Version 3 Medical Asepsis Case Study Review with Next Gen Spring 2024-1.pdf

KATHY KUSHTO-REESE, MSN, RN MEDICAL ASEPSIS NICOLE JOHNSON, MSN, RN CASE STUDY SHARI LYNN, MSN, RN LECTURE REVIEW  MEDICAL ASEPSIS REVIEW Wolf Hospital is very concerned with their infection rate and keeping their patients safe from infec...

KATHY KUSHTO-REESE, MSN, RN MEDICAL ASEPSIS NICOLE JOHNSON, MSN, RN CASE STUDY SHARI LYNN, MSN, RN LECTURE REVIEW  MEDICAL ASEPSIS REVIEW Wolf Hospital is very concerned with their infection rate and keeping their patients safe from infection. Medical Asepsis is very important to them. Patient X is admitted to Wolf Hospital. Patient X is having a benign tumor removed from the right lower extremity. The surgeons will need to remove the tumor and some surrounding tissue, resulting in a deep surgical wound. You are the patient’s nurse. The patient states “Everyone keeps washing their hands and using hand sanitizer all the time. I was told this is related to medical asepsis. What is medical asepsis?” What do you tell your patient? Answer: Medical asepsis is reducing the number or spread of microorganisms to keep staff, visitors and other patients safe. Why are we so concerned with hand washing? Answer: Best method to decrease the spread of organisms.  MEDICAL ASEPSIS REVIEW During the admission process, you find out that Patient X is 77 years old, is a diabetic, has been feeling very stressed so has not been eating. The patient has PVD (peripheral vascular disease). What information increases the patient’s risk of infection? Answer: Elderly Decreased nutritional status. Poor circulation secondary to PVD resulting in decreased oxygen and nutrients delivered to the wound. Diabetes Increased cortisol production secondary to stress which can decrease the immune response and increase glucose levels. MEDICAL ASEPSIS REVIEW Patient X goes off to surgery. The patient returns to the unit in the evening with a central line in place, along with an indwelling (Foley) urinary catheter. The next morning, while you are getting report, the night nurse states that Patient X spiked a fever last night and was shivering. The patient’s temperature was 39°C (102.2°F). The patient is later cultured only to find out that Patient X has MRSA. The patient states, “I heard the nurse talking about a nosocomial infection. What does that mean?” Answer: Nosocomial infection is a hospital acquired infection that was not present when the patient was admitted.  MEDICAL ASEPSIS REVIEW As a nurse, you are aware of many possible sources of infection such as SSI, CAUTI, CLABSI, MRSA, VRE and C-diff? What are these? SSI MRSA Surgical Site Infection Methicillin Resistant Staff Aureus CAUTI Catheter Associated Urinary Tract VRE Infection Vancomycin Resistant Enterococcus CLABSI Central Line Associated Bloodstream C-Diff Infection Clostridium Difficile MEDICAL ASEPSIS REVIEW Patient X is now on Contact Precautions? What PPE will you be wearing to enter the room? (Pre-Covid). Answer: Gown and Gloves  MEDICAL ASEPSIS REVIEW Patient X has been complaining of a cough and chest tightness in addition to fever. The patient is diagnosed with pneumonia, put on 3 liters of oxygen through a nasal cannula and is put on Droplet Precautions. What PPE will you be wearing to enter the room? (Pre-COVID). Answer: Gown, gloves, and mask/shield.  MEDICAL ASEPSIS REVIEW Patient X is on multiple antibiotics which can cause C-Diff. What objective data might make you suspect that the patient has C-Diff? Answer: Explosive, consistent diarrhea, abdominal discomfort/ pain, dehydration, nausea, loss of appetite. What is an important hand disinfecting rule you need to know regarding C-Diff? Answer: Soap and water. Purell is not effective.  MEDICAL ASEPSIS REVIEW A new patient has been admitted to the unit and has been placed in a negative pressure room. What kind of precaution is this? Answer: Airborne Precaution. A negative pressure room is required for patients with airborne infections such as TB, Measles, SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome) and COVID. What PPE will be worn to enter the room? Answer: N95 mask or PAPR (Powered Air Purifying Respirator). What is the purpose of a negative pressure room? Answer: Protects healthcare workers, not the patient, by drawing air into the room from the hallway and ante room, up into the ventilation system which includes HEPA filters. PPE is donned and doffed in the ante room. MEDICAL ASEPSIS REVIEW Post surgery, Patient X has a wound that needs a moist-to-moist dressing change. How will you perform the a moist-to-moist dressing change? Answer: Irrigate wound, place pre- moistened gauze in the wound, then cover with a thick bandage (ABD pad). Why is this considered a sterile dressing change? Answer: This dressing change requires sterile supplies.  