Download - Nursing Lecture Safety Infection Control

8/8/2019 Nursing Lecture Safety Infection Control

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C) Standard precautions

* D) Contact isolation

Review Information: The correct answer is:

D) Contact isolation.

Contact or Body Substance Isolation (BSI) involves the use of barrier

protection (e.g. gloves, mask, gown, or protective eyewear as

appropriate) whenever direct contact with any body fluid is expected.When determining the type of isolation to use, one must consider the

mode of transmission. The hands of personnel continues to be theprincipal mode of transmission for methicillin resistant staphylococcus

aureus (MRSA). Because the organism is limited to the sputum in thisexample, precautions are taken if contact with the patient''s sputum is

expected. A private room and BSI, along with good hand washingtechniques, are the best defense against the spread of MRSA

pneumonia.

Ewald, G.A., & McKenzie, C.R. (Eds.) (1995).The Washington Manual, 28th Edition.

Boston: Little Brown.

Morita, M. (1993).

Methicillin resistant staphylococcus aureus, past, present and future.Nursing Clinics of North America, 28(3), 625-637.

Question 3

Several clients are admitted to an adult

medical unit. The nurse would ensure airborneprecautions for a client with which of the

following medical conditions?

A)A diagnosis of AIDS and

cytomegalovirus

* B)A positive PPD with an abnormal chestx-ray

C) A tentative diagnosis of viral pneumoniaD) Advanced carcinoma of the lung

AnswersCorrect B

Student'sC

Review Information: The correct answer is:B) A positive PPD with an abnormal chest x-ray.

The client who must be placed in airborne precautions is the client with

a positive PPD (purified protein derivative) who has a positive x-ray


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for a suspicious tuberculin lesion.

Black, J., Matassarin-Jacobs, E. (1997).

Medical-Surgical Nursing: Clinical Management for Continuity ofCare (5th ed.).

Philadelphia: Saunders.

Lewis, S., Collier, I., & Heitkemper, M. (1996).

Medical-Surgical nursing: Assessment and management of clinicalproblems. (4th ed).

St. Louis: Mosby

Question 4

Which of the following is the FIRST priority

in preventing infections when providing carefor a client?

* A) Handwashing

B) Wearing gloves

C)Using a barrier between client's furnitureand nurse's bag

D) Wearing gowns and goggles

AnswersCorrect A

Student'sA

Review Information: The correct answer is:A) Handwashing.

Handwashing remains the most effective way to avoid spreading

infection. However, too often nurses do not practice good handwashingtechniques and do not teach families to do so. Nurses need to wash

their hands before and after touching the client and before entering thenursing bag.

Nelson, M. (1996, December).It''s As Easy As Washing Your Hands.Home Health FOCUS, 3(7), 51.

Miranda, G. (1997).Universal Precautions. In KS Martin, BJ Larson, LA Gorski, and DM

Hayko (Eds.)


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Question 5

When a client is diagnosed with tuberculosis,the nurse notifies the public health department

because

A) Disease statistics must be maintained

* B) Disease contacts need to be traced

C) Incidence of tuberculosis is on the rise

D) Additional tests must be done

AnswersCorrect B

Student'sB

Review Information: The correct answer is:B) Disease contacts need to be traced.

Tuberculosis is a reportable disease because persons who had contact

with the client must be traced.

Ashwill, J. W., and Droske, S. C. (1997)

Nursing care of children: Principles and practice.Philadelphia: W. B. Saunders. pp. 898-899.

Question 6

The school nurse is teaching the faculty the

most effective methods to prevent the spreadof lice in the school. The MOST appropriate

information would be

A)The classroom should be sprayed withan insecticide at the end of each day

B)The transmission can be prevented by

personal cleanliness

* C)Lice can be transmitted by hats andcombs

D) Lice are carried by household pets

AnswersCorrect C

Student'sC

Review Information: The correct answer is:C) Lice can be transmitted by hats and combs.

Head lice live only on human beings and can be spread easily by

sharing hats, combs, scarves, coats and other items of clothing thattouch the hair.

