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

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TYPES OF MICROORGANISMS

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

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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.

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Survival of Microorganisms

• See box 21-1

• Development of Antibiotic- Resistant Bacterial
  Strains-
• Staphylococcus aureus
• Enterococcus faecalis
• Streptococcus pneumoniae

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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.)

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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

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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.

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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.

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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)

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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

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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

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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.

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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.

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Sterile field

• Sterile glove application and removal

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NURSING IMPLICATIONS NURSING DIAGNOSES

• Risk for infection
• Risk for Infection Transmission
• Ineffective Protection
• Delayed Surgical Recovery
• Deficient Knowledge

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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.