Nursing: A Concept-Based Approach to Learning, 2nd Edition

- 3 - 3 Click to edit Master text styles Second level Third level Fourth level Click to edit Master title style Copyright 2015, 2011 by Education, Inc. All Rights Reserved Nursing A Concept-Based Approach to Learning Volume One, Second Edition Copyright 2015, 2011 by Education, Inc. All Rights Reserved Nursing A Concept-Based Approach to Learning VOLUME ONE SECOND EDITION Nursing A Concept-Based Approach to Learning Volume One, Second Edition Copyright 2015, 2011 by Education, Inc. All Rights Reserved Nursing A Concept-Based Approach to Learning Volume One, Second Edition Click to edit Master text styles Second level Third level Click to edit Master title style Copyright 2015, 2011 by Education, Inc. All Rights Reserved Nursing A Concept-Based Approach to Learning Volume One, Second Edition Click to edit Master text styles Second level Third level Fourth level Fifth level Click to edit Master title style Copyright 2015, 2011 by Education, Inc. All Rights Reserved Nursing A Concept-Based Approach to Learning Volume One, Second Edition Click to edit Master text styles Second level Third level Fourth level Fifth level Infection Nursing A Concept-Based Approach to Learning MODULE VOLUME ONE SECOND EDITION The Concept of Infection Concept Learning Outcomes Concept Learning Outcomes, continued After reading about this concept, you will be able to Differentiate common assessment procedures used to examine for the presence of infection across the life span. Describe diagnostic and laboratory tests to determine the individual s infection status. Concept Learning Outcomes, continued Concept Learning Outcomes, continued After reading about this concept, you will be able to Compare and contrast common independent and collaborative interventions for clients with infection. Normal Presentation Normal Presentation, continued Microorganisms vary in virulence Pathogenicity Pathogen Opportunistic pathogen Infectious diseases major cause of death Asepsis Medical asepsis Surgical asepsis Types of Microorganisms Causing Infections Four categories of microorganisms Bacteria Most commonly cause infection Viruses Nucleic acid, must enter living cells Fungi Yeasts, molds Parasites Protozoa, helminths, arthropods Types of Infections Chain of Infection Six links Etiological agent Reservoir Portal of exit from reservoir Method of transmission Direct Indirect Airborne Chain of Infection, continued Six links Portal of entry Skin is barrier to infectious agents Break in skin can readily serve as a portal of entry Enter the body as the same route as they left the source Mouth, throat, nose, eyes and genitalia are most frequent portals of entry Chain of Infection, continued Six links Susceptible host An individual who is at risk for infection Infants Young children Compromised host Individual at risk that is more likely than others to acquire infection Physiology Review Specific defenses Anatomical and physiological barriers Intact skin Nasal passages Each body orifice has its own defenses Genetic and Lifespan Considerations Genetic and Lifespan Considerations, continued Older adults Have reduced defenses Physiological changes Cardiovascular changes Respiratory system changes Genitourinary changes Gastrointestinal changes Skin, subcutaneous tissue changes Immune changes Genetic and Lifespan Considerations, continued Older adults Aging process Thymus gland atrophies Antibody responses decline Reduced resistance to antigens Classic signs of infection may be absent Alterations Pathogens Pathogens, continued Exotoxins Soluble proteins that the microorganisms secrete into surrounding tissue Highly poisonous Causes cell death or dysfunction Endotoxins Found in the cell wall of gram-negative bacteria Released only when the cell wall is disrupted Stages of the Infectious Process Stages of the infectious process Incubation period Prodromal stage Illness stage Convalescent stage Carrier state Host defenses eliminate infectious disease Organism continues to multiply Concepts Related to Infection Elimination Inflammation Sexuality Tissue Integrity Teaching and Learning Alterations and Manifestations Alterations and Manifestations, continued Healthcare-associated infections (HAIs) Can develop During client s stay in the facility Manifest after discharge Urinary tract infection is the most common type of HAIs Alterations and Manifestations, continued Healthcare-associated infections (HAIs) Sources Endogenous Exogenous Iatrogenic Alterations and Manifestations, continued Alterations and Manifestations, continued Alterations and Manifestations, continued Biological threat infections Most likely pathogens Anthrax Smallpox Botulism Pneumonic plague Viral hemorrhagic fevers Alterations and Manifestations, continued Pediatric infectious and communicable diseases Healthy People 2020 goal Eliminate Rubella and congenital rubella syndrome Serogroup A meningitis Neonatal tetanus Alterations and Manifestations, continued Healthy People 2020 goal Reduce Pertussis Hepatitis B Varicella Measles Other vaccine-preventable diseases Food-borne pathogens HIV infection Prevalence Change of a healthcare worker becoming infected from exposure to pathogens varies widely 30 hepatitis B 1.8 for hepatitis C 0.3 for HIV Genetic Considerations and Nonmodifiable Risk Factors Some medical therapies may predispose an individual to infection Radiation treatments Medications such as antineoplastic medications Disease that lowers the body s defenses Prevention Good hand washing Getting immunizations Preventing airborne droplets from spreading Taking precautions when handling potentially contaminated materials Healthcare Worker Precautions Healthcare Worker Precautions, continued Disinfecting When disinfecting articles, consider Type, number of infectious organisms Recommended concentration of disinfectant, duration of contact Presence of soap Presence of organic materials Surface areas to be treated Healthcare Worker Precautions, continued