NUR 1022C Foundations of Nursing Latest Updates

NUR 1022C Foundations of Nursing What organization develops the standards of professional performance for nurses? - American Nurses Association (ANA) What is a Nurse Practice Act? - - NPA is unique to each state - each state has their own board of nursing - peer based (7 out of 8 are nurses on the board) What is the Florida State Board of Nursing? - aka BON, testing (NCLEX-RN), require CEU 24 hours for renewal of license every 2 years/24 months - Some are mandatory courses such as HIV or human trafficking What is a Unlincensed Assistive Personnel? - UAP = unlicensed assistive personnel = support staff, be respectful of techs, tasks are delegated to these individuals by the RN *team based What is Evidence Base Practice (EBP)? - Constant learning + based on research not past/ old ways of doing something + use your expertise + listen to the patient's wants = Evidence Based Practice (EBP) What are the steps of EBP? - Inquiry, have continuous curiousity Ask a clinical question - ex: "Is it better to use the baby warmer or skin to skin contact when a baby is first born?" Collect best evidnece Integrate the evidence/ implement Evaluate the change Share the outcomes What are the 5Cs and how do they relate to the nursing profession? - **"5 C's" - the SSC student learning outcomes 1. Caring - we are not judges 2. Communication = always communicate with your charge nurse (for students that is your clinical instructor), includes patient education 3, Collaboration and management of care - working with auxillary staff and other deparments like physical theraphy 4. Commitment to professionalism = example, shred documents to protect privacy, follow HIPAA 5. Clinical competence and decision making What are the roles of a professional nurse? - Autonomous = independent, ex: has to follow doctor's orders, but use knowledge to take action when appropriate Accountability Caregiver = * most trusted profession Advocacy = speak for the patient and make sure that the patient's wants are being considered Educator = teachers, teach everyone on all levels, patient education Communicator = with both patients and other staff Manager = delegation of tasks What are some EBPs related to infection? - Evidence shows that patients develop infections in the hospital because healthcare personnel don't use proper hand hygiene. Hand hygiene is the #1 way to prevent infection and standard precautions should be used with every patient every time because 90,000 patients die every year due to HCAIs. What are some factors that affect the prevention, control, or transmission of infection? - Poor hand hygiene, poor sterile technique when performing invasive procedures like placing catheters, not using standard precautions. How can you recognize the clinical appearance of a patient with an infection? (Clinical Manifestation) - If it's a local infection the pt will most likely experience the symptoms of inflammation (RHSP), they may experience some immobility, and some drainage. If it's a systemic infection - a pt will have an elevated temp., they might experience fatigue/malaise, nausea/vomiting, increase HR and respiration, but decreased BP, and an altered level of consciousness. What is the difference between medical and surgical asepsis? Explain the continuum. - Medical asepsis is general clean technique while surgical asepsis is sterile technique. Surgical asepsis is cleaner than medical asepsis on the continuum. What is the difference between sterilization, disinfection, and cleaning? - Sterilization means kill all the microbes and remove the spores. Disinfection - the creation of a bacteriostatic environment through the use of chemicals like bleach and betadine. Cleaning refers to general cleanliness, regular soap and water. What are the different types of isolation? - There are two types of isolation. Protective isolation is about protecting ourselves from the infected patient. "Reverse" isolation is about protecting the patient from us, this type of isolation is used for immunocompromised patients and it involves not reusing gowns/gloves, using a mask, standard precautions, and the use of private rooms. Nurses with active infections won't be assigned these pts. What are the general principles of isolation? - Use standard precautions which means having good hand hygiene. Dispose of contaminated supplies/equipment/PPE, think about protecting everyone including your coworkers/UAPs/techs, and be clinically competent (5Cs). How can you apply the general principles of isolation when working in isolation rooms? - When delegating tasks make sure to communicate, notify team members, Be a good steward of supplies and only take in what you need/minimize waste, cluster your care, and be prepared you shouldn't need to walk in and out of the room bc you forgot equipment, properly dispose of PPE, never wear PPE out on the floor, keep the pt's door closed. What are some common healthcare acquired infections (HCAIs) that are drug resistant? - MRSA - Methicillin Resistant Staphylococcus Aureus, VRE - Vancomycin Resistant Enterococcus, and C.Diff. - Clostridium Difficile What would be involved in the care of a client experiencing infection issues? - We would use the CDC's two tier approach to prevent the transmission of the infectious agent from that particular