NCM 103 Lec Midterm Infection Control PDF

NCM 103 LEC MIDTERM Staphylococcus aureus (causes skin infections) and Escherichia coli (causes gastrointestinal infections). INFEC...

NCM 103 LEC MIDTERM Staphylococcus aureus (causes skin infections) and Escherichia coli (causes gastrointestinal infections). INFECTION CONTROL IN NURSING Viruses: Microscopic infectious agents that ★ Microorganisms exist everywhere: in water, require a host cell to replicate. They are in soil, and on body surfaces such as the composed of genetic material (DNA or skin, intestinal tract, and other areas open RNA) surrounded by a protein coat. to the outside such as our mouth, upper Examples include the influenza virus (causes respiratory tract, vagina, and lower urinary the flu) and HIV (causes AIDS). tract. Many organisms are harmless, others Fungi: Eukaryotic organisms that can be are lethal, some are a normal part of our unicellular (yeasts) or multicellular (molds). body. As such, the ones directly involved in Some fungi are pathogenic, causing providing a biologically safe environment infections, especially in are none other than the nurses. immunocompromised individuals. Examples include Candida albicans (causes yeast What is Infection? infections) and Aspergillus spp. (causes ★ Infection is the growth of microorganisms in respiratory infections). body tissue where they are not usually Parasites: Organisms that live on or in a host found. and benefit at the host's expense. They can ★ A condition characterized by the invasion be protozoa (single-celled) or multicellular and multiplication of pathogenic organisms (like worms). Examples include microorganisms (such as bacteria, viruses, fungi, or parasites) within the body, leading 2. Reservoir to tissue damage and an immune response. ★ The reservoir is the natural habitat of the Infections can manifest as localized or infectious agent, where it lives and systemic and may result in a range of multiplies. This can be a human, animal, or clinical signs and symptoms, including fever, environment. inflammation, pain, and impaired function ★ Examples: of affected tissues or organs. Humans: A person with a respiratory infection (common cold) Key Components Animals: A dog carrying rabies virus ★ The chain of infection is a model used to Environment: Soil contaminated with understand how infections are transmitted Clostridium tetani (causes tetanus) and spread from one individual to another. This model outlines six components, each of 3. Portal of Exit which must be present for an infection to ★ The portal of exit is the route through which occur. By breaking any link in this chain, the infectious agent leaves the reservoir. healthcare providers can effectively control ★ Examples: and prevent the spread of infections. Here’s Respiratory Tract: Coughing or sneezing (as a detailed explanation of each component seen with influenza) along with examples: Skin: Cuts or abrasions (as with MRSA infections) 1. Infectious Agent Gastrointestinal Tract: Diarrhea (as seen with ★ The infectious agent is the pathogen Salmonella infections) (microorganism) that causes disease. This can include bacteria, viruses, fungi, and 4. Mode of Transmission parasites. ★ The mode of transmission refers to how the ★ Examples: infectious agent is spread from one host to Bacteria: Single-celled organisms that can another. multiply rapidly and may be pathogenic. ★ Examples: They can be classified further into Direct Contact: Touching a person with an Gram-positive and Gram- negative based active infection (e.g., a wound) on their cell wall structure. Examples include  Indirect Contact: Touching contaminated Portal of Exit: Cover wounds; ensure proper surfaces or objects (fomites) like doorknobs waste disposal; use masks for respiratory or utensils illnesses. Droplet Transmission: Respiratory droplets Mode of Transmission: Practice hand expelled when an infected person coughs hygiene, use personal protective or sneezes (e.g., COVID-19) equipment (PPE), and follow infection Airborne Transmission: Infectious agents that control protocols. remain suspended in the air (e.g., Portal of Entry: Maintain skin integrity; use tuberculosis) aseptic techniques during procedures. Vector-borne Transmission: Insects or Susceptible Host: Vaccinate individuals; animals that carry the infectious agent (e.g., educate on healthy lifestyles and infection mosquitoes transmitting malaria) prevention measures. 5. Portal of Entry Types of Infection ★ The portal of entry is the way the infectious ★ Infection occurs when newly introduced or agent enters a new host. This is often the resident microorganisms succeed in same as the portal of exit. invading a part of the body where the ★ Examples: host’s defense mechanisms are ineffective Respiratory Tract: Inhalation of droplets (as and the pathogen causes tissue damage. with the flu) Mucous Membranes: Through the eyes, 1. Local Infection nose, or mouth ★ A local infection is confined to a specific Skin: Through breaks in the skin or mucous area of the body, where the infectious membranes (as with MRSA) microorganisms remain. The immune response is localized to the site of infection, 6. Susceptible Host and systemic symptoms may be minimal. ★ A susceptible host is an individual who is at ★ Example: risk of infection due to a lack of immunity, Skin Abscess: A localized collection of pus pre-existing health conditions, or other caused by bacterial infection (e.g., factors that weaken their defense against Staphylococcus aureus). It appears as a pathogens. swollen, red, and painful area on the skin. ★ Examples: The surrounding tissue may be inflamed, but Individuals with Weakened Immune the infection typically