Non-Invasive patient care skills Test

What are the 6 elements of chain of infection?

• Infectious agents

• Reservoir

• Portal of exit

• Modes of transmission

• Portal of entry

• Susceptible host

What are examples infectious agents?

• Bacteria

• Viruses

• Fungi

• Parasites

Define infectious agent

The potential for microorganisms/parasites to cause disease depends on virulence, Invasiveness and pathogenicity.

What are the factors for infectious agents?

• Virulence - Ability to multiply and grow

• Invasiveness - ability to enter tissue

• Pathogenicity - ability to cause disease

What does reservoir mean in chain of infection?

Place where the infectious agent resides, survives and reproduces

Presence of microorganisms does not always cause illness in a person

What is the most common reservoir?

Human body

What are some examples of reservoirs other than the human body?

• Animals

• Food

• Water

• Insects

• inanimate objects

Why is the purpose of reservoirs for pathogens?

Pathogens require proper environment to thrive

What do pathogens need to survive?

• Appropriate food

• oxygen

• Water

• temperature

• pH

• Light

What is portal of exit in chain of infection?

A way for the infectious agent to leave reservoir

What are some examples of Portal of Exit?

• Blood

• Skin and mucous membranes

• Respiratory tract

• Urinary tract

• GI Tract

• Transplacental (Mother to foetus)

What is mode of transmission in chain of infection?

• Mechanism of transfer of infection from reservoir to a susceptible host

• Through direct or indirect contact, droplet, airborne vehicles and vector borne

What is portal of entry in chain of infection?

Path that infection is able to enter the susceptible host (same as portal of exit)

What does susceptible host mean in chain of infection?

Person who is at risk for developing an infection from the infectious agent.

What are the factors that make a person more susceptible?

• Age

• Underlying chronic diseases

• Conditions that weaken the immune systems

• Invasive devices

Why is hand hygiene done?

• Decision to perform hand hygiene depends on 4 factors

  • the intensity of degree of contact with patients or contaminated objects

  • the amount of contamination that may occur with the contact

  • the patient or healthcare workers ability to infection and

  • the procedure or activity to be performed

How is hand hygiene done?

• Stand in front of the sink keeping hands and body away from sink surface

• turn on water turn on faucet to regulate flow and temperature

• avoid splashing water against uniform regulate flow of water so temperature is warm

• wet hands and wrists thoroughly underwater Keep hands and forearms lower than elbows during washing

• apply 3 to 5 ML of antiseptic soap and rub hands together

• Perform hand hygiene using plenty of lather and friction for at least 15 seconds Interlace fingers and rub palms and the back of hands with circular motion at least five times each keep fingers down to facilitate removal of microorganisms

• areas underlying fingernails are often soiled cleaned up with fingernail of other hand an additional so or with nail cleaner

• rinse hands and wrists thoroughly keeping hands down and elbows up

• dry hands thoroughly from fingers to wrists with paper towel single use cloth or warm air dryer

• if used discard paper towel in proper receptacles

• to the turn off hand faucet used clean dry may paper avoid touching handles with hands

• If hands are dry or chapped use a small amount of lotion or barrier cream dispense from individual container

What are the six types of vital signs?

• Temperature

• Pulse

• Blood pressure

• respiratory rate

• oxygen saturation

• pain

What are factors that affect vital signs?

• Temperature of environment

• patient's physical exertion

• effects of illness

When is vital signs taken?

• On admission to a health care facility

• in a hospital or care facility on routine schedule according to a healthcare providers order or standards of practice of agency

• before during and after a surgical or invasive diagnostic procedure

• when patient reports specific symptoms of physical distress

• before during and after the administration of medications or application of therapies that affect cardiovascular respiratory or temperature control functions

• when patient's general physical condition changes

What are some important considerations on patient centered care?

• Be sensitive to each patient's need for privacy and observe cultural norms

• Always inform patients about the vital measurements

• Procedures that are normally non invasive sometimes produce anxiety because of cultural variabilities of touch privacy and gender

What are the core sites for temperature measurement?

• Rectum

• earlobe

• temporal membrane

• esophagus

• pulmonary

• urinary bladder

What are the surface sites for temperature measurement?

• Skin oral

• cavity

• axilla*

How are specimen’s collected?

• In appropriate containers, at the correct time and in the appropriate amount

• Properly label all specimens with the patient identification (Name & IC) complete laboratory requisition if necessary

• Deliver specimens to the laboratory within the recommended time or ensure that they are stored properly for later transport

What are the 4 Different collection types and they're uses?

• Random

  • For routine analysis

  • collect during normal voiding from an indwelling catheter or urine collection bag

  • use a clean specimen cup

• Clean-voided or midstream urine

  • For culture and sensitivity

  • requires proper cleansing to perineum before collecting urine

  • use a sterile specimen cup

• Sterile specimen

  • for culture and sensitivity

  • usually from an indwelling urine catheter

  • Use sterile syringe and transfer to a sterile specimen cup

• Time urine specimen

  • for measuring levels of adrenal cortisol steroids or hormones creatine clearance or protein quantity test use

  • special collection container which contains special preservatives

What is the normal pH for urine and how does it protect against bacterial growth?