Sterilizing Destroys all microorganisms Moist heat Gas Boiling water Radiation Healthcare Worker Precautions, continued Isolation precautions Isolation Measures to prevent spread of infection Category-specific Disease-specific Universal precautions Body substance isolation Avoid injury from sharp instruments Healthcare Worker Precautions, continued CDC (HICPAC) isolation precautions New guidelines Standard precautions Transmission-based precautions Airborne Droplet Contact Healthcare Worker Precautions, continued Isolation practices Initiation of isolation nursing responsibility Based on comprehensive assessment Aseptic precautions Strict aseptic technique Change IV tubing, solution containers per policy Healthcare Worker Precautions, continued Isolation practices Initiation of isolation nursing responsibility Aseptic precautions Check all sterile supplies for expiration, intact packaging Prevent UTIs Measures to prevent impaired skin integrity Healthcare Worker Precautions, continued Personal protective equipment (PPE) Gloves Protect hands Reduce transmission of microorganisms Change between client contacts Clean hands with glove removal Latex allergy issues Gowns Clean or sterile Single-use gown technique Healthcare Worker Precautions, continued Personal protective equipment (PPE) Face masks Reduce risk of droplet or airborne transmission Worn by Those close to client if droplet route All individuals entering room if airborne Healthcare Worker Precautions, continued Personal protective equipment (PPE) Face masks Types of masks Single-use disposable Disposable particulate respirators N95 Surgical asepsis Eyewear Healthcare Worker Precautions, continued Disposal of soiled equipment and supplies Specific policies, procedures Bagging Linens Laboratory specimens Dishes Blood pressure equipment Disposable needles, syringes, sharps Disposable and nondisposable equipment and supplies Healthcare Worker Precautions, continued Transporting clients with infection Avoid transporting outside room Cover wound Surgical mask Psychosocial needs of isolation clients Sensory deprivation Decreased self-esteem Nursing interventions Sterile Technique Sterile Free of all microorganisms Principles and practice of surgical asepsis Sterile field Microorganism-free area Use the innermost side of a sterile wrapper Use a sterile drape Sterile Technique, continued Sterile gloves May be donned by the open method or closed method Packaged with a cuff of approximately 5 cm and palms facing upward when package is opened Sterile gowns Where surgical asepsis is necessary Effective hand washing is the single most important measure in infection control Invasive procedures and equipment should only be used when absolutely necessary Medical and surgical asepsis is necessary Infection Control for Healthcare Workers NIOSH found majority of needlestick injuries preventable OSHA publishes and enforces regulations to protect healthcare workers from occupational injuries Infection Control for Healthcare Workers, continued Occupational exposure Modes of transmission in clinical setting Puncture wounds Skin contact Mucous membrane contact Role of the Infection Control Nurse Specially trained Knowledgeable about Prevention Detection Treatment All infections reported to IC nurse Employee education Client Precautions Modifiable risk factors Hygiene Nutrition Fluid Sleep Stress Client Precautions, continued Immunizations Dramatically decrease incidence of infectious disease Should begin shortly after birth Completed throughout childhood Injection Inhalation Oral solutions Nasal sprays Assessment Assessing clients for infection is vital to Treating clients Preventing spread of infection Especially important for clients at risk of infection such as those with IV lines Indwelling catheters Surgical wounds Nursing Assessment Nursing history Assess degree of client risk Chart review Interview Physical assessment Signs, symptoms vary with body area involved Skin, mucous membranes Signs of systemic infection Nursing Assessment, continued Physical assessment Localized swelling Localized redness Pain or tenderness with palpation movement Palpable heat in infected area Loss of function in body part affected Depends on site and extent of involvement Nursing Assessment, continued Physical assessment Signs of systemic infection Fever Increased pulse Malaise and loss of energy Loss of appetite and, in some situations, nausea and vomiting Enlargement or tenderness of lymph nodes that drain area of infection Lifespan and Cultural Considerations Infants and children Need special consideration during assessment Hands and instruments warm Explain procedures to children old enough to understand Infant and toddlers held by parents to feel secure Distractions might calm child Lifespan and Cultural Considerations, continued Pregnant women Special considerations for infection that may cause birth defects Rubella Cytomegalovirus Parvovirus Chicken pox Lifespan and Cultural Considerations, continued Infections that may be transmitted to the newborn HIV Group B Streptococcus Cytomegalovirus Listeriosis Diagnostic Tests WBC count WBC differential Procalcitonin Cultures of wound, blood, or other infected body fluids Serological testing Direct antigen detection methods Diagnostic Tests, continued Antibiotic peak, trough levels Radiological examination of the chest, abdomen, or urinary system Lumbar puncture Ultrasonic examination Urinalysis Interventions and Therapies Identify organ system involved Identify causative agent Achieve a cure by the least toxic, least inexpensive and most effective means Once causative agent is identified, therapy can be specifically tailored Independent Hand hygiene Basic medical asepsis Use of standard precautions Isolation techniques Sterile field Use of PPE and decontamination Collaborative With physician or other healthcare professionals Nurse may be responsible for Collecting specimens for laboratory testing Retrieving lab results Administering medications