does not spread to Systems: Patients undergoing other parts of the body. chemotherapy, individuals with HIV/AIDS Elderly Individuals: Older adults with 2. Systemic Infection comorbidities ★ A systemic infection occurs when Unvaccinated Individuals: Those not microorganisms spread from their original vaccinated against diseases like measles or site and cause damage to various body influenza systems or organs. This type of infection can lead to severe illness and may involve Breaking the Chain of Infection multiple body systems. ★ By understanding the chain of infection, ★ Example: healthcare providers can implement Pneumonia: When a lung infection caused strategies to break this chain at any point. by bacteria (e.g., Streptococcus Here are some interventions: pneumoniae) or viruses spreads into the bloodstream, it can lead to systemic Infectious Agent: Use antimicrobial agents symptoms like fever, chills, and fatigue. or appropriate vaccinations. Severe cases can result in sepsis, a Reservoir: Maintain hygiene and sanitation; life-threatening condition. isolate infected individuals. 3. Bacteremia lead to immunosuppression, making ★ Bacteremia is the presence of bacteria in individuals vulnerable to opportunistic the bloodstream. This condition can be infections and other health complications. transient and may not always lead to an infection or noticeable symptoms. Line of Defenses ★ Example: ★ Non-specific: first line and second line Dental Procedures: Following certain dental ★ Specific: Antibody mediated and procedures, such as tooth extraction, cell-mediated bacteria from the mouth can enter the bloodstream, leading to bacteremia. While The body has a series of defenses, referred to as the this may resolve without treatment, it poses lines of defense, that work to protect against a risk for individuals with heart valve pathogens and maintain overall health. These abnormalities. defenses are categorized into three main lines: the first line (physical and chemical barriers), the second 4. Septicemia line (innate immune response), and the third line ★ Septicemia is a more serious condition that (adaptive immune response). Each line plays a occurs when bacteremia results in a crucial role in the body’s ability to fend off infections systemic infection, leading to sepsis. It often and disease. causes severe and widespread inflammatory responses in the body. First Line of Defense: Physical and Chemical Barriers ★ Example: The first line of defense includes physical and Sepsis from Urinary Tract Infection: If a chemical barriers that prevent pathogens from urinary tract infection (UTI) caused by entering the body. Escherichia coli spreads to the bloodstream, it can lead to septicemia. Symptoms may Physical Barriers include high fever, increased heart rate, ★ Skin: The skin is the body’s largest organ and and confusion. Septicemia is a medical acts as a physical barrier against emergency that requires immediate pathogens. Its outer layer (epidermis) is treatment. tough and impermeable. For example, a cut in the skin can allow pathogens to 5. Acute Infection enter, which is why intact skin is crucial for ★ An acute infection typically appears protection. suddenly and has a short duration. The ★ Mucous Membranes: Mucous membranes immune response is rapid, and symptoms line the respiratory, gastrointestinal, and can be intense but resolve relatively quickly. urogenital tracts. They secrete mucus, which ★ Example: traps pathogens and debris. For instance, in Influenza: The flu is an acute viral infection the respiratory tract, mucus traps dust and characterized by sudden onset of microbes, which are then cleared by cilia. symptoms such as fever, chills, body aches, ★ Cilia: Hair-like structures in the respiratory and fatigue. Most cases resolve within one tract that help to move mucus and trapped to two weeks. pathogens out of the airways. 6. Chronic Infection Chemical Barriers ★ A chronic infection develops slowly and can ★ Antimicrobial Secretions: The skin secretes persist for months or years. These infections antimicrobial peptides and oils that inhibit may have periods of exacerbation and microbial growth. For instance, sebum remission, leading to ongoing health issues. produced by sebaceous glands has ★ Example: antibacterial properties. HIV/AIDS: Human Immunodeficiency Virus ★ Acidic Environment: The stomach produces (HIV) is a chronic infection that can remain hydrochloric acid, creating an acidic asymptomatic for years before progressing environment that destroys pathogens to Acquired Immunodeficiency Syndrome ingested with food. (AIDS). Ongoing replication of the virus can  ★ Lysozyme: This enzyme is found in saliva, ★ Complement Proteins: A group of proteins in tears, and mucus and can break down the the blood that can be activated by cell walls of bacteria, effectively killing pathogens. They enhance phagocytosis, them. promote inflammation, and can directly kill bacteria by forming pores in their Second Line of Defense: Innate Immune Response membranes. The second line of defense is a non-specific immune response that activates when pathogens breach the Cell-mediated and antibody-mediated defenses are first line of defense. This response includes various two critical components of the adaptive immune immune cells and proteins that respond to infections. response. Both mechanisms work together to protect the body from infections and diseases caused by Cellular Defenses various pathogens. Here’s a detailed overview of ★ Phagocytes: Cells such as neutrophils and each type, including their functions and examples. macrophages engulf and digest pathogens. For example, when a bacterial Cell-Mediated Immunity (CMI) infection occurs, neutrophils are often the ★ Cell-mediated immunity is primarily first responders, moving to the site of mediated by T lymphocytes (T cells) and infection to engulf and destroy bacteria. does not involve antibodies. This type of ★ Natural Killer (NK) Cells: These cells immunity is crucial for the defense against recognize and destroy infected or intracellular pathogens, such as viruses and cancerous cells by releasing cytotoxic some bacteria, as well as cancer cells. substances. Key Components: Inflammatory Response ★ T Cells: The main players in cell-mediated ★ Inflammation: This is a localized response immunity include: characterized by redness, heat, swelling, Cytotoxic T Cells (CD8+ T Cells): These cells and pain. Inflammation occurs when tissues directly kill infected or cancerous cells. are injured or infected, leading to the When a CD8+ T cell recognizes a specific release of signaling molecules (e.g., antigen presented by infected or malignant histamines) that increase blood flow and cells, it binds to the cell and induces attract immune cells to the site of infection. apoptosis (cell death). For example, in response to a sprained Helper T Cells (CD4+ T Cells): These cells ankle, the area becomes inflamed as blood help regulate the immune response by vessels dilate and white blood cells move to releasing cytokines that activate other the area. immune cells, including B cells, cytotoxic T ★ First stage: Vascular and cellular responses. cells, and macrophages. Helper T cells play There is constriction of blood vessels, a crucial role in orchestrating the overall dilatation of small vessels, increased vessel immune response. permeability, increased leukocytes, swelling, and pain; leukocytes begin to engulf the Mechanism: infection. 1. Antigen Presentation: Pathogen-derived ★ Second stage: Exudate production. This antigens are presented on the surface of stage is characterized by exudation with antigen-presenting cells (APCs) through fluids and dead cells; serous (clear, part of major histocompatibility complex (MHC) the blood), purulent (thick, pus with molecules. leukocytes), and sanguineous (bloody). ★ MHC Class I: Presents antigens from ★ Third stage: Reparative phase. The repair of intracellular pathogens to CD8+ T cells. tissues; examples are regeneration (same ★ MHC Class II: Presents antigens from tissues), stroma (connective tissues), extracellular pathogens to CD4+ T cells. parenchyma (functional part), and fibrous (scar). Complement System 2. Activation of T Cells:  ★ Once the T cells bind to their specific Neutralization: Antibodies bind to antigen-MHC complex, they become pathogens and neutralize their harmful activated. effects (e.g., blocking a virus from entering ★ Activated cytotoxic T cells proliferate and cells). differentiate into effector cells that can kill Opsonization: Antibodies coat pathogens, infected cells. making them more recognizable for ★ Helper T cells release cytokines that further phagocytes (e.g., macrophages) to engulf activate other immune cells, enhancing the and destroy. immune response. Complement Activation: Antibodies can activate the complement system, leading Examples: to the lysis of pathogens. ★ Viral Infections: Infections like HIV or influenza lead to the activation of CD8+ T Examples: cells that destroy virus-infected cells. ★ Bacterial Infections: Infections caused by ★ Cancer Immunity: Cytotoxic T cells can Streptococcus pneumoniae or recognize and kill tumor cells by identifying Staphylococcus aureus stimulate B cells to specific tumor antigens. produce antibodies that help neutralize and eliminate these bacteria. Antibody-Mediated Immunity (Humoral Immunity) ★ Vaccination: Vaccines introduce antigens ★ Antibody-mediated immunity, also known that stimulate the immune system to as humoral immunity, is primarily mediated produce antibodies, providing immunity by B lymphocytes (B cells) and involves the against diseases like measles or polio. production of antibodies. This type of immunity is crucial for defending against Definition of Asepsis extracellular pathogens, such as bacteria ★ Asepsis is defined as the absence of and toxins. pathogenic microorganisms or their toxins in a particular environment or on a specific Key Components: surface. The main goal of aseptic ★ B Cells: The main players in techniques is to prevent infection and antibody-mediated immunity include: maintain a sterile environment during Plasma Cells: When B cells encounter their medical procedures, surgeries, and the specific antigen, they differentiate into handling of sterile instruments and supplies. plasma cells that secrete large quantities of antibodies. Types of Asepsis Memory B Cells: Some B cells become 1. Medical Asepsis (Clean Technique) memory cells after activation, which ★ Medical asepsis involves practices that provide long-term immunity and a rapid reduce the number and spread of response upon re-exposure to the same pathogens. It is aimed at preventing the antigen. transfer of microorganisms from one person, place, or object to another. Mechanism: ★ Examples: 1. Antigen Recognition: B cells have surface Hand Hygiene: Regular handwashing with immunoglobulin (antibodies) that recognize soap and water or using alcohol-based and bind to specific antigens. hand sanitizers to eliminate pathogens on 2. Activation and Proliferation: Upon binding to the hands. an antigen, B cells require help from CD4+ T Use of Personal Protective Equipment (PPE): cells (via cytokines) for full activation and Wearing gloves, masks, gowns, and eye proliferation. protection when dealing with patients or 3. Antibody Production: Activated B cells contaminated materials. differentiate into plasma cells that produce Environmental Cleaning: Routine cleaning and secrete antibodies specific to the and disinfecting of surfaces, equipment, antigen. and instruments in healthcare settings to 4. Antibody Function: minimize the risk of infection.  