• 4.6 - 8.0

• An acidic pH protects against bacterial growth

What's the normal level of protein in urine what does protein presence indicate?

• None or up to 8 /100mL

• common in renal disease

What is the normal level of glucose in urine and what the presence of glucose indicate?

• None

• Common in diabetic patients

• Ingestion of high concentration of glucose

What's the normal level of ketone in the urine and what does ketonuria indicate?

• None

• ketonuria is poorly controlled in diabetic patients

• Patients with dehydration starvation or excessive aspirin → risk of ketoacidosis

When is blood positive in urine test?

• Positive when intact erythrocytes hemoglobin or myoglobin is present

• In woman it may be a result of contamination with menstrual fluid

What's the specific gravity of urine and What does a high and low value represent?

• High SG reflects concentrated urine low SG reflects diluted urine

• Conditions elevate SG

  • dehydration reduce

  • renal blood flow

  • increase ADH secretion

• conditions reduce SG

  • over hydration

  • early renal disease

  • inadequate ADH secretion

What's the normal red blood cell count in urine?

• Up to 2

• Damage to Glomeruli or tubules trauma disease or surgery of lower urinary tract can also cause blood to be present

What's a normal white blood cell count in urine?

• 0-4

• greater number indicate urinary infection

What are other microscopic things that should not be present in urine?

• Bacteria that indicates UTI

• Casts that indicates renal alterations

• crystals that result in Renal Stone formation

What are the advantages of oral temperature taking?

• easily accessible - requires no position change

• Patience comfortable for a patient

• Provides accurate surface temperature reading

• reflects rapid change in core temperature

• reliable route to measure temperature for Intubated patients

What are the limitations of oral temperature taking?

• Causes delay in measurement if patient recently ingested hot cold fluids or foods chewed gum or smoked

• Not used with patients who had had oral surgery or facial trauma are unable to position mouth or have shrinking chills or history of seizures

• not used with infant small children or confused unconscious or uncooperative patients

• Risk for body fluid exposure

What are the advantages of tympanic membrane (Earlobe) temperature taking

• Easy accessible site

• obtained without disturbing waking or repositioning patient

• used for patients with Tachypnea without affecting breathing

• Sensitive to call temperature changes

• very rapid measurement (2 to 5) seconds

• unaffected by oral intake of food or fluids or smoking

• use in newborns to reduce infant handling and heat loss

What are the limitations of tympanic membrane (earlobe) temperature taking?

• More variability of measurement than with other core temperature devices

• Requires removal of hearing aids before measurement

• requires disposable sensor cover with only one size available

• readings possibly to start it with Otitis Media and ceremonial impaction

• not used with patients who have had surgery of the ear or tympanic membrane

• does not accurately measure core temperature changes during and after exercise

• affected by ambient temperature devices such as incubators radiant warmers or facial fans

• anatomy of ear canal makes it difficult to correctly position in neonates infants and children younger than three years of age

• inaccuracies reported because of incorrect positioning of handheld unit

What are the advantages of axillary (under arm) temperature taking?

• Safe and inexpensive

• reliable and stable and preterm infants

What are the limitations of axillary (under arm) temperature taking?

• Long term measurement time

• requires continuous positioning

• poorly reflects call temperature

• not recommended for detecting fever in infants and young children

• requires exposure of thorax which can result in temperature loss especially in newborns

• affected by exposure to the environment including time that takes to place with thermometer

• underestimates core temperature

What is pulse rate?

Pulse rate is the measurement of the heart rate or the number of times the heart beats per minute

What does measuring pulse help to indicate?

• Heart function

• tissue perfusion

• Heart rhythm

• strength of pulse

What is the site for pulse assessment

Radial pulse

When and how is respiration rate?

• When patient is at rest

• Count number of breaths for one minute ( how many times chest rises)

What does increased respiration rate indicate?

• Fever

• Illness

• medical conditions

• Difficulty breathing

What is blood pressure?

• Is the force exerted by the blood against the arterial walls.

What is systolic pressure?

• pressure of contraction of the heart

What is diastolic pressure?

• Pressure of the ventricles contract

When should a diagnosis of hypertension be given?

• Only after multiple blood pressure measurements over several days or weeks

What are the advantages Of assessing blood pressure electronically?

• Ease of use efficient

• when frequent repeated measurements are indicated

• stethoscope not required

• allows blood pressure to be recorded more frequently as often as every 15 seconds with accuracy

what are the limitations of assessing blood pressure electronically?

• Expensive

• required source of electricity

• requires space to position machine

• sensitive to outside motion interference and cannot be used in patients with seizures tremors or shivers or patients unable to cooperate

• Not accurate for patients with irregular heart rate or hypotension or in conditions with reduced blood flow

• accuracy standards for electronic blood pressure machine manufacturers are voluntary

• vulnerable to error among older adults and obese patients

How are blood tests collected?

• Specimen are collected through

  • Capillary skin puncture

  • arterial or venous sampling

  • bone marrow aspiration

When is capillary puncture/skin puncture preferred?

• Preferred for a peripheral blood smear

• Adult: skin puncture through fingertips

• children: fingertips

• infants: the great toe For a side of you