Fundamentals of Nursing Prelims PDF

FUNDAMENTALS OF NURSING PRELIMS -​ Treating the sick is nothing new. People have cared for the sick throughout history, beginning in ancient times. -​ However, considering the long history of nursing, it was not until fairly recently that nurses received a formal...

FUNDAMENTALS OF NURSING PRELIMS -​ Treating the sick is nothing new. People have cared for the sick throughout history, beginning in ancient times. -​ However, considering the long history of nursing, it was not until fairly recently that nurses received a formal nursing education -​ Over hundreds of years, nursing has undergone an evolution, eventually transforming itself into the respected profession we all know of today. NURSE AS A PROFESSION Profession- has been defined as an occupation that required extensive education or a calling that requires special knowledge, skills, and preparation CRITERIA 1. Requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed (liberal arts, in addition to biologic and social science) 2. Orientation of an individual toward service either to the community or an organization 3. Ongoing research 4. Autonomy 5. Professional organization NURSING PROFESSION Many nursing leaders believe that nursing established itself as a profession rather than being an occupation or a discipline. Acceptance as a profession allows nursing to have more knowledge, authority, and self governing. There are as yet no clear-cut answer to “Is nursing a profession” but as nursing continue to develop in it’s three primary areas (education, practice, and research) it more and more meets the criteria defining a profession NURSING PROFESSION...CONT -​ Over the years nurses developed many philosophies and definition of nursing. -​ Nursing as a profession is a unique in that it addresses in humanistic and holistic responses of the individual clients and their families to actual or potential health problems. -​ Expertise in nursing is the result of theoretical knowledge and clinical practice. THE AIMS OF NURSING Maintain and promote wellness, prevent illness, care for and rehabilitate the sick of disabled through the human science of nursing. Reduce stress. Provide comfort to the client during diseases process. THE AIMS OF NURSING...CONT Provide service to individual families and societies.  Work independently with other health workers assisting the client to gain independence as quickly as possible. Develop interaction between nurse and client. Focus on a man a living unity and man’s qualitative participation with experience. CHARACTERISTICS OF NURSING PROFESSION Well defined and well organized body of knowledge. Constantly enlarged body of knowledge improves techniques, used scientifically based. Entrusts education of practitioners (increase education). CHARACTERISTICS OF NURSING PROFESSION...CONT Apply knowledge into practice. Function autonomously (comparison between nursing and medicine). Wanted as chosen occupation as life work. Provides freedom of action and opportunity for continues professional growth and economic security STEPS OF PROFESSIONAL DEVELOPMENT Recognition of a problem by community Untrained personnel deal with problem, using skills and procedures to handle the problem. Theoretical body of knowledge basic to procedures is developed. Members continue to work together. STEPS OF PROFESSIONAL DEVELOPMENT...CONT Professional interests or common interests are formed and developed. People pay for service. Codes and standards are developed. These codes concerned with formed rules and formal practice. Methods of enforcing standards are established. STATUS OF PROFESSION People expect special person of this profession and high quality service. Professional should have high knowledge and high ideals. Professional will have high status in society. NURSING IS A UNIQUE AND ESSENTIAL PUBLIC SERVICE In the practice of nursing great emphases is placed on the acquisition of knowledge, application of scientific principals, and the development skills. When planning patient care, each nurse is expected by the public to use good common sense and mature judgment.  Developing and implementing this plan requires nurse to function both dependant and independent role as follows:- DEPENDENT FUNCTION Dependant function of nursing is the traditional one of implementing the doctor’s order, but the major difference today lies in the interpretation of these orders. Nurse is not blind obedient servant for doctor, but must know (why) the medication or treatment is prescribed, (what) to observe, (how) to prevent unwanted reaction, and (when) intelligently intervene if reaction should occur. DEPENDENT FUNCTION...CONT Nurse may have occasion to question the advisability of putting the doctor’s order into action. Questioning the physician order doesn’t mean that the nurse countermands the order. It means seeking clarification for safety of patient. If you deem an order written by the physician and administer it without thoughtful contemplation, you may cause harm to your patient. You -as a nurse or student nurse- are obliged to bring knowledge, skill competence to all aspects of patient care. The independent functions of nurses are related to three factors ; -​ The limitation as defined in the nurse practice act -​ The level of competence achieves as a nurse practitioner -​ What is deemed prudent and safe nursing according to local regulations Example of independent functions ; a.