Patient Safety Protocols in Healthcare

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Questions and Answers

What is a primary characteristic of airborne isolation precautions?

Requires a private room with negative air pressure (correct)

Allows the patient’s door to remain open

Only requires standard PPE for all patients

Can be in a room with positive air pressure

Which of the following illnesses is transmitted through droplet isolation?

Varicella Zoster Virus

Measles

Tuberculosis

Diphtheria (correct)

What is a key requirement for contact isolation?

Direct contact must be limited between patients and caregivers (correct)

Standard PPE is sufficient without any additional measures

Patients can share rooms as long as they are separated by a minimum of 3 feet

Patients must be in a room with negative air pressure

In which scenario should a patient wear a mask when being transported?

With droplet precautions if transportation is necessary Signup and view all the answers

Which type of mask is essential for patients under airborne precautions?

N-95 mask or better Signup and view all the answers

What is the primary goal of wound irrigation?

To facilitate wound healing and comfort Signup and view all the answers

When performing wound irrigation, how should the procedure be carried out?

Gently, to minimize further tissue damage Signup and view all the answers

What protective measures should be taken during the wound irrigation procedure?

Use a sterile device and wear PPE Signup and view all the answers

How is suctioning performed for nasopharyngeal and tracheal care?

Sterile suctioning technique with assessment before and after Signup and view all the answers

What is a critical aspect to remember when administering an enema?

Position the patient in the left Sims position Signup and view all the answers

Which of the following is an essential step for tube feeding?

Regularly monitoring for any complications from the feeding Signup and view all the answers

What should be avoided during hygiene procedures for a patient unless specifically requested?

Applying soap on the patient's face Signup and view all the answers

When taking a patient’s vital signs, what is recognized as the 5th vital sign?

Pain level Signup and view all the answers

Which statement correctly describes oxygen therapy for chronic respiratory illnesses?

Lower O2 settings of 1-2 L/min are typically required. Signup and view all the answers

When using a lift, what is the most important step to ensure safety?

Always lock the lift before using it. Signup and view all the answers

What should be done before applying a nasal cannula to a patient?

Assess and document skin condition behind the ears and in nares. Signup and view all the answers

For effective delivery of oxygen using a non-rebreather mask, what is critical?

The mask needs to have a tight seal over the nose and mouth. Signup and view all the answers

What is the primary method for dealing with a fire in a healthcare setting, according to RACE?

R – Rescue patients in danger. Signup and view all the answers

How often should a patient receiving oxygen therapy be monitored for signs of oxygen toxicity?

Regularly, especially if receiving more than 50% O2 for extended periods. Signup and view all the answers

Which type of oxygen delivery method allows for very precise control of oxygen levels?

Venturi Mask Signup and view all the answers

What safety precaution must be followed when using lubricants during oxygen therapy?

Use only water-soluble lubricants. Signup and view all the answers

What role does humidification play in long-term oxygen therapy?

It helps maintain moisture levels in the airway. Signup and view all the answers

What should be the position of the wheelchair when assisting a patient?

Locked when stopped and near the strong side. Signup and view all the answers

Which combination of personal protective equipment (PPE) is necessary for Enteric isolation?

Gloves and gown Signup and view all the answers

In the cycle of infection, which component follows 'Exit'?

Transport Signup and view all the answers

What is the primary consideration when using a respiratory mask during patient care?

To protect healthcare providers from inhaling pathogens Signup and view all the answers

What is a fundamental principle of surgical asepsis regarding sterile items?

All objects must remain sterile to maintain a sterile field Signup and view all the answers

Which of the following statements about documenting patient care is accurate?

Mistakes should be marked with a single line and initialed Signup and view all the answers

What is essential to remember when using a lift to ensure client safety?

The base of the lift must be correctly spread out. Signup and view all the answers

Which of the following methods of oxygen delivery requires monitoring of the reservoir bag?

Non-rebreather Mask Signup and view all the answers

During O2 therapy, which symptom indicates potential oxygen toxicity?

Persistent cough Signup and view all the answers

Which statement about fire safety procedures in healthcare settings is accurate?

Pulling the alarm should be the first step in case of a fire. Signup and view all the answers

When securing a patient in a wheelchair, where should the wheelchair ideally be positioned?

Nearest to the patient's strong side. Signup and view all the answers

Which type of face mask allows for the delivery of the most precise amounts of oxygen?

