Hello and welcome to the unit 5 lecture on asepsis and infection control. Your
Competency for this is to provide nursing care with for patients with infection.
Your learning objectives are here. Again, Please familiarize yourselves with them in preparation for class and in preparation for the exam.
So there's many agents and organisms that cause infection. Bacteria and viruses are probably the most common.
Unfortunately, multi drug-resistant organisms, or superbugs, are becoming more common.
These superbugs are particularly concerning because they're resistant to certain antibiotics. This really limits treatment options for patients.
Treatment becomes even more limited if the patient is or develops an allergy to antibiotics that would normally work.
Infection requires each one of the six genes to be present.
So we break any link in the chain of infection to stop infection. And what's the most important?
Hand-washing! Hand-washing is the most important way we can stop the spread of infection and break that chain.
Healthcare associated infections, also known as nosocomial infections, are infections that happen to patients receiving medical care.
They can happen as a result of antibiotic use. These are called multi
drug-resistant infections and they happen as bacteria mutate and become resistant to antibiotics.
They can also happen as a result of devices used in healthcare such as central lines and Foley catheters.
Nosocomial infections are a real problem for patients who are probably already compromised and this adds to their healthcare needs.
Reimbursement for complications of HAI's may be denied and this leaves hospitals without revenue.
Additionally these increase costs, the length of stay, and patient mortality rates.
Hand hygiene is the most important thing you can do to stop the spread of infection. So when should you wash your hands?always? Always,
it seems! At the beginning and end of your shift, before and after contact with the patient,
between contacts with different patients, before and after contact with wounds, dressings,
specimens or bedclothes,
before performing any invasive procedure, before administering medications,
after contact with any patient secretion or excretion, after body fluid exposure,
after contact with the patient's environment, before and after you use the bathroom,
after sneezing coughing or blowing your nose, and especially after removing your gloves.
When in doubt wash even if you had gloves on. Gloves don't eliminate the need for hand hygiene because gloves might have
microscopic tears or holes that we can't see and this actually allows bacteria onto our hands.
Hand sanitizer is an acceptable alternative, but not with c-diff. It doesn't kill the spores.
So remember soap and water is a must for c-diff!
Also keep your fingernails short and avoid nail polish. Personal protective equipment or PPE
is used when we need extra protection based on how the illness or diseases spread. So for example, influenza is spread by droplets
so we need a mask when caring for these patients. And that's to protect us from catching their influenza.
Standard or universal precautions are used with every patient.
They include basic precautions like hand washing and wearing gloves. The Centers for Disease
Control recommends treating every patient as though they're infectious. There's no way to tell that a
patient might be infected with hepatitis or HIV until they're in their later stages.
So anytime there's a risk of getting blood or body fluids splash on you, please wear a protective
personal equipment and make it appropriate- so like goggles, mask, and a gown if you're thinking there's gonna be a splash. And
then remove contaminated items as soon as possible and of course
wash your hands!
Isolation precautions are special precautions used in conjunction with
universal precautions for patients with certain communicable diseases like MRSA and TB.
Contact precautions include wearing gloves and a gown when entering the patient's room and this is for diseases like MRSA.
Anytime of patients on isolation precautions
they should have their own dedicated equipment like a blood pressure cuff or stethoscope that gets left in the room, and
this is to minimize the risk of spreading the disease to other patients.
Modified contact percussions are the same as contact
but the only difference is they require the use of soap and water instead of hand sanitizer, and like I mentioned this is for c-diff.
Droplet precautions require the use of gloves and a surgical mask and it's indicated for diseases like
disseminated shingles and influenza.
Airborne precautions
require a negative pressure room and the use of a special
respirator mask as well as a gown and gloves and this is indicated for TB and some others as well.
Reverse isolation on the other hand is used in high-risk
situations to prevent infection in people whose body defenses are known to be compromised.
This is to prevent the patient from us so they don't get sick.
So if we are caring for patients in isolation, we need to realize how this affects the patient and the patient's
feelings about themselves, so
patients might feel dirty or like we don't want to be around them.
So we need to be very careful to use therapeutic communication techniques when we interact with patients in isolation.
And it's important to maintain regular contact with isolated patients.
They're really at risk for neglect and failure to rescue type situations. So in one study in
2003
It was found actually that compared with controls patients isolated for infection control precautions
experience more preventable adverse
events, expressed
greater dissatisfaction with their treatment and have less
documented care. This supports that idea that they're at risk for failure to rescue and neglect and
You know their emotional well-being might suffer as a result. Why?
Why does this happen to them?
Well
it takes extra time out of an already busy day to put for nurses to put gown and gloves on and
so they may be less likely to go in there resulting in the patient getting less care that they need.
We need to make sure that we're making time for our isolated patients because we don't want to be negligent of their care or
their healthcare needs.
So what's our normal resistance? Well the big one is intact skin. This is a first line of defense against infection.
Normal skin flora protect us against harmful bacteria.
Leukocytes, which are your white blood cells and the inflammatory response is the second line
of
defense against infection. The inflammatory response is a nonspecific response to tissue injury.
So what happens as blood vessels dilate it lets the white blood cells get to the area and attack and ingest the bacteria.
So this leads to redness which is your erythema,
warmth, edema, pain and functional impairment from edema & pain. At this stage
the tissue is inflamed, but it's not infected. So then what might happen is a collection of dead leukocytes,
digested bacteria, dead tissue cells and plasma may result in pus formation.
Fever increases cell metabolism and interrupts viral replication and slows down
bacterial growth and this increases leukocyte mobility and action.
So that is why often times when people have infection especially a systemic infection they get a fever.