​ Supervision of pt (as a whole management care-bio psycho social and spiritual b.​ Observation of symptoms and reactions (physical and mental)\ c.​ Accurate recording and reporting ( facts and evaluation) d.​ Supervision of nursing personnel and coordination of others (contributions) e.​ Application of nursing procedures and techniques f.​ Direction and education to secure physical and mental care of pt The role of professional nurse can be seen in; -​ Providing skilled nursing care in hospital and community, performing complex functions requiring specific skill and judgement (assessment, diagnosis, plan, implementation and evaluation) -​ Maintain collaborative relationship with the physician and other health workers and coordinating nursing care plan with medical care plan. -​ Observing assessing and reporting effects of therapy making changes in nurse regime if indicates. The professional nurse… CONT; -​ Interpreting and demonstrating skills of nursing care to others requiring this service.  -​ Initiating changes in nursing care plan based on understanding principals and assessment of advances in medical and social sciences. -​ Recognizing and using health practice, utilizing opportunity to teach the patient and the family about health problem. -​ Performing to the level of team leader at the beginning and by experiences and higher education may progress to positions of administration, teaching, consultation -​ The professional nurse,,,,cont -​ - recognizing the extent need of patient for personal counseling and maintaining a relation with him that provide support and security without losing him his identity and not violating his privacy. -​ Participating with member of allied profession, other professionals and community groups in solving health problems of community. -​ Understanding and fulfilling the historic role of nursing. The code for professional nurse 1.​ The nurse provides service with respect for dignity ofman, unrestricted by consideration of nationality, race creed, color or status 2.​ The nurse safeguards individual’s right to privacy by judciously protecting information of confidential nature sharing only that information relevant to his care. 3.​ The nurse maintains individual competence in nursing practice, recognizing and accepting responsibility for individual action and judgement. The code for professional nurse….cont -​ The nurse acts to safeguard the patient when his care and safety are affected by incompetent,unethical or illegal conduct of any person. -​ The nurse uses individual competence as criterion in accepting delegated responsibility and assigning nursing activities to others. -​ The nurse participates in research activities when assured that the rights of individual subjects are protected. -​ The nurse participates in the efforts of profession to define and upgrade standards of nursing practice and education. -​ The nurse participates in establishing and maintaining conditions of employment conductive to high quality nursing care, -​ The nurse work with members of health professions and other citizens in promoting effort to meet health needs of the public. -​ The nurse refuses to give or imply endorsement to advertising, promoting, or sale for commercial products, services or enterprise. Role and function of the nurse 1.​ Caregiver 2.​ Communicator 3.​ Teacher 4.​ Client advocate 5.​ Counselor 6.​ Change agent  7.​ Leader 8.​ Manager Expanded career roles for nurses 1.​ Nurse practitioner 2.​ Clinical nurse specialist\ 3.​ Nurse anesthethist 4.​ Nurse midwife 5.​ Nurse researcher 6.​ Nurse administrator 7.​ Nurse educator 8.​ Nurse entrepreneur NURSING NOTE DOCUMENTATION & REPORTING 1.​ Documentation in the health record is an integral part of safe and effective nursing practice. 2.​ Clear comprehensive and accurate documentation is a judgement and critical thinking used in professional practice and provides an account of nursing unique contribution to health care. 3.​ Effective communication requires to be done in a timely manner. 4.​ Is a vital component of safe, ethical and effective nursing practice or whether the documentation paper based or electronic. Why nursing documentation is important? 1.​ Communication - it helps communicate between health care team and prevents fragmentation, repetition and delays in client care 2.