NUR 242 Exam 2

List the parts of the chain of infection (in order):

- infectious agent

- reservoir

- portal of exit

- mode of transmission

- portal of entry

- susceptible host

infectious agent

something that contains bacteria, fungi, virus, parasite(s), or prion(s)

reservoir

the habitat of the infectious agent and is where it lives, grows, and reproduces itself or replicates

animate examples: people, insects, birds, animals

inanimate examples: contaminated soil, water, food, medical equipment, IV fluids, feces

portal of exit

the means by which the infectious agent can leave the reservoir

examples: any body orifice (ears, nose, or mouth), the skin, or blood or body fluids that leave the body through coughing, sneezing, etc.

mode of transmission

how a bacteria, virus, fungus, parasite, or prion moves from place to place

contact transmission

occurs when microorganisms move from an infected person to another person

droplet transmission

occurs when airborne droplets from the respiratory tract of a client travel through the air and into the mucosa of a host

can be from sneezing, coughing, singing, and talking

medical procedures like CPR and intubation can release droplets into the air

airborne transmission

occurs when small particulates move into the airspace of another person and carry infectious agents

these patients should be placed in a private room with negative air pressure (circulates the air outside of the building)

portal of entry

provides a place for an infectious agent to enter the individual so it can replicate or its toxin can act

examples: any body orifice or the skin

List factors that increase host susceptibility (8):

- age

- underlying disease (like HIV/AIDS)

- malignancy

- transplants

- medications (like immunosuppressants, antirejection meds, etc.)

- surgical procedures

- radiation therapy

- indwelling devices (like urinary catheters, central lines, etc.)

List the modes of transmission (5):

- contact

- droplet

- airborne

- vector

- vehicle

vehicle transmission

transmission of infectious agents to multiple individuals through a common source, such as contaminated food or water

example: food contaminated with e. coli

vector transmission

transmission of infectious agents through animals, such as an inset or rodent

examples: mosquitoes and rats

Who can be a susceptible host? (4)

- elderly

- infants

- immunocompromised

- anyone

What are the 2 types of contact transmission?

- direct

- indirect

direct contact

transmission occurs when microorganisms are directly moved from the infected person to another person without having a contaminated object or person between the 2

indirect contact

transmission occurs when microorganisms are moved from the infected person to another person with a contaminated object or person between the 2

List infections caused by airborne transmission (3):

- tuberculosis

- rubeola (measles)

- varicella (chickenpox)

List 2 infections spread through droplet transmission:

- influenza virus

- Bordetella pertussis

What type of transmission is the following an example of?

A patient has a draining, infected wound. The drainage touches a cut on the nurse's skin, leading to infection.

direct contact transmission

What type of transmission is the following an example of?

A patient who has a respiratory infection sneezes without covering the mouth and nose. A person a few feet away becomes infected because large mucus particles land in their mouth.

droplet transmission

What type of transmission is the following an example of?

A patient who coughed in their hand touches a door handle. Another person touches the same door handle and becomes infected with the same pathogen as the patient.

indirect contact transmission

What type of transmission is the following an example of?

A nurse enters a room where a patient who has a respirator infection was present for several hours. The nurse inhales small particles that remain in the air and develops an infection.

airborne transmission

What are the 3 types of body defenses?

- barriers (physical or chemical)

- nonspecific immunity

- specific immunity

What is the primary physical defense mechanism of the body?

the skin

List the 3 major functions of the skin:

- reduce loss of water

- protect against abrasion and microorganisms

- provide a permeable barrier against the environment

What things diminish skin integrity? (6)

- dry/cracked skin

- adhesive tape

- some chemicals

- unintentional injury

- intentional breaks in the skin

- insect bites

skin tear

a break or rip in the outer layers of the skin

the epidermis separates from the underlying tissues

mucous membranes

the membranes that line body cavities that open to the outside of the body

examples: the linings of the mouth, nose, eyes, rectum, or genitals

How can the mucous membranes be damaged?

if it dries out, it can lead to cracking

can also be damaged by intentional or unintentional injury

cilia

short hair-like structures that help prevent particulates from entering the body

How does the GI act as a defense against infection?

