Fundamentals Exam 1

Safety

Freedom from psychological and physical injury

Joint Commission (TJC)

Accredits healthcare organizations based on safety performance, policies, procedures, practices, and outcomes

Patient identification

Use at least two identifiers, such as name and date of birth

Medical equipment alarms

Never turn alarms down; they must be heard and responded to on time

Surgical site verification

Correct surgical site must be marked and verified before surgery

Pathogen

Any microorganism capable of producing illness

Most common means of pathogen transmission in healthcare

Hands

Near miss

An event 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 causes severe physical or psychological harm, including death or permanent injury

Root-cause analysis (RCA)

Investigation used to determine causes of potential or actual errors and whether human error or system failure contributed

Infant and toddler car safety

Ride in a rear-facing car safety seat as long as possible

Infant/toddler/preschool safety risks

Poisoning, choking, fire, motor vehicle accidents, and drowning

School-aged child safety risks

Bicycle accidents and head injuries; helmets should be worn

Adolescent safety risks

High-risk behaviors, smoking, alcohol, drugs, motor vehicle accidents, STDs, and suicide

Older adult safety risks

Medication effects, illness, falls, decreased strength, impaired mobility/balance, and decreased sensory perception

Fall-risk armband

Yellow

Fall prevention

Low locked bed, nonskid footwear, call light within reach, regular rounding, toileting, clear pathways, appropriate mobility equipment, and patient education

BMAT

Mobility assessment tool that assigns a mobility level from 1-4 and recommends mobility devices

TUG

Timed Up and Go; more than 12 seconds indicates increased fall risk

SPLATT

Symptom at time of fall, Previous fall, Location of fall, Activity at time of fall, Time of fall, Trauma after fall

After a patient fall

Call for assistance, assess for injury, stay with patient, notify provider/family as required, complete incident report, and participate in huddle/debrief

Incident report

Contains objective details about a safety event and is not placed in the patient's medical record

Physical restraint

Manual method, physical/mechanical device, material, or equipment that limits the patient's ability to move freely

Chemical restraint

Medication used to restrict a patient's movement or behavior

Complications of restraints

Pressure ulcers, pneumonia, constipation, incontinence, and death

When restraints should not be used

For staff convenience or punishment

Clinically justified reasons for restraints

Reduce risk of injury, prevent interruption of necessary therapy, prevent removal of life support, or reduce risk of injury to others

Restraint order

Physician/HCP order specifying the type and location; not ordered PRN

Restraint application

Restrict movement as little as necessary, fit properly, and not interfere with treatment

Restraint knot

Use a quick-release knot

Restraint attachment

Attach to the bedframe, never the side rails

Space under restraint

Approximately two fingers should fit between restraint and patient

Restraint circulation checks

Assess pulses, skin temperature, color, sensation, and skin integrity

Restraint removal

Remove every 2 hours according to the lecture

Restraint alternatives

Sitter, moving patient closer to nurses' station, frequent rounding, family involvement, activities, reorientation, bed alarms, and TeleSitter

RACE

Rescue/remove patients in immediate danger, Activate alarm, Confine fire, Extinguish fire

Four side rails

May be considered a physical restraint

Irritant contact dermatitis from latex

Most common latex reaction and is not a true allergy

Allergic contact dermatitis

Delayed reaction that may occur 24-48 hours after latex contact and may cause oozing skin blisters

True latex allergy

Immediate hypersensitivity reaction that can begin within minutes

Mild latex allergy symptoms

Redness, hives, and itching

Severe latex allergy symptoms

Runny nose, sneezing, scratchy throat, asthma, dyspnea, coughing, wheezing, and itchy eyes

Infection

Invasion of a susceptible host by pathogens or microorganisms resulting in disease

Colonization

Presence and growth of microorganisms within a host without tissue invasion or damage

Communicable disease

Infectious disease that can be transmitted directly from one person to another

Chain of infection

Causative agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host

Causative agent

Pathogen capable of causing infection

Reservoir

Favorable environment where microorganisms survive, multiply, and await transfer

Portal of exit

Route through which microorganisms leave the reservoir

Mode of transmission

Method by which microorganisms are transferred to another host

Portal of entry

Route through which microorganisms enter a susceptible host

Susceptible host

Person whose immune defenses are unable to adequately resist the infectious organism

Breaking the chain of infection

Break any one link in the chain to help prevent infection

Types of infectious agents

Bacteria, viruses, fungi, protozoa, prions, and parasites

Normal flora

Resident organisms that normally live on the skin and body without causing illness

Factors affecting ability to cause disease

Number of microorganisms, virulence, ability to enter/survive in host, and susceptibility of host

Reservoir examples

Animals, humans, insects, food, water, and inanimate surfaces

Environmental factors affecting microorganisms

Food, oxygen, water, temperature, pH, and light

Common portals of exit and entry

Blood, skin, mucous membranes, GI tract, GU tract, and transplacental routes

Direct contact transmission

Transmission from person to person

Indirect contact transmission

Transmission through contact with a contaminated object

Droplet transmission

Large respiratory particles from coughing or sneezing that travel short distances

Airborne transmission

Infectious particles remain suspended in the air

Vehicle transmission

Transmission through contaminated items, water, blood, solutions, or food

Vector transmission

Transmission through organisms such as flies, mosquitoes, fleas, and ticks

Innate immunity

Immunity present at birth that responds immediately and does not retain memory of a specific antigen

Adaptive immunity

Immunity that develops when the body encounters and remembers antigens

Active immunity

Person produces their own antibodies after exposure or immunization

Passive immunity

Antibodies are received from another source; acts quickly but does not last as long

Passive immunity examples

Maternal antibodies through placenta or breast milk and antibody-containing blood products

Incubation stage

Time between exposure and first symptoms

Prodromal stage

Period from onset of general symptoms to more distinct symptoms

Illness stage

Period when the patient has specific symptoms of the disease

Convalescence

Period when acute symptoms disappear and the patient begins recovery

Localized infection

Infection affecting a specific area of the body

Localized infection findings

Pain, tenderness, warmth, and redness

Systemic infection

Infection affecting a larger proportion of the body

Systemic infection findings

Fever, elevated WBCs, nausea/vomiting, lymphadenopathy, and possible organ failure

Skin as a defense mechanism

Provides a physical barrier against microorganisms

Respiratory defenses

Cilia and alveolar macrophages

Urinary defense

Flushing action of urine

GI defense

Acidity

Vaginal defense

Normal vaginal flora maintain a low pH that helps prevent microorganism growth

Inflammation

Cellular response to injury or infection that brings blood, fluid, and nutrients to the site

Older adult infection risk

Reduced inflammatory and immune responses may cause infection to be advanced before identification

Atypical infection findings in older adults

Agitation, confusion, or incontinence

HAI

Healthcare-associated infection acquired while receiving care in a healthcare setting

Nosocomial infection

Another term for healthcare-associated infection

Exogenous infection

Infection originating outside the patient

Endogenous infection

Infection resulting from overgrowth or alteration of the patient's normal flora

Iatrogenic infection

HAI resulting from a diagnostic or therapeutic procedure

Common HAI sites

Urinary tract, surgical/traumatic wounds, respiratory tract, and bloodstream

Most important infection-prevention measure

Good hand hygiene

Medical asepsis

Clean technique that reduces the number, growth, and spread of microorganisms

Surgical asepsis

Sterile technique that eliminates microorganisms from an object or area and prevents contamination

Asepsis

Absence of pathogens

Sterile field contaminated border

1 inch

Below the waist and sterile field

Considered contaminated

Water and sterile field

Water contaminates a sterile field