NUR140 Exam 1 – Infection Control, Safety & Mobility Vocabulary

Infection Control and Isolation

• Room Assignment
• Cohort clients with the same organism when private rooms unavailable.
• Immunocompromised or highly contagious clients = private, negative-pressure (TB) or positive-pressure (protective) rooms as ordered.
• Maintain spatial separation ≥ 3\text{ ft} between beds if cohorting.

• Standard / Transmission-Based Precautions ("FAE" chart)
• Contact – wound infections, RSV, scabies, herpes.
• PPE: gown + gloves (visitors & staff).
• Remove PPE before exiting room; dedicate equipment.
• Droplet – rubella, pertussis, mumps, meningitis influenza.
• Surgical mask within 3\text{ ft}; gloves/gown PRN; client wears mask for transport.
• Airborne (Respiratory) – measles, varicella, tuberculosis.
• Negative-pressure room, keep door closed.
• N-95 or higher respirator (fit-tested).
• Susceptible personnel kept out of room (e.g., no pregnant staff for rubeola/varicella).
• Protective / Reverse – neutropenia, HSCT recipients.
• Positive-pressure room, HEPA filtration.
• Client wears mask when leaving room; no fresh flowers, fruits, standing water.

• Gloves – Indications
• Contact with infectious materials, mucous membranes, non-intact skin, contaminated equipment, visibly/ potentially soiled skin.

• Protective Eyewear / Face Shield
• Anytime splashes or sprays of body fluids, viruses, bacteria are possible (suctioning, irrigations, childbirth).
• Combine with mask if airborne or droplet spread.

• Hand Hygiene
• When? Before/after pt contact, before clean/aseptic tasks, after body fluid exposure, after touching pt surroundings, after glove removal.
• How?
• Alcohol-based sanitizer \ge 60\% — rub until dry (\sim 20\text{ sec}).
• Soap & water \ge 15\text{ sec}, warm water, friction all surfaces incl. between fingers, under nails, rinse hands downward.
• Clostridioides difficile – MUST use soap & water (spores not killed by alcohol). Dry with paper towel; towel to turn off faucet.

• Health-Care Associated Infections (HAIs)
• Types: CAUTI, CLABSI, VAP, SSI.
• ↑ morbidity, mortality, length of stay, cost; many are preventable via bundles / hand hygiene.

• Signs & Symptoms
• Inflammation – redness, swelling, heat, pain, loss of function, fever, abdominal pain, cough, chills.
• Infection – sore throat, sweats, fever, SOB, dysuria/burning.

• Breaking the Chain of Infection
• Hand hygiene; immunizations; covering coughs/sneezes; proper PPE; environmental cleaning; safe disposal of sharps/linens.

• Linens
• Keep away from uniform; never shake; place directly into leak-proof bag/hopper; do not place on floor.

• Needlestick Prevention
• Safety-engineered needles; activate device immediately; never recap; dispose sharps when container < \tfrac{3}{4} full.

Safety

• Fall Risk Assessment / Interventions
• Assess history, mobility, medications, cognition, continence.
• Bed low & locked; call bell & items within reach; non-skid footwear; adequate lighting; hourly rounding; use of assist devices.

• Restraints
• Indications: violent/self-harm behavior, interference with therapy when less restrictive measures failed.
• Application: Quick-release knot to movable part of bed frame; allow 2\text{ fingers} between skin & restraint; pad bony areas.
• Care: VS & CMS q 15\text{–}30\text{ min} initially then per policy (≥ q 2\text{ h}); ROM, hydration, toileting, skin care; reassess need.
• Complications: Pressure injury, nerve injury, impaired circulation, asphyxiation, psychological trauma.

• Fire – RACE / PASS
• Rescue → Alarm → Contain (close doors/windows) → Extinguish/Evacuate.
• Pull → Aim → Squeeze → Sweep for extinguisher.

• National Patient Safety Goals (NPSGs)
• Identify pts correctly – 2 identifiers (name, DOB).
• Improve communication – timely reporting of critical results (ISBARR).
• Medication safety – label all meds; med reconciliation; high-alert (anticoagulants) protocols.

• Seizure Precautions
• Bed low; side rails up & padded; O2 & suction available; loosen clothing; do NOT restrain; note onset, duration, progression; place on side post-ictal.

• Home Oxygen Education
• No smoking/open flames; keep \ge 5\text{–}10\text{ ft} from heat; store tanks upright; check electrical safety; humidification as prescribed.

• Body Mechanics
• Wide base, bend knees, tighten core, keep load close, avoid twisting, use assistive devices, push > pull.

