Patient care test 3

Pathogens

Microorganisms that cause disease

Normal flora

Microorganisms that live on or inside the body without causing disease

Medical asepsis

The removal of or destruction of infected material

Surgical asepsis

Protection against infection before, during and after surgery by using sterile technique

Sterile field

Microorganism-free area prepared for the use of sterile supplies and equipment sterilization

Bloodborne pathogens

Disease-causing microorganisms present in human blood. Can or could be considered nosocomial. Two types of concern in hospital setting: HIV & HBV

Airborne pathogens

Dust containing spores, droplet nuclei 5um or less. Remain suspended in air for long periods of time

Nosocomial infection

Hospital acquired infection

Barium peritonitis

Extravasation of barium into peritoneal cavity (Very Bad!)

Opportunistic infections

Infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems

PPE

Personal protective equipment

Enteral

Involves using the GI system

Parenteral

Involves using the vascular system

Cathartic

Strong laxatives

Bacteria

Does NOT need a host to replicate

Viruses

Smallest known disease-causing organisms

Endospores

Resistant to destruction

Prions

Smallest and least understood of all microbes “infectious proteins”

Fungi

Size much larger than bacteria. Two forms: yeast and molds

Steps to establishment of infectious diseases

1. Encounter: organism coming in contact with the host

2. Entry: access to the organism through a portal of entry. Ex. Ingression, penetration

3. Spread: the propagation of the infectious organism

4. Multiplication: the growth in microbe numbers as a function of mitosis

5. Damage: damage can be either direct or indirect

6. Outcome: results in any of three outcomes

   • Host gains control of the infectious agent and eliminates it

   • Infectious agent overcomes hosts immunities to cause disease

   • Host and infectious agent compromise and live in a sort of symbiotic state

Cycle of infection

\-means of transmission

\-portal of entry

\-susceptible host

\-pathogenic organism

\-reservoir of infection

\-portal of exit

Direct contact

Pathogens are placed in direct contact with susceptible tissue

Formite- indirect

An object that has come in contact with pathogenic organisms

Vector-indirect

Pathogen develops or multiplies before becoming infective to a new host

Vehicle-indirect

Any medium that transports microorganism a

Airborne contamination-indirect

Remain suspended in air for long periods of time

Droplet contamination-indirect

Contact with mucous membranes of the eyes, nose, or mouth of host with large droplets greater than 5 um containing pathogens

Another name given to nosocomial infections

Healthcare-associated infections (HAI)

How to perform exams of the patient in reverse isolation or protective isolation

• patients with limited immunity

• Equipments must be cleaned before entering patients room

• 2 members: “clean” has direct contact with patient

  • “Dirty” had indirect contact with patient

Direct contact

Host is touched by an infected person pathogens are placed in direct contact with susceptible tissue HOST TO HOST. Some sort of touch, Secretions, excretions, mucous membranes, syphilis HIV staph infection

Airborne contamination

Indirect contact

Droplet

Indirect contact

What is the proper order for putting on protective PPE and taking it off

• wash hands

• Tie at back of neck and waist

• Apply surgical mask

• Apply gloves

Proper way to remove PPE

• gloves first

• Gown, rolled inward where the dirty side is inside and not out coming in contact with you

• Surgical mask

Natural resistance

Provided by mechanical barriers of intact skin and mucous membranes

Acquired immunity(long term)

Occurs when an individual develops antibodies to a particular organism as a result of either infection or immunization

Passive immunity

Occurs following an infection of preformed antibodies to a particular infection

How to effectively wash your hands

Use warm water with regular soap and wash for about 40-60 seconds

When is it unacceptable to use hand sanitizer

When hands are visibly soiled

Standard precautions- why we use standard precautions and when to apply these methods

Designed to reduce the risk of transmission of unrecognized sources of bloodborne and other pathogens in healthcare

How to properly open sterile package and recognize when it is unsterile

Place pack on a clean surface

Break open the seal

Fold all the corners away from you

Don't touch the interserface

It becomes unsterile if an unsterile object or person touches it Don't reach across it, Don’t leave it unattended

1 inch border is the “buffer zone” meaning its contaminated

What is considered a sterile field

Defined as a microorganism free are prepare for the use of sterile supplies and equipment

How to prep a patient for a sterile procedure

Start in the center and clean out at site

Clean 2-3 times

Using new cleaning solution and swab each time

Clean area larger than what is actually needed

Members of the OR who are considered sterile and non sterile members

Sterile: Surgeon Assistant to surgeon Non physician assistant Scrub person (Registered nurse, licensed vocational nurse, surgical tech.)

