-1423-Unit 3 EXAM BP - Google Docs
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North Central Texas College *
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Communications
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Feb 20, 2024
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Chapter 24 Communication ● Identify ways to apply critical thinking to the communication process ○ Gathering relevant & comprehensive information about the patient helps form therapeutic relationships. ○ When you consider a patient's problems it is important to apply critical thinking and critical reasoning skills to improve communication in assessment and care of the patient. ○ Critical thinking helps nurses overcome perceptual biases/stereotypes that interfere with accurately perceiving messages from others. ● Describe features of the verbal communication process ○ Vocabulary - communication is unsuccessful if senders & receivers cannot translate one another’s words and phrases. ○ Denotative & Connotative Meaning- Be careful to select words carefully, avoiding easily misinterpreted words. Some words have several meanings. ○ Pacing- Speak moderately slowly and enunciate clearly. ○ Intonation- Tone of voice ○ Clarity & Brevity- Simple, Brief, and direct . ○ Timing & Relevance- Timing is critical for communication. Poor timing prevents the message from being effective. ● Identify key aspects of nonverbal communication process ○ Personal Appearance ○ Posture & Gait ○ Facial Expression ○ Eye Contact ○ Gestures ○ Sounds ○ Territoriality & Personal Space- Territory is important because it provides people with a sense of privacy, identity, security and control. (BOX 24.3) Zones of Personal Space ■ Intimate Distance (0-18 in) ● Holding a crying infant ● Performing physical assessment ● Bathing, grooming, dressing, feeding and toileting a patient ● Changing a patient’s surgical dressing ■ Personal Distance (18-40 in) ● Sitting at a patient’s bedside ● Taking a patient’s nursing history ● Teaching an individual patient ■ Social Distance (4-12 ft) ● Giving directions to visitors in the hallway ● Asking whether families need assistance from the patient doorway ● Giving verbal report to a group of nurses ■ Public distance (12 ft or more) ● Speaking at a community forum
● Lecturing to a class of students ● Testifying at a legislative hearing. ● Identify a nurse’s communication approaches within the four phases of a nurse-patient helping relationship. ○ Pre Interaction phase-think Prep before you see the PT-REVIEW DATA, TALK TO OTHER HEALTHCARE STAFF
(1 EX:HAND-OFF’S), PLAN ENOUGH TIME,ROOM,LOCATION,ANTICIPATE HEALTH CONCERNS/ISSUES THAT ARISE. ○ Orientation Phase-think assessment-WHEN YOU AND PT MEET AND GET TO KNOW EACH OTHER ○ Working Phase- think intervention-YOU AND PT WORK TOGETHER TO SOLVE PROBLEMS AND ACCOMPLISH GOALS
( self-disclosure)apply therapeutic communication skills to facilitate successful interactions. ○ Termination Phase - think evaluation EX: EVALUATE GOAL ACHIEVEMENT WITH THE PT — ○ SACCIA is one way to assist nurses in communicating effectively S
ufficiency
, A
ccuracy, C
larity, C
ontextualization, I
nterpersonal A
daptation — ○ SBAR technique is used for communicating critical information S
ituation, B
ackground, A
ssessment, R
ecommendation ● Engage in effective communication techniques for older patients. ○ Communicate with older adults on an adult level and avoid patronizing or speaking in a condescending manner. ○ Face the patient, Speak clearly but do not exaggerate lip movement or shout. ○ Speak a little more slowly but not excessively slow. ○ Choose a quiet, well-lit environment with minimal distractions ○ Give the patient a chance to ask questions ○ Keep communication short & to the point. Asking one question at a time. ○ Allow enough time for the patient to respond. Do not assume they’re not cooperative if he/she does not reply or takes a long time to answer the question. Chapter 25 Patient Education ● Identify the three purposes of patient education 1. Maintenance & Promotion of Health and Illness Prevention 2. Restoration of Health 3. Coping with Imparied Functions ● Identify the purpose of Speak Up initiatives set up by The Joint Commission ○ To help patients understand their rights when receiving medical care. ○ The assumption is that patients who ask questions and are aware of their rights have a greater chance of getting the care they need when they need it.
