Management Of Care/ Safety And Infection Control

Front 1

Scope for LPN

Back 1

assist in implementing a defined plan of care and to perform procedures according to protocol
assessment skills are directed at differentiating normal from abnormal
competence to care for physiologically stable clients with predictable conditions

Front 2

"Scope" for UAP

Back 2

assist in a variety of direct client care activities or tasks
perform indirect activities such as housekeeping, transporting people and stocking supplies

Front 3

Steps of Delegation

Back 3

1. Define the task
2. Match the task to the delegatee
a.Within scope
b. Know role expectations
3. Communicate clearly about expected outcomes and when the task should be done
4.Reach mutual agreement that all prior questions and problems are sorted and that the delegatee knows what to do
5. Supervise performance of task
6. Evaluate
7. Share feedback of delegatee

Hint 3

Five rights of delegation
Right task
Right circumstances
Right person
Right direction/communication
Right supervision

Front 4

Nursing Care Delivery System
Functional/Task Nursing

Back 4

Needs of clients are broken down into tasks
Tasks are assigned to various levels of health care workers according to licensure and skill
Example: RN gives medications and UAP give bed baths for one group of clients

Front 5

Nursing Care Delivery System Team Nursing

Back 5

Most common nursing care delivery system
A team of nursing personnel provides total care to a group of clients
Team leaders supervise client care teams, which usually consist of an RN, LPN, and UAP
Team leader reviews the client's plan of care and progress with team members during team conference

Front 6

Nursing Care Delivery System Total Client Care Method

Back 6

An RN is responsible for all aspects of care of one or more clients
The LPN may be assigned to assist the RN
Currently, this type of care is provided in areas requiring high level of nursing expertise, such as the critical care unit (CCU) or the post-anesthesia recovery unit (PACU)

Front 7

Nursing Care Delivery System Primary Nursing

Back 7

The RN maintains a client load of primary clients
The primary nurse designs, implements and is accountable for the nursing care of those clients during their entire stay on the unit

Front 8

Nursing Care Delivery System
Practice Partnerships

Back 8

An RN and an assistant (UAP, LPN, less-experienced RN, graduate nurse, or nurse intern) agree to be practice partners
Partners work together on same schedule with same group of clients
Senior partner directs the work of the junior partner within the scope of each partner's practice

Front 9

Negligence

Back 9

Legally, a breach of the duty to provide nursing care to the client
Malpractice is professional negligence
The unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not perform in a similar set of circumstances

Front 10

Legal concepts of Negligence

Back 10

Duty: nurses have a legal obligation to provide nursing care to clients
must meet a reasonable and prudent standard of care under the circumstances
must deliver care as any other reasonable and prudent nurse of similar education and experience would, under similar circumstances
Breach of duty: failure to provide expected, reasonable standard of care under the circumstances (includes errors of omission or commission)
Proximate cause:
relationship between the breach of duty and the resulting injury
the injured party must prove that the nurse's action or omission led to the injury
Damages: the injury and the monetary award to the plaintiff

Front 11

LIving Will

Back 11

identifies what a client wishes for their care should they become unable to communicate these wishes

Front 12

Durable Power Of Attorney for Health Care decisions

Back 12

the client has appointed a person to make decisions about their care if they are unable to do so.

Front 13

DNR

Back 13

this has been expanded to include identification of medications that may be given without any defibrillation attempts (comfort measures only)

Front 14

Ethical Principles

Back 14

Respect for others
Autonomy
Nonmaleficence - "do no harm"
Beneficence - do good and avoid evil
Justice
Veracity - the ethical duty to tell the truth
Confidentiality
Fidelity - loyalty, faithfulness and honoring commitments

Front 15

Stages of Infectious Process

Back 15

Incubation period
Prodromal period
Illness period
Convalescent period

Front 16

Standard Precautions

Back 16

apply to
blood
all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood
non-intact skin
mucous membranes

Front 17

Contact Precautions

Back 17

gown and glove for all contact
examples of opportunities for contact transmission: epidemiologically important organisms, e.g., VRE; excessive wound damage; fecal incontinence

Front 18

Droplet Precaution

Back 18

requires close contact (typically within 3 feet or less)
use of a standard surgical mask within 3 feet of the client is required
respiratory droplets are generated when an infected person coughs, sneezes, or talks, or during procedures such as suctioning, endotracheal intubation, cough induction by chest physiotherapy and cardiopulmonary resuscitation

Hint 18

examples of infectious agents transmitted through droplet route: group A streptococcus (for the first 24 hours of antimicrobial therapy), adenovirus, rhinovirus, Neisseria meningitis, pertussis, influenza virus