So sometimes normal resistance from infection doesn't work and this could be due to a compromised host and this could be anything from
a break in the skin and mucous membranes to invasive devices,
stasis of body fluids, inadequate nutrition stress and hyperglycemia,
or immune system dysfunctions like AIDS or cancer.
So stasis of body fluids like when patients are sedated and paralyzed and have a breathing tube in place,
can result from
decreased coughing and sneezing, because we're taking these
protection mechanisms away and then they don't clear their respiratory secretions. So this can lead to pneumonia.
Malnutrition decreases the body's ability to make antibodies and white blood cells and this makes it hard to fight infection and increases metabolic needs, and
stress causes cortisol release which suppresses immune system
response and increases serum glucose. And this is ideal for bacterial growth
And that is why good glycemic control is imperative for hospitalized patients.
People with diabetes or just the elevated blood sugars from a stress response in general makes wound healing slow and can lead to infection.
Immune system dysfunction also can cause problems. So like we said with cancers, leukemia
increases the production of leukocytes.
But they're immature and they can't fight infection.
And then AIDS also causes poorer immunity. And finally drug therapies such as chemo or steroids or inappropriate about it
Antibiotic use excuse me, also contribute to poor infection resistance.
So let's talk for a little bit here about the infectious process. So acute infection is a short duration like pneumonia,
whereas chronic infection can last quite a while and this example would be like c diff
infections which can be devastating the patient's because they linger on for years and some people never get rid of them.
Local infection is localized to a single body area and then systemic
infection is infection that is spread to other areas or organs in the body.
Bacteremia is infection that spreads through the bloodstream.
Sirs, this is systemic inflammatory response syndrome.
This is a critical thing for nurses to recognize as the signs of sirs because treatment for sirs
early before it gets on to sepsis saves lives.
Catching infection and treating it at this point has a greater chance of success than waiting for full-blown sepsis,
which actually can have up to a 60 percent mortality rate!
It's important to realize that temperature can be high or low and white blood cells can be high or low with sirs.
Low temperatures or low white blood cells is actually a bad sign because it means the patient has used up all their
defenses and their body has less ability to fight off the infection.
Then if it progresses to sepsis, this is a severe systemic inflammatory response
to infection.
Sepsis can progress to septic shock which is shown by low blood pressure hypotension and organ failure.
Mortality rate like I said is up to 60% and this usually results from organ failure related to
little micro clots clogging the vascular beds of the organs.
So take a few minutes here and pause and just think about some signs and symptoms of infection that you might see in your
patients and then list them in your notes. So
if we're going to take this through the nursing process
we realize that the first step in the nursing process is always assessment. We're looking for normal pattern identification. Ask the normal
measures taken by the patient to stay
well.
We want to look at risk identification and ask about exposure to illness from other family members, general health, smoking,
alcohol, drug use, sexual practices,
recent travel to foreign countries, chronic health conditions, any chemo, radiation
immunosuppressant drugs that they might be taking. During the physical assessment perform a general inspection.
We want to check vitals. Listen to lung sounds, bowel sounds,
palpate lymph nodes.
Remember that early recognition of sirs
by a physical assessment is key to improving mortality rates.
Diagnostics and lab procedures include a CBC. That's a complete blood count.
We want to look at the white blood cells and if it's increased it's called leukocytosis.
Neutrophils will increase until they can't be produced quick enough and then we get immature granulocyte releasing which are bands and this is where
They get the term shift to the left.
Remember that white blood cells can be elevated or decreased with infection.
The UA/UC shows bladder infections, blood cultures check for bacteria in the blood and other Diagnostics
That might be ordered are x-rays, CT scans, sputum culture, wound culture,
fluid, stool or throat cultures as well.
So after we assess we cluster or group the data and we form a nursing diagnosis.
These are some possible nursing diagnosis for infection.
Then we set the outcome and plan our nursing interventions.
Here are some potential patient goals, you know for your patient
they would need to be modified to your specific patient and then make them smart as well.
So then we implement and again, that's our action phase.
And this is implementation of our nursing interventions.
These can focus on health promotion like personal hygiene, protection of the skin and mucous membranes, rest and relaxation,
nutrition and hydration, or immunization programs.
Interventions could also focus on altered functions such as comfort measures, ambulating and positioning.
Respiratory interventions, fever management, neutropenic precautions,
antimicrobial therapy or prevention of infection spread are some other things we can focus on. And
finally, we evaluate the interventions and whether or not the goals were met if they're not met revise the plan of care. We want to
look at the goals and interventions and fix them as we need to.
This concludes our lecture on infection. Thank you for watching. And please be sure to watch the other lectures
as well before class. Thanks and have a great day
For more infomation >> 3 questions à Garbage Beauty | Surfaces l'expo d'art urbain - Duration: 2:19. 
For more infomation >> 7.5 - Duration: 6:36. 
For more infomation >> amazarashi - "Perfect life" 『traduzido em português』 - Duration: 5:11. 
For more infomation >> Vaadin Designer for web
For more infomation >> RHOD: Full Opening Scenes - God Save The Queen, Bitch (Season 3, Episode 4) | Bravo - Duration: 7:16. 
For more infomation >> Toyota Verso 2.2 D-4D DYNAMIC | CRUISE | CLIMA | 17 INCH | ALL-IN!! - Duration: 1:07. 
For more infomation >> Mazda 6 2.2D SKYLEASE Navi Ecc Cruise trekhaak 63dkm! - Duration: 1:06. 
For more infomation >> Mazda CX-5 2.2D TS+ Lease Pack Trekhaak Camera - Duration: 1:08. 
For more infomation >> Jaguar F-Pace 2.0 R-Sport 20d AWD (Leder/Camera/Navigatie/19"LMV) - Duration: 1:03. 
No comments:
Post a Comment