Non sterile: Anesthesiologist Circulating nurse Various other technologist such as biomedical orthopedic and radiologic technologists

What is sterile in the OR

Urinary catheters – uses French system to describe sizes of tubes: 8F(small diameter) to 18F(large diameter) 2 types of catheters 1-retention balloon 2-straight type

NG Tubes - uses for them- common examples:

feeding, decompression of stomach by (aspiration) sucking up the gastric contents (fluid, air, blood) Introduce fluid (lavage fluid, tube feeding, activated charcoal into stomach) Gavage Help with clinical diagnoses through analysis of gastric contents

NE Tubes- difference between NE and NG tube and how do we confirm placement on these tubes:

NE: through the nose to duodenum

NG: through the nose to stomach

We confirm placement by taking an x-ray

How to properly tip a patient for a BE:

Lubricate tip

patient in sims position

Direct tip superiorly and anteriorly , 2-4 inches (no more than 4”) Aim for belly button

On females, make sure it enters the Anus and not the vagina

BE- Prep, about the exam, height of bag, filling of bag with contrast:

Patient must be prepped

Enema/ NPO or clear liquid diet

Exam may be postponed/ rescheduled

Cleanse out gas and fecal matter

Enema bag to hang 18’’ above level of anus for soap suds enema

Will hang higher for BE due to viscosity of the barium

Difference between double contrast and singe contrast exam

Double contrast: barium enema with air.

Single contrast: without air

Contraindication for Ba in GI exam

Allergic to barium. Suspected bowel perforation. Severe ulcerative colitis. Pregnancy. Toxic mega colon. Acute abdominal pain

When scheduling patients with multiple contrast exams what order should they be scheduled:

IV contrast studies first

Will do barium work last

Multiple barium studies start at the end and work your way up

Scope Exams

EGD, colonoscopy. Need to do before barium studies

Most effective method of sterilization

Autoclaving

Colostomies

From the large colon

The more proximal the ostomic opening the more odorless and irritating the recal matter

Ileostomies

From the small bowel

Stoma

Artificial opening above the skin

Apnea

Cessation of spontaneous ventilation

Auscultation

Listening to sounds of the body

Atelectasis

Partial or complete collapse of the lung

Bradycardia

Slow heart beat < 60 BPM

Bradyapnea

Slow breathing < 12 RPM

Diaphoresis

Profuse sweating or diaphoretic

Diastolic

Period of dilation

Systolic

Pertaining to contraction

Dyspnea

Labored breathing

Febrile

Pertaining to fever

Hypertension

High blood pressure

Hypotension

Low blood pressure - indication of shock

Hyperthermia

High body temperature

Hypothermia

Low body temperature

Hypoxia

Low oxygen

Anoxia

Absence of oxygen

Intubation

Insertion of at tubular device into a canal, hallow organ or cavity

Pneumothorax

Presence of air or gas in the pleural cavity that separates the lung from the chest wall and which may interfere with normal breathing

pleural effusion

Increased amounts of fluid within the pleural cavity

Tachycardia

Rapid heart rate >100 BPM

Tachypnea

Rapid breathing > 20 RPM

Pallor

Lack of color

Cyanotic

Bluish in color in skin - look at their lips, nail beds, patient needs O2

Orthropnea

Inability to breathe when lying down

Aphasic/asphasia

Inability to speak

Palliative

Relieving pain or alleviating a problem without dealing with the underlying cause

Dysphagia

Trouble swallowing

Tracheostomy

Refers to the opening itself

Tracheotomy

Is the operation to create the opening

ET tube Endotracheal tube

For oxygen administration only- manual or ventilator

Correct positioning of the tip is just above the carina

PCXR will be used to confirm placement

Thoracostomy Tube chest tube

Drain the intrapleural space either due to accumulation of air or fluid Used to re-establish negative intrapleural pressure Drainage for air – placed higher PNTX Drainage for fluid – placed lower near base of lung PE, hemothorax, empyema, cardiac tamponade PCXR to confirm placement of tube and for follow ups

CV lines- central venous lines are inserted into a large vein

Tip placement is in the SVC – 2-3cm above the right atrial junction Different Lumens – single, double, multi Flushed with Heparin Insertion sites – subclavian or IJ internal jugular

Can use Femoral AKA Central Line Hickman, Broviac, Groshong Catheter tunneled or non tunneled under the skin Groshong – 3 tip valve

PICC line peripherally inserted central catheter

Insertion site- Antecubital fossa

Implanted ports

Mediport

Port a cath

Lifeports

Ports that are implanted for venous access. The port has a catheter attached to it that allows access for fusions or draws

Pulmonary arterial lines (PA Lines) Swan-Ganz Catheter

This line placement will go beyond the SVC

It is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs. The pulmonary artery catheter allows direct, simultaneous measurement of venous oxygen and pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure (wedge pressure) of the left atrium.

Tip is allowed to flood into pulmonary artery when accessing wedge pressure

Nasal cannulas

1-6L

Masks

6-10L

Non-rebreather masks

15L

Nebulizer

8 L

Pulse oximeter

Used to assess oxygen saturation and pulse below 92% O2 and an alarm will sound

EKG

Electrocardiograph or ECG

A quick non-invasive assessment of the heart’s electrical activity

Patient must be still

NG Tubes

Passed from nose to stomach

NE tubes

Passed from nose to duodenum