Venturi Mask Signup and view all the answers

What precaution should not be taken regarding the use of lubricants during oxygen therapy?

Oil-based lubricants can be safely used if necessary. Signup and view all the answers

In the context of patient care, what should be routinely assessed when distal restraints are in place?

Skin and circulation where restraints are applied. Signup and view all the answers

Which of the following isolation types requires a room with negative air pressure?

Airborne Isolation Signup and view all the answers

What is a recommended protective measure when transporting a patient under droplet precautions?

Ensure the patient wears a mask Signup and view all the answers

Which of the following diseases is NOT typically associated with droplet isolation?

Tuberculosis Signup and view all the answers

When implementing contact isolation, which of the following is essential?

Use of standard PPE Signup and view all the answers

What type of mask is required for healthcare workers caring for patients under airborne precautions?

N-95 mask or better Signup and view all the answers

Which illness is primarily associated with contact isolation due to its transmission method?

Strep throat Signup and view all the answers

What is the minimum distance required between a patient under droplet precautions and a roommate?

3 feet Signup and view all the answers

For which of the following infections is airborne precaution necessary?

Covid-19 Signup and view all the answers

While managing a patient under airborne isolation, which of the following actions should be avoided?

Opening the windows to increase airflow Signup and view all the answers

What is a characteristic of droplet isolation compared to airborne isolation?

Transmission occurs through large particle droplets Signup and view all the answers

What is the correct order for removing Personal Protective Equipment (PPE)?

Gloves, Gown, Goggles, Mask Signup and view all the answers

Which type of wound healing involves the edges of the wound being close together with minimal tissue loss?

Primary intention Signup and view all the answers

In which scenario would a contaminated wound be left open before closing it later?

Tertiary intention healing Signup and view all the answers

Which type of PPE is specifically used to protect the eyes from potential splashes?

Goggles Signup and view all the answers

Which group is at the highest risk for developing keloids after wound healing?

Dark-skinned individuals Signup and view all the answers

What is the primary reason for performing a wound contracture during the healing process?

To seal the wound and protect it Signup and view all the answers

How frequently should restraints be checked and released for patient care?

Every 15-30 minutes Signup and view all the answers

What is the maximum timeline for wound healing to continue gaining strength after initial closure?

Up to 1 year Signup and view all the answers

What does the term 'purulent' indicate regarding a wound?

The wound contains pus Signup and view all the answers

What is the primary function of myofibroblasts during the wound healing process?

To form collagen and provide strength Signup and view all the answers

What is the appropriate method for cleansing a wound during irrigation?

Gently clean from least contaminated to most contaminated Signup and view all the answers

Which type of suctioning requires a sterile technique?

Nasopharyngeal suctioning Signup and view all the answers

What is a critical step to take when administering an enema?

Hold the enema no higher than 18 inches from the patient’s body Signup and view all the answers

When performing basic hygiene procedures, which of the following should be avoided unless specifically requested?

Using soap on the face Signup and view all the answers

What is the preferred maximum temperature of the solution used in an enema?

105 degrees Fahrenheit Signup and view all the answers

What crucial step should be taken every time a patient is tube-fed?

Check the placement of the feeding tube Signup and view all the answers

Which of the following enema types is specifically used for treating constipation?

Oil retention Signup and view all the answers

Which type of bath is used to provide comfort after childbirth or rectal surgery?

Sitz bath Signup and view all the answers

What is the significance of knowing a patient's baseline when taking vital signs?

To allow for immediate changes to be noted against expected values Signup and view all the answers

Which of the following statements about the use of PPE is accurate during wound irrigation?

PPE should always be used to prevent contamination Signup and view all the answers

What type of wound healing involves significant granulation and the edges of the wound not being approximated?

Secondary intention Signup and view all the answers

What is the primary focus of wearing personal protective equipment (PPE) in healthcare settings?

To prevent transmission of infections Signup and view all the answers

Which statement about keloids is true?

They can form due to excessive collagen growth. Signup and view all the answers

Which PPE should be removed first when doffing after exposure to a patient with an infectious disease?

Gloves Signup and view all the answers

What is the significance of internal wounds regaining strength faster than skin wounds?

Internal organs have a richer blood supply aiding healing. Signup and view all the answers

Which action should be taken when assessing a patient with distal restraints in place?