Wong, D. (1999)


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Whaley and wong''s nursing care of infants and children (5th ed.)

St. Louis: Mosby. pp. 783-785.

Ball J. and Bindler, R. (1995).Pediatric nursing: Caring for children.

Norwalk, CN: Appleton and Lange.p. 698.

Question 7

A client is scheduled to receive an oral

solution of radioactive iodine. In order toreduce hazards, the nurse should instruct the

client that

* A)Urine and saliva will be radioactive for

24 hoursB) No solid food may be eaten for 24 hours

C) No precautions will be necessary

D) No visitors will be allowed

AnswersCorrect A

Student'sA


A) Urine and saliva will be radioactive for 24 hours.

The client''s urine and saliva are radioactive for 24 hours after

ingestion, and vomitus is radioactive for 6-8 hours. The client should

void into a lead-lined container, use disposable utensils, and avoid

close contact with children and pregnant women for 48 hours afteringestion.

Nettina, Sandra (2000).The Lippincott Manual of Nursing Practice. Sixth Edition.

Lippincott. Philadelphia - New York. 1966. Page 112.

Luckmann, Joan.

Saunders Manual of Nursing Care.W.B.Saunders Company. Philadelphia. 1997. Page 1397.

Question 8

Which of the following nursing diagnosis

would place an 86 year-old client atGREATEST risk for falls?

AnswersCorrect D

Student'sA


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A)Sensory perceptual alterations related todecreased vision

B) Alteration in mobility related to fatigue

C)Impaired gas exchange related to

retained secretions

* D)Altered patterns of urinary eliminationrelated to nocturia


D) Altered patterns of urinary elimination related to nocturia.

Nocturia is especially problematic because many elders fall when they

rush to reach the bathroom at night. They may be confused or not fullyalert. Inadequate lighting can increase their chances of stumbling and

they may fall over furniture or carpets.

Sloan, H. (1997).Preventing Falls among the Elderly. In KS Martin, BJ Larson, LA

Gorski, and DM Hayko (Eds.), Mosby''s Home Health Client TeachingGuides: Rx for Teaching, IV G 1-8.

St. Louis: Mosby.

Question 9

A ten year-old child has a history of tonic-

clonic seizures. The school nurse shouldinstruct the classroom teacher that if the child

experiences a seizure in the classroom, theMOST important action would be to

A)Insert a plastic airway to maintainrespirations

B) Restrain the child to prevent self-injury

C)Provide privacy to prevent

embarrassment

* D) Protect the child from injury

AnswersCorrect D

Student'sD

Review Information: The correct answer is:D) Protect the child from injury.

The child must be protected from injury during a seizure. Place apillow, folded blanket or your hands under the child''s head to prevent

harm.


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Wong, D. (1999).

Whaley & Wong''s Nursing Care of Infants and Children..St. Louis: Mosby. Pages 1722.

Ball, J.& Bindler, R. (1995).

Pediatric nursing: Caring for children.Norwalk: Appleton & Lange. Page 444

Question 10

A child has been admitted after swallowing ahousehold cleaner. Which of the following

assessments suggests to the nurse that thepoison is a corrosive?

* A) Burning mouth and throat painB) Bradycardia and orthopnea

C) Oliguria and cyanosis

D) Diarrhea and vomiting

AnswersCorrect A

Student'sA


A) Burning mouth and throat pain.

Local irritation of tissues points to corrosive poisoning.

Wong, D (1995).

Whaley and Wong''s Nursing care of infants and children.St. Louis: Mosby. page 691.

Ashwill, J & Droske, S (1997).

Nursing care of children.Philadelphia: Saunders. page 337.

Question 11

The nurse assigned to the emergency roomunderstands that syrup of ipecac iscontraindicated in which of the following?

* A)An infant has ingested a mouthful ofgasoline

B)A toddler ate a number of ibuprofen

tablets

AnswersCorrectA

Student'sA


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C)A preschooler swallowed powderedplant food

D)A school aged child took a handful of

vitamins

Review Information: The correct answer is:A) An infant has ingested a mouthful of gasoline.