Isolation Precautions: Implementing Key Principles of Asepsis measures such as droplet, contact, or 1. Sterility: Maintaining a sterile environment is airborne precautions to prevent the spread critical. Any breach in sterility can lead to of infections from infected patients to infection. others. 2. Cleanliness: Regular cleaning and disinfection of surfaces and equipment help 2. Surgical Asepsis (Sterile Technique) minimize the presence of pathogens. ★ Surgical asepsis involves practices that 3. Personal Hygiene: Healthcare workers must maintain a sterile environment during adhere to strict hand hygiene practices to surgical procedures to prevent prevent the transmission of infections. contamination by pathogens. It ensures that 4. Environmental Control: The healthcare all instruments, equipment, and the surgical environment must be designed to reduce field are free from microorganisms. the risk of contamination (e.g., using ★ Examples: negative pressure rooms for airborne Sterilization of Instruments: All surgical infections). instruments and equipment must be sterilized using methods such as autoclaving Examples in Practice (steam under pressure), ethylene oxide gas, ★ In Surgery: Surgeons and their teams follow or chemical sterilants. strict aseptic techniques, including wearing Sterile Fields: Creating and maintaining a sterile gowns and gloves, to ensure a sterile sterile field using sterile drapes and covers field and prevent postoperative infections. during surgical procedures to ensure that ★ In Injection Procedures: Nurses and only sterile items come into contact with the healthcare providers use aseptic surgical site. techniques when administering injections, Proper Gowning and Gloving: Surgical staff such as using alcohol swabs to clean the must wear sterile gowns, gloves, and masks skin before injection and ensuring the use of to prevent contamination during sterile needles and syringes. procedures. Gowns must be worn correctly ★ In Wound Care: When dressing wounds, to ensure that the sterile side remains healthcare providers follow aseptic uncontaminated. principles to avoid introducing pathogens Skin Antisepsis: Preparing the patient's skin that could lead to infection. before surgery using antiseptic solutions (e.g., chlorhexidine or iodine-based Standard Precautions solutions) to reduce the microbial load on ★ Standard precautions are used in the care the skin. of all hospitalized individuals regardless of their diagnosis and possible infection status. Importance of Asepsis Designed for all clients in the hospital. 1. Infection Prevention: Aseptic techniques are These precautions apply to (a) blood; (b) all essential for preventing body fluids, excretions, and secretions healthcare-associated infections (HAIs), except sweat; (c) nonintact broken skin; which can lead to serious complications, and (d) mucous membranes. prolonged hospital stays, and increased Designed to reduce risk of transmission of healthcare costs. microorganisms from recognized and 2. Patient Safety: By reducing the risk of unrecognized sources. infection, asepsis contributes to improved Perform hand hygiene after contact with patient outcomes and enhances overall blood, body fluids, excretions, secretions, safety during medical procedures. and contaminated objects whether or not 3. Contamination Control: Aseptic practices gloves are worn. help maintain the integrity of sterile Wear clean gloves when touching blood, products, such as medications and surgical body fluids, secretions, excretions, and supplies, preventing contamination that contaminated items. could compromise their effectiveness.  Wear a mask, eye protection, or face shield Wear a mask if working within 1 meter (3 ft) if splashes or sprays of blood, body fluids, of the client. secretions, or excretions can be expected. Limit movement of client outside the room Wear a clean, non-sterile, water-resistant to essential purposes; place a surgical mask gown if client care is likely to result in on the client during transport. splashes or sprays of blood, body fluids, secretions, or excretions; the gown is Contact Precautions intended to protect clothing. ★ Use standard precautions as well as the Handle client care equipment that is soiled following: with blood, body fluids, secretions, or Place client in private room. excretions carefully to prevent transfer of If a private room is not available, place the microorganisms to others and to the client with another client who is infected environment. with the same microorganism. Handle all soiled linen as little as possible. Wear gloves as described in standard Place used needles and other “sharps” precautions. directly into puncture- resistant containers Wear a gown when entering a room if there as soon as their use is completed. is a possibility of contact with infected surfaces or items, or of the client is Transmission-based Precautions incontinent, or has diarrhea, a colostomy, or ★ Transmission-based precautions are used in wound drainage not contained by a addition to standard precautions for clients dressing. with known or suspected infections that are Limit movement of client outside the room. spread in one of three ways: by airborne or Dedicate the use of noncritical client care droplet transmission, or by contact. equipment to a single client or to clients with the same infecting microorganisms. Airborne Precautions ★ Use standard precautions as well as