Assess mental function and document findings. Signup and view all the answers

What is a key characteristic of the Non-rebreather mask used in oxygen therapy?

It can deliver high concentrations of oxygen when the reservoir is full. Signup and view all the answers

Which of the following statements accurately reflects the safety precautions for using oxygen therapy?

Signs of oxygen toxicity include headache and nasal congestion. Signup and view all the answers

Which procedure is critical in utilizing a lift to assist a patient safely?

Asking for help if unsure how to operate the lift. Signup and view all the answers

When managing oxygen therapy with a nasal cannula, which factor is essential to monitor?

The condition of the skin behind the ears and in the nares. Signup and view all the answers

In a fire emergency, what is the first action to take under the RACE protocol?

Rescue any patients in immediate danger. Signup and view all the answers

What method entails delivering 100% oxygen at three times the atmospheric pressure?

Hyperbaric Chamber Signup and view all the answers

What should be the priority when securing a patient in a wheelchair?

Lock the wheels of the wheelchair when stopped. Signup and view all the answers

Which of the following statements correctly describes airborne isolation precautions?

Airborne isolation requires room venting to the outside. Signup and view all the answers

What is a primary characteristic of droplet isolation?

Involves mandatory use of masks for patients when transported. Signup and view all the answers

Which illnesses would typically require contact isolation due to direct transmission?

Gastrointestinal infections and Clostridium difficile Signup and view all the answers

When wearing PPE for droplet precautions, which of the following is essential to include?

Eye protection Signup and view all the answers

What is the recommended minimum distance required between a droplet precaution patient and their roommate?

3 feet Signup and view all the answers

Which type of mask is required for healthcare workers caring for patients under airborne precautions?

N-95 respirator or better Signup and view all the answers

For patients under droplet precautions, what is a key requirement during transportation?

A surgical mask should be worn by the patient. Signup and view all the answers

Which protective measure is critical for reducing infections during patient care in isolation?

Changing gloves between patient contacts Signup and view all the answers

Which of the following illnesses is primarily associated with airborne precautions?

Tuberculosis Signup and view all the answers

What is a common misconception regarding contact isolation?

It is only necessary for skin infections. Signup and view all the answers

Which of the following steps is not part of the wound irrigation procedure?

Irrigate with the patient in a supine position Signup and view all the answers

During tracheal suctioning, what is the correct method?

Suction only when pulling the catheter out Signup and view all the answers

Which statement best describes the administration of enemas?

No more than 3 buckets can be used without a physician's permission Signup and view all the answers

What is the appropriate action to take when delivering tube feeding to a patient?

Confirm tube placement before every shift Signup and view all the answers

What should be avoided while performing hygiene on a patient?

Using soap on the face if not requested Signup and view all the answers

Which type of enema is primarily utilized for softening feces?

Oil retention Signup and view all the answers

What is a crucial aspect of attending to a patient's vital signs?

The definition of pain as the 5th vital sign must be recognized Signup and view all the answers

Which protective measure is critical during invasive procedures?

Using PPE to protect oneself from exposure Signup and view all the answers

In what scenario should suctioning be performed using sterile technique?

For all types of suctioning, including tracheal Signup and view all the answers

Which bath type is specifically utilized for reducing fever?

Sponge bath Signup and view all the answers

What is a critical safety guideline when using an oxygen tent for patient care?

Maintain a temperature of at least 70 degrees inside the tent. Signup and view all the answers

Which of the following masks is designed to deliver a precise amount of oxygen to the patient?

Venturi mask Signup and view all the answers

What is a common misconception about the use of lubricants during oxygen therapy?

Water-soluble lubricants are safe to use. Signup and view all the answers

When using restraints on a patient, which of the following practices is essential to ensure safety?

Check skin and circulation where restraints are applied frequently. Signup and view all the answers

Which method of oxygen delivery allows for the highest concentration of oxygen?