​ Planning client care- we use data from the clients record to establish nursing care plan for that client 3.​ Auditing health agencies - an audit is a review of client records for quality assurance purposes. 4.​ Research - the treatment plans for a number of clients with the same health problem can yield information helpful in treating other client. Documentation Guidelines ; 1.​ Correct patient identification are on every page of the record. 2.​ Never record opinions or assumption. 3.​ Do not chart for someone else. 4.​ Chart as close as possible to the time care was performed. 5.​ Document if medications not given or treatment not completed & reason & action take above or beside the entry and signed. DO’s in Nursing Documentation 1.​ If certain matter affecting pt care is required it must be charted. 2.​ Check that you have correct chart before beginning your writing 3.​ Make sure your documentation reflect the nursing process and professional capabilities 4.​ Chart the time you gave medication, administration route and the patient response. 5.​ Chart patient care at the time you provided.  6.​ If you remember an important point after youve completed your documentation chart an information with a notation that is “late entry” “addendum” include the date and time of the late entry and signed by nod. DONT in Nursing Documentation 1.​ Dont chart a symptoms such as with pain without nursing action about it dont alter patient record– this is criminal offense accepted. 2.​ Dont use shorthand or abbreviation that arent widely accepted. 3.​ Dont write imprecise description, such as “bed soaked: or a “large amount” Do’s 1.​ Write all notes in blue or black ink 2.​ The patient’s name room medical record must be written on each record form 3.​ Document date and time of each recording 4.​ Use correct spelling 5.​ Document event in the order they occurred 6.​ Use only commonly accepted abbreviations and terms that are specified by the agency 7.​ Place your signature at the end Dont’s 1.​ Dont erase written mistakes or scratch over a word, note error by lining throw it writing “error” and insert your initial 2.​ Dont destroy or modify notes previously written 3.​ Dont write procedures to be done until they have been done 4.​ Dont leave blank or space in paper. Methods of documentation -​ Computerized documentation - increase quality of documentation and save time, increase legibility and accuracy. Facilitate statistical analysis of data. Confidentiality of computer records -​ Personal password is needed to enter and sign off computer files -​ After logging on, never leave a computer terminal unattended -​ Do not leave client information displayed on the monitor where others may see -​ Know the facility policy and procedure for correcting an entry error. Signature -​ Each recording on the nursing notes is signed by the nurse making it. a.​ Includes the name and title; for example “Susan J. Green, RN.” b.​ Some agencies have signature sheet and after signing this sheet, nurses can use their initials c.​ With computerized charting, each nurse has his or her own code, which allows the documentation to be identified. Date & Time Telephone Reports -​ Date -​ Time -​ Name -​ Subject -​ Signature NO RECORDING SHOULD BE DONE BEFORE PROVIDING NURSING CARE, NOT WRITTEN, NOT DONE Reporting - Reports are oral or written exchange of information shared between care givers in a number of ways. Oral Reports - are given when the information is for immediate use and not for permanency. Written Reports - are to be written when the information to be used by several personnel which is more or less of permanent. Types of Report in Nursing 1.​ Change of shift reports -​ This type of reporting most commonly used. -​ At the end of each shift nurses report information about their assigned client’s to the nurses working on the next shift -​ The report provides continuity of nursing care among nurses who are caring for a client. 2.​ Transfer reports -​ Pt are often transfer from one unit to another to receive different levels of care and treatment 3.​ Incident reports -​ An incident is any event that is not consistent with the routine operation of health care unit. -​ Incidents are comonly occur when patient under care within hospital settings -​ Incident reports are in major part of a unit quality improvement program 4.