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?

    <p>With droplet precautions if transportation is necessary</p> Signup and view all the answers

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

    <p>N-95 mask or better</p> Signup and view all the answers

    What is the primary goal of wound irrigation?

    <p>To facilitate wound healing and comfort</p> Signup and view all the answers

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

    <p>Gently, to minimize further tissue damage</p> Signup and view all the answers

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

    <p>Use a sterile device and wear PPE</p> Signup and view all the answers

    How is suctioning performed for nasopharyngeal and tracheal care?

    <p>Sterile suctioning technique with assessment before and after</p> Signup and view all the answers

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

    <p>Position the patient in the left Sims position</p> Signup and view all the answers

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

    <p>Regularly monitoring for any complications from the feeding</p> Signup and view all the answers

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

    <p>Applying soap on the patient's face</p> Signup and view all the answers

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

    <p>Pain level</p> Signup and view all the answers

    Which statement correctly describes oxygen therapy for chronic respiratory illnesses?

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

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

    <p>Always lock the lift before using it.</p> Signup and view all the answers

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

    <p>Assess and document skin condition behind the ears and in nares.</p> Signup and view all the answers

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

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

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

    <p>R – Rescue patients in danger.</p> Signup and view all the answers

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

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

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

    <p>Venturi Mask</p> Signup and view all the answers

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

    <p>Use only water-soluble lubricants.</p> Signup and view all the answers

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

    <p>It helps maintain moisture levels in the airway.</p> Signup and view all the answers

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

    <p>Locked when stopped and near the strong side.</p> Signup and view all the answers

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

    <p>Gloves and gown</p> Signup and view all the answers

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

    <p>Transport</p> Signup and view all the answers

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

    <p>To protect healthcare providers from inhaling pathogens</p> Signup and view all the answers

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

    <p>All objects must remain sterile to maintain a sterile field</p> Signup and view all the answers

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

    <p>Mistakes should be marked with a single line and initialed</p> Signup and view all the answers

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

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

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

    <p>Non-rebreather Mask</p> Signup and view all the answers

    During O2 therapy, which symptom indicates potential oxygen toxicity?

    <p>Persistent cough</p> Signup and view all the answers

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

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

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

    <p>Nearest to the patient's strong side.</p> Signup and view all the answers

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

    <p>Venturi Mask</p> Signup and view all the answers

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

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

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

    <p>Skin and circulation where restraints are applied.</p> Signup and view all the answers

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

    <p>Airborne Isolation</p> Signup and view all the answers

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

    <p>Ensure the patient wears a mask</p> Signup and view all the answers

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

    <p>Tuberculosis</p> Signup and view all the answers

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

    <p>Use of standard PPE</p> Signup and view all the answers

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

    <p>N-95 mask or better</p> Signup and view all the answers

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

    <p>Strep throat</p> Signup and view all the answers

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

    <p>3 feet</p> Signup and view all the answers

    For which of the following infections is airborne precaution necessary?

    <p>Covid-19</p> Signup and view all the answers

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

    <p>Opening the windows to increase airflow</p> Signup and view all the answers

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

    <p>Transmission occurs through large particle droplets</p> Signup and view all the answers

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

    <p>Gloves, Gown, Goggles, Mask</p> Signup and view all the answers

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

    <p>Primary intention</p> Signup and view all the answers

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

    <p>Tertiary intention healing</p> Signup and view all the answers

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

    <p>Goggles</p> Signup and view all the answers

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

    <p>Dark-skinned individuals</p> Signup and view all the answers

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

    <p>To seal the wound and protect it</p> Signup and view all the answers

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

    <p>Every 15-30 minutes</p> Signup and view all the answers

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

    <p>Up to 1 year</p> Signup and view all the answers

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

    <p>The wound contains pus</p> Signup and view all the answers

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

    <p>To form collagen and provide strength</p> Signup and view all the answers

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

    <p>Gently clean from least contaminated to most contaminated</p> Signup and view all the answers

    Which type of suctioning requires a sterile technique?

    <p>Nasopharyngeal suctioning</p> Signup and view all the answers

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

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

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

    <p>Using soap on the face</p> Signup and view all the answers

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

    <p>105 degrees Fahrenheit</p> Signup and view all the answers

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

    <p>Check the placement of the feeding tube</p> Signup and view all the answers

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

    <p>Oil retention</p> Signup and view all the answers

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

    <p>Sitz bath</p> Signup and view all the answers

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

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

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

    <p>PPE should always be used to prevent contamination</p> Signup and view all the answers

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

    <p>Secondary intention</p> Signup and view all the answers

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

    <p>To prevent transmission of infections</p> Signup and view all the answers

    Which statement about keloids is true?

    <p>They can form due to excessive collagen growth.</p> Signup and view all the answers

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

    <p>Gloves</p> Signup and view all the answers

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

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

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

    <p>Assess mental function and document findings.</p> Signup and view all the answers

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

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

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

    <p>Signs of oxygen toxicity include headache and nasal congestion.</p> Signup and view all the answers

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

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

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

    <p>The condition of the skin behind the ears and in the nares.</p> Signup and view all the answers

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

    <p>Rescue any patients in immediate danger.</p> Signup and view all the answers

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

    <p>Hyperbaric Chamber</p> Signup and view all the answers

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

    <p>Lock the wheels of the wheelchair when stopped.</p> Signup and view all the answers

    Which of the following statements correctly describes airborne isolation precautions?

    <p>Airborne isolation requires room venting to the outside.</p> Signup and view all the answers

    What is a primary characteristic of droplet isolation?

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

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

    <p>Gastrointestinal infections and Clostridium difficile</p> Signup and view all the answers

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

    <p>Eye protection</p> Signup and view all the answers

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

    <p>3 feet</p> Signup and view all the answers

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

    <p>N-95 respirator or better</p> Signup and view all the answers

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

    <p>A surgical mask should be worn by the patient.</p> Signup and view all the answers

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

    <p>Changing gloves between patient contacts</p> Signup and view all the answers

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

    <p>Tuberculosis</p> Signup and view all the answers

    What is a common misconception regarding contact isolation?

    <p>It is only necessary for skin infections.</p> Signup and view all the answers

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

    <p>Irrigate with the patient in a supine position</p> Signup and view all the answers

    During tracheal suctioning, what is the correct method?

    <p>Suction only when pulling the catheter out</p> Signup and view all the answers

    Which statement best describes the administration of enemas?

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

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

    <p>Confirm tube placement before every shift</p> Signup and view all the answers

    What should be avoided while performing hygiene on a patient?

    <p>Using soap on the face if not requested</p> Signup and view all the answers

    Which type of enema is primarily utilized for softening feces?

    <p>Oil retention</p> Signup and view all the answers

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

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

    Which protective measure is critical during invasive procedures?

    <p>Using PPE to protect oneself from exposure</p> Signup and view all the answers

    In what scenario should suctioning be performed using sterile technique?

    <p>For all types of suctioning, including tracheal</p> Signup and view all the answers

    Which bath type is specifically utilized for reducing fever?

    <p>Sponge bath</p> Signup and view all the answers

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

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

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

    <p>Venturi mask</p> Signup and view all the answers

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

    <p>Water-soluble lubricants are safe to use.</p> Signup and view all the answers

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

    <p>Check skin and circulation where restraints are applied frequently.</p> Signup and view all the answers

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

    <p>Non-rebreather mask</p> 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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    Description

    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.

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