it secretes acids and enzymes that can destroy or neutralize some foreign invaders

nonspecific immunity

neutrophils and macrophages and their work as phagocytes

both neutrophils and macrophages are released during the inflammatory response

phagocytes

eat and destroy microorganisms, thereby helping to protect the body from harm

specific immunity

refers to the work of antibodies (also called immunoglobulins) and lymphocytes

antibodies bind to infectious agents and call tot he white blood cells and complement to destroy them

inflammatory response

body's natural defense that is activated when the body is injured, when foreign substances are present, or when an infectious agent attacks

List the basic steps of inflammation:

- pattern receptors on cell surface recognize harmful stimuli

- inflammatory pathways activated

- inflammatory markers released

- inflammatory cells recruited

List infectious inflammatory response triggers:

- viruses

- bacteria

- other microorganisms (like fungi)

List noninfectious inflammatory response triggers:

- physical (like burns, frostbite, trauma, etc.)

- chemical (like fluoride, nickel, toxins, etc.)

- biological (like damaged cells)

- psychological (think excitement like when blushing)

List the stages of infection:

- incubation

- prodromal

- acute illness

- decline

- convalescence

incubation stage of infection

an infection enters the host and begins to multiply

asymptomatic

prodromal stage of infection

the patient begins having general "I don't feel good" symptoms

acute illness stage of infection

manifestations of the specific infectious disease process are obvious and may become severe

decline stage of infection

manifestations begin to wane as the degree of infectious disease decreases

convalescence stage of infection

the client returns to a normal or a "new normal" state of health

local infections

confined to one area of the body

can be treated with topical antibiotics and oral antibiotics

systemic infections

start as local infections and then spread to the bloodstream to infect the entire body

What should we look at with a WBC count in terms of diagnosing infection?

- overall count (normal is 5,000-10,000 per cubic mm)

- high WBC = infectious process likely

- low WBC = decreased ability to fight infections (also called neutropenia)

- differential (shows each individual type of WBC)

asepsis

the absence of infection/pathogens

hand hygiene

a broad term to cover any type of cleansing of the hands as in normal handwashing, alcohol-based hand sanitizers, using an antiseptic handwash or hand rub, and surgical hand antisepsis

medical asepsis

clean technique

practices that reduce the presence of disease-causing micro-organisms on surfaces

used in administration of: medications, enemas, tube feedings, and daily hygiene

surgical asepsis

includes techniques that ensures the sterility of items that will come in contact with the client, through use of equipment such as sterile gloves, in order to prevent pathogen transfer to the client

helps prevent surgical-site infections (SSIs)

sterile field, gown, gloves, mask, hats

used in: dressing changes, catheterizations, and surgical procedures

What are 6 important things to remember when preparing a sterile field?

- flat work surface that is 12-18 in from any walls or potentially contaminating objects (also close to the patient)

- check packaging to ensure no tears/holes/damage

- peel back the first flap away from the nurse's body

- peel the sides back one at a time

- peel the flap closest to the nurse's body

- the outer inch is contaminated so you want to add to the middle of the field

sterilization

involves cleaning instruments so that all micro-organisms, including bacterial spores, are eradicated

can be achieved with steam and then dry heat, ethylene oxide gas, or with chemicals

equipment must be cleaned before sterilization

standard precautions

infection prevention practices applied to all patients (whether or not they are known to have an infection)

used to protect self and others from blood, body fluids, secretions, excretions, nonintact skin, and mucous membranes

PPE can include: masks, gloves, face shield, gowns, glasses

contact precautions

at minimum: gown and gloves

What infections require contact precautions? (5)

- VRE

- C diff

- noroviruses

- any intestinal tract pathogen

- RSV

droplet precautions

minimum: mask

patient should wear a mask when leaving their room

What infectious agents require droplet precautions? (5)

- influenza virus

- adenovirus

- covid

- rhinovirus (common cold)

- mycoplasma pneumoniae

airborne precautions

patient should be in a negative pressure room

at minimum: N95 mask

protective isolation

used during approximately the first 100 days after a transplant

specific engineering and hospital designs that decrease the risk of environmental fungi to the client

no plants

health care-associated infections (HAIs)

infections that are acquired in a health care facility

What are the 4 major HAIs?

- central line-associated bloodstream infections (CLABSIs)

- catheter-associated urinary tract infections (CAUTIs)

- surgical site infections (SSIs)

- ventilator-assisted pneumonias (VAPs)

infection control bundles

guidelines for practice that are bundled together to help prevent HAIs

multidrug-resistant infections

bacteria that are resistant to one or more classes of existing antimicrobials

What 3 ways to decrease the chance of transmitting MDROs?

