SLO - Skin & Isolation PDF

Infection Control SLO Review of Body Defenses. ◦ Normal oras, body system defenses, and in ammation are all nonspeci c defenses that protect against microorganisms regardless of prior exposure. ◦ Immune response: releases substances (ex: T-cells, white blood cells) to kill bacteria and viruses ◦ Fev...

Infection Control SLO Review of Body Defenses. ◦ Normal oras, body system defenses, and in ammation are all nonspeci c defenses that protect against microorganisms regardless of prior exposure. ◦ Immune response: releases substances (ex: T-cells, white blood cells) to kill bacteria and viruses ◦ Fever: the rise in temperature inhibits the growth of many pathogens. It also enhances the nonspeci c innate immune defenses by stimulating white blood cells to kill pathogen. ◦ In ammation: the blood supply increases, helping carry immune cells (ex:white blood cells) to the a ected area. ◦ Physical barriers: skin, mucous membranes, tears, earwax, mucus, and stomach acid. ◦ The blood: the white blood cells attack invading microorganisms and release substances that continue the process of in ammation. ◦ B lymphocytes: make proteins called antibodies ◦ Macrophages: phagocytes Discuss the Chain of Infection. ◦ It is a cycle of how infection can occur. All of the following elements has to be present in order for an infection to occur: ‣ An infectious agent or pathogen: includes bacteria, viruses, fungi, and protozoa. ‣ A reservoir or source for pathogen growth: a place where microorganisms survive, multiply, and await transfer to a susceptible host. Common reservoirs are humans and animals (host), insects, food, water, and organic matter on inanimate surfaces (fomites) ‣ A port of exit from the reservoir: after microorganisms nd a site to grow and multiply, they need to nd a portal of exit if they are to enter another host and cause disease. Portal of exit include sites such as blood, skin, and mucous membranes, respiratory tract, GU tract, GI tract, and transplacental (mother to fetus) ‣ A mode of transmission: Contact (direct or indirect), droplet, airborne, vehicles (contaminated items, water, drugs, blood, food), and vector (external [ ies], internal [mosquito, ea, tick, louse]). ‣ A port of entry to a host: organisms enter the body through the same routes they use for exiting. ‣ A susceptible host: susceptibility to an infectious agent depends on an individual’s degree of resistance to pathogens. An infection does not develop until an individual becomes susceptible to the strength and numbers of the microorganisms in Implementation of Medical Aseptic Technique (MAT): ◦ Aseptic technique refers to the practices/procedures that help reduce the risk for infection. Basic medical aseptic techniques break the chain of infection. ◦ Use these techniques for all patients, even when no infection is diagnosed. ◦ Hand hygiene, use of personal protective equipment, and routine environmental cleaning are examples of medical asepsis. ◦ Aseptic technique is the use of practices and procedures such as hand hygiene, non-touch techniques, appropriate aseptic eld, sterilized equipments and cleaning existing key parts to minimize the presence of disease causing pathogens. Di erentiate types of isolation: ◦ Standard Precautions:the rst and most important tier ‣ Designed to be used for the care of all patients, in all settings, regardless of risk or presumed infection status. ‣ Apply to contact with blood, body uids, non intact skin, mucous membranes, and equipment or surfaces contaminated with potentially infectious material. ‣ Appropriate use of PPE such as gowns, gloves, masks, eyewear, and other protective devices or clothing. ‣ The choice of barriers depends on the task being performed and the patient’s disease. ‣ It applies to all patients because every patient has the potential to transmit infection via blood and body uids, and the risk for infection transmission is unknown. ‣ Respiratory hygiene/cough etiquette applies to any person with signs of respiratory infection, including cough, congestion, rhinorrhea, or increased production of respiratory secretions, when entering a health care site. ◦ The second tier of precautions includes precautions designed for the care of patients who are known or suspected to be infected or colonized with microorganisms transmitted by droplet, airborne, or contact routes. ◦ There are four types of transmission-based precautions, which are based on the mode of transmission of a disease: Airborne, Droplet, Contact, and Protective Environmentg Precautions. ‣ Contact Precautions: used for direct and indirect contact with patients and their environment. Direct contact refers to the care and handling of contaminated body uids. Requires to wear a gown and gloves. Indirect contact involves the transfer of an infectious agent through a contaminated intermediate object such as contaminated instruments or hands of health care worker. ‣ Droplet Precautions: focus on diseases that are transmitted by large droplets (greater than 5 microns) expelled into the air and by being within 3 feet of a patient. Droplet precaution require