pt experiencing the issue to other patients by following isolation protocols, using proper precautions, making sure to communicate and use proper techniques when performing procedures for the pt. What is the chain of infection? - The chain of infection is cyclical process. First there's an Infectious Agent = fungi, protozoa, microbe, bacteria, virus then we have a Reservoir = where microbes live and multiply ex: human, wound, surface. Then comes the Portal of Exit = GI tract, sneezing, secretion, in the air/ something you breathe in, coughing then it is transmitted through a Mode of Transmission = direct contact, touch, breathed in, indirect contact. The infectious agent needs to enter into a host through a Portal of Entry = how the microbe get inside of the patient, ex: ENT, breathing it in, open wound, catheter (not using proper sterile technique). Lastly, Host = the patient, a susceptible host (age, immunocompromised, AIDS). What are some risk factors that make a person more susceptible to disease? - Age - very old or very young, underdeveloped immune system, Stress, Medical therapies - chemotherapy, not using proper sterile technique when administering meds, Unclean medical equipment - ex: unclean feeding tubes or catheters, Smoking, Alcohol, Unhealthy eating, Environmental hazards - work environment, Unaffordability of medical care What are some sites that can predispose a patient to infection? - Surgical wounds - impaired skin integrity, the respiratory tract (airborne pathogens - port of entry), Genitourinary tract (ex: bladder is sterile so inserting equipment with improper technique can introduce infection), Invasive Devices (ex: ventilator acquired infections, catheter), Bloodstream (ex: central lines have to be cleaned a specific way, catheters can also introduce pathogens), TPN (outside of GI Tract = high sugar content = favorable microbe growth environment), Enteral (used inside the GI Tract), Implanted Prosthetic Devices (metal/ foreign objects) What are the stages of an infection? - Incubation - from the time the pathogen enters the body to the manifestation of the first symptoms Prodromal - the "off"/ vague/malaise feelings that happen before actual symptoms, onset of nonspecific symptoms to specific symptoms Illness - full blown specific symptoms, acute symptoms Convalescence - from the time where the acute symptoms disappear to complete healing, "when you start to feel better" What are some characteristics of inflammation? - With inflammation there is the formation of EXUDATES/DRAINAGE = WBCs and other cellular components, nutrients, vascular rxn. There are 4 types of exudate: Serous = clear, light pink, looks like plasma, watery, Sanguineous = bloody, Serosanguineous = light pinkish, not frank blood, Purulent = pus, WBCs, pus means there's bacteria or infection at work, BAD, can be different colors. The second part of the inflammation process is TISSUE REPAIR = tissue healing. Lastly there's GRANULATION = good sign, new vascular blood supply, healthy red tissue. What are some types of transmission contact? - Direct = touch, Indirect = from surface to person, Droplet = small particles, suctioning, sneezing, coughing What are some types of transmission non-contact? - Airborne - droplet nuclei in the air | Vehicle - contaminated source | vector- borne - transmission via insect or animal (ex: zika virus, malaria) What are some hand washing guidelines? - What's important to note with handwashing is that it is the #1 way to prevent the spread of infection, you should use warm water not hot water because hot water can make your hands more susceptible to cracks by breaking down oils in your hands, clean beneath jewelry, and time: 15 seconds for non- surgical and 2-6 mins for surgical settings. When are you supposed to wash your hands? - Before and after gloving, before and after patient contact, before and after going into a patient room/ touching equipment in the room, *wash your hands with soap and water (NOT foam/sanitizer) when dealing with C.Diff. to get rid of spores*, and use common sense if you can see your hands are dirty go wash your hands What is PPE? - Personal Protective Equipment (PPE) - ex: gown and gloves, mask, eye protection. When should you wear gloves? - Gloves = soiled linen/equipment, wounds, open sores, body fluids,impaired skin NO gloves - outside of patient room, no reusing gloves and no washing gloves What is the CDC 2 tier approach to preventing transmission? - 1st tier aka Standard precautions - use with all patients all the time = "foam in, foam out", use PPE when appropriate, cough/sneeze using your inside elbow, dispose of sharps, needles, syringes in the proper containers. 2nd tier is used when the pt is suspected of or is infected and we use one of the three transmission based categories of precaution: airborne, droplet, or contact precautions depending on the patients infection. What precautions are used for the airborne category of transmission? - Airborne precautions are used when the infectious agents can be transmitted into the air when the patient breathes or through the vents. This means that a negative pressure room gets used to isolate the agents to one room. Since the particles can be very light, fit/mask testing is done for employees to get fitted for **N-95 respirator masks, pt's have private rooms