designed to test neurologic responses of the deep tendons to assess for abnormalities of the central or peripheral nervous system