​ Telephone reports WEEK 3 INFECTION CONTROL Epidemiology is the study of the distribution and determinants of health-related states and events in populations, and the application of this study to control health problems (Last, 1983). EPIDEMIOLOGIC TRIAD INFECTIOUS DISEASE MODEL A communicable disease is an illness due to a specific infectious (biological) agent or its toxic products capable of being directly or indirectly transmitted from man to man, from animal to man, from animal to animal, or from the environment (through air, water, food, etc..) to man. all types of diseases na naipapasa. IMPORTANCE OF STUDYING COMMUNICABLE DISEASES EPIDEMIOLOGY Changes of the pattern of infectious diseases Discovery of new infections The possibility that some chronic diseases have an infective origin INFECTION- is the entry and development or multiplication of an infectious agent in the body of man or animals. An infection does not always cause illness. Asymptomatic - no signs and symptoms even tho there’s presence of infection. CONTAMINATION - The presence of an infectious agent on a body surface, on or in clothes, beddings, toys, surgical inpresence struments or dressings, or other articles or substances including water and food INFESTATION - It is the lodgment, development and reproduction of arthropods on the surface of the body or in the clothing, e.g. lice, itch mite. This term could be also used to describe the invasion of the gut by parasitic worms, e.g. ascariasis. A contagious disease is the one that is transmitted through contact. Examples include scabies, STD and leprosy HOST A person or an animal that affords subsistence or lodgment to an infectious agent under natural conditions. Types include: an obligate host, definitive (primary) host, intermediate host and a transport host. VECTOR OF INFECTION An insect or any living carrier that transports an infectious agent from an infected individual or its wastes to a susceptible individual or its food or immediate surroundings. Both biological and mechanical transmissions are encountered. RESERVOIR Any person, animal, arthropod, plant, soil, or substance, or a combination of these, in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host. It is the natural habitat of the infectious agent. INCIDENCE AND PREVALENCE OF INFECTIOUS DISEASES ⦿Incidence of an infectious disease: number of new cases in a given time period expressed as percent infected per year (cumulative incidence) or number per person time of observation (incidence density). ⦿Prevalence of an infectious disease: total number of cases at a given time expressed as a percent at a given time. Prevalence is a product of incidence x duration of disease, and is of little interest if an infectious disease is of short duration (i.e. measles), but may be of interest if an infectious disease is of long duration (i.e. chronic hepatitis B). EPIDEMIC- “The unusual occurrence in a community of disease, specific health related behavior, or other health related events clearly in excess of expected occurrence” (epi= upon; demos= people) Epidemics can occur upon endemic states too. Unexpected bigla kumalat. ENDEMIC- It refers to the constant presence of a disease or infectious agent within a given geographic area or population group. It is the usual or expected frequency of disease within a population. (En = in; demos = people) ex; Malaria sa Palawan HYPERENDEMIC -The term “hyperendemic” expresses that the disease is constantly present at high incidence and/or prevalence rate and affects all age groups equally. HOLOENDEMIC- The term “holoendemic” expresses a high level of infection beginning early in life and affecting most of the child population, leading to a state of equilibrium such that the adult population shows evidence of the disease much less commonly than do the children (e.g. malaria) PANDEMIC - An epidemic usually affecting a large proportion of the population, occuring over a wide geographic area such as a section of a nation, he entire nation, a continent or the world, e.g. Influenza pandemics. 1 or 2 more continents na yung sakop. EXOTIC - Exotic diseases are those which are imported into a country in which they do not otherwise occur, as for example, rabies in the UK. SPORADIC - The word sporadic means “scattered about”. The cases occur irregularly, haphazardly from time to time, and generally infrequently. The cases are few and separated widely in time and place that they show no or little connection with each other, nor a recognizable common source of infection e.g. polio, meningococcal meningitis, tetanus…. ASEPSIS Medical asepsis – “Clean technique” – Includes all practices intended to confine a specific microorganism to a specific area – Limits the number, growth, and transmission of microorganisms – Objects referred to as clean or dirty (soiled, contaminated) Surgical asepsis – Sterile technique – Practices that keep an area or object free of all microorganisms – Practices that destroy all microorganisms and spores – Used for all procedures involving sterile areas of the body Type of Infections Local infection (eg; pimple) Systemic infection (eg; infects as body system) Bacteremia (presence of bacteria in the blood) Septicemia (a lot of effects in the body) Acute infections (pt has infections but still