the wearing of a surgical mask when within 3 feet of the patient, proper hand hygiene, and some dedicatedcare equipment. ‣ Airborne Precautions: focus on disease that are transmitted by smaller droplets, which remain in the air for longer periods of time. Airborne Precautions require a specially equipped room with negative air ow referred to as an airborne infection isolation room. ‣ Protective Environment: focuses on a very limited patient population, all of whom are highly susceptible to infection because of an underlying condition or treatment. This for of isolation requires a specialized room with positive air ow. The air ow rate is set at greater than 12 air exchanges per hour. De ne bacterial infections: E. Coli, C-di , MRSA, VRE & ESBL. ◦ E. Coli: a bacterium commonly found in the interstices of humans and other animals, some strains of which can cause severe food poisoning. A gram-negative, facultative anaerobic, rod-shaped. ◦ C-di : also known as Clostridioides di cult is a bacterium that causes diarrhea and colitis. It often a ects people who have been taking antibiotics. ◦ MRSA (Methicillin-resistant Staphylococcus aureus: staph bacteria are usually harmless, but they can cause serious infections that can lead to sepsis or death. MRSA is di cult to treat because of resistance to some antibiotics. ◦ VRE (vancomycin-resistant enterococcus): is an infection with bacteria that are resistant to the antibiotics called vancomycin. Enterococcus is a type of bacteria that normally lives in the intestines and the female genital tract. It usually doesn’t make us sick. ◦ ESBL (Extended Spectrum Beta-Lactamase): Betalastamases are enzymes produced by some bacteria that may make them resistant to some antibiotics. ESBL production is associated with a bacteria usually found in bowel. Assessment of the Integumentary system of the Adult/geriatric client SLO Discuss the role of the Integumentary system in a client. ◦ The skin’s function is to maintain a homeostatic environment. ◦ It protects the body from bacteria, infection, injury and sunlight. ◦ It allows you to feel skin sensations. ◦ It produces Vitamin D. Discuss the steps that constitute a nursing assessment of the Integumentary System. ◦ Inspection should include assessment of the skin’s color, temperature, texture, moisture, integrity, and include the location of any skin breakdown or wounds. ◦ Inspect and palpate the ngernails and toenails, noting their color and shape and whether any lesions are present. Identify nursing interventions to prevent altercation in the Integumentary system. ◦ Eliminate friction and irritation to the skin, such as from shearing, and reducing moisture so that tissues do not break down. ◦ Manage incontinence and enhancing mobility ◦ Displacing body weigh from prominent areas to facilitate circulation to the skin ◦ Lift the patient when moving, rather than dragging ◦ Use pillows or wedges so the skin does not touch anything else ◦ Use devices that eliminate pressure on the heels. ◦ Repositioning is very important to prevent pressure injury. ◦ Pressure injury are evaluated with each dressing change ◦ Use PUSH tool to assess PIO Identify the most common skin problems for geriatric population. ◦ The most common skin problems of aging are: ‣ Xerosis: ‣ Pruritus: ‣ Seborrheic keratosis: wants common seria genite ‣ Herpes zoster: ‣ Cancer: Imi's Erythema skinredness in Communication- SLO Identify the 4 phases of a therapeutic relationship ◦ Pre-interaction phase: (report, your state) ‣ Prepare for your meeting with the patient, review chart ‣ Examine your thoughts and feelings about working with the patient. ◦ Orientation phase: (introduction, social) ‣ You will perform introductions with the patient, establish a rapport, establish boundaries, and explain patient con dentiality. ‣ You will seat mutually agreed-upon goals with the patient and establish the date, time, place, and duration of meetings. ◦ Working phase: solving problems, accomplishing goals ‣ You will gather date and identify and practice problem-solving skills and coping skills with your patient. ‣ You will provide education to the patient, and then evaluate the progress being made towards the agreed-upon goals. ◦ Termination phase: evaluate goal, achievement, reminisce, transition to other caregivers. ‣ Nurse-client relationship come at the end, and during this phase you will summarize goals that were achieved during the relationship, discuss incorporation of new coping mechanism and problem solving skills in the patient’s life, and discuss their discharge plans. ‣ Di erentiate between the levels of communication. ◦ Intrapersonal communication: ‣ “self talk”; it is your internal thoughts and conversation happening inside your head. ‣ Positive self-talk provides a mental rehearsal for di cult tasks or situations. ‣ You use it to develop self-awareness and a positive self-esteem. ◦ Interpersonal communication: ‣ Is a one-on-one interaction between a nurse and another person that occurs face to face or via text or other electronic format. ‣ It is most frequently used in nursing situations and lies at the heart of nursing