Vital Signs

Blood Pressure

• Correct cuff width: 40\% arm circumference; bladder length 80\% circumference.
• Position: seated, back & feet supported, arm heart level.
• Normal 120/80\;\text{mmHg}.
• Stages:
• Stage 1: 130\text{–}139/80\text{–}89.
• Stage 2: \ge 140/\ge 90.
• Hypertensive crisis: \ge 180/\ge 120.
• Risk factors – age, obesity, smoking, ETOH, stress, salt, DM, dyslipidemia.
• Interventions – low-Na diet, exercise, meds, slow position changes; hypotension → fluids, supine w/ legs elevated.

• Orthostatic Hypotension
• ↓ \ge 20 systolic OR ↓ \ge 10 diastolic within 1\text{–}3\text{ min} of standing.
• Interventions: compression stockings, dangle before stand, review meds.

Apical Pulse

• Location – 5th ICS, LMCL.
• Count 1 full minute when irregular, on cardiac meds (digoxin, beta-blockers), or < !3\text{ yrs} age.

Respirations

• Normal 12\text{–}20\,/\min.
• Patterns & causes:
• Eupnea – normal.
• Apnea – arrest; neuro injury, narcotics.
• Cheyne–Stokes – cyclical crescendo/decrescendo w/ apnea; CHF, stroke, ICP ↑.
• Kussmaul – deep, rapid, regular; metabolic acidosis (DKA), renal failure.

Peripheral Pulses

• Sites: temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis.
• Strength: 0 absent, 1 weak, 2 normal, 3 full/bounding; document bilaterally.

Oxygen Saturation

• Pulse oximeter on finger, ear, toe, nose; remove polish, warm extremity.
• Normal \ge 95\% (COPD baseline lower).
• Low → reposition, deep breathing, ↑ O2 flow, assess lung sounds, prepare for advanced airway.

Temperature

• Oral, tympanic, temporal, rectal, axillary, core.
• Oral easy but affected by intake/smoking; rectal most accurate core but invasive; axillary safe neonates but less accurate; tympanic rapid but cerumen.

Mobility & Immobility

• ROM
• Active – patient moves joint.
• Passive – nurse moves joint (> risk stiffness but maintains function).

• Bed Positions
• Supine – post-op spinal, cerebral.
• Prone – spine surgery, COVID ARDS proning.
• Semi-Fowler (30^{\circ}) – ease breathing, enteral feeds.
• Fowler (45\text{–}60^{\circ}) – respiratory distress, NG insertion.
• Trendelenburg – hypotension, central line insertion.
• Sims/semi-prone – enemas, unconscious oral drainage.

• Crutches
• Height – 1\text{–}2\text{ in} (2–3 fingers) below axilla; elbows flex 15^{\circ}!–30^{\circ}.
• Gaits: 2-point (partial wt), 3-point (non-weight bearing), 4-point (stable), swing-to, swing-through.

• Anti-embolism Stockings – measure calf/thigh, apply before rising, no wrinkles, remove q shift.

• Ambulation / Transfers
• No weight – mechanical lift, 2 staff, slide board.
• Partial weight – gait belt, pivot disc, sit-to-stand device.
• Full weight but weak – cane, walker.

• Moving in Bed – use draw-sheet/friction-reducing device, count to 3, maintain neutral spine.

• Effects of Immobility & Interventions
• Cardiovascular – DVT, orthostatic hypotension ⇒ VS supine/sit/stand, SCDs, anticoagulation.
• Integumentary – pressure injury ⇒ turn q 2\text{ h}, moisture control, cushions.
• Respiratory – atelectasis, pneumonia ⇒ IS 10×/h while awake, cough & deep-breath, chest physiotherapy.
• GI – constipation, GERD ⇒ ↑ fluids \ge 2\text{ L/day}, fiber, stool softeners, HOB ↑ after meals.
• GU – urinary stasis, calculi ⇒ encourage voiding q 2\text{–}4\text{ h}, ↑ fluids.
• Musculoskeletal – contractures, foot-drop, bone loss ⇒ ROM, splints, footboard, calc Ca/Vit D.
• Psychosocial – isolation, depression ⇒ socialization, clocks/calendars, autonomy in care.

Movement Terminology (Pairs)

• Flexion / Extension – bend ↓ angle vs straighten ↑ angle.
• Abduction / Adduction – away from midline vs toward.
• Pronation / Supination – palm down vs up.
• Circumduction – circular.
• Rotation – bone turns on axis.
• Inversion / Eversion – sole in vs out.
• Dorsiflexion / Plantarflexion – toes up vs toes down.