an early stage) Chronic infections (pt with infections that is chronic) Nosocomial Infections Originate in the health care facility Health care associated infections (HAIs) Common HAIs Factors Nosocomial (hospital acquired) infection is an infection originating in a patient while in a hospital or another health care facility. It has to be a new disorder unrelated to the patient’s primary condition. Examples include infection of surgical wounds, hepatitis B and urinary tract infections. Opportunistic Infection - This is infection by organisms that take the opportunity provided by a defect in host defense (e.g. immunity) to infect the host and thus cause disease. For example, opportunistic infections are very common in AIDS. Organisms include Herpes simplex, cytomegalovirus, M. tuberculosis…. -​ Immunosuppresed - weak immune system ERADICATION and ELIMINATION Termination of all transmission of infection by the extermination of the infectious agent through surveillance and containment. Eradication is an absolute process, an “all or none” phenomenon, restricted to termination of infection from the whole world. The term elimination is sometimes used to describe eradication of a disease from a large geographic region. Disease which are amenable to elimination in the meantime are polio, measles and diphtheria. Reproductive rate of infection: potential for an infectious disease to spread. Influential factors include the probability of transmission between an infected and a susceptible individual; frequency of population contact; duration of infection; virulence of the organism and population immune proportion. CHAIN OF INFECTION ​ Susceptible Host -​ Anyone ​ Pathogen -​ Bacteria -​ Virus -​ Fungi -​ Parasite ​ Reservoir -​ People -​ Animals -​ Soil -​ Food -​ Water ​ Portal of Exit -​ Coughing/sneezing -​ Body Secretions -​ Feces ​ Mode of Transmission -​ Direct Contact -​ Indirect Contact -​ Vectors ​ Portal of Entry -​ Mouth -​ Nose -​ Eyes -​ Cuts in Skin Etiologic Agent Microorganisms Number of microorganisms present Virulence and potency of the microorganisms (pathogenicity) Ability to enter the body Susceptibility of the host Causative Agent/ Pathogens -​ Parasites eg; helminths (worm) -​ Protozoa eg; plasmodia -​ Fungi eg; tinea -​ Prokaryote eg; bacteria Reservoir Where the microorganism lives  Common sources Carrier Types Of Reservoir -​ Human reservoir -​ Animal reservoir -​ Non living reservoir CARRIERS It occurs either due to inadequate treatment or immune response, the disease agent is not completely eliminated, leading to a carrier state. Three elements have to occur to form a carrier state: 1. The presence in the body of the disease agent. 2. The absence of recognizable symptoms and signs of disease. 3. The shedding of disease agent in the discharge or excretions. ANIMAL RESERVOIRS Zoonosis is an infection that is transmissible under natural conditions from vertebrate animals to man, e.g. rabies, plague, bovine tuberculosis….. There are over a 100 zoonotic diseases that can be conveyed from animal to man Condition for a disease causing microorganism to thrive \ 1.Must have a source of nutrition 2.Right environment (hot/cold/room temperature 3.Light/ dark 4.Moist Method of Transmission Direct Transmission eg; droplet Indirect Transmission – Vehicle borne ▪ Formite – Vector borne Airborne Transmission Portal of entry (5th link of chain of infection) – Any opening in the body – Non-intact skin Susceptible host (6th link of chain) – Person who is at risk for infection Susceptible Host - An infectious agent seeks a susceptible host aiming “successful parasitism”. First line of defenses against infection Intact skin & mucous membranes Mouth Cilia of the nasal passages Tears - it carries bateria away from the eyes GI - stomach acid/ gastric acid Vagina - acidic environment Urine flow - Second line of defense against infection Inflammatory Response  Signs Suffix –itis - anything with itis has the presence of infection Stages of Inflammatory Response First Stage- vascular & cellular response – Vessel constriction quickly followed by dilation – Increase in vascular permeability – Production & release of leukocytes (type of WBC) into bloodstream Second Stage – Exudate production – Fibrinogen, thromboplastin & platelets clump together – Form a barrier to prevent additional harm/injury Third Stage – Reparative phase – Regeneration – Granulation tissue – Fibrous tissue formation (scar) Third line of defense against infection- Specific Defenses Active immunity – Host produces antibodies in response to natural antigens or artificial antigens – Natural ▪ From active infection – Artificial ▪ Administered Passive immunity Host receives natural or artificial antibodies – Natural passive immunity ▪ Ex. from mother to baby through breastmilk – Artificial passive immunity ▪ injection of antibodies