JEOPARDY KNOWLEDGE CHECK SURGICAL WOUND HEALING ( OR “WHAT IS YOUR INTENTION?”) PLEASE ANSWER IN THE FORM OF A QUESTION☺ Answer: Purposeful delay of closure due to an infection or need to first remove eschar/slough. Question: What is Tertiary Intention? Answer: Well approximated edges. Question: What is Primary intention? Answer: Open wound, edges not approximated due to tissue loss. Question: What is Secondary Intention? MEDICAL ASEPSIS REVIEW Patient X states that their neighbor fell out of a tree and was admitted to the hospital with a broken leg. When Patient X went to visit, the neighbor had a “cage” on their leg. Patient X asks what it is. How do you respond? Answer: The device is an external fixator. What is the purpose of this device? Answer: Stabilizes fractured bones while they heal. As a nurse, you know, if you had a patient with an “ex fix,” you would be performing pin care. What is pin care? Answer: It is care of the pins that anchor the device in place as to reduce the chance of infection at the insertion site.  KNOWLEDGE CHECK Xeroform Hydrocolloi Silver d What are these examples of? Answer: Wound care modalities. Calcium Nu Gauze Alginate MEDICAL ASEPSIS REVIEW Patient X states that there was a program on TV that showed maggots being used to treat a wound. The patient asks why maggots would be used and why don’t the maggots just eat the patient’s whole leg off and then turn into flies? How do you respond? Answer: Maggots are used as a last resort when other treatments have failed. Maggots only eat dead tissue, not healthy tissue. The maggots are raised in a sterile lab and disinfected/sterilized so they do not turn into flies. MEDICAL ASEPSIS REVIEW You have a nursing student with you and the student is doing the dressing change for Patient X. You notice that the student flipped the gauze onto the sterile field, and it landed at the very edge. What would you tell the student to do next? Answer: Leave the gauze there and use a different gauze because that piece of gauze is no longer sterile as it is now resting on the one-inch border. MEDICAL ASEPSIS REVIEW You have a nursing student with you and the student is doing the dressing change for Patient X. You notice that the student has already donned sterile gloves before pouring the saline on the kerlix (gauze), and the bottle of saline is sitting on the opposite side of the sterile field. Why does this concern you? Answer: The student will contaminate the sterile field by reaching over the sterile field to reach the bottle of saline and they will contaminate their sterile gloves by touching the bottle of saline. MEDICAL ASEPSIS REVIEW You notice there is a pinkish clear fluid on the dressing when it is removed from the wound. How would you document this fluid? Answer: Serosanguinous What would you document if it was bright red? Answer: Sanguinous What would you document if it was clear? Answer: Serous What would you document if it was a milky, white pus, yellow or greenish tinge? Answer: Purulent MEDICAL ASEPSIS REVIEW Lucky you, new admission Patient Y, has been assigned to you. Patient Y also needs a dressing change for a decubitus ulcer. Upon first assessment, you note that tendons are visible in the wound. How would you stage this wound? Answer: Stage IV, full thickness tissue loss with exposed bone, tendon or muscle. May include tunneling. Increased risk for osteomyelitis.  JEOPARDY KNOWLEDGE CHECK: WOUND STAGING PLEASE ANSWER IN THE FORM OF A QUESTION☺ Area of redness, may be painful, and skin intact. What is a Stage I wound? Full thickness tissue loss, significant amounts of slough/eschar. What is an Unstageable wound? Partial thickness loss of dermis, red/pink wound bed. Example: formed or popped blister. What is a Stage II wound? Purple/red colored area of intact tissue, blood filled area, may be painful, boggy to touch. What is a Deep Tissue Injury? Full thickness tissue loss, may see subcutaneous tissue but no bone, tendon or muscle. May include tunneling. What is a Stage III wound?  