Non-rebreather mask Signup and view all the answers

Study Notes

Restraints

Check skin and circulation regularly when restraints are used
Always obtain consent for restraints, ensure the client's mental status allows for informed consent
Document any refusals, notify the doctor, and responsible party when restraints are used

Lifts

Always lock lifts before use
Ensure the base of the lift is correctly spread out
Carefully position the client in the center of the sling
Seek help if unsure about using a lift and never use it alone

Wheelchairs

Lock the wheels of the wheelchair when stationary
Position the wheelchair on the client’s strong side
Never secure any tubing or lines to the wheelchair

Oxygen Therapy

Oxygen is an odorless, tasteless, colorless, and non-flammable gas, but it supports combustion
The Flow Meter regulates the oxygen flow rate
Oxygen is typically ordered in liters per minute (L/min)
Chronic respiratory illnesses require lower oxygen settings, generally no more than 1-2 L/min
Long-term oxygen use requires humidification
Enforce NO SMOKING signs strictly around oxygen
Know the location of all fire extinguishers
Only use water-soluble lubricants for oxygen equipment; petroleum-based lubricants can cause a combustion risk
Examples of combustible materials to avoid: grease, oil, Vaseline, alcohol, ether, or any ungrounded equipment

Methods of Oxygen Delivery

Nasal Canula (Bi-prongs):
- Documented as BNP or BNC
- Fits into the nares
- Delivers 24-40% concentration
- Maximum flow rate of 6 liters
- Turn oxygen on before placing the canula 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, during, and after treatment
- Only use water-soluble lubricants
Face Mask:
- Provides greater control over oxygen levels
- Concentration of 60-100% oxygen (required flow rate depends on the L/min)
- Humidified oxygen should produce a fine mist
- Adjust the mask snugly over the nose and chin
- The reservoir should never fully collapse (increase oxygen flow if it does, but only with a doctor's permission)
- Types of Face Masks:
  - Venturi: Delivers very precise amounts of oxygen
  - Non-rebreather: Delivers up to 100% oxygen
  - Simple: Delivers 40-60% oxygen
Oxygen Tent:
- Delivers a fine mist, maintains a constant temperature, and provides high concentration
- The canopy should cover at least the patient's torso
- Keep the patient dry to prevent chilling and change linens frequently
- The internal temperature should be at least 70 degrees
- Adjust the oxygen flow rate to 10-12 L/min
- Tuck the tent sides under the mattress if needed
- Parents might have to get under the tent with a child
Hyperbaric Chamber:
- Delivers 100% oxygen at 3 times the atmospheric pressure
- Facilitates faster tissue regeneration, particularly beneficial for wound healing
Ambu Bag:
- Delivers up to 100% oxygen depending on the presence of a reservoir
- The mask must firmly cover the nose and mouth to create a seal
- Deliver breaths every 5 seconds
- Can be attached to an endotracheal tube (ET)

Patient Teaching for Oxygen Therapy

Explain oxygen application and safety procedures
Discuss the signs and symptoms of oxygen toxicity:
- Seen in concentrations over 50% for longer than 24-48 hours
- Nonproductive cough
- Substernal chest pain
- Nasal stuffiness/congestion
- Nausea/vomiting
- Fatigue
- Headache
- Sore throat
- Hypoventilation
Emphasize the importance of oral hygiene
Encourage fluid intake
Teach the patient about T C D B (Turn, Cough, Deep, Breath)

Fire Safety

RACE:
- Rescue Patients
- Alert the alarm
- Confine the fire
- Extinguish the fire
PASS:
- Pull the pin
- Aim low
- Squeeze the trigger
- Sweep from side to side

Types of Isolation

Airborne: Used for patients with confirmed or suspected serious illnesses transmitted by airborne droplet nuclei
- Examples: Measles, Varicella zoster virus, TB, COVID-19
- Isolation Precautions:
  - Single-patient room
  - Room with negative air pressure
  - Room vented to the outside
  - Door to the patient's room remains closed
  - N-95 mask or better
Droplet: Used for patients with known or suspected illnesses caused by large particle droplets
- Examples of Illnesses:
  - Invasive Haemophilus Influenzae (meningitis, pneumonia, epiglottis, & sepsis)
  - Invasive Neisseria Meningitidis Disease (meningitis, pneumonia, & sepsis)
- Serious Respiratory Illnesses:
  - Diphtheria (Pharyngeal)
  - Mycoplasma Pneumonia
  - Pertussis
  - Pneumonic Plague
  - Streptococcal pharyngitis, pneumonia, & scarlet fever in infants and young children
- Serious Viral Illnesses:
  - Adenovirus
  - Influenza
  - Mumps
  - Parvovirus B19
  - Rubella
- Isolation for Droplet Precaution:
  - Standard PPE
  - Private room or at least 3 feet separation from roommates
  - Limited patient transportation, wear a mask during transport
Contact: Used for serious illnesses easily transmitted by direct patient contact or contact with objects in the patient's environment
- Isolation for Contact Precaution:
  - Gloves and gown required when entering the room
  - Dedicated equipment for the patient
  - Careful hand hygiene