○ Patients are advised they have the right to be informed about the care they will receive, obtain information about care in their preferred language, know the names of their caregivers,receive treatment for pain, receive an up to date list of current medications and expect that they will be heard and treated with respect. ● Describe appropriate communication principles when providing patient education ○ Attitudes, values, emotions, cultural perspective, & knowledge influence the way information is delivered. ● Describe the domains of learning ○ Cognitive ○ Affective ○ Psychomotor ● Identify basic learning principles ○ Motivation to learn ○ Readiness to Learn ○ Ability to learn ○ Learning Environment ● Identify factors that influence an adult’s readiness to learn ○ Stages of grief ○ Health status ○ Physical discomfort, anxiety, confusion,depression, and environmental distractions ○ Sensory Deficits ○ Patients literacy level, cognitive function, developmental level. ● Describe how to create an environment that promotes learning ○ Factors to determine the setting - # of people included in the teaching session; need for privacy; room temperature; room lighting; noise, ventilation, and furniture are important when choosing a setting. ○ IDEAL learning environment is well lit, good ventilation, appropriate furniture, and a comfortable temperature. ● Describe how to use the teach-back method during evaluation. ○ Also known as the “show me” method, is a communication confirmation method used by healthcare providers to confirm whether a patient understands what is being explained to them, if they understood they’ll be able to “teach-back” the information. Chapter 26 Informatics and Documentation ● Identify the purposes of a health care record
: vital aspect of nursing practice -valuable source of data for all members of the health care team -facilitating interprofessional communication among health care providers -providing legal record of care provided -justification for financial and reimbursement of care
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Data use: audit, monitor, and evaluate care provided to support the process needed for quality and performance improvement. ● Discuss the relationship between documentation and financial reimbursement for health care: to limit liability liability document clear description of individualized and goal-directed nursing care a nurse provides based on nursing assessment. -Mistakes in documentation: 1.failing to record pertinent health or drug info 2.failing to record nursing actions 3.failing to record med administration 4.failing to record drug reactions or changes in pt’s conditions 5.incomplete or illegible records 6.failing to doc discontinued med Reimbursement:
insurance companies use documentation to determine payment or reimbursement for health care services. Diagnosis-related groups
: are classifications based on a hospitalized pt’s primary and secondary medical diagnoses that are used as the basis for establishing Medicare reimbursement for pt care. ● Discuss legal guidelines for documentation: pg.367 table 26.1 - Guidelines for electronic and written doc Rationale Correct action Do not doc retaliatory or critical comments about pt or care provided by another HCP. Don't enter personal opinions Statements can be used a s evidence for unprofessional behavior or poor quality care Only objective and factual observations. Quote all pt statements. Correct all errors promptly Errors can lead to wrong treatment or can imply mislead or hide evidence Avoid rushing when doc Record all facts Record must be accurate, factual, and objective Be certain that each entry is through. Another person reading it needs to be able to determine adequate pt care. Doc discussions w/providers that you initiate to seek clarification regarding an order that is questioned You can be just as liable for prosecution as the health care provider if you carry out an order that is written incorrectly Ex: “dr smith was called to clarify order for analgesic” include date, time, who you spoke with, and the outcome. Document only for self You are accountable for info that you enter into a Never doc for someone else EXCEPT if a caregiver has left
pt record the unit for the day and calls w/info that needs to be doc;include date,time of entry include that info was provided via phone Avoid using generalized, empty phrases sus as “status unchanged” “had a good day” This is subjective and does not reflect pt assessment Use complete, concise descriptions. Doc is objective and factual Begin each entry with a date and time and end with your signature credentials Ensure correct sequence of events is recorded; signature docs who is accountable for care delivered Do not wait until the end of the day to record important changes that occurred several hours earlier Protect the security of your password for computer doc Maintains security and confidentiality for pt health records Don't leave the computer unattended. Log out when you leave the computer. Make sure computer is not accessible for public viewing Guidelines specific to written doc Rationale Correct action Do not scratch out errors Can become eligible and can appear as if you are attempting to hide a written record Draw a line through error and write the word “error” above it, sign or initial and date it. Do not leave blank spaces or lines in a written nurses progress note Allows another person to add incorrect info in open space Chart consecutively, line by line, if space is left draw a line horizontally through it and place signature and credentials at the end Use black ink, no pencils, felt tip pen, or erasable ink Illegible entries are misinterpreted, causing errors and lawsuits. Black ink is more legible Write clearly and include appropriate abbreviations using black ink - ● Identify ways to maintain confidentiality of health care record data:
pg 368 -legally and ethically obligated to keep info about pt confidential -only members of HC team who are involved in a pt care have legitimate access and can discuss a pt diagnosis, treatment, assessment, and any personal conversations - pt have right to request copies of their medical records/follow hospital policy -HIPA ● Describe guidelines for quality documentation: pg 370 -
enhances efficient, individualized pt care and has 5 important characteristics
1.
