Fundamental Concern of Nurses

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Fundamental Concern of Nurses

• Prevention of Harm
• Harm from accidents injury
• -Prevent falls, fires, etc
• Harm by the spread of infection
• -Control infectious organisms

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Safety Needs

• To Meet Safety Needs of Patients consider
• Physical Factors in Environment
• Psychological State
• Physiologic State

3
Hospital Safety

• Disaster Planning
• Emergency Codes
• -Code Red
• -Code Blue
• -Code Pink
• Emergency Nursing
• -CPR

4
Patient Safety

• Factors Affecting Safety
• Age Development
• Mobility
• Health Status
• Sensory-Perceptual Alterations

• Cognitive Awareness
• Emotional State
• Ability to Communicate
• Safety Awareness

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Safe and Comfortable Environment

• Space
• Lighting
• Temperature
• Ventilation
• Comfortable sound levels
• Furniture Bed Safety
• Food and Water

• Hazardous Products
• Waste Management
• Organization of time
• Privacy
• Individualized Care
• Information and Teaching
• Safety Precautions
• -fall prevention

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• Poor Vision
• Confused
• Disoriented
• Impaired memory
• Impaired gait/balance
• Difficulty walking
• Difficulty getting in and out of bed

• Orthostatic hypotension
• Urinary frequency
• Weakness
• Medications
• -sedatives, hypnotics, tranquilizers, narcotic
  analgesics, diuretics

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Fall Risk Assessment

• Mr. Jackson is a 73-yr-old stroke patient with
  recent mental status changes, admitted for
  prostate surgery. He has right-sided weakness
  and has fallen once at home while trying to go to
  the bathroom. He has difficulty initiating a
  urinary stream, dribbling of urine, and nocturia.
  He has a history of hypertension, for which he
  takes hydrochlorothiazide (diuretic).

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Fall Prevention

• List specific interventions to ensure the Mr.
  Jacksons safety in the hospital?

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Fall Prevention

• Risk Assessment
• Indicate fall risk on door chart
• Bed in low position
• Wheels locked
• Call light
• Side rails
• Bed alarms
• Bedside commode
• Shower chair
• Night light
• Sitters

• Room closer to nursing station
• Water, tissues, bedpan within reach
• Monitor changes in cognitive status
• Eliminate clutter
• Non skid footwear
• Ambulatory devices
• Dangle
• Secure tubes, drains

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If a Fall Occurs

• Assess for injury
• Check vital signs
• Assist back to bed, if safe
• Notify MD
• Monitor frequently
• Incident Report

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Fire Safety

• A family member reports a lit cigarette dropped
  on the clients mattress, but they were able to
  put out the small fire. What actions are needed
  to ensure the safety of the patients?

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Fire Safety

• Immediately Assess pts room
• -surface fire maybe out
• -smoldering inside mattress
• Assess pt for injury
• Call for Help

• Rescue patients
• Activate the alarm
• Contain fire
• -close doors
• -turn off oxygen
• Extinguish the fire

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How To Use A Portable Fire Extinguisher

• Remember the acronym PASS
• PPull the Pin
• AAim at the base of the flames
• SSqueeze the trigger
• SSweep from side to side

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Fire Safety

• Thorough assessment of patients
• Notify physician
• Thank the family
• Review No Smoking Policy
• Alternative means for smoking
• -nicorette gum

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Electrical Safety

• Equipment is checked by biomed dept
• Pts personal devices
• Read warning labels
• No smoking
• Check for frayed electrical cords
• Avoid overloading circuits
• Report any shocks to biomed dept
• Electrical shock
• -turn off remove source before touching
• pt, v vital signs, v skin for burns, notify
  MD.