Wound Irrigation

Sterile procedure
Promotes wound healing and comfort
Gentle cleansing technique to prevent further tissue damage
Clean from the least contaminated to the most contaminated area
Use a syringe alone or with an IV catheter or needle
Wash hands before and after the procedure
Use a collection device to catch irrigation fluid
Wear appropriate PPE

Tracheostomy Care

Suctioning:
- Nasopharyngeal/Tracheal: Sterile
- Oropharyngeal: Clean
- Suction only when withdrawing the catheter
- Assess respiratory status before and after suctioning

Indwelling Urinary Catheter

Sterile procedure
Follow the same steps as the check-off procedure

Enemas

Clean procedure
Types:
- Fleet
- Oil retention
- Soap/Suds (SSE)
- Tap water (TWE)
Steps to Perform an Enema:
- Position the patient in left Sims position
- Ensure the solution temperature is no higher than 105 degrees
- Add soap only after the water has entered the rectum
- Hold the container no higher than 18 inches from the patient's body
- Typically, no more than 3 enemas are administered without a physician's permission
- Review the procedure carefully

Tube Feeding

Follow the same steps as the check-off procedure
Remember to check tube placement every time the patient is fed if on intermittent feeding, and every shift if on continuous feeding

Hygiene

Do not use soap on the face unless the patient requests it
Rinse all soap from the body thoroughly to prevent skin irritation
Use long strokes when washing, moving towards the heart

Baths

Tepid: Used to reduce fever
Sitz: Used for comfort after childbirth, rectal surgery, or hemorrhoids
Medicated: Used to moisturize and treat dry skin; monitor for skin breakdown

Vital Signs

Pain is now considered the 5th vital sign
Always know the patient's baseline vital signs
Use the same scale, clothing, and time of day for daily weight measurements

Distal Restraint Safety

Check skin and circulation frequently where distal restraints are placed
If a client refuses restraints, assess their mental function, notify their doctor and responsible party, and document the refusal thoroughly

Lift Safety

Always lock lifts before using
Ensure the base of the lift is spread out correctly
Position the client in the center of the sling
Get training, if unsure, ask for help, DO NOT USE ALONE

Wheelchair Safety

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

Oxygen Therapy Key Points

Oxygen is an odorless, tasteless, colorless, and non-flammable gas but does support combustion
The flow meter regulates the oxygen flow rate
Oxygen is usually ordered in liters per minute (L/min)
Chronic respiratory illnesses require lower oxygen settings (no more than 1-2 L/min)
Long-term oxygen use requires humidification
NO SMOKING signs should be enforced
Know the location of all fire extinguishers
Only use water-soluble lubricants, avoid oil or petroleum-based lubricants, as they can cause a combustion (examples include grease, oil, vaseline, alcohol, ether, or any ungrounded equipment near oxygen)

Oxygen Therapy Delivery Methods

Nasal Cannula (Bi-prongs):
- Documented as BNP or BNC
- Fits into the nares
- Concentration of 24-40%
- Maximum flow rate of 6 liters
- Turn oxygen on 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
- Concentration of 60-100% (6-10 L depending on L/min)
- Should see a fine mist with humidified oxygen
- Adjust the mask so it fits snugly over the nose and chin
- The reservoir should never fully collapse (if it does, oxygen needs to be turned up, but only with permission from the doctor)
- Types of Face Masks:
  - Venturi: Delivers very precise amounts of oxygen
  - Non-rebreather: Can deliver up to 100% oxygen
  - Simple: 40-60% oxygen
Oxygen Tent:
- Fine mist, constant temperature, high concentration
- Canopy must at least cover the patient's torso
- Keep the patient dry to prevent chilling and change linens frequently
- Temperature inside should be at least 70 degrees
- Adjust oxygen flow rate to 10-12 L/min
- Tuck the sides of the tent under the mattress if needed
- A parent may have to get under the tent with a child
Hyperbaric Chamber:
- Delivers 100% oxygen at 3 times the atmospheric pressure
- Helps regenerate new tissue at a faster rate (works well with wound healing)
Ambu Bag:
- Up to 100% concentration depending on the presence of a reservoir
- Mask must firmly cover the nose and mouth and make a seal
- Breaths should be delivered every 5 seconds
- May be attached to an endotracheal tube (ET)

