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PNR140 Week 1: Key Terms - Pressure Ulcer Prevention, Infection Control, and Neurological Nursing

INTEGUMENTARY NURSING

  • BASIC PRINCIPLES OF PRESSURE ULCER PREVENTION

    • 1. Risk Assessment
    • Use validated tools like the Braden Scale.
    • Assess on admission and regularly thereafter.
    • Identify high-risk patients (e.g., limited mobility, poor nutrition).
    • 2. Skin Care
    • Perform daily skin inspections, especially over bony prominences.
    • Keep skin clean and dry.
    • Use moisturizers to maintain skin integrity.
    • 3. Pressure Redistribution
    • Reposition patients at least every 2 hours.
    • Use pressure-redistributing devices (mattresses, cushions).
    • Avoid positioning directly on bony prominences.
    • 4. Nutrition and Hydration
    • Ensure adequate nutrition and hydration.
    • Monitor nutritional status.
    • Consult with dietitian if necessary.
    • 5. Moisture Management
    • Manage incontinence promptly.
    • Use moisture barriers.
    • Keep skin dry, especially in skin folds.
    • 6. Minimize Friction and Shear
    • Use proper lifting techniques.
    • Elevate head of bed no more than 30^ ext{o} when possible.
    • Use transfer aids to reduce friction during patient movement.
    • 7. Education
    • Educate patients and families about pressure ulcer prevention.
    • Teach self-care techniques for mobile patients.
    • 8. Documentation
    • Record assessments, interventions, and outcomes.
    • Include measurements.
    • Use standardized documentation tools.
    • 9. Interdisciplinary Approach
    • Collaborate with wound care specialists, dietitians, and physical therapists.
    • Implement facility-wide prevention protocols.
      1. Continuous Monitoring
    • Reassess risk regularly.
    • Adjust care plan as needed.
    • Stay updated on best practices and guidelines.

  • PRESSURE ULCER PREVENTION CASE STUDY

    • Mrs. Johnson, 78-year-old admitted to medical-surgical unit after hip replacement.
    • Limited mobility; high risk for pressure ulcers.
    • Patient Information:
    • Age: 78 years old
    • Recent hip replacement surgery
    • Limited mobility
    • History of diabetes
    • Slightly overweight

  • CONNECTIONS AND RELEVANCE

    • Principles align with preventing hospital-acquired pressure injuries.
    • Emphasize interdisciplinary collaboration (nursing, wound care, dietetics, PT).
    • Importance of regular reassessment and updating care plans with evolving patient status.
    • Ethical considerations include patient dignity, comfort, and prevention of harm.

INFECTION CONTROL

  • 1. Hand Hygiene
    • Practice proper hand washing technique.
    • Use alcohol-based hand sanitizers when appropriate.
    • Perform hand hygiene before and after patient contact.
  • 2. Personal Protective Equipment (PPE)
    • Use gloves, gowns, masks, and eye protection as needed.
    • Don and doff PPE correctly.
    • Change PPE between patients.
  • 3. Standard Precautions
    • Apply to all patients, regardless of diagnosis.
    • Include hand hygiene, PPE, and safe injection practices.
  • 4. Transmission-Based Precautions
    • Implement for specific pathogens or conditions.
    • Categories: Contact, Droplet, and Airborne precautions.

TYPES OF INFECTION

  • 1. Bacterial Infections
    • Caused by bacteria.
    • Treated with antibiotics.
    • Examples: strep throat, pneumonia.
    • Treatment example: ext{Penicillin} (as an antibiotic).
  • 2. Viral Infections
    • Caused by viruses.
    • Generally not treated with antibiotics.
    • Examples: common cold, HIV.
    • Treatment example: antiviral (e.g., ext{Acyclovir}).
  • 3. Fungal Infections
    • Caused by fungi.
    • Examples: candidiasis, athlete's foot.
    • Treatment: antifungal (e.g., ext{Nystatin}).
  • 4. Parasitic Infections
    • Caused by parasites.
    • Examples: malaria, giardiasis.
    • Treatment: antiparasitic (e.g., ext{Metronidazole}).

ISOLATION

  • 1. Contact Precautions
    • For diseases spread by direct or indirect contact.
    • Requires gloves and gown.
  • 2. Droplet Precautions
    • For pathogens transmitted by respiratory droplets.
    • Requires surgical mask within 3-6 feet of patient.
  • 3. Airborne Precautions
    • For airborne infectious agents.
    • Requires N95 respirator or PAPR.
    • Negative pressure room.

NEUROLOGICAL NURSING

  • Case Summary

    • Jeff Dickson, 17-year-old, MVC with possible basilar skull fracture.
    • Admitted to ED; awake but lethargic; responds verbally; memory impaired for event.
    • Pupils equal, round, reactive to light; pupil size 4 ext{ mm}.
    • Positive Battle’s sign; clear nasal drainage (rhinorrhea).
    • Headache: 4/10.
    • CT head pending; monitored in ED before radiology.

  • ASSESSMENT TECHNIQUES FOR TBI (Select all that apply)

    • 1. Assess the equality of Jeff’s pupils → Yes
    • 2. Observe the area behind Jeff’s ears → Yes
    • 3. Observe the area around Jeff’s eyes → Yes
    • 4. Test Jeff’s renal function → No
    • 5. Check Jeff’s nasal cavity for leaking → Yes
    • Key point: Pupillary equality, periorbital signs (raccoon eyes), Battle’s sign (behind ears), and rhinorrhea are relevant to basilar skull fracture and TBI assessment.

  • OTHER MANIFESTATIONS OF TBI (basilar skull fracture)

    • Tinnitus, facial paralysis, hearing difficulty, epistaxis (nosebleed), CSF leakage from nose or ears.
    • Rhinorrhea caution: concern for CSF leak; CSF drainage requires specific assessment.

  • METHODS TO DETERMINE CSF DRAINAGE (rhinorrhea)

    • Likely methods: 1. Measure the specific gravity of the drainage. ( CSF typically has different composition than regular nasal drainage; testing can help differentiate. )
    • 3. Observe for a “halo” around a spot of drainage. (Halo sign suggests CSF leakage.)
    • 2 and 4 are less definitive in bedside CSF differentiation as listed here.

  • MEDICATION FOR HEADACHE (Jeff’s request)

    • Options: Morphine sulfate; Percodan; Lortab; Acetaminophen (Tylenol).
    • Best choice for this scenario: ext{Acetaminophen (Tylenol)}. (Non-opioid analgesic preferred initially in suspected TBI when possible to avoid sedation/depression.)

  • STUMP THE STUDENT

    • Activity: Take 10 minutes to write a question based on pre-class activities and lecture.
    • Purpose: Group engagement; the person who stumps the class is the winner.

NOTES AND REMINDERS

  • Revisit Braden Scale and other risk assessment tools regularly.
  • Ensure documentation is clear, objective, and includes measurements (e.g., wound measurements, Braden score, etc.).
  • Maintain a collaborative, interdisciplinary approach for prevention and management of ulcers and infections.
  • For suspected CSF leaks, monitor for changes in drainage characteristics and consider confirmatory testing as per clinical protocol.