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Infections Precautions
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Infection Control

• Microorganisms
• Bacteria
• Viruses
• Fungi
• Parasites

• Harmless Organisms
• Resident flora
• -E Coli (intestine)
• -Staph aureus (skin)
• Colonization
• -microorganisms
• become resident flora

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Harmful Actions of Microorganisms

• Infections or disease occur
• of organism present
• Ability of organism to cause disease
• Persons immune system
• Length of contact between person organism

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Risk Factors for Infection

• Age
• Heredity
• Stress
• Nutrition
• Medication
• Diseases
• -burns, PVD, DM

• Invasive techniques
• -surgical wounds
• -? immunity
• -trachs, ventilators
• -foley cath
• -IV therapy
• -venipuncture sites
• -TPN
• -Implanted devices

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Chain of Infection

• Infectious agent
• -The Bug
• Reservoir
• -Hiding Places
• Portal of Exit
• -Way out

• Mode of transmission
• -Getting around
• Portal of entry
• -Way in
• Susceptible host
• -Another sick person

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The Spread of Infection

• An elderly pt, admitted with a GI disorder, is on
  bedrest and requires assistance with adls. The
  pt has frequent uncontrolled diarrhea stools and
  the nurse provided excellent care to maintain
  cleanliness and comfort. After one episode of
  cleaning the pt and changing the bed linen, the
  nurse went over to a second pt to adjust foley
  cath tubing. The nurses hands were not washed
  before assisting the second patient.

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Spread of Infection

• Infectious agent-E Coli
• Reservoir-Large Intestine
• Portal of Exit-Feces
• Mode of transmission-Contaminated hands
• Portal of entry-foley cath tubing
• Susceptible host-elderly, chronic illness, foley
  cath

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Breaking the Chain

• A patient assigned for morning care has an open
  wound on her left lower leg. The wound is
  draining and when last cultured, the organism
  MRSA was identified. What steps would you take
  to break the chain of infection while changing
  the patients bed.

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Breaking the Chain

• Infectious agent-MRSA
• Reservoir-infected wd
• Portal of exit-Break the chain
• -Handwashing, gloves, handle linen properly
• MRSA is commonly transferred on the hands of the
  nurse by indirect contact.

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Nosocomial Infections

• Drug Resistant Organisms
• Clostridium difficile (C Diff)
• Methicillin-resistant Staph aureus (MRSA)
• Vancomycin-resistant enterococcus (VRE)
• C Diff MRSA

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Nosocomial Infections

• Urinary Tract
• -E Coli
• -Poor cath care
• Surgical Site
• -Enterococcus
• -Improper dsg change
• POOR HAND HYGIENEAPPLIES TO ALL

• Bloodstream
• -Staph aureus
• -Improper IV site care
• Pneumonia
• -Pseudomonas
• -Improper suctioning
• technique

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Preventing Nosocomial Infections
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Controlling Microorganism in the Environment

• Medical Asepsis
• Clean technique
• Limit , growth, transmission of microorganisms
• Handwashing
• Barrier techniques
• Environmental cleaning

• Surgical Asepsis
• Sterile technique
• Completely free of microorganisms

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Transmission Based Precautions

• Infected or colonized
• Airborne (measles, TB)
• -Private neg airflow room 6 air exchanges/hr
• -Mask
• Droplet (pneumonia, meningitis)
• -Private room/mask
• Contact
• -gloves/gown
• -Direct (kissing, bathing, toughing)
• -Indirect (instruments, needles, dressing)
• Protective Isolation

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Safety of Healthcare Workers

• Occupational Safety and
• Health Administration
• (OSHA)
• Federal Agency
• Dept of Labor
• Safe environment for all workers
• Violations
• -Fines

• Hospital Specific
• Safety needles
• Sharp containers
• Exposure to TB, Hep B, HIV, Radiation
• Latex allergies
• PPE
• Electrical

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Isolation PPE
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Latex Allergies

• Assess for allergies to avocados, bananas, kiwi
  or chestnuts for cross sensitivity to latex
• S/S of latex allergy
• -Contact dermitis
• -Facial swelling, itching, hives, rhinitis, eye
  symptoms
• -Potentially dangerous bronchospasms,
  generalized edema, difficulty breathing, cardiac
  arrest
• Latex cart at bedside

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Latex Allergy Precautions

• Mrs. Smith tells you she has allergic reactions
  when she eats bananas, seafood, eggs. Based on
  this information what would you ask Mrs. Smith,
  and what actions would you take?

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Isolation Room

• Isolation Cart
• Isolation Signs
• Equipment
• Donning PPE
• Removing PPE

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Psychological Interventions