Patient Teaching for Oxygen Therapy

Application and safety
Signs and symptoms of oxygen toxicity:
- Seen in concentrations over 50% for longer than 24-48 hours
- Nonproductive cough
- Substernal chest pain
- Nasal stuffiness/congestion
- Nausea/vomiting
- Fatigue
- Headache
- Sore throat
- Hypoventilation
Oral hygiene
Forcing fluids
T C D B - (Turn, Cough, Deep, Breath)

Fire Safety

RACE:
- R - Rescue Patients
- A - Pull Alarm
- C - Confine Fire
- E - Extinguish
PASS:
- P - Pull the Pin
- A - Aim Low
- S - Squeeze the Trigger
- S - Sweep from Side to Side

Types of Isolation

Airborne Isolation: Used for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei:
- Examples of Illnesses:
  - Measles
  - Varicella Zoster Virus (Chickenpox)
  - Tuberculosis
  - COVID-19
- Isolation Precautions:
  - Single patient room
  - Room with negative air pressure
  - Room vented to the outside
  - Door to patient room always closed
  - N-95 mask or better
Droplet Isolation: Used for patients known or suspected to have an illness caused by large particle droplets:
- Examples of Illnesses:
  - Invasive Haemophilus Influenzae (meningitis, pneumonia, epiglottis & sepsis)
  - Invasive Neisseria Meningitidis Disease (meningitis, pneumonia, & sepsis)
  - Serious respiratory illnesses caused by droplets:
    - Diphtheria (Pharyngeal)
    - Mycoplasma Pneumonia
    - Pertussis (Whooping Cough)
    - Pneumonic Plague
    - Streptococcal pharyngitis, pneumonia, & scarlet fever in infants and young children
  - Serious viral illnesses caused by droplets:
    - Adenovirus
    - Influenza
    - Mumps
    - Parvovirus B19
    - Rubella (German Measles)
- Isolation Precautions:
  - Standard PPE
  - Private room or separated from a roommate by a minimum of 3 feet
  - Limited patient transportation - if transporting, the healthcare worker must wear a mask
Contact Isolation: Serious illnesses easily transmitted by direct patient contact or by contact from items in the patient’s environment.
- Use a sterile stick, swab, or syringe
  - Wound Irrigation:
    - Promotes wound healing and comfort
    - Method of cleansing a wound
    - Gently done to prevent further tissue damage
    - Clean from least contaminated to most contaminated
    - Uses either a syringe alone or a syringe with an IV Catheter or needle
    - Wash hands before and after the procedure
    - Use a collection device to catch the irrigation
    - Protect yourself with PPE

Tracheal Care

Follow the same steps as in the check-off
Suctioning:
- Nasopharyngeal/Tracheal - Sterile
- Oropharyngeal - Clean
- Suction only when coming out
- Assess respiratory status before and after

Indwelling Urinary Catheter

Sterile Procedure
Follow the same steps as in the check off

Enemas

Clean procedure
Types:
- Fleet
- Oil retention
- SSE (Soap/Suds enema)
- TWE (Tap water enema)
Steps to Perform an Enema:
- Patient in the left Sims position.
- Temperature is no higher than 105 degrees
- Do not add soap until the water is in
- Hold no higher than 18 inches from patient's body
- Typically, no more than 3 enemas without a physician's permission
- Review procedure with the patient

Tube Feeding

Follow the same steps as in the check-off. Be sure to remember to check placement every time the patient is fed if on intermittent feeding, and every shift if on continuous feeding.

Hygiene

No soap on the face unless requested by the patient.
Rinse all soap from the body - can cause skin irritations if not.
Use long strokes when washing that go TOWARD the heart.

Baths

Tepid Bath: Used to reduce fever
Sitz Bath: Used for comfort after childbirth, rectal surgery, or for hemorrhoids
Medicated Bath: To moisturize & treat dry skin - Always monitor for skin breakdown

Vital Signs

Pain is now considered the 5th vital sign.
Know the patient's baseline vital signs; weight, height, and temperature.
Weights: Use the same scale, same amount of clothing, and at the same time each day.