factual:
contains clear descriptive, objective info about what the nurse observes, hears, palpates,and smells. AVOID “appears, seems, or apparently” Objective
:data obtained through direct observation and measurement Subjective: doc a pt exact words within “” whenever possible ex: “the pt seems anxious” 2
.accurate
:exact measurements can determine if pt condition changed in a positive or negative way ex: “intake, 360 mL of water” 3.
current: delay in doc can lead to unsafe pt care,doc at time of occurrence for vitals, pain assessment, med administration and treatments, preparation for diagnostic test or surgery, change in pt status,admission, transfer,discharge, death of pt, pt respond to treatment or intervention. 4.
organized: doc is more effective when notes are concise,clear and to the point and presented in a logical order 5.
complete: be sure the info is complete, containing appropriate and essential info, follow established criteria and standards for thorough communication within the HC record -to maintain characteristics in documentation Stick to the facts Write in short sentences Use simple, short words Avoid the use of jargon or abbreviations ● Describe elements to include in documentation of telephone conversations with providers pg 376 BOX 26.3 -
clearly identify the pt name, room#, and diagnosis -use clarification questions to avoid misunderstanding -doc “TO” (telephone order) or “VO” (verbal order) include date, time, name of pt, complete order, name and credentials of provider given order, nurse name and credential taking order -read back order to provider who gave them and document “TORB” (telephone order read back) when signing name and credentials - For Telephone orders & verbal orders repeat back to doctor and then you must get a signature within 24 hours of that TO OR VO. -follow agency policies regarding TO ● Methods of documentation: pg 372-374 BOX 26.1 -EHR this form allows quick and easy assessment data Flow sheets:graphic records that are organized by body and navigated through use of the computer mouse with a series of tabs or rows Narrative documentation: format traditionally used by nurses and HC providers to record pt assessment,clinical decisions, and care provider; storyline format PIE: Nursing problem of diagnosis, Interventions that will be used to address the problem, nursing evaluation Focus charting: uses DAR format to report problem D:data, A: action or nursing intervention, R response of the pt
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SOAP note: subjective, objective, assessment, plan - Chapter 27 Safety and Quality ● Discuss the key factors in patient-centered care that can improve patient safety. ○ Partnership is the key factor - Patient and family engaged care is care planned, delivered, managed and continuously improved in active partnership with patients and their families to ensure integration of their health and health care goals, preferences and values. ● Discuss common physical hazards and methods for preventing them. ○ Common physical hazards: Motor Vehicle Accidents, Poisoning, Falls. ■ Motor vehicle accident prevention- Encourage Seatbelt use for teenagers, educate about drinking and driving, texting/talking and driving. Elderly drivers are encouraged to drive in daylight/good weather, promoting yearly eye exams, and getting with their doctor to review medications to reduce side effects/interactions. ■ Poisoning prevention- Keep all hazardous substances up and away or locked in a cabinet out of reach of children. Prescription Medication needs to be in a child resistant container, lock box or medicine safe. ■ Preventing Falls- older adults are at greatest risk for falls due to decreased strength, imparied mobility and balance, improper use of mobility aids, unsafe clothing, environmental hazards, endurance limitations, and decreased sensory perception. ○ In healthcare facility fall prevention interventions: (Content mastery series:Fundamentals pg. 59-60) ■ Fall risk assessment ■ Call light in reach ■ Hourly rounding ■ Fall risk alert wristbands ■ Place clients at risk for falls near the nurses station ■ Use gait belts ■ Keep the bed in low position & lock the brakes ■ Use electronic safety monitoring devices (bed alarms, chair alarms) ■ Keeping assistive devices within reach (glasses, walkers, transfer devices) ● In- home fall prevention teaching : ○ Encourage the patient to keep the environment clutter free, clean and dry with a clear path to walk through with adequate lighting.
