Patient Safety and Quality

Chapter 27: Patient Safety and Quality

• Vulnerable populations includes infants, children, older adults, individuals with chronic illnesses, individuals with physical and mental disabilities, those who have difficulty communicating, and people with low incomes or who are homeless.
• These populations face various risks, including falls, neglect, abuse, medication errors, and challenges in independently managing their safety needs.
• Individual risk factors for violence include history of domestic violence, substance abuse, mental illness, poverty or financial stress, and social isolation.
• Environmental hazards include clutter, poor lighting, slippery floors, and improperly stored chemicals.
• Prevention methods involve decluttering pathways, ensuring adequate lighting, using non-slip mats, securing electrical cords, and storing chemicals out of reach.
• RACE stands for Rescue, Activate, Confine, and Extinguish.
• Potential safety risks in the home include falls, burns, choking, poisoning, and drowning.
• Risks for infants and toddlers include falls, choking, poisoning, drowning, and burns, which are caused by curiosity and lack of awareness of danger.
• Education for toddler safety includes using baby gates, securing furniture, storing hazardous substances out of reach, supervising children near water, and using outlet covers.
• Infants/Toddlers face safety risks such as choking, poisoning, and drowning
• Adolescents face safety risks such as risky behaviors, substance abuse, and emotional stress
• Older adults face safety risks such as falls and medication errors
• A 15-year-old student who recently lost their pet kitten is at a higher risk for depression and suicidal thoughts.
• Factors that increase risk in adolescents include peer pressure, family conflict, academic stress, and substance abuse.
• Mobility alterations pose risks for falling include muscle weakness, dizziness, unsteady gait, and the use of assistive devices.
• Subjective data of dizziness and weakness in both lower extremities increases the risk for falls
• A patient will be on fall risk until discharge or when her condition stabilizes.
• Interventions for a patient at fall risk include maintaining the bed in a low position, providing non-slip socks, ensuring the call light is within reach, and conducting frequent rounds.
• Immobility can lead to pressure injuries, DVT, pneumonia, and muscle atrophy
• Check skin integrity, circulation, and comfort to prevent pressure injuries during repositioning.
• Prolonged pressure reduces blood flow, leading to tissue ischemia and necrosis and formation of pressure injuries.
• Serious reportable events include surgery on the wrong site, patient falls resulting in injury, medication errors causing harm, and the development of preventable pressure injuries.
• Evidence-based alternatives to restraints include bed alarms, sitter services, and distraction techniques.
• Factors to assess before and during the placement of patients in physical restraints include the patient’s mental status, risk of harm to self or others, and attempts to use alternative methods.

Chapter 40: Hygiene

• Factors that influence personal hygiene practices include cultural norms, personal preferences, economic status, and physical limitations.
• Dentures should be carefully removed by holding the front teeth, soaking them in denture cleaner, gently brushing them with a soft-bristled brush, and rinsing them thoroughly.
• Conditions that place patients at risk for impaired skin integrity include immobility, incontinence, malnutrition, dehydration, and advanced age.
• Factors that influence the condition of nails and feet include diabetes, poor hygiene, circulatory issues, and fungal infections.
• Foot care is important for patients with diabetes because it prevents injuries and infection, reduces the risk of ulcers, and promotes circulation.
• Home assessments should consider clutter, loose rugs, lighting conditions, and the availability of grab bars or assistive devices to reduce the risk of falls.
• Critical education for patients with diabetes mellitus includes blood sugar control, proper diet, and daily foot inspections.
• A nurse's assessment of a diabetic patient's feet should check for wounds, redness, swelling, and reduced sensation.
• Typical hair and scalp problems include dandruff, lice, and fungal infections
• Interventions for hair and scalp issues include using medicated shampoos and maintaining hygiene.
• Hygiene care for older adults differs from that for younger patients, needing gentler products, less frequent bathing, and monitoring for dry or fragile skin.
• A partial bath is required
• It is important that the patient bathes.