MEDICAL ASEPSIS REVIEW Patient X is complaining of pain where the nasal cannula rests on the patient’s ear. You take a look and see a blister has formed. What is this an example of? Answer: HAPI (Hospital Acquired Pressure Injury), The cannula has rubbed the patient’s ear causing a wound. MEDICAL ASEPSIS REVIEW Patient X tells you that after a previous surgery, the patient had a drain, right near the surgical site, that the nurse had to empty. What did the patient mean by that? Answer: The patient may have had a Hemovac, Jackson Pratt or Davol. How do these drains work? Answer: Suction. Usually emptied q4 hours, measured and documented.  MEDICAL ASEPSIS REVIEW While changing the dressing on Patient X, you notice some yellow and black tissue in the wound. You document this and mention it to the wound care nurse. What is that tissue? Answer: Yellow – slough Black - eschar MEDICAL ASEPSIS While completing your online documentation, you see a new order has been added for Santyl cream to the wound to address eschar and slough. What is this cream and what is it for? Answer: This cream is a collagenase enzymatic ointment for debridement of the slough/eschar to liquefy this tissue so it can be removed from the wound. MEDICAL ASEPSIS Patient X has a lot of drainage from the wound. The wound care nurse recommends a wound vac. The patient asks you what a wound vac is and what it does for a wound. What do you tell your patient? Answer: A wound VAC (Vacuum Assisted Closure) device is a vacuum-like device for wounds with extensive drainage. What are the benefits of a wound VAC? Remove exudate/drainage Decrease edema Increase approximation of wound edges Increase capillary growth Increase blood flow Decrease healing time Promote granulation tissue Decrease length of hospital stay Increase proliferation of cells MEDICAL ASEPSIS REVIEW The student nurse working with you asks, “Does every patient get a wound vac for every wound?” With your great knowledge of wound vacs, how do you respond? Answer: No, not every patient can have a wound vac. What would be a contraindication to a wound VAC? Eschar/slough in a wound Untreated osteomyelitis Cancer in the wound  While standing at the nurse’s station, you hear another nurse state that one of their patients will be going to the hyperbaric chamber for wound MEDICAL healing. How would the hyperbaric ASEPSIS chamber assist in wound healing? REVIEW Answer: The chamber is filled with pressurized oxygen, 2.5 times normal air pressure which encourages oxidative killing of bacteria, angiogenesis and collagen synthesis to help speed up the healing process.  MEDICAL ASEPSIS REVIEW Great job nurse!! You did a great job caring for your patient and it was so kind of you to work with a nursing student! But we are not done yet…………. NextGen Case Study Medical Asepsis  PART I ASSESSING CUES Patient is a 75-year-old with a history of osteoporosis and diabetes, is admitted with a fractured femur. Patient is on bedrest. It is currently day 4. You are performing a skin assessment. When assessing the sacral area, which findings are normal or abnormal? Normal Abnormal Dry skin Red skin Intact skin Painful to touch  PART II WHAT COULD IT MEAN? 0800 When bathing patient, Based on your assessment, what could they complain of pain in be happening? (Mark All That Apply) sacral area. Assessment includes pain rating of a. Tissue breakdown 8/10, reddened skin and b. Diabetic neuropathy small blister. c. Sciatica d. Decreased perfusion e. Immobility complication f. DVT  PART III PRIORITIZE HYPOTHESIS 0800 Based on the findings, what When bathing patient, could be happening? they complain of pain in sacral area. Assessment a. Eschar formation includes pain rating of b. Tunneling of wound 8/10, reddened skin and c. Unstageable wound small blister. d. Slough formation e. Stage II decubitus ulcer f. Wound evisceration  PART IV GENERATE SOLUTIONS (WHAT CAN THE NURSE DO) Based upon the nursing actions, please indicate the immediacy of the action 0800 When bathing patient, Action Immediate Within the Hour they complain of pain in Turn patient sacral area. Assessment Wound consult includes pain rating 8/10, reddened skin and small Notify provider blister. Cleanse wound Pain assessment Apply dressing  PART V TAKE ACTION 0800 Upon your new assessment When bathing patient, data, what orders would the they complain of pain in nurse expect? (Mark All sacral area. Assessment That Apply?) includes pain rating 8/10, reddened skin and small a. Wound culture blister. b. Debridement of wound 1200 c. Leave wound open to air During dressing change, it d. Turn q 2 hours is noted that the blister has e. VS q 4 hours popped and exudate f. Pain medication present THANK YOU FOR YOUR ATTENTION