- proper handwashing

- wearing gloves

- using contact precautions

What are 3 factors increasing the risk of infection?

- being in the healthcare environment

- having a medical device

- proximity to other patients

What should a nurse wear when administering medications to a client on contact precautions?

gloves and a gown

What should a nurse wear when performing a wound irrigation where splashing is expected in the facial area?

gown, gloves, and a face shield

What should a nurse wear when transporting a client who is on droplet precautions to the x-ray department?

mask (gloves based on facility rules)

What PPE item should be removed first?

gloves (technically gown comes off with gloves too)

What should a nurse wear when administering medications to a patient with a c diff infection?

gown and gloves (contact precautions)

hygiene

can be defined as actions and practices that decrease the spread or transmission of pathogens, thereby lessening the occurrence of illness

Langerhans cells

cells in the epidermis

role is to sense and kill pathogens that are found on the skin trying to enter the body

epidermis

outer layer of the skin

dermis

middle layer of the skin

provides skin with its strength and elasticity

hypodermis

aka subcutaneous layer

innermost layer of the skin

contains adipose tissue

acts as a cushion and stores fat

health promotion

viewed as facilitating the client's control over improving their general health

What are some factors that can affect hygiene? (5)

- culture

- religion

- developmental stage

- cognitive functioning

- personal preferences

What are some physiological considerations that can affect hygiene? (6)

- stroke

- spinal cord injury

- visual impairment

- bariatric challenges

- dementia

- amputation

What are hygiene considerations for a patient who had a stroke?

when dressing: the unaffected arm is used first to place clothing on the affected side

when undressing: the clothing is removed from the unaffected side first, then the affected side

What are hygiene considerations for a patient with a spinal cord injury?

these patients have an increased risk for the development of pressure injuries caused by hard surfaces when the skin is wet

bariatric clients

clients of increased weight or BMI

increased BMI causes distinctive physiological changes that affect skin integrity such as extremely deep skin folds, especially in the abdominal region

areas that are susceptible to deep skin folds include the groin, glutes, under the breasts, behind the knees, elbows, ankles, and the neck

foot care consideration:

clients who are at a higher risk for infection should have their feet more closely monitored as infections can cause serious foot problems

nail care consideration:

longer nail length has been shown to conceal a greater number of germs compared to shorter nail length

complete bed bath

bath administered to totally dependent patient in bed

the joint commission (TJC)

established in 1951

evolved as an impartial national organization that accredits hospitals and other health care facilities based on their safety performance, policy, procedures, practice, and outcomes

national patient safety goals (NPSG) and standards of compliance

initiated in 2002 by TJC

identify established relevant safety practices health care institutions should accomplish

since most health care organizations embrace and routinely practice these goals, they are cataloged into a register of adopted "standards of compliance" that must be met on a consistent basis

What are examples of patient identifiers?

- name

- DOB

- designated hospital number (NOT room number)

alarm fatigue

sensory overload from noise pollution created in part by the numerous distress alerts

Who should be screened for suicide?

- all patients who may be at risk for suicide

- patients with intentions of suicide

- all patients 12 and older whose primary admitting diagnosis is for a behavioral health condition

adverse event

any event that is not consistent with the desired or normal operation

What is a "time-out" in regard to surgery?

a pause in all personnel activities within the operating or procedure room to ensure correct client, site, and procedure

What are the components of transforming care at the bedside?

- have nurses spend 70% of their time at the bedside performing direct client care

- strengthen management through leadership development programs

- implement a rapid response team for the facility's medical and surgical units

- create frameworks for standardized communication

What does "ISBARR" stand for?

identity

situation

background

assessment

recommendation

read back

near miss

a potential error or event or circumstance that could have caused harm but was caught and avoided

patient safety event

an unexpected event or circumstance that occurred without injury to the patient

sentinel event

a critical, unexpected adverse event that caused severe physical or psychological harm to a patient, including death and dismemberment; permanent injury; or severe, temporary injury

root-cause-analysis (RCA)

the review process used to probe potential or actual errors

errors are reviewed and a determination is made as to whether human error or systems failure led to the error

also establishes a corrective action plan to address the problem or system error

List some barriers to event and near miss reporting (7):

- fear of repercussions

- lack of time to write the report

- unclear facility policies and standards

- bullying

- insufficient education and training

- lack of understanding of the roles and responsibilities of team members

- favoritism and influence of some employees