Chapter 28: Infection Prevention and Control

• Ms. Green has a poor appetite, resulting in weight loss, has not received the flu vaccine this year, and is lonely.
• Ms. Green's lab results includes WBC 17,000, Iron level 42, positive Blood cultures, A1C 7%, and Neutrophils 33%.
• It is likely that Miss Green has a systemic infection, as shown by elevated WBC, positive blood cultures, and a low neutrophil percentage.
• Factors that increase a patient’s risk for infection include poor nutrition, chronic conditions like diabetes, loneliness, advanced age, and lack of vaccinations.
• Homelessness would increase the risk of infections due to limited access to hygiene, nutrition, and healthcare services.
• Receiving the flu vaccine decreases the risk of contracting influenza and its related complications
• Receiving a lung transplant increases the risk of infection due to post-transplant immunosuppressive medications.
• Corticosteroids, immunosuppressants, and chemotherapy medications increase risks for infection in a patient.
• To decrease the risk of infection, encourage proper hand hygiene, balanced nutrition, regular vaccinations, and avoiding contact with sick individuals.
• Cover the mouth and nose when coughing, use disposable tissues, wear a mask in crowded areas, and practice frequent handwashing to avoid the spread of infection.
• Symptoms of a localized infection include redness, swelling, warmth, pain, and purulent drainage.
• Symptoms of a systemic infection include fever, chills, fatigue, increased heart rate, and elevated WBC count.
• When a wound on the lower left leg has purulent drainage (green/yellow pus), anticipate the doctor ordering a wound culture, starting antibiotics and implementing wound care.
• Information to prepared when calling the doctor include patient's vitals, wound description, lab results, and current treatments.
• Normal defenses of the body against infection include healthy skin, mucous membranes, beneficial bacteria, and cilia in the respiratory system.
• Key events in the inflammatory response include:
  • Vasodilation: Increased blood flow to the site.
  • Phagocytosis: White blood cells engulf pathogens.
  • Exudate Formation: Fluids, cells, and inflammatory substances form at the site.
  • Tissue Repair: Healing begins with regeneration or scar formation.
• Patients who are immunocompromised, older adults, individuals with chronic diseases, surgical patients, and those with medical devices are at risk for infection.
• MRSA stands for Methicillin-resistant Staphylococcus aureus.
• It is difficult to treat MRSA as it is resistant to many common antibiotics.
• Contact precautions, including wearing gloves and gowns, are in place.
• Nurses can reduce healthcare-associated infections by:
  • Practicing proper hand hygiene.
  • Following aseptic techniques.
  • Regularly cleaning and disinfecting equipment.
  • Using proper PPE when caring for patients.
• Nurses can help decrease the risk of infection by maintaining a closed drainage system, performing catheter care regularly, and removing the catheter as soon as it is no longer needed.
• A patient in room 24 who has a urinary catheter, states he needs to use the restroom, and is confused is at risk for falls and catheter-related infections.
• Nursing interventions for the prevention of falls include utilizing bed alarms, keeping the bed in a low position, ensuring non-slip socks are worn and doing regular checks.
• Medical asepsis reduces the number and spread of microorganisms (clean technique)
• Surgical asepsis eliminates all microorganisms (sterile technique).
• Standard precautions for infection control include hand hygiene, and gloves when exposure to body fluids is possible.
• Contact isolation requires gloves and a gown, and a private room for patients with infections such as MRSA or C. difficile.
• Droplet isolation requires a mask, gloves, gown, and a private room for infections such as influenza pertussis or mumps.
• Airborne isolation requires an N95 respirator and a negative-pressure room for infections such as tuberculosis, measles, or chickenpox.
• Apply PPE in the following order: gown, mask or respirator, goggles or face shield, and gloves
• Remove PPE in the following order: gloves, goggles or face shield, gown, mask or respirator, and hand hygiene

CHAPTER 27 Patient Safety and Quality

• Critical thinking involves logically analyzing and evaluating information to make informed decisions, a broad concept applicable in various contexts.
• Clinical judgment is a specific application of critical thinking within patient care, assessing, interpreting data and making decisions based on clinical situations.
• Basic problem-solving is a simple process used to tackle immediate issues like applying a bandage to stop bleeding.
• Diagnostic reasoning is a more complex process involving collecting data, recognizing patterns, generating hypotheses to diagnose and address a problem, such as analyzing symptoms to identify an infection.
• Components of critical thinking:
  • Interpretation: Assessing and understanding patient data.
  • Analysis: Examining information objectively.
  • Inference: Drawing conclusions based on evidence.
  • Evaluation: Assessing outcomes and determining if interventions were effective.
  • Explanation: Communicating findings clearly and logically.
  • Self-regulation: Reflecting on and adjusting personal thinking and actions.
• Clinical experiences help nurses develop better judgment, adaptability, reinforce theoretical knowledge and build confidence in handling complex situations through hands on exposure to diverse patient cases.