practice. ‣ “Teach-back method”- veri es how well you explained the information to your patient; it does not test your patient’s knowledge. ◦ Small-group communication: ‣ The interaction that occurs when a small number of people meet. ‣ This type of communication is usually outcome oriented and requires an understanding of group dynamics. ‣ In these situation, communication should be organize, concise and complete. ◦ Public communication: ‣ Interaction with an audience. ‣ Requires special adaptations in eye contact, gestures, voice in ection, and the use of media materials to communicate messages e ectively. ◦ Electronic communication: ‣ The use of technology to create ongoing relationships with patients and their health care team. ‣ It provides an opportunity for frequent and timely communication with a patient’s physician or nurse via a patient portal. Discuss the nurse’s role in situation monitoring. ◦ The process of actively scanning and assessing elements of the situation to gain information or maintain an accurate understanding of the situation in which they team functions. ◦ Self (IM SAFE), Patients, Families, Health Care Team, Environment. ◦ Compare and contrast the elements of communication in the sender-receiver model vs. human being as energy eld model, with associated implications. ◦ Sender-receiver model: ‣ The sender selects the channel of communication that will be used. ‣ The message travels over the channel of communication. ‣ The message is received by the receiver. ‣ The receiver decodes the message. ‣ The receiver provides feedback, if applicable. ◦ Human being as energy eld model: ‣ The nurse is not simply part of the patient’s environment, the nurse IS the patient’s environment. ‣ The energy elds of nurse and patient merge and form a new pattern. ‣ Implications: the clearer the energy eld of the nurse, the better the healing environment is for the patient. The nurse “being” is as important as the nurse “doing”. ‣ If our energy elds interact, what is our responsibility for keeping ours clear? (Self Care) ‣ If our thought “shape” our attitudes and our emotions are “carried” in our elds, how do we work with hem to maximize therapeutic interaction? (Re ective Practice!) ‣ How can we use intention with ourselves and with others to promote best outcomes? Compare and contrast therapeutic vs non-therapeutic communication techniques. ◦ Therapeutic communication: ‣ Use Open-ended questions ‣ It requires an in-depth response. ‣ Portray empathy, builds trust. ‣ Restating what the patient said, to make sure that patient’s know that you understand. ‣ O ering “self”, letting the patient’s know that you are there for them. ‣ Re ecting, return focus on client. ◦ Non-therapeutic communication: ‣ Close ended questions. ‣ Avoid this technique ‣ One word answers ‣ False reassurance, (everything is going to be ok) ‣ Never ask, “why”, makes the patient feel like they are being judge. ‣ Passing judgement. ‣ Never leave the room ‣ Never: o er opinions, advice, or personal experiences. Select appropriate communication approaches to use with special populations, including use of interpreters. ◦ Respect the individuality of each patient and adapt your communication techniques based on patient preferences. ◦ For example, you will approach a patient who is open and willing to discuss private family matters very di erently from a patient who is reluctant to reveal personal or family information to strangers. ◦ Those who speak English as a second language often have trouble with self-expression of language comprehension. ◦ Understand that people of di erent ethnic origins use di erent degrees of eye contact, personal space, gestures, loud voice, pace of speech, touch, silence, and meaning of language. ◦ Avoid stereotyping, patronizing, and making fun of other cultures. ◦ A professional interpreter is necessary even those who speak the same language, use subcultural variations of certain words. ◦ Medical jargon sounds like a foreign language to patients unfamiliar with the health care setting. ◦ Limiting use of medical jargon to conversations with other health care team members improves communication. ◦ Speak directly to the patient even if an interpreter is present. Describe the importance of nonverbal behavior. ◦ Nonverbal aspects of communication such as voice tone, eye contact, and body positioning are often as important as verbal messages. ◦ Non verbal communication is unconsciously motivated and more accurately indicates a person’s intended meaning than spoken words. ◦ Sociocultural background is a major in uence on the meaning of nonverbal behavior. ◦ Assessing and responding to nonverbal messages appropriately are important for accurate assessment and evaluation of nursing care. ◦ Nonverbal behavior: personal appearance, posture and gait, facial expression, eye contact, gestures, sounds, territoriality and personal space. Describe expectations for professional communications. ◦ Professional appearance, demeanor, and behavior are important in establishing trustworthiness and competence. ◦ AIDET is a technique developed to enable health care workers to