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Fundamental Nursing Skills and Concepts

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Title: Fundamental Nursing Skills and Concepts


1
Fundamental Nursing Skills and Concepts
  • Chapter 21 page 437
  • Skill page 454

2
MICROORGANISMS
  • Living animals or plants visible only with a
    microscope
  • Also called germs
  • Live in soil, air, and water. To survive
    microorganisms need a favorable environment.
  • Warmth, darkness, O2, H2o, nourishment.
  • Events noted when microorganisms invade the
    bodys defense mechanisms eliminate them, they
    reside within the body without causing disease,
    cause an infection or infectious disease

3
TYPES OF MICROORGANISMS
  • NONPATHOGENS harmless and beneficial
    microorganisms
  • PATHOGENS microorganisms that cause illness
  • Bacteria
  • Viruses
  • Fungi
  • Rickettsiae
  • Protozoans
  • Mycoplasmas
  • Helminths
  • Prions

4
SURVIVAL OF MICROORGANISMS
  • Biological adaptation is the ability of some
    microorganisms to form spores.
  • A spore is a temporarily inactive microbial life
    form that can resist heat and destructive
    chemicals and survive without moisture.
  • When favorable conditions exist for resuming
    growth and reproduction they may become active
    once more.

5
Survival of Microorganisms
  • See box 21-1
  • Development of Antibiotic- Resistant Bacterial
    Strains-
  • Staphylococcus aureus
  • Enterococcus faecalis
  • Streptococcus pneumoniae

6
CHAIN OF INFECTION pg 440
  • An infectious agent-microorganisms
  • A reservoir for growth and reproduction such as
    crevices of the skin, hair shafts, wounds,
    bloodstream, inside digestive tract, nasal
    passages. (Aerobic microorganisms- depend on O2,
    Anaerobic microorganisms depend on O2)
  • An exit route from the reservoir-displaced by
    touching or handling objects or the release of
    body fluids- secretions or excretions.)

7
Cont.
  • A mode of transmission- 5 routes- Contact,
    droplet, airborne, vehicle, and vector borne
    transmission.
  • A port of entry- microorganisms find a way on or
    into a new host. ( Breaks in the skin or mucous
    membranes, could be inhaled, swallowed,
    bloodstream introduction, contaminated surgical
    instruments.
  • A susceptible host

8
Infections
  • Susceptible host-weakened body defenses, due to
    illness,makes a good host.
  • Nosocomial infections- hospital acquired
    infections.
  • Normal flora- microorganisms that reside in on
    humans that rarely cause disease.
  • Opportunistic infections- once the body is
    weakened or comprimised, normal flora can take
    over and cause an infection.

9
Defense mechanisms
  • Microbes are everywhere, they are prevented from
    producing infection because of biologic defense
    mechanisms either mechanical or chemical.
  • Mechanical- examples are intact skin m/m,
    reflexes such as sneezing or coughing or
    vomiting. Infection fighting blood cells called
    phagocytes or macrophages.
  • Chemical defense mechanisms destroy or
    incapacitate microorganisms such as enzymes, acid
    in gastric tract or antibodies.

10
Common infectious disorders
  • Tuberculosis, common cold
  • Hepatitis A B, AIDS
  • Pneumonia, meningitis
  • Measles, chickenpox
  • Gonorrhea, tonsillitis
  • Herpes, influenza
  • Wound infections, boils, diarrhea
  • Viral infections are self-limiting minor, if
    you do something about it or not, it will be over
    soon.

11
Susceptibility- factors-
  • Box 21-2 page 441
  • Particularily susceptible clients include burn
    pts., major trauma pts., invasive procedures,
    indwelling equipment such as foley catheters,
    implantable devices such as pacemakers or
    tunneled catheters, infected with HIV, antibiotic
    inappropriate use.