○ Complete a room assessment and observe the condition of flooring, adequate lighting, presence of safety devices, and placement of furniture. ○ If a patient lives in older homes, encourage them to have inspections for lead in paint, dust or soil. ● Discuss how an individual’s developmental age creates safety risks. Pg 388 - 389 ○ Infant, Toddler, Preschool- Infants run the risk of SIDS due to the sleep environment, Toddlers risk Injuries, Poisoning, aspiration, choking by development exploring everything with their hands and mouth. Preschooler risks include falls from bikes, playground equipment, burns and drowning. ○ School- Aged Children- Sport contact injuries, School violence. ○ Adolescent - Risk for suicide, substance abuse causing drowning & vehicle accidents. ○ Adult - risk for adults are related to their lifestyle habits, the use of excessive alcohol increases the risk for a vehicle accident or injuring themselves at home. High stress can cause an accident or illness such as headaches, GI disorders, and infections. ○ Older adult - Risk of falls, Mind wandering, Burns, Vehicle accidents ● Explain the mobility alterations that pose risks for falling. pg. 390 ○ Muscle weakness, paralysis, abnormal gait, and poor coordination or balance. ● Describe ways to prevent procedure-related accidents. pg.392 ○ Always follow the policies and procedures of a health care agency and the standards of nursing practice to prevent these accidents. ■ Ex: Proper preparation and administration of medications, use of patient and medication bar coding and “smart” IV pumps to reduce medication errors. ■ Ex: Common risk for injury is transferring to a bed or chair. Correct use of safe patient handling techniques and equipment reduces the risk of injuries when moving and lifting patients. Chapter 28 Infection Prevention and Control ● Give an example of preventing infection for each element of the infection chain. Total of 6 ■ 1) Infectious agent or pathogen- Hand Hygiene is the most effective way to break chain of infection; if hands are not visibly soiled alcohol-based hand product or handwashing with soap and water; keeping sterile field with surgeries or invasive procedures so infection doesn’t occur in the deep tissues, pg. 424 ■ 2) Reservoir or source for causative agents/pathogen growth-
( bacteria, viruses, toxins, fungi, parasites) box 28.10 pg.437 ○ Bathing
-
use soap and water to remove drainage, dried secretions, or excess sweat (perspiration).
○ Dressing changes
- if they are wet or soiled change them( microorganisms like both of those features to grow). ○ Bedside Units
-
keep clean and dry. ○ Bottle Solutions
-
NEVER LEAVE opened, keep tightly capped, date bottles and throw away in 24hrs. ○ Surgical Wound
s- drainage tubes/collection bags patent to prevent accumulation of serous(serum) fluid under the skin area. p.s. 4 types of wound drainage: serous, sanguineous, serosanguinous, and purulent. ○ Drainage bottles and Bags
-ONLY raise a drainage system(urinary bag) above the level of site being drained when it’s clamped off; wear gloves & protective eye wear(if splash/spraying) when addressing a wound or when using body fluids/blood contaminated bottles/bags. Empty & dispose used bottles according to agency policy;EMPTY ALLdrainage systems on each shift UNLESS otherwise ordered by a health care provider. ■ Port of exit from the reservoir- ○ Blood- when an organism enters through open sore/skin/puncture ex:blood draws throw away sharp/used needles in the sharp container, teach pts to use an empty gallon of milk, container ○ Reproductive tract-ex:mother to fetus(transplacental)ex: test mother before ○ Respiratory tract-Droplets from an infected/sick person that coughs/sneezes secretions ex: teach pt’s about cough etiquettes ○ Gastrointestinal tract- ex: by wiping woman from the urinary meatus towards the rectum clean from least to most contaminated area helps reduce Gi infections. ○ Urinary tract-provide perineal care those that wear disposable incontinence pads specially older-adult women.; provide proper handling and management of urinary catheters and drainage sets. ○ Skin and mucous membrane-ex: maintaining the integrity of skin and mucus membranes ex: keep skin lubricated by applying lotion as appropriate; immobilized and debilitated pts are particularly susceptible to skin break down.. Pg. 437 ■ Mode of transmission pg. 425 box 28.1 ○ Contact - BARRIER PROTECTION: private room or cohort pt, use gloves and gown whenever entering pt’s room ex: c.diff pt. Colonization/Infection with multidrug-resistant organisms [VRE and MRSA, C. difficile, shigella, and other enteric pathogens; major wound infections; herpes simplex; scabies;respiratory syncytial virus in infants, young children or immunocompromised adults] Large Droplets ○ Infected person talks,coughs, or sneezes(short distance germ droplets apprx.6ft.