provide accurate and timely professional communication to patients and families while focusing on excellent patient service. ◦ The acronym stands for Acknowledge, Introduce, Duration, Explain, and Thank you. ◦ Acknowledge the person in front of you. ◦ Introduce yourself and let the person know what your role is in the department and in the person’s care. ◦ Duration, give a patient or family an idea of how long a procedure may take. This keeps the patient informed of any delays that may occur and how long tests can take. ◦ Explain, describe what the patient will experience with the treatment, procedure, or test. Inform the patient of any safety precautions. ◦ Thank you, thank patients for coming to your organization for care and let them know how much you enjoyed working with them. Discuss the impact of culture, gender, and developmental stage on communication. ◦ Perception provides a uniquely personal view of reality formed by an individual’s culture, expectations, and experiences. ◦ Cultural humility enables you to recognize that you do not completely understand your patient’s culture and allows you to explore the interpersonal variables such as educational and developmental level, sociocultural background, values and beliefs, emotions, gender, physical health status, and roles and relationships that a ect how a patient communicates. ◦ Gender in uences how we think, act, feel, and communicate. ◦ Men tend to use less verbal communication but are mor likely to initiate communication and address issues more directly and more likely to talk about issues. ◦ Women tend to disclose more personal information and use more active listening, answering with responses that encourages the other person to continue the conversation. ◦ Changes in health status and human response limit communication. ◦ ‘People with hearing or visual impairments often have di culty receiving messages. ◦ Reviewing of a patient’s medical record provides relevant information about the patient’s ability to communicate. Apply e ective strategies to address complaints e ectively. ◦ “LAST” ◦ Listen: without interrupting, blaming others, or making excuses. ◦ Apologize: on behalf of the organization. This is not admitting guilt. ◦ Solve: take action to solve the problem. If you can’t solve it, nd someone who can. ◦ Thank: Thank the person for bringing the problem to your attention and for his/her patience and understanding. List risk factors for aggression in a patient. ◦ Neuro or cognitive disorder resulting in acute or chronic cognitive impairment and/or lack of impulse control. ◦ Psychiatric disorder or 5150: “Crazy” ◦ Current drug/ETOH abuse (withdrawal). ◦ Current disruptive behavior or history of. ◦ Current incarceration: state of being con ned. ◦ Severe electrolyte imbalance (glucose, sodium, ETC.) ◦ Sundown syndrome: a set of symptoms or dementia-related behaviors that may include di culty sleeping, anxiety, agitation, hallucinations, pacing and disorientation. ◦ Trauma ◦ Stressors ( nancial, relational, situational) Apply safety strategies nurses can use with potentially violent patients. ◦ Notify transport sta that person is at risk for violent behavior. ◦ When entering the room of at-risk patient, work with a buddy. ◦ Do not expose your back to the patient. ◦ Keep your back to the door, and ensure clear path of escape to door. ◦ Do not stand directly in front of someone. ◦ Avoid the “strike zone” by maintaining 3 feet of distance from the patient so they cannot hit or kick you if they are upset or angry. ◦ Ask the patient if it is “OK” to touch them, ex: take their vital signs. ◦ Remove stethoscopes from neck, use breakaway lanyards for key/hospital ID badges, etc. ◦ Consider use of PPI if patient throws objects/spits. ◦ For cognitive impairment, maintain low simulation environment. ◦ Remove extra furniture/equipment such as chairs, IV poles, footstools, housekeeping supplies. ◦ Always try to de-escalate the patient rst (provide attention, listen, negotiate). ◦ If patient throws a tantrum, close curtains, door to patient room, call security, stay in room near door to observe what is going on unless patient xates on you. If possible, preserve IV access. Adapt communication to meet the needs of cognitively impaired patients. ◦ Set a positive mood for interaction: your attitude and body language communicate your feelings and thoughts more strongly that your words do. ◦ Get the person’s attention: limit distractions and noise. ◦ State your message clearly: use simple words and sentences. Speak slowly, distinctly, and in a reassuring tone. ◦ Ask simple, answerable questions: ask on question at a time; those with yes or no answers work best. Refrain from asking open-ended questions. ◦ Listen with your ears, eyes, and heart. Watch for nonverbal cues and body language, an respond appropriately. ◦ Break down activities into a series of steps. This makes many tasks much more manageable. ◦ When the going gets tough, distract and redirect. ◦ Respond with a ection and reassurance ◦ Remember the good old days. Remembering the past is often a soothing and a rming activity. ◦ Maintain your sense of humor.