the Personal Protective Equipment following: ★ All healthcare providers must apply PPE Place client in an airborne infection isolation according to the risk of exposure to room that has negative air pressure, 6 to 12 potentially infective materials. air changes per hour, and either discharge of air to the outside or a filtration system for Gloves the room air. Gloves are worn for three reasons: first they If a private room is not available, place the protect the hands when the nurse is likely to client with another client who is infected handle any body substances; second, with the same microorganism. gloves reduce the likelihood of nurses Wear an N95 respirator mask when entering transmitting their own endogenous the room of a client who is known to have microorganisms to individuals receiving or suspected of having primary tuberculosis. care; and third, gloves reduce the chance Susceptible people should not enter the that the nurses’ hands will transmit room of a client who has rubeola (measles) microorganism to from one client or object or varicella (chicken pox). to another client. Limit movement of client outside the room In all situations, gloves are changed to essential purposes; place a surgical mask between client contacts. on the client during transport. The hands are cleansed each time the gloves are removed for two primary Droplet Precautions reasons: (1) the gloves may have ★ Use standard precautions as well as the imperfections or be damaged during following: wearing so that they could allow Place client in private room. microorganism entry; and (2) the hands If a private room is not available, place the may become contaminated during glove client with another client who is infected removal. with the same microorganism. Gowns operating or delivery room; however, not all Clean or disposable impervious of the sterile techniques that follow are (water-resistant) gowns or plastic aprons are always required. worn during procedures when the nurse’s uniform is likely to become soiled. Principles of Surgical Asepsis Sterile gowns may be indicated when the ★ All objects used in a sterile field must be nurse changes the dressings of a client with sterile. extensive wounds. ★ Sterile objects become unsterile when Single-use gown technique (using a gown touched by unsterile objects. only once before it is discarded or ★ Sterile objects that are out of sight or below laundered) is the usual practice at hospitals. the waist or table level are considered unsterile. Face Masks ★ Sterile objects may become unsterile by Masks are worn to reduce the risk for prolonged exposure to airborne transmission of microorganisms by the microorganisms. droplet contact or airborne routes and by ★ Fluids flow in the direction of gravity. splatters of body substances. ★ Moisture that passes through a sterile object The CDC recommends that masks be worn: draws microorganisms from unsterile By those close to the client if the infection is surfaces above or below to the sterile transmitted by large-particle aerosols surface by capillary action. (droplet); large particle aerosols are ★ The edges of a sterile field are considered transmitted by close contact and generally unsterile. travel short distances (about 1 m or 3 ft). ★ The skin cannot be sterilized and is unsterile. By all individuals entering the room if the ★ Conscientiousness, alertness, and honesty infection is transmitted by small particle are essential qualities in maintaining surgical aerosols (droplet nuclei); small-particle asepsis. aerosols remain suspended in the air and thus travel great distances in the air. PATIENT SAFETY AND SECURITY Eye Wear ★ Patient safety and security are fundamental Protective eye wear (goggles, glasses, face components of quality healthcare, aimed shields) and masks are indicated in at preventing harm to patients and ensuring situations where body substances may a safe environment for their care. splatter the face. If the nurse wear prescription eyeglasses, Patient Safety goggles must still be worn over the glasses ★ Refers to the prevention of errors and because the protection must extend adverse effects associated with healthcare. around the sides of the glasses. It encompasses the systematic reduction of risk and harm to patients during healthcare Sterile Technique delivery. ★ An object is sterile only when it is free of all microorganisms. Patient Security It is well known that sterile technique is ★ Involves safeguarding patients from practiced in operating rooms and special intentional harm, including violence, theft, diagnostic areas. and breaches of privacy. It also addresses Sterile technique is also employed for many the protection of patient data and procedures in general care areas such as confidentiality when administering injections, changing wound dressings, performing urinary Principles of Patient Safety catheterization, and administering 1. Patient-Centered Care: Involve patients in intravenous therapies. their care decisions and encourage open In these situations, all principles of the surgical asepsis are applied as in the  communication about their health and plans, enabling them to participate actively treatment plans. in their care and recognize potential 2. Teamwork and Collaboration: Foster a warning signs. culture of collaboration among healthcare professionals to enhance communication Principles of Patient Security and coordination in patient care. 1. Access Control: Implement policies and 3. Open Communication: Encourage technologies to restrict access to patient transparent communication among care areas and sensitive information, healthcare providers, patients, and families ensuring only authorized personnel can to identify and address safety concerns. enter. 