There is a risk of aspiration pneumonia if fumes from hydrocarbons are

inhaled during vomiting. The poison control center should be contacted

and the infant should be rushed to the emergency room.

Wong, D (1995).Whaley and Wong''s nursing care of infants and children. (5th ed).

St. Louis: Mosby page 688.

Ashwill, J & Droske, S (1997).Nursing care of children.Philadelphia: Saunders, page 340.

Question 12

In caring for a client with salmonella infection,

the PRIMARY nursing intervention to limittransmission is

* A) Wash hands thoroughly before and afterclient contact

B)Wear gloves when in contact with body

secretions

C)Double glove when in contact with fecesor vomitus

D)Wear gloves when disposing of

contaminated linens

AnswersCorrect A

Student'sA


A) Wash hands thoroughly before and after client contact.

Gram-negative bacilli cause Salmonella infection. Two million new

cases appear each year. Lack of sanitation is the primary means of

contamination. Thorough handwashing can prevent the spread ofsalmonella.

Springhouse.Handbook of Medical-Surgical Nursing. Second Edition.


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Springhouse Corporation, Springhouse, PA. 1998. Pages 830-833.

Question 13

The mother of an infant who is being treatedfor pesticide poisoning asks why activated

charcoal is the treatment. What is the nurse'sBEST response?

A)"Activated charcoal stimulates bowelevacuation, thus decreasing systemic

absorption of the poison."

* B)"The charcoal absorbs the poison andforms a compound that doesn't hurt your

child."

C)"This liquid causes vomiting whicheliminates the poison from the body."

D)"When it is absorbed from her veins,activated charcoal neutralizes the

poison."

AnswersCorrect B

Student'sB


B) "The charcoal absorbs the poison and forms a compound thatdoesn''t hurt your child.".

This response is accurate information about the effectiveness of

activated charcoal. Language is appropriate for a parent''s

understanding.

Wong, D (1995).

Whaley and Wong''s Nursing care of infants and children.St. Louis: Mosby. page 682.

Hodgson, B & Kizior, R (1998).Saunders nursing drug handbook 2001.Philadelphia: Saunders. .

Question 14


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The nurse is caring for a newly admitted adultclient with a diagnosis of Hepatitis A. The

MOST significant routine infection controlstrategy, in addition to handwashing, is

A) Implementing a ventilation flow

B) Wearing a mask during care

C) Using a gown to change linens

* D) Gloving while handling bedpans

AnswersCorrect D

Student'sD


D) Gloving while handling bedpans.

The specific measure to prevent the spread of hepatitis A is careful

handling and protection while handling fecal material.

Potter, P. & Perry, A. (2000).Fundamentals of Nursing: Concepts, Process and Practice.

St. Louis: Mosby.

Thompson, J., McFarland, G., Hirsch, J., & Tucker, S. (1993).Mosby''s Clinical Nursing. (3rd ed.).

St. Louis: Mosby.

Question 15

The nurse is caring for a client with active

tuberculosis. Which of the following protocolswould be ESSENTIAL for the nurse to

implement?

A)

Place client in a room with another

client with tuberculosis and staff shouldwear masks

B)Place client in a negative pressure room

and staff uses mask and gloves

C)Place client in a private room and staffwears masks, gloves and gowns

* D)Place client in a negative pressure room

and staff uses masks

AnswersCorrect D

Student'sD


D) Place client in a negative pressure room and staff uses masks.


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A client with active tuberculosis should be hospitalized in a negative

pressure room to prevent respiratory droplets from leaving the room

when the door is opened.

Nettina, Sandra (2000).The Lippincott Manual of Nursing Practice. Sixth Edition.Lippincott. Philadelphia-New York. 1996. Page 224.

Luckmann, Joan.