Wound Healing: Phases

Phase I: Inflammatory Phase:
- Hemostasis: Immediately after injury, the blood vessels constrict and coagulate.
- Vasodilation: Blood vessels enlarge, increasing blood flow to the area.
- Inflammation: The site is invaded by white blood cells.
Phase II: Proliferation Phase:
- New cells and capillaries fill in the wound from the underlying tissue to the skin surface.
- This process seals the wound and protects from contamination
- Collagen Formation: Occurs during reconstruction or proliferation phase. The would contracts as new tissue is reconstructed.
- Myofibroblasts: Produce collagen (glue-like substance) and adds strength to the wound and tissue.
- Collagen formation increases rapidly between post-op days 5-25.
- Wound dehiscence most frequently occurs during this phase.
Phase IV: Maturation Phase:
- Fibroblasts exit the wound, collagen forms, and tissue and skin become stronger.
- The wound will continue to gain strength but healing can take up to 1 year.
- Internal wounds (Stomach, Colon) regain faster than skin wounds.
- Keloid: Occasionally, an overgrowth of collagen at the site of the wound forms. African Americans, dark-skinned people of all races, and young women are at the highest risk for developing keloids.
Primary Intention: Skin edges of the wound are close together, and little tissue is lost. Primary intention healing begins in the inflammatory phase.
Secondary Intention: When a wound must granulate during healing, and the edges are not approximate (come together), or when pus is visible.
Tertiary Intention: Delayed primary intention. The provider will leave a contaminated wound open and close it later once the infection is controlled.

Wound Terminology

Purulent: Contains or produces pus.
Exudate: Fluid, cells, or other substances that have slowly exuded or discharged from cells or blood through small pores or breaks in cell membranes.

PPE (Personal Protective Equipment)

PPE should be worn for any patient with any suspicion of or known infectious disease.
Types of PPE:
- Gown
- Mask
- Goggles (or other eye protection)
- Gloves

PPE Removal Order:

1. Gloves
1. Gown
1. Goggles
1. Mask
DON- means to put on
DOFF - means to take off

Restraints

Require a Doctor's Order
Try least restrictive options first.
Must be the ONLY option left available
Check every 15-30 minutes, release to the toilet, and perform ROM exercises every 2 hours

Restraints

Check skin and circulation frequently where restraints are placed.
If a client refuses restraints, assess their mental function. Notify the doctor, responsible party, and document thoroughly.

Lifts

Always lock lifts before using.
Ensure the base of the lift is spread out correctly.
Place the client in the center of the sling.
Get training if unsure how to use a lift, ask for help, and DO NOT USE ALONE.

Wheelchairs

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

Oxygen Therapy

Oxygen is an odorless, tasteless, colorless, and non-flammable gas. However, it does support 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 oxygen use requires humidification.
NO SMOKING SIGNS should be enforced.
Know the location of all fire extinguishers.
Only use water-soluble lubricant. Any oil or petroleum-based lubricants can cause combustion (e.g., grease, oil, Vaseline, alcohol, ether, or any ungrounded equipment around oxygen).

Oxygen Delivery Methods

Nasal Canula (bi-prongs)
- Fits into the nares
- Documented as BNP or BNC
- Concentration of 24-40%
- 6 liters max
- Turn oxygen on before putting it 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.
- Concentration of 60-100% (6-10 L depending on L/min)
- Should see a fine mist with humidified oxygen.
- Adjust the mask so it fits snugly over the nose and chin.
- The reservoir should never fully collapse (If it does, oxygen needs to be turned up, but only with permission from the doctor).
  - Venturi - Delivers very precise amounts of oxygen.
  - Non-rebreather - Can deliver up to 100% oxygen.
  - Simple - 40-60% of oxygen.
Oxygen Tent
- Fine mist, constant temperature, high concentration.
- Canopy must at least cover the patient's torso.
- Keep the patient dry to prevent chilling and change linens frequently.
- Temperature inside should be at least 70 degrees.
- Adjust oxygen flow rate to 10-12 L/min.
- Tuck the sides of the tent under the mattress if needed.
- Parents might have to get under the tent with a child.
Hyperbaric Chamber
- Delivers 100% oxygen at 3 times the atmospheric pressure.
- Helps regenerate new tissue at a faster rate (works well with wound healing).
Ambu Bag
- Up to 100% concentration depending on the presence of a reservoir.
- The mask must firmly cover the nose and mouth and make a seal.
- Breaths should be delivered every 5 seconds.
- May be attached to an endotracheal tube (ET).