4. Continuous Learning: Implement ongoing 2. Data Privacy and Confidentiality: Protect education and training programs to keep patient information through secure data healthcare staff informed about best storage, encryption, and strict practices, emerging threats, and lessons confidentiality policies to prevent learned from past errors. unauthorized access. 5. Error Reporting and Analysis: Establish a 3. Emergency Preparedness: Develop and non-punitive environment for reporting regularly update emergency response plans errors and near misses to identify areas for for various scenarios, including natural improvement and prevent future incidents. disasters, violent incidents, and data 6. Evidence-Based Practices: Utilize breaches. standardized protocols and 4. Training and Awareness: Provide ongoing evidence-based guidelines to ensure training for all staff on security protocols, consistent and safe care delivery. recognizing potential threats, and 7. Monitoring and Evaluation: Regularly assess responding effectively to security incidents. patient safety performance through audits, 5. Incident Reporting and Response: Establish feedback, and performance metrics to clear procedures for reporting security identify areas needing improvement. breaches, threats, and incidents, ensuring timely investigation and response to Patient Safety minimize impact. Medication Reconciliation 6. Environmental Safety: Maintain a safe and ★ Conducting thorough medication reviews secure physical environment, including during patient admissions, transfers, and adequate lighting, surveillance systems, and discharges to prevent adverse drug emergency exits to protect patients and interactions and errors. staff. 7. Collaboration with Law Enforcement: Foster 1. Hand Hygiene Protocols: Implementing strict partnerships with local law enforcement handwashing and sanitization protocols for and security agencies to enhance facility healthcare providers to reduce the risk of safety and prepare for potential threats. healthcare-associated infections (HAIs). 2. Fall Prevention Programs: Developing Complementary and alternative therapies comprehensive fall risk assessment tools and ★ Complementary and alternative therapies implementing interventions, such as non-slip (CAT) are increasingly being integrated into socks, handrails, and bed alarms, to prevent conventional healthcare settings. These patient falls, especially among elderly therapies are utilized to enhance patient patients. care, promote healing, and improve overall 3. Surgical Safety Checklists: Utilizing checklists well-being. before, during, and after surgical procedures to ensure all necessary steps are Complementary Therapy completed, reducing the risk of errors such ★ Refers to treatments used alongside as wrong-site surgery. conventional medicine to enhance the 4. Patient Education: Providing clear effectiveness of standard care. Examples instructions to patients about their include acupuncture, yoga, and diagnoses, medications, and discharge aromatherapy.  ★ Practices such as Reiki and therapeutic Alternative Therapy touch that focus on the manipulation of ★ Refers to treatments that are used in place energy fields to promote healing. of conventional medical treatments. Examples include herbal medicine, Nursing Implications homeopathy, and naturopathy. Assessment: Principles of Complementary and Alternative Therapy ★ Nurses should assess patients' use of complementary and alternative therapies Holistic Approach: during the initial assessment and throughout ★ CAT emphasizes treating the whole care. This includes understanding patients’ person—body, mind, and spirit—rather than beliefs, preferences, and past experiences focusing solely on the disease. This aligns with CAT. with the holistic care philosophy in nursing, recognizing the importance of mental and Education: emotional wellbeing in physical health. ★ Nurses play a vital role in educating patients about safe and effective CAT options. They Patient-Centered Care: should provide information on potential ★ CAT promotes active patient participation interactions with conventional treatments, in their own health decisions, fostering a side effects, and evidence supporting the sense of autonomy and empowerment, use of these therapies. which is a core principle in nursing practice. Collaborative Care: Integrative Care ★ Nurses should collaborate with other ★ CAT can complement conventional healthcare professionals to create an therapies, providing a more comprehensive integrative care plan that includes treatment plan. This integrative approach complementary therapies. This approach can improve patient satisfaction and ensures that all aspects of a patient’s care adherence to treatment regimens. are coordinated and aligned. Classifications of Complementary and Alternative Monitoring and Evaluation: Therapies ★ Nurses should monitor the effectiveness of complementary therapies and evaluate Mind-Body Interventions: their impact on patient outcomes. This may ★ Techniques such as meditation, guided involve assessing pain levels, anxiety, and imagery, and biofeedback that aim to overall satisfaction with care. enhance the mind's capacity to affect bodily functions and symptoms. Evidence Supporting Complementary and Alternative Therapy Biologically Based Therapies: ★ Research has shown that CAT can provide ★ Include herbal supplements, dietary benefits for various health conditions. changes, and vitamins that utilize natural substances for healing. Some evidence-based examples include: Pain Management: Manipulative and Body-Based Methods: ★ Studies indicate that acupuncture and ★ Techniques