Saunders Manual of Nursing Care.W.B.Saunders Company. Philadelphia. 1997. Page 949-951

SAFETY AND INFECTION CONTROL

Fire Extinguishers

Types Use

1. Carbon dioxide grease, electrical

2. Soda and acid paper and rubbish

3. Dry Chemical rubbish, electrical

4. Antifreeze or water rubbish, grease, wood

1. In a fire, the nurse acts in PRC order:A. Protects clients from injuryB. Reports the fireC. Contains the fire

Get a clue

Remember the kinds of Infection Control by remembering which link

they attack:

Six Links Five Control Mechanisms: AXIPPI

Pathogen Anti-drugs: Kill or weaken pathogens

Reservoir Host X-terminators: Kill nonhuman reservoirs & vectors

Port of Exit Isolation &Precautions


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Transmission Precautions

Port of Entry Precautions

Susceptible Host Immunization

Strict Isolation

1. Designed for highly contagious infections that are spread by airborne dropletnuclei and contact transmission

2. Required in these diseases (among others):A. Varicella-zoster (chicken pox)B. Pharyngeal diphtheriaC. Herpes zoster (shingles)D. Viral hemorrhagic fevers

3. Strict Isolation requires two techniques: PAN+MGA. Private room with Negative AirflowB. Everyone who enters the room must wear Mask, Gown and Gloves.

Contact Isolation

1. Prevents highly transmissible infections that are not spread by airborne dropletnuclei, but are transmitted mainly by close and direct contact


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2. Required in (for example):A. Viral respiratory infections in children (such as respiratory syncytial virus--

RSV)B. Vancomycin-resistant enterococcusC. Disseminated herpes simplexD. Scabies

E. Pediculosis (lice)F. Methicillin-resistant staphylococcus aureus

3. Contact Isolation Involves: PMG A. Private room,B. Masks for anyone providing close, direct care to the client,C. Gowns if soiling is likely, andD. Gloves for touching infective material

Respiratory Isolation

1. Prevents transmission of diseases that spread short distances via the air (droplettransmission)

2. Required in (for example): A. MeaslesB. Meningococcal meningitisC. PneumoniaD. MumpsE. Pertussis (whooping cough)

3. Respiratory Isolation Involves: P (or C) +MA. Private room or cohorting clients with the same pathogen, andB. Masks for everyone providing close, direct care to the client

Drainage/Secretions Precautions

1. Prevents infections transmitted by direct or indirect contact with pus or otherdrainage from an infected body site

2. Used in, for example:A. Skin infectionB. Minor abscess

C. Conjunctivitis3. Drainage/Secretion Precautions Involve: G; Gowns and gloves if contact withinfective material is likely

Tuberculosis/Acid-Fast Bacillus

(AFB Isolation)Used for clients with pulmonary or pharyngeal tuberculosis

1. AFB Isolation involves: PAN, M, G


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y Sterile touching questionable is contaminated.y Only sterile objects may be placed on a sterile field.

2. A sterile object or field out of range of vision, or an object held below aperson's waist, is contaminated.

3. Never turn your back on a sterile field.

4. A sterile object or field becomes contaminated5. by prolonged exposure to air.6. When a sterile surface comes in contact with a wet, contaminated surface,

the object or field becomes contaminated by capillary action.7. Always hold your hands above the level of your elbows.8. The edges of a sterile field or container are considered contaminated.

Safety

y Know your institution's plan for fire drills and evacuation.y Know the emergency phone number for reporting fire.y

Know locations of all fire alarms, exits, and extinguishers.y PRC: first protect people, then report fire, then try to contain it.y In a fire, never use an elevator.y Turn off all oxygen supplies in the area of the fire.y In a fire, close all doors and windows.y In a power failure, only certain electrical outlets access the emergency

generators, know which ones they are.

Poisons

y Never induce vomiting for these poisons: Iye, household cleaners,

petroleum products, and furniture polish.y If you suspect someone has taken poison, save any vomitus and take it

with the victim to an emergency room.

Infection

y A pathogen cannot infect if you break even one of the six links in the chainof transmission.

y Clients at high risk for infection get prophylactic antibiotics before surgicalprocedures.

y The major sites fornosocomial infections are urinary and respiratorytracts, blood, and wounds.

y All nosocomial infections that occur in hospitals must be tracked andrecorded.

y The single most effective preventer of infection is hand washing.