Front 19

Airborne Precautions

Back 19

microorganisms dispersed over long distances that remain infective over time and distance
use of special air handling and ventilation systems
wearing respiratory protection with NIOSH-certified N95 or higher level respirator for all health care workers

Hint 19

examples of microorganisms spread through airborne route: rubeola virus (measles), varicella-zoster virus (chickenpox), Mycobacterium tuberculosis

Front 20

Triage

Back 20

treated first: individuals who have life-threatening injuries that are readily correctable

treated last: individuals who have no injuries, or noncritical injuries, and who are ambulatory, as well as individuals who are dying or are dead

Front 21

Erythrocyte sedimentation rate

Back 21

>15-20 mm/h indicates inflammation

Front 22

Highly C-Reactive Protein is a marker of...?

Back 22

Inflammation

Front 23

Chicken pox (varicella) incubation/transmission/S&S

Back 23

incubation: 13- 17 days

Transmission; airborne, contact, objects

S/S: slight fever, malaise, anorexia, rash, macule>papule>vesicle, lymphadenopathy

Front 24

Varicella Interventions

Back 24

isolate until vesicles crusted

avoid aspirin may lead to Rye's disease

airborne and contact precautions at hospital

Front 25

Diphtheria
incubation time

Back 25

2-5 days

Front 26

Diphtheria transmission

Back 26

direct contact with a carrier, infected client contaminated articles

Front 27

Diphtheria S/S

Back 27

Prodromal: common cold
low-rade fever, hoarseness, malaise, pharyngeal lymphadenitis;white/gray pharyngeal membrane

Front 28

Diphtheria Interventions

Back 28

contact & droplet precautions until two successive negative nose and throat cultures

complete bedrest; watch for resp distress and obstruction; provide humidification, suctioning, and tracheostomy prn

severe= sepsis and death

Front 29

Pertussis( whooping cough) incubation

Back 29

5-21 days usually 10

Front 30

Pertussis Transmission

Back 30

direct, droplet, contaminated articles

Front 31

Pertussis S/S

Back 31

Prodromal: upper resp infection for 1-2 weeks
severe cough with high pitched whooping sound, esp at night and lasts 4-6 weeks, vomiting

Front 32

Pertussis Interventions

Back 32

Hospital for infants; bedrest and hydration
Complications; pneumonia, wt loss, dehydration, hemorrhage, hernia, airway obstruction

Maintain high humidity and restful environment; suctionl and O2

Admin erythromycin and pertussis immune globulin

Front 33

Rubella (german measles) incubation

Back 33

14-21 days

Front 34

Rubella S/S

Back 34

Prodromal; none in children, low fever and sore throat in adolescent

Maculopapular rash appears first on face then rest of body

Symptoms subside first day after rash

Front 35

Rubella Transmission

Back 35

droplet and contaminated articles

Front 36

Rubella Interventions

Back 36

contact and droplet
risk of fetal deformity
isolate child from potentially pregnant women
antipyretcis and analgesics
rare complications of arthritis and encephalitis

Front 37

Rubeola Incubation

Back 37

10-20 days

Front 38

Rubeola S/S

Back 38

Prodromal: fever and malaise> Koplik's spots on buccal mucosa

Erythematous maculopapular rash with face first affected

Front 39

Rubeola transmission

Back 39

direct contact with droplets

Front 40

Rubeola interventions

Back 40

isolate until 5th day; maintain bed rest for first 3-4 days
Airborne and seizure precautions
antipyretics, dim light, humidifier
clean skin and hydration

Front 41

Scarlet Fever Incubation time

Back 41

2-4 days

Front 42

Scarlet Fever S/S

Back 42

Prodromal; high fever vomiting , chills, malaise ,enlarged tonsils covered with exudate, strawberry tongue
Rash: red tiny lesions that become generalized and desqumate; appears in 24 hrs

Front 43

Scarlet Fever Transmission

Back 43

droplet or contaminated articles , Group A nbeta-hemolytic streptococci

Front 44

Scarlet Fever Interventions

Back 44

Droplet precautions for 24 hours after start of antibiotics

Bed rest while febrile
Analgesics for sore throat
Fluids and soft diet
Penicillin and erythromycin

Front 45

Mono Incubation

Back 45

4-6 weeks

Front 46

Mono S/S

Back 46

malaise, fever, enlarged lymphs, sore throat, flulike aches, low grade temp

usually in 15-30 yr/olds

Front 47

Mono Transmission

Back 47

direct contact with oral secretions

Front 48

Mono Interventions

Back 48

Avoid sharing saliva for 3 months, treat with rest and nutrition, strenuous exercise is to be avoided or spleen will rupture
Complications: encephalitis & spleen rupture