like chiropractic care and massage therapy can effectively reduce massage therapy that involve manipulation pain in patients with chronic conditions like of the body’s structure. arthritis and fibromyalgia (Vickers et al., 2018). Energy Therapies: Anxiety and Stress Reduction:  ★ Mind-body interventions such as mindfulness Right Response: Monitor the patient’s response to the meditation and yoga have been shown to medication, assessing for both therapeutic effects reduce anxiety levels and improve and potential side effects or adverse reactions. emotional well-being in patients (Goyal et al., 2014). Right Education: Provide the patient with relevant information about the medication, including its Enhancing Quality of Life: purpose, potential side effects, and instructions for ★ Integrative approaches that combine use. Educate the patient about what to expect and conventional treatment with CAT have when to seek help. been found to improve quality of life in cancer patients, reducing symptoms and Right to Refuse: Acknowledge and respect the enhancing overall health (Coyle et al., patient’s right to refuse medication. Ensure that the 2020). reasons for refusal are understood and document the refusal appropriately. Medication is defined as a substance or combination of substances used for the prevention, diagnosis, Forms and Routes of Drug Administration treatment, or management of a disease or health ★ There are many different forms of condition. Medications can alter physiological medication: liquid, suspensions, tablets, functions in the body, alleviate symptoms, and capsules, lotions, and ointment, to name a improve the quality of life for patients. few. There are also many routes through which medications can be given and Right Patient: Verify the patient's identity using at least absorbed into the body. The routes of two identifiers (e.g., name and date of birth) to medication administration are broadly ensure that the medication is administered to the categorized as follows: correct individual. Enteral administration: “Enteral” means Right Medication: Ensure that the medication being “pertaining to the intestines.” Most enteral administered is the one that was prescribed, medications are absorbed in the intestines. double-checking the label against the medication The primary routes for enteral administration administration record (MAR). are oral and, to a lesser extent, rectal. Some clients have tubes placed directly into the Right Dose: Confirm the prescribed dose is gastrointestinal tract (e.g., nasogastric tubes appropriate for the patient, considering factors like or percutaneous endoscopic gastrostomy weight, age, and specific health conditions. [PEG] tubes). Absorption will vary, but all will be affected by the first-pass effect. Right Route: Administer the medication via the Parenteral administration: “Parenteral” correct route (e.g., oral, intravenous, intramuscular) refers to any drug that is administered as specified in the prescription. outside of the GI tract; however, it most commonly refers to injectable drugs Right Time: Administer the medication at the correct administered via the subcutaneous, time, following the prescribed schedule, and intramuscular, or intravenous routes. Drugs consider specific timing requirements (e.g., with or administered via these routes have without food). improved bioavailability because they bypass the first-pass effect, making Right Documentation: Accurately document the absorption and onset of action more rapid. administration of the medication immediately after Percutaneous administration: Some sources giving it, including the time, dose, and any relevant will define percutaneous administration as a observations. separate category or a subcategory of parenteral routes. The percutaneous route Right Reason: Understand and verify the reason for refers to topical drugs absorbed through the administering the medication, ensuring that it aligns skin—lotions, ointments, creams, or patches. with the patient’s diagnosis and treatment goals. Oral Medications  ★ Oral administration encompasses several When filling a calibrated plastic cup with different drug forms. Liquids, elixirs, liquids, fill at eye level. suspensions, tablets, capsules, and caplets Always remain with the client until all may all be given orally. Oral administration medications are taken; do not leave drugs is usually quick, easy, and convenient, but at the bedside unattended. the onset of action is longer and unpredictable due to the first-pass effect, and not all drugs can be administered this Sublingual and Buccal Administration way. ★ Absorption of sublingual medications occurs in the area under the tongue, whereas buccal medications are absorbed in the oral mucosa, generally between the cheek and gums. These are vascular areas, and medications administered here are absorbed rapidly because they do not undergo the first-pass effect. Nursing Implications for Oral Medications ★ The nurse should do the following for clients who are taking oral medications: If a tablet needs to be split, split only tablets Nursing Implications for Sublingual or Buccal that are scored. If a client has difficulty Medications swallowing a tablet or capsule, consult a ★ The nurse should do the following for clients pharmacist for advice about the technique who are taking sublingual or buccal of administration because some capsules medications: may be opened and emptied into a food Always remain with the client until all or liquid. medications are taken; do not leave drugs Timed-release capsules or tablets should not at the bedside unattended unless the be crushed or chewed because this may provider has ordered the medication