)
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Direct-
person-person(fecal,oral) physical contact between source and susceptible host;(if you go to clinicals at the nursing home think of pt in RooM 101) Enteric Infections: Clostridium difficile Influenza:infect.can occur by touching something with flu virus on it and then touching the mouth or nose. Wound infections Skin infections: cutaneous diphtheria, herpes simplex, impetigo, pediculosis, scabies, staphylococci, and varicella zoster. Eye Infections:conjunctivitis Indirect- person-to-contaminated object When contaminated object or instrument, or hands are encountered. ○ Airborne - (droplet nuclei smaller than 5 microns
, which remain in the air for longer periods of time) Barrier Protection: Private room, Negative-pressure airflow of at least 6-12 exchanges per hour via high-filtrations of air (HEPA) Air is not returned to inside ventilation system but is filtered through a HEPA filter and exhausted directly to the outside Mask or Respiratory protection device, N95 respirator (depending on condition) Diseases: measles, chickenpox (varicella), disseminated varicella zoster, pulmonary/laryngeal tuberculosis-SEE PIC BELOW ○ DROPLET: (droplets larger than 5 microns
; being within 3ft of the patient) Barrier Protection: Private room or cohort patient, mask or respirator required (depending on condition) (refer to agency policy) proper hand hygiene, and some dedicated-care equipment. Diseases:diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague Equipment stays in pt’s room; take a single use thermometer to avoid electronic instruments for temps: Chemical Dot Thermometers and Temperature-Sensitive Patch (oral sores/isolation pt’s) pg. 475 ○ Vehicles-
contaminated items( contaminated sharp injuries, pathogens enter a person thought skin puncture by a used needle or sharp instrument. Water Drugs, solutions Blood
Food( improperly handled, stored, cooked, fresh, or thawed meats) ○ Vector- External mechanical transfer(flies);internal transmission such as parasitic conditions between vector and host such as: pg. 425 box 28.1 Mosquito Louse Flea Tick ■ Port of entry to a host-pg.424 ○ Enters through a portal susceptible host. ■ Susceptible host- follow proper skin preparations ex: during blood draws. ○ Characteristics:Table 28.3 p.430 if pt’s have: Sickle cell anemia Poor nutrition-reduces immune function Resistance to antibiotics ex:C.diff as pt’s are typically on antibiotics for a while and they kill the good Bacteria/Flora. Occupations: Coal miners-black lung; Prison guards/social workers-Risk for contracting TB due to areas where immigrants & asylum seekers have a high increase of TB. ● Describe the signs/symptoms of a localized infection and those of a systemic infection. ■ Systemic Infections- requires measures to prevent complications of fever.infection spread all over vs 1 body part All over the body-sometimes develop after failed treatment for localized infections. Fatal if undetected or untreated.pg.425 Ex: Maintaining intake of fluids prevents dehydration resulting from diaphoresis.pg.435 ■ Fever ■ Chills ■ Fatigue ■ Malaise ■ Tachycardia ■ Tachypnea ■ Localized Infections- Often require measures to assist removal of debris to promote healing. Pg.430 localized symptoms to a SINGLE ORGAN part of the body or organ (mainly wounds/skin, but other areas as well) Ex: apply principles of wound care to remove infected drainage from wound site.pg. 435 ■ Edema ■ Pain ■ Erythema(redness)-high erythrocytes on labs= inflammation)pg.431as well ■ Decreased function
■ Warmth localized body part ■ Abscess ■ Ulcer(s) ● Identify the normal defenses of the body against infection. ○ NORMAL FLORAS- ○ BODY SYSTEM- Lymphatic System ○ INFLAMMATION- ● Identify patients most at risk for infection. ■ Most at Risk for Infection-p.428-429 Poor Nourished: low on protein, carbohydrates, and fats(lipids) Pt’s with HIGH CBC’s-(WBC-lymphocytes-viruses or bacteria); (low-sepsis) Transplant Pt’s Pt’s that take Steroid meds (ex:cortisone, hydrocortisone, and prednisone p.s.