Infection Control Practices

Airborne Isolation

• Used for patients with serious illnesses transmitted via airborne droplet nuclei
• Examples: Measles, Varicella Zoster Virus, TB, COVID-19
• Single patient room with negative air pressure
• Room vented to the outside
• Door always closed
• N95 mask or better required

Droplet Isolation

• Used for patients with illnesses spread by large particle droplets
• Examples: Invasive Haemophilus influenzae, Invasive Neisseria meningitidis, Diphtheria, Mycoplasma Pneumonia, Pertussis, Streptococcal pharyngitis
• Standard PPE, private room or at least 3 feet separation from roommates
• Limit patient transportation with mask use during transport

Contact Isolation

• For serious illnesses easily spread by direct contact or contact with items in the patient's environment
• Check skin and circulation frequently if restraints are used
• Patient can refuse restraints; assess their mental function, notify the doctor and responsible party, and document thoroughly

Lifts

• Always lock before using
• Ensure the base of the lift is spread correctly
• Place the client in the center of the sling
• Get training and do not use alone if unsure

Wheelchairs

• Lock wheels when stopped
• Place closest to the patient's strong side
• Do not secure any tubing or lines to moveable equipment

Oxygen Therapy

• Odorless, tasteless, colorless, and non-flammable gas but supports combustion
• The Flow Meter regulates the rate of oxygen flow, usually ordered in L/min
• Chronic respiratory illnesses require lower oxygen settings (no more than 1-2 L/min)
• Long-term O2 use requires humidification
• NO SMOKING signs and enforce them
• Use only water-soluble lubricants, avoid oil or petroleum-based lubricants, as they may cause combustion
• Location of fire extinguishers is important

Methods of Oxygen Delivery

• Nasal Cannula:
  • Fits into the nares
  • 24-40% concentration
  • 6 liters maximum flow
  • Turn on oxygen before putting on the patient
  • Tubing goes over the ears and under the chin
  • Assess and document skin condition behind the ears and in the nares before applying and during treatment
  • Use only water-soluble lubricants
• Face Mask
  • Allows more control over oxygen levels
  • 60-100% concentration depending on flow (6-10 L)
  • Should see a fine mist with humidified oxygen
  • Adjust mask for a snug fit over the nose and chin
  • Reservoir should never fully collapse (if it does, oxygen needs to be turned up with physician permission)
  • Types of Face Masks:
    • Venturi: Precise oxygen delivery
    • Non-rebreather: Deliver up to 100% oxygen
    • Simple: 40-60% oxygen
• Oxygen Tent:
  • Fine mist, constant temperature, high concentration
  • Canopy must cover the patient's torso and keep the patient dry
  • Change linens frequently
  • Maintain a temperature inside of at least 70 degrees Fahrenheit (21 degrees Celsius)
  • Adjust oxygen flow rate to 10-12 L/min
  • Tuck tent sides under the mattress if needed
  • A parent may need to be under the tent with a child
• Hyperbaric Chamber
  • Delivers 100% oxygen at 3 times the atmospheric pressure
  • Promotes faster tissue regeneration, beneficial for wound healing
• Ambu Bag
  • Up to 100% concentration depending on the presence of a reservoir
  • Mask should fit firmly over the nose and mouth creating a seal
  • Deliver breaths every 5 seconds
  • May be attached to an endotracheal tube (ET)

Patient Teaching for Oxygen Therapy

• Explain application and safety
• Explain signs and symptoms of oxygen toxicity which include:
  • Non-productive cough
  • Substernal chest pain
  • Nasal stuffiness/congestion
  • Nausea and vomiting
  • Fatigue
  • Headache
  • Sore throat
  • Hypoventilation
• Emphasize oral hygiene
• Encourage fluid intake
• Teach T C D B (Turn, Cough, Deep Breathe)

Fire Safety

• RACE: Rescue patients, pull alarm, confine fire, extinguish
• PASS: Pull pin, aim low, squeeze the trigger, sweep from side to side

Glucose

• Normal fasting levels: 60-110 mg/dl
• No special preparation unless fasting is ordered (NPO overnight)
• Accu-Chek is a glucose monitoring brand
• Post-prandial check is an after-meal check

Glycosylated Hemoglobin (A1C)

• Provides an accurate picture of blood sugar levels over the past 120 days
• No special preparation needed
• Elevated in diabetes mellitus
• Values:
  • Adult: 4-7%
  • Child: 1.8-4%
  • Poor diabetic control: 10-20%

Terminating Hypoglycemia

• Recheck blood sugar frequently to ensure correction
• Use options like:
  • Orange juice or other fruit juices
  • Hard candy or honey
  • Commercial glucose
  • Glucagon by subcutaneous, intramuscular, or intravenous administration
  • Glucose 10% or 50% intravenous administration

Uric Acid

• No special preparation needed
• Elevated in gout
• Normal value range: 3.0-7.0 mg/dl

Creatinine

• Indicator of kidney function
• Elevated in kidney failure
• Normal level: 0.6-1.2 mg/dl