to be affect the rate of absorption and toxicity left at the bedside. may occur. For this reason, timed-release Exception: Sublingual nitroglycerin tablets or capsules should not be opened and sprays are often ordered to be left at the emptied into food for ease of swallowing. bedside so that a client may take them as Use a hospital-approved device to split the needed in the event of chest pain. tablet. (Some health systems split the tablets in the pharmacy and send them to the unit Nasal Spray Administration in unit-dosed packaging for safety ★ Nasal sprays can be rapidly absorbed into purposes.) the mucous membranes of the nasal cavity. Discard any unused portion according to institutional policy. If the drug is a controlled substance, document the waste with another nurse in the medication room. If a tablet needs to be crushed: Ensure that it can be crushed. Nursing Implications for Nasal Sprays Never crush sustained-release, ★ The nurse should do the following for clients extended-release, or enteric-coated who are taking nasal sprays: tablets. Do not readminister the drug if the client If crushing more than one tablet, keep them sneezes following the administration of the separate; do not combine them. nasal spray because there is no way to  assess how much of the drug has been Administer subcutaneous injections at a 45- absorbed. to 90-degree angle depending upon the body habitus of the individual. For extremely Subcutaneous Administration thin individuals and children, ensure that the ★ Subcutaneous injections are administered angle is shallow enough that the “under the skin” into the adipose tissue medication is not given intramuscularly between the dermis and muscular layer. ★ Common medications administered within Intramuscular Injections this layer are enoxaparin, heparin, and ★ Intramuscular injections (IM) are insulin. administered deep into the muscular tissue ★ Medication administered here is often beneath the dermis and subcutaneous absorbed slowly due to the reduced layers. The most common sites for IM number of blood vessels in this area. injections are the ventrogluteal and deltoid ★ There are many potential sites for areas. Vastus lateralis landmarks are subcutaneous injections: upper arms, thighs, preferred for infants and children under age abdomen, back, and buttocks. The specific 2. sites for each drug are usually detailed in the drug’s package insert or labeling. ★ Routine injections should be rotated regularly among the different sites. Do not inject into sites that are hard when palpated. Do not rub the injection site, though gentle pressure may be applied to the area after the drug has been administered. Nursing Implications for Subcutaneous Administration ★ The nurse should do the following for clients receiving a subcutaneous injection: For heparins and insulins: Both are high-alert medications. A second nurse will need to verify the dose. Do not draw up the dose until a witness is available to verify. Never draw heparin up into an insulin syringe. (Fortunately, many heparins come in prefilled syringes for safety reasons.) Insulin, and only insulin, should be drawn up into an insulin syringe. Never draw up insulin into a regular syringe with milliliter (mL) markings because this will cause an overdose of insulin.  are suffering from nausea and vomiting, Intradermal injections (ID) especially if no IV is in place. This route has ★ are administered into the dermis just below both a mixed first-pass effect and a the epidermis. See Figure 18.14 for an non-first-pass effect. There are capillaries in image of the layers of the skin. Intradermal the rectum that feed the portal circulation, (ID) injections have the longest absorption which causes some of the medication to time of all parenteral routes because there undergo first-pass effect; however, some of are fewer blood vessels and no muscle the medication will also be absorbed into tissue. These types of injections are used for the perirectal tissues locally. sensitivity testing because the patient’s reaction is easy to visualize and the degree of reaction can be assessed. Examples of intradermal injections include tuberculosis (TB) and allergy testing. ★ Suppositories are medications that are solid at room temperature but soften and dissolve once in the rectal cavity. These medications are wrapped in foil or plastic packaging. ★ Nursing Implications for Rectal Administration ★ The nurse should do the following for clients Intravenous Administration who are taking drugs rectally: ★ Intravenous medications are introduced Do not insert a rectal suppository into the directly into the vein and, thus, into the stool. Palpate the rectal wall for the circulation during administration. This route is presence of feces. the fastest because no absorption is Have the client defecate prior to inserting necessary, and drugs are 100% bioavailable the suppository, if possible. because they bypass the first-pass effects of Never divide suppositories. the liver. Loss of sphincter control may be seen in older clients. Have a bedpan handy. Suppositories may be administered by the client. Be clear in your teaching of the process. It is important to educate clients who are self-administering suppositories that these drugs are to be given rectally, not orally. Vaginal Administration ★ Vaginal medications may come in a variety tapos na gago of forms: creams, suppositories, foams, and so forth. Although vaginal suppositories may be inserted with a gloved finger, foams, creams, tablets, and jellies should be inserted with a special vaginal applicator. Rectal Administration ★ Several medications can be given via the rectal route. This route can be used if clients