Front 49

Tonsillitis (Streptococcal) S/S

Back 49

fever, white exudate on tonsils

Positive culture GpA strep

Front 50

Tonsillitis Interventions

Back 50

Antibiotics

Complications: rheumatic fever, glomerulonephritis

Front 51

Mumps Incubation

Back 51

14-21 days

Front 52

Mumps S/S

Back 52

malaise, headache, fever, parotid gland swelling

Front 53

Mumps transmission

Back 53

direct contact with saliva, droplet

Front 54

Mumps interventions

Back 54

isolation before and after swelling
soft, bland diet

Complications: deafness, meningitis, encephalitis, sterility

Front 55

Hepatitis Diet

Back 55

Low in fat, high in calories, carbs, and protein; no alcohol

Front 56

Hepatitis Meds

Back 56

Vitamin K (Aquqa MEPHYTON)
Antivirals: interferon and lamivudine
Post exposure Hep B vaccine

Front 57

Syphilis Symptoms

Back 57

Stage 1: painless chancre that disappears in 4 weeks

Stage 2: Copper colored rash on palms and soles; low grade fever

Stage 3: cardiac & CNS dysfunction

Front 58

Syphilis Interventions

Back 58

Treat with Penicillin G IM or erythromycin if PCN allergy
Ceftriaxone and tetracyclines for non preggers

Abstinence until treatment complete

Front 59

Gonorrhea Symptoms

Back 59

Thick discharge
Females: usually asympt, but may have purulent discharge, dysuria, and dyspareunia (painful sex)

Males; painful urination, yellow/green discharge

Front 60

Gonorrhea Treatment

Back 60

IM Ceftriaxone (Rocephin)
1 time PO doxycillin BID for 1 week; azithromycin (Zithromax)

Penicillin with Probenecid, Spectinomycin if allergic to rocephin

monitor for PID

Front 61

Herpes Symptoms

Back 61

painful vesicular genital lesions
difficulty voiding
recurrent during stress, infection, and menses

Front 62

Herpes treatment

Back 62

acyclovir
sitz bath

Front 63

Chlamydia symptoms

Back 63

Men-dysuria, freq.urination, watery discharge

Women-may be asymptomatic, thick discharge with acrid odor, pelvic pain, yellow discharge; painful menses

Front 64

Chlamydia interventions

Back 64

Notify contacts, may cause sterility, treat with azithromycin, doxycycline, erythromycin

Front 65

Genital Warts (condylomata acuminata) Symptoms

Back 65

Initially single, small papillary lesion spreads into large cauliflower like cluster on perineum and genitals; may itch or burn

Front 66

Genital warts interventions

Back 66

curettage, cryotherapy with liquid nitro or podophyllin resin
Kerotolytic agents
avoid sex until lesions healed
May lead to genital dysplasia or cervical carcinoma
Atypical, pigmented, or persistent warts should be biopsied
notify contacts

Front 67

Aspirin (Salicylate) Poisoning Assessment

Back 67

Tinnitus, n/v, sweating , dizziness, headache

change in mental status, fever hyperventilation (resp alk) > metabolic acidosis, and resp acidosis, bleeding and hypovolemia

Toxicity begins at doses of 150-200 mg/kg; 4 grams may be fatal to child

Front 68

Aspirin poisoning interventions

Back 68

induce vomiting; initiate gastric lavage with activated charcoal
maintain IV hydration and I/O, skin turgor, fontanels
reduce temp with tepid water baths or hypothermia blankets; prone to seizures
Vitamin K for bleeding disorder
IV sodium bicarb enhances excretion

Front 69

Tylenol (acetminophen) Poisoning Assessment

Back 69

first 2 hours n/v, sweating, pallor, hypothermia, slow-weak pulse

Toxicity begins at 150 mg/kg

Front 70

Tylenol poisoning treatment

Back 70

induce vomiting
N-acetylcysteine( Mucomyst) =antidote; must be effective in 8-10 hours; must be given w/in 24hrs

Front 71

Lead toxicity assessment

Back 71

irritability, sleepiness, n/v, abd pain, poor appetite
constipation/diarrhea
dec.activity, Increase ICP

Blood level less than or equal to 9 mcg/dL is normal

Front 72

Lead toxicity interventions

Back 72

chelating agents, calcium disodium, succimer, deferoxamine( desferal)

maintain hydration, id source and tell parents