12
ASEPSIS
  • Practices that decrease or eliminate infectious
    agents, their reservoirs, and vehicles for
    transmission.
  • Medical asepsis-those practices that confine or
    reduce the numbers of microorganisms (clean
    technique)
  • Surgical asepsis-those measures that render
    supplies and equipment totally free of
    microorganisms (sterile technique)

13
Medical asepsis clean technique
  • Frequent hand washing and maintaining intact skin
    are the best methods for reducing the
    transmission of microorganisms.
  • Hand washing is an aseptic practice that removes
    transient and resident microorganisms.
  • Handwashing is the best way to prevent
    infections.
  • Skill 21-1 handwashing- page 454
  • Table 21-3 pg. 444
  • Box 21-3 pg. 443

14
ANTIMICROBIAL AGENTS
  • Chemicals that limit the number of infectious
    microorganisms by destroying them or suppressing
    their growth.
  • Antiseptics- chemicals that inhibit growth of
    microbes- also known as bacteriostatic, can be
    used on skin and m/m (ie.) mouthwash
  • Disinfectants- germicides or bactericides,
    destroyes microorganisms, but not spores, very
    strong, not usually used on skin. Used on walls,
    floors, equipment.

15
Cont.
  • Anti-infective drugs, sulfonamides, antibiotics-
    drugs or chemicals that alter the metabolism of
    microorganisms as to damage them or destroy them
    so it interrupts their processes.
  • It does not attack viruses.
  • It does also effect the bodys normal flora.
  • Antiviral agents- control viral replication or
    release of the virus from the infected cell.
  • Goal of antiviral- to limit the viral load
    (numbers of viral copies).

16
HANDWASHING
  • An aseptic practice that involves scrubbing hands
    with nonantimicrobial or antimicrobial soap,
    water, and friction, removes transient and
    resident microbes. Minimum of 15 seconds.
  • Resident microorganisms-nonpathogens constantly
    present on the skin
  • Transient microorganisms-pathogens picked up
    during brief contact with contaminated reservoirs
  • Single most effective way to prevent infections.

17
PERFORMING HAND ANTISEPSIS
  • The removal and destruction of transient
    microorganisms without soap and water
  • Involves the use of antiseptic products such as
    alcohol-based liquids, thick gel, and foams
  • Alcohol is not a substitute for handwashing in
    all situations
  • Alcohol does produce antisepsis when the hands
    are visibly clean
  • Alcohol rubs- minimum of 5 seconds removes 99
    of microorganisms on the hands.

18
WEARING PERSONAL PROTECTIVE EQUIPMENT
  • Uniforms-reduce the spread of microorganisms,
    avoid touching the uniform with any soiled items.
    Do not lean on pts. beds, countertops or med
    carts.
  • Scrub suits and gowns-Mandatory in the nursery,
    operating, and delivery room. (Specialty units)
  • Masks-Cover the nose and mouth and help prevent
    the spread of microorganisms, either transmitting
    or receiving, by droplet and airborne
    transmission
  • Top pg. 445 nsg. guidelines, and fig. 21-4
  • A N95 respirator mask has the ability to filter
    particles 0.3 microns in size with a minimum
    efficiency of 95.

19
WEARING PERSONAL PROTECTIVE EQUIPMENT
Gloves-Barrier to prevent hand contact with
blood, body fluids, secretions, excretions,
mucous membranes, and non-intact skin
  • Latex stretch to mold like a second skin.
  • Have a capacity to reseal tiny punctures.

20
Latex allergy
  • Skin rash, flushing, itching, watery eyes nasal
    stuffinessgtgtgtgtlife threatening swelling of the
    airway low B/P.
  • Alternatives- synthetics or double glove with
    vinyl for protection from blood or body fluids.
  • Gloving demonstration
  • Always contain the soiled sides with in each
    other.

21
Barriers
  • Hair and shoe covers-Reduce the transmission of
    pathogens present on the hair or shoes, usually
    worn in specialty areas. Shoe covers enclose pant
    leg. Hair covers cover entire head.
  • Hospital garments provided to reduce transfer of
    microorganisms
  • Protective eyewear - essential when there is a
    possibility that body fluids will splash into the
    eyes. Goggles and face shields are used when the
    likelihood of splashing occurs.

22
Soiled utility room
  • Soiled articles should never be taken into clean
    utility areas.
  • Soiled utility room contains- waste receptacles,
    laundry hampers, flushable hoppers, and sink.
  • Good place for testing urine, and stool for
    occult blood.
  • Housekeeping is responsible for disposing of the
    refuse from this room.