-prednisone can cause pt’s to gain weight/swell) Multiple Illnesses: Chronic diseases ex: diabetes, multiple sclerosis Focus on Older Adults Box 28.4 pg. 428 → Less Lymphocytes: T-cell help autoimmune system, kill tumor cells; B-cells- make antibodies (shorter response when produced) → Recommend Flu & Pneumonia Vaccines to reduce inf.risks. → Teach pt & family proper hand hygiene & how it benefits. → Poor nutrition, weight-loss, less physical activity, poor social support & LOW SERUM ALBUMIN LEVELS associated with development or health care associated infections. ● Explain the difference between medical and surgical asepsis. ○ Medical asepsis ■ Control or elimination of infectious agents (cleaning, disinfection and sterilization. ■ Protection of susceptible host ● Explain the rationale for Standard Precautions. ○ 1st Tier/Primary Strategy (barrier precautions/appropriate PPE) used w/ALL = Standard Precautions to prevent transmission of diseases/infections and apply to contact w/blood, body fluids(except sweat), non intact skin, mucus membranes, and equipment or contaminated surfaces. ● Explain procedures for each isolation category. I added the others at the top with modes of transmission ○ PROTECTIVE ENVIRONMENT ■ Focuses on a very limited patient population(immunosuppressed/high susceptible to infection ex:pt
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who received a kidney transplant/allogeneic hematopoietic stem cell transplants) ■ –Barrier Protection: ■ Private room; positive airflow with 12 or more air exchanges per hour; HEPA filtration for incoming/all air ■ Masks, gloves, gowns ■ Mask to be worn by patient when out of room during times of construction in area ■ patients not allowed to have dried/fresh flowers or potted plants in these rooms ● Explain how infection control measures differ in the home versus the hospital. (p.s. Th ink if they are POROUS OR NONPOROUS may help) ○ Hand Hygiene- home-
reg.soap; ○ Home-decreased risk of infection compared to a hospital due to less exposure to resistant organisms. ○ Hospital-pt’s are more at risk to getting infections
, in healthcare(hospital)setting they use sterile procedures when changing a wound or inserting/changing catheters vs at home pts only use regular hygiene and boiling water to disinfect tubes. ○ Cleaning -(water, detergents/disinfectant & scrubbing)-home and hospital. ○ Disinfecting
-Chemical Sterilants-High-Level Disinfection (HDL)- Chemicals disinfect HEAT-SENSITIVE instruments & equip.such as endoscopes & respiratory therapy equip. Some Disinfectants include: Alcohols & Chlorines (you can use at home), Formaldehyde, Glutaraldehyde, Hydrogen Peroxide(you can use at home), Iodophors, phenolics, and quaternary ammonium compounds. Each has a specific purpose. ○ Sterilizing
-Autoclave(surgical instruments ex:items that touched tissue,vascular system) Ethylene Oxide(ETO) Gas- GAS DESTROYS SPORES & MICROORGANISMS. ○ Noncritical items- that come in contact w/intact skin, but NOT mucus membranes; must be CLEAN & DISINFECTED: Stethoscopes, bedpans, bp cuffs, linens, utensils, trays,furniture. ○ Home- Boiling water to clean Urinary Catheters, Suction Tubes, & Drainage collection devices. ○ Semicritical Items- that come in contact with MUCUS MEMBRANES or NONINTACT SKIN also present at risk. objects must be free from Microorganisms(except bacterial spores ex:c.diff); must be HIGH-LEVEL DISINFECTED(HDL) or STERILIZED: Resp.& Anesthesia equip., Endoscopes, GI Endoscopes, Endotracheal Tubes, Diaphragm fitting rings. Rinse then Dry & store in a protective manner from damage & contamination. ○ Critical Items- that enter sterile tissue or vascular system present a High Risk of Infection, if contaminated with microorganisms, especially bacterial spores. Must
be STERILE: Surgical Instruments, Cardiac/Intravascular catheters, Urinary catheters & Implants ○ Home-
Medical Asepsis ( Hand Hygiene w. Soap and water) ○ Hospital- Medical Asepsis use with all pt’s. & STRICT ADHERENCE TO ASEPTIC PRINCIPLES. Chapter 46 Urinary Elimination ● Identify factors that commonly impact urinary elimination. (pg 1151) - Growth & Development: ○ Children cannot voluntarily control voiding until 18-24 months ○ Older adults may decrease in bladder capacity, increase in bladder irritability, and increased frequency of bladder contractions during bladder filling ○ Older adults become unable to hold it for long periods of time ○ Older adults are at an increased risk for UTIs because of chronic illness and factors that interfere with mobility, cognition, and manual dexterity - Sociocultural Factors: ○ Some cultures only except private toilets whereas other will except public ○ Religious or cultural norms may dictate who is acceptable to help with elimination practices ○ Social expectations may interfere with timely voiding (school, work, etc.) - Psychological Factors: ○ Anxiety and stress and affect the sense of urgency and increase frequency of voiding ○ Depression can decrease desire for urinary continence - Personal Habits: ○ The need for privacy and adequate time to void - Fluid Intake: ○ Increased fluid intake can increase urine production ○ Alcohol decrease the release of antidiuretic hormones, thus increasing urine production ○ Fluids containing caffeine and other bladder irritants can prompt unsolicited bladder contractions, resulting in frequency, urgency, and incontinence - Pathological Conditions: ○ Diabetes, MS, and stroke can alter bladder contractility. Patients either experience bladder overactivity or deficient bladder emptying ○ Arthritis, Parkinson’s, dementia, and chronic pain syndrome can interfere with timely voiding