Factors Influencing Susceptibility to Infection Age - too young too old Heredity - genetics Stress - it affects our ability to fight infection. Nutrition Medications/procedures Disease Other Nursing Nursing history Physical assessment – S/S localized infection – S/S systemic infection – Laboratory data ▪ Elevated WBC count LEARN THE CAUSATIVE AGENTS!!!! ▪ Increase in specific WBC types ▪ Elevated erythrocyte sedimentation rate (ESR) ▪ Cultures of urine, blood, sputum, or other drainage Nursing goals focus on: –Maintaining/restoring defenses eg; intact skin –Avoiding spread of infection eg; handwashing, wearing of PPE –Reduce/alleviate complications STOPPING THE CHAIN OF INFECTION Billions of dollars and thousands of lives are lost each year because of communicable diseases. The basic component of every communicable disease transmission is the chain of infection. By breaking just 1 link in the chain, a communicable disease cannot be passed on to another individual. Radiologic technologists have the ability to continue the chain of infection or stop transmission. This article explores how a disease is transmitted and what techniques are available to stop transmission. CHAIN OF INFECTION The entire chain of infection must be intact for a person to become infected. If just 1 piece of the chain is missing, the infectious disease cannot spread. The chain of infection is made up of 6 components: 1.infectious agent 2.a reservoir 3.portal of exit 4.mode of transmission 5.portal of entry susceptible host NOSOCOMIAL INFECTION/HOSPITAL-ACQUIRED INFECTIONS HAIs are nosocomial infections. In other words, the patient does not have the infection upon entering a health care facility, but becomes infected while being treated at the institution. Several factors in the health care environment make the chain of infection difficult, but not impossible, to break; patients often have weakened immune systems and are undergoing invasive procedures, and health care staff come into contact with multiple patients during their shift. Every health care worker who is responsible for patient care or for cleaning patient equipment can be a part of the solution or part of the problem of disease transmission. STANDARD PRECAUTIONS  In 1970, the CDC made recommendations to apply standard precautions — an evolving set of recommendations that change as more is learned about the transmission of pathogens. In 2007, the CDC added 3 new parts to standard precautions: Respiratory hygiene/cough etiquette. Safe injection practices. The use of masks for insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture procedures. Equipment found in the patient room that is used daily patient bed, linen, patient gown etc, CDC Guidelines to Prevent Infection Two tiered approach – Standard precautions (SP) – Transmission based precautions Hand hygiene Personal protective equipment Environmental controls Respiratory hygiene (cough etiquette) Standard Precautions Designed for all clients Apply to: – Blood – All body fluids, excretions, secretions, except sweat – Nonintact skin – Mucous membranes Transmission-Based Precautions Used in addition to standard precautions For known or suspected infections that are spread in one of three ways: – Contact – Airborne – Droplet May be used alone or in combination but always in addition to standard precautions General Guidelines for Isolation Precautions Limit supplies taken into room Limit client transport outside of room Use disposable supplies if possible Keep precaution supplies just outside the client’s room Removal of items from room Private room if possible (or place with client with same infection) Contact Precautions Transmitted by direct or indirect contact Includes drug resistant bacteria – Methicillin-resistant Staphylococcus Aureus (MRSA) – Vancomycin-resistant Enterococcus (VRE) – Extended spectrum beta-lactamase-producing (ESBL) – Clostridium difficile (C-diff) ▪ Spore which requires soap and water, not alcohol based hand sanitizer CONTACT PRECAUTIONS - When caring for a patient under contact precautions, health care workers must wear gowns and gloves. The gowns and gloves should be disposed of prior to exiting the patient’s room. Immediately after removing their gloves, health care workers should wash their hands. MDR - Multidrug Resistance Airborne Precautions Transmitted by small droplets – TB, measles, varicella Airborne infection isolation room – Negative air pressure room PPE Droplet Precautions Transmitted by larger droplets – Pertussis, mumps, influenza (flu), strep throat 3 ft. diameter PPE\ Personal Protective Equipment (pg. 695-700) As discussed in learning lab: Indications, donning and removal of: Gloves Gowns Face masks Eyewear Psychosocial Needs of Isolation Clients Sensory deprivation – Environment lacks normal stimuli – Lack of interaction Feeling of Inferiority