23
Keeping the environment clean
  • Concurrent disinfectant- environment cleaned
    daily, such as trash emptied, over-bed table
    wiped down with a disinfectant, window ledge
    cleaned. Bathroom cleaned and floors mopped.
  • Terminal disinfectant- thorough cleaning for next
    patient. Such as room stripped. Mattress wiped
    down with disinfectant, walls cleaned, bed
    railings disinfected as well as all chairs and
    furniture. The room is readied for a new
    admission.

24
STERILIZATION
  • Physical and chemical techniques to destroy ALL
    microorganisms including spores.
  • RADIATION-ultraviolet- kills bacteria, especially
    the organism that transmits tuberculosis.
  • BOILING WATER-15 minutes _at_ 212 degrees F _at_ sea
    level.

25
STERILIZATION
  • FREE-FLOWING STEAM-item exposed to heated vapor
    from boiling water.
  • DRY HEAT-expose to dry heat 3 hours at 330 340
    degrees F. (simular to baking)
  • STEAM UNDER PRESSURE-autoclave. Widely used in
    hospitals destroys all forms of microorganisms
    and spores. Heat sensative tape used to give
    visual indicator of sterility.

26
Chemical Methods
  • CHEMICAL STERILIZATION-peracetic acid, ethylene
    oxide gas
  • Peracetic acid- short time to sterilize, 12
    minutes of 122 to 131 F good for invasive
    equipment. Short turn around time.
  • Ethylene Oxide gas- used for gas sterilization.
    Kills micros, spores, viruses. Expose to gas for
    3 hours at 86F, but then items have to be aired
    for 5 days to get rid of all gas traces, which
    can cause chemical burns.

27
PRINICIPLES OF SURGICAL ASEPSIS
  • Touching one sterile item with another sterile
    item
  • Touching one sterile item with a non-sterile item
    yields it contaminated
  • Partially unwrapped sterile package is
    contaminated
  • If a question arises about sterility it is
    contaminated
  • A commercially packaged sterile item is not
    considered sterile past its recommended
    expiration date
  • Once a sterile item is opened it is only a matter
    of time before it becomes contaminated
  • A sterile wrapper, if it becomes wet, wicks
    microorganisms from its supporting surface,
    causing contamination

28
PRINICIPLES OF SURGICAL ASEPSIS
  • Any opened sterile item or sterile area is
    considered contaminated if it is left unattended
  • Coughing, sneezing, or excessive talking over a
    sterile field causes contamination
  • Reaching across an area that contains sterile
    equipment has a high potential for causing
    contamination and therefore is avoided
  • Sterile items that are located or lowered below
    the waist are considered contaminated

29
Sterile field
  • Skill page 457
  • Keep in mind the principles of asepsis page 449A
  • Work area must be clean and dry
  • Wash hands
  • Wrapped package above waist level
  • Unwrap package away from body, then sides, then
    toward body. (Why?)
  • Touch no more than 1 outer edge.

30
Sterile field
  • Adding sterile items to sterile field- open
    carefully, support loose edges then hold over
    field and drop without touching sterile field.
  • Sterile solutions- cap removed and placed upside
    down, lip the solution by holding the label in
    your hand and pour a little solution out to
    cleanse the lip of the bottle. Holding the bottle
    in this way protects from spills obliterating the
    print on the bottle.
  • Remember to date and time solutions. Always
    change solutions every 24.

31
Sterile field
  • Sterile glove application and removal

32
NURSING IMPLICATIONS NURSING DIAGNOSES
  • Risk for infection
  • Risk for Infection Transmission
  • Ineffective Protection
  • Delayed Surgical Recovery
  • Deficient Knowledge

33
GERONTOLOGIC CONSIDERATIONS
  • Conscientious handwashing is necessary
  • Maintain skin integrity
  • They are at risk for infection
  • Colonization with antibiotic-resistant bacteria
  • Life threatening consequences of infections
  • Increased susceptibility to infections
  • Provide good perineal care
  • Obtain annual immunizations against influenza and
    pneumonia

34
Recapping
  • Non-pathogens are generally harmless
    beneficial.
  • Pathogens have the potential for causing
    infections contagious disease. Both must be
    considered to be infectious agents.
  • Normal flora reside in on humans for mutual
    benefit, until the host is in a weakened
    condition, then the microorganisms take advantage
    and produce what are termed opportunistic
    infections.
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