BUN (Blood Urea Nitrogen)

• Assesses kidney function
• Elevated in dehydration and kidney impairment
• Normal level: 10-20 mg/dl

Electrolytes

• Potassium: 3.5-5.0 mEq/L
• Sodium: 135-145 mEq/L

Triglycerides

• NPO for 12-14 hours prior to test
• No alcohol for 24 hours prior to test
• High fat intake up to two weeks before the test may elevate findings
• Normal Findings:
  • Male: 40-160 mg/dl
  • Female: 35-135 mg/dl
  • Greater than 400 mg/dl is considered critically high

Lipoproteins

• HDL (High-Density Lipoproteins) "Good Cholesterol"
  • 30-80 mg/dl
  • Lower levels indicate a greater risk for heart disease
  • NPO for 12-14 hours
  • Smoking and alcohol may lower HDL levels
• LDL (Low-Density Lipoproteins) "Bad Cholesterol"
  • 60-180 mg/dl
• VLDL (Very-Low-Density Lipoproteins) "Very Bad Cholesterol"
  • 25-50%
  • NPO before testing
  • Smoking can elevate VLDL levels

Cholesterol

• Fast for 12-14 hours after eating a low-fat diet
• No alcohol for 24 hours before the test
• Normal values:
  • Adult/ Elderly People: less than 200 mg/dl

Wound Care (Wet to Dry Dressing)

• Apply a wet dressing and allow it to dry
• Used for wound debridement
• Sterile procedure
• Discard wetting solution after 24 hours
• Cleanse the wound before applying a new dressing
• Document the condition of the wound and any drainage that is colorful or has an odor
• Collect culture AFTER cleaning the wound of any old drainage

Pain

• Assess pain before and after medication administration to evaluate effectiveness
• Vital signs (except temperature) may be elevated with pain
• Believe the patient's report of pain, no matter what

Medication Administration

• The 6 Rights of Medication Administration:
  • Right patient
  • Right drug
  • Right dose
  • Right route
  • Right time
  • Right documentation
• Verify orders carefully
• Understand how medication routes affect absorption (ex: PO, SL, SQ, IM, IV)
• Monitor for therapeutic and non-therapeutic effects
• Assess for allergies FIRST
• Know how to avoid medication errors and always double check
• Some medications can cause life-threatening allergic reactions

Legal/Ethical Issues

• Informed Consent:
  • The physician discusses risks, benefits, etc.
  • The nurse witnesses the signature only
  • Ensure patient's questions are answered before the procedure
  • Usually done only with invasive procedures
• Incident Reports:
  • DO NOT chart in nursing notes that a report was filed
  • Document unusual events
  • Use factual information
• Definitions:
  • Assault: Intentional threat to cause bodily harm. Does not involve physical contact.
  • Battery: Unlawful touching of another person without informed consent
  • Defamation:
    • Slander: Malicious or untrue spoken words about another person that are brought to the attention of others.
    • Libel: Same as slander but written.
  • Tort: Wrongs against a person or property, including negligence, assault, battery, defamation, fraud, false imprisonment, and invasion of privacy.

Invasion of Privacy

• Privacy is a client's right
• Keep the door closed, no photographs
• Maintain client information confidentiality
• Do not attempt to access records of a client that is not your client or part of your responsibility

Negligence

• Four elements must be proven:
  • Duty: A legal obligation to provide care
  • Breach of Duty: Failure to meet the standard of care
  • Injury: Actual harm or damage occurred
  • Proximate Cause: The breach of duty was the cause of the injury

Client/Patient Bill of Rights

• Created by the American Hospital Association (AHA)
• Lists client rights including:
  • Right to information
  • Right to refuse treatment
  • Right to adequate, competent care
  • Right to have their bill explained
  • Right to confidentiality
  • And more…

Definitions

• Delegation: Transferring authority to perform selected nursing tasks to a competent individual in a specific situation
• Accountability: Being responsible and answerable for actions or inactions of self or others in the context of the delegation process
• Unlicensed Assistive Personal (UAP): Any unlicensed personnel, regardless of title, to whom nursing tasks are delegated
• Supervision: Guidance, direction, evaluation, and follow-up by a licensed nurse for the completion of delegated tasks

Guidelines for Delegation

• The task must be delegable
• Patient needs must be the priority
• The UAP must be competent
• Communicate clearly with the UAP
• Evaluate task completion

5 Rights of Delegation

• Right Task: Is it appropriate to delegate?
• Right Circumstances: Are the circumstances suitable for delegation?
• Right Person: Is the UAP qualified and competent?
• Right Directions/Communication: Were clear instructions provided?
• Right Supervision/Evaluation: Will appropriate supervision and evaluation occur?

Delegation & Supervision

• Provide clear instructions and evaluate the outcome

This quiz covers key concepts in infection control related to airborne, droplet, and contact isolation practices. It includes examples of illnesses for each type of isolation and the necessary precautions to be taken for patient safety. Essential guidelines for personal protective equipment (PPE) and patient management will also be reviewed.