Nursing interventions Sterile Technique -sterile field -Sterile gloves -sterile gowns Infection Control for Health Care Workers Regulations Common hazards – Contaminated needles/sharps injury – Skin contact – Mucous membrane contact Medical asepsis, PPE, and avoiding carelessness behavior Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen Provide immediate care to exposed area Report the incident immediately Complete injury report Seek appropriate evaluation and follow-up HAND HYGIENE A part of the standard precautions is hand washing. Reports published as early as 1825 state hand washing helps eliminate odors and disease transmission. Unfortunately for patients, even with more than 180 years of knowledge, not all health care workers comply. According to study published in 1999, health care workers had proper hand hygiene only 48% of the time. This lack of compliance helps pathogens transmit to other individuals and continue the chain of infection. HANDWASHING Hands should be washed before patient contact, before invasive procedures, and after the removal of gloves. In addition to health care workers washing their hands before and after caring for a patient, hands should be washed: Before and after eating. After use of a restroom. Before and after procedure After changing a diaper. After blowing your nose, coughing, or sneezing. After touching an animal. After touching garbage. Health care workers should take between 40 and 60 seconds to wash their hands properly. The following steps will greatly minimize the transmission of pathogens: Wet your hands and then apply soap. For approximately the next 30 seconds, rub your hands together vigorously. After the vigorous rubbing, rinse your hands under water, dry them off with a disposable towel, and then use the towel to shut off the water. If you are washing your hands in a room with a light switch or door that must be opened, use the paper towel to open the door and turn off the switch. HAND RUB To use a hand rub properly, a health care worker should allot 20 to 30 seconds. Hand rubs should only be used for hand hygiene. If hands are noticeably soiled they must be washed with soap and water. To help sanitize hands, a health care worker should dispense a palm full of the hand rub solution into a cupped hand. He or she must then rub palms together to spread the solution around, then rub the back of the hand, interlace fingers to scrub between them, rub the thumbs individually, and then rub the fingertips into the palm in a circular motion. These steps should be continued until the  hands are dry. Hands may not be safe if the continuous rubbing motion is stopped prior to the hands being dry. VITAL SIGNS Vital signs are physical signs that indicate an individual is alive, such as heartbeat, breathing rate, temperature, blood pressures and recently oxygen saturation. These signs may be observed, measured, and monitored to assess an individual's level of physical functioning. The traditional vital signs are: 1. Body Temperature 2. Pulse 3. Respirations 4. Blood Pressure ✓(Oxygen Saturation) NOTE: Many agencies such as the Veterans Administration, American Pain Society, and The Joint Commission have designated: ✓ PAIN as a fifth vital sign, to be assessed at the same time as each of the other four. Normal vital signs change with age, sex, weight, exercise tolerance, and condition. All measurements are made while the patient is seated. Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes Factors affecting vital signs (include in your interview) Age Stress. Smoking. Cold temperatures. Exercise. Full stomach. Full bladder. Caffeine, alcohol consumption. Certain medicines. Observation :Before diving in, take a minute or so to look at the patient in their entirety. A. Temperature Observation : Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Old people, people with disabilities, babies and young children typically feel more comfortable at higher temperatures. Women notice that they are feeling cool quicker than men, which may be related to their different body size. The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Temperature is measured in either Celcius or Farenheit, with a fever defined as greater then 38- 38.5 C or 101- 101.5 F. Rectal temperatures taken rectally (using a mercury or digital thermometer) tend to be 0.5 to 0.7° (Fahrenheit) higher than when taken by mouth. Oral temperature can be taken by mouth using classic glass mercury-filled or digital thermometers. Axillary temperatures can be taken under the arm. Temperatures taken by this route tend to be 0.3 to 0.4° (Fahrenheit) lower than those temperatures taken by mouth. By ear a special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature. Degree Celsius Degree Fahrenheit 1.​ Normal Temp 36.6-37.2 98-99 2.​ Febrile >37.2 >99 3.​ Hyperpyrexia >41.6 >107 4.​ Subnormal