Patient Teaching for Oxygen Therapy

Application and safety.
Signs and Symptoms of oxygen toxicity:
- Seen in concentrations over 50% for longer than 24-48 hours.
- Nonproductive cough
- Substernal chest pain
- Nasal stuffiness/congestion
- N/V
- Fatigue
- Headache
- Sore throat
- Hypoventilation
Oral Hygiene
Forcing Fluids
T C D B - (Turn, Cough, Deep Breath)

Fire Safety

RACE:
- R - RESCUE patients
- A - PULL the alarm
- C - CONFINE the fire
- E - EXTINGUISH the fire
PASS:
- P - PULL the pin
- A - AIM low
- S - SQUEEZE the trigger
- S - SWEEP from side to side

Types of Isolation

Airborne - Used for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei.
- Examples of Illnesses:
  - Measles
  - Varicella Zoster Virus
  - TB
  - COVID-19
- Isolation for Airborne Precautions:
  - Single patient room
  - Room with negative air pressure
  - Room vented to the outside
  - Door to patient room always closed
  - N-95 mask or better
Droplet - Used for patients known or suspected to have an illness caused by large particle droplets. - Examples of Illnesses: - Invasive Haemophilus Influenzae (meningitis, pneumonia, epiglottis, & sepsis) - Invasive Neisseria Meningitidis Disease (meningitis, pneumonia, & sepsis) - Serious respiratory illnesses caused by droplets: - Diphtheria (Pharyngeal) - Mycoplasma Pneumonia - Pertussis - Pneumonic Plague - Streptococcal pharyngitis, pneumonia, & scarlet fever in infants and young children. - Serious Viral Illnesses caused by droplets: - Adenovirus - Influenza - Mumps - Parvovirus B19 - Rubella
- Isolation for Droplet Precaution:
  - Standard PPE
  - Private room or separated from roommate by minimum of 3 feet.
  - Limited patient transportation – if transporting, must wear a mask.
Contact - Serious illnesses easily transmitted by direct patient contact or by contact from items in the patient’s environment.
- Wound Irrigation - Promotes wound healing and comfort. Method of cleansing wound.
  - Use a sterile stick, swab, or syringe.
  - Gently done to prevent further tissue damage.
  - Clean from least contaminated to most contaminated.
  - Uses either a syringe alone or a syringe with an IV Catheter or needle.
  - Wash hands before and after procedure
  - Use a collection device to catch irrigation.
  - Protect yourself with PPE.

Trach Care

Same steps as check-off.
Suctioning:
- Nasopharyngeal/Tracheal - Sterile
- Oropharyngeal - Clean
- Suction only when coming out.
- Assess respiratory status before and after.

Indwelling Urinary Catheter

Sterile procedure.
Same steps as check-off.

Enemas

Clean Procedure.
Types:
- Fleet
- Oil retention
- SSE (Soap/Suds enema)
- TWE (Tap Water Enema)
Steps to Perform Enema:
- Patient in L Sims position
- Temp is no higher than 105 degrees
- DO NOT add soap until water is in
- Hold no higher than 18 inches from the patient’s body
- Typically, no more than 3 buckets without physician's permission.
- Review procedure.

Tube Feeding

Exactly like check off - Be sure to remember to check placement every time the patient is fed if on intermittent, and every shift if constant.

Hygiene

No soap on the face unless requested by the patient.
Rinse all soap from the body - it can cause skin irritations if not.
Use long strokes when washing that go TOWARD the heart.

Baths

Tepid - Used to reduce fever.
Sitz - Used for comfort after childbirth, rectal surgery, or hemorrhoids.
Medicated - To moisturize and treat dry skin - ALWAYS MONITOR FOR SKIN BREAKDOWN.

Vital Signs

Pain is now known as the 5th vital sign.
Know the patient’s baseline.
Weight - Use the same scale, same amount of clothes, and at the same time every day.

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This quiz focuses on essential protocols around patient safety, including the use of restraints, lifts, wheelchairs, and oxygen therapy. It covers specific guidelines to ensure the well-being of patients during care. Test your knowledge on these critical health care practices.