○ Spinal cord injury or intervertebral disk disease (above S1) can cause the loss of urine control because of bladder overactivity and impared coordination between contracting bladder and urinary sphincter. ○ Prostatic enlargement can cause obstruction of the bladder outlet, causing urinary retention. - Surgical Procedures: ○ Local trauma during lower abdominal and pelvic surgery sometimes obstructs urine flow, requiring temporary use of indwelling catheter ○ Urinary retention in postop period has 2 main causes- one is mechanical obstruction of lower urinary tract; the other is altered neurological control of the bladder and detrusor mechanism, most commonly due to analgesic drug. - Medications: ○ Diuretics increase urine output by preventing reabsorption of water containing electrolytes ○ Some drugs change the color of urine (Phenazopyridine- orange, riboflavin- intense yellow) ○ Anticholinergics (atropine, overactive agents) may increase the risk for urine retention by inhibiting bladder contractility ○ Hypnotic and sedatives may reduce the ability to recognize and act on the urge to void - Diagnostic Examinations: ○ Cystoscopy may cause localized trauma of the urethra, resulting in transient (1-2 days) dysuria and hematuria ○ Whenever catheterized there is a risk for infection ● Interpret features of normal and abnormal urine. (pg 1160-1161) - Color: Normal urine color ranges from a pale straw to amber, depending on its concentration. Blood in the urine is never normal. Blood in the urine will usually make the color dark to bright red. Hematuria(blood in urine) and blood clots are a common cause of urinary catheter blockage. Clay color=No bile;bile is what makes it brown. - Clarity: Normal urine appears transparent at the time of voiding. Urine that stands several minutes in a container becomes cloudy. Renal disease will cause freshly voided urine to appear cloudy due to protein concentration. Urine may also appear thick and cloudy due to bacteria and white blood cells - Odor: Urine has the characteristic ammonia odor. The more concentrated the urine the stronger the smell. A foul odor may indicate a UTI. ● Discuss nursing interventions to promote normal urinary elimination. (pg1164) - Teach about common bladder irritants such as caffeine, strengthening pelvic floor muscles, kegel exercises, normal positions, and contracting the bladder twice to ensure proper bladder elimination. ● Discuss nursing interventions to reduce risk for urinary tract infections. (pg 1166) - Promoting adequate fluid intake, promoting perineal hygiene, and having patients void in regular intervals. Encourage women to wipe front to back, tell them to
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avoid perineal perfume washes and sprays, bubble baths, and tight clothes. Avoid prolonged periods of wetness. Chapter 47 Bowel Elimination ● Discuss how psychological and physiological factors may alter the elimination process. ○ Age, diet, fluid intake, physical activity, prolonged emotional stress, personal habits, position during defecation, pain, pregnancy, surgery and anesthesia, medications, and diagnostic tests. ● List nursing interventions that promote normal elimination. ○ Encourage increased activity during the day as tolerated ○ Provide pain medication as needed ○ Teach relaxation techniques ○ Encourage patient to Increase fluid intake (water), ○ Encourage patient to Increase fiber in diet ○ Proper positioning for a patient on a bed pan is with the head of the bed elevated 30 to 45 degrees. ● Describe nursing procedures related to bowel elimination. ○ Enema Administration ○ Digital Removal of Stool ○ Inserting and Maintaining a Nasogastric Tube ○ Irrigating Colostomies ○ Maintain skin integrity ● Explain how critical thinking is important in providing care to patients with alterations in bowel elimination ○ Critical thinking is important when providing care to patients with alterations because it helps provide an appropriate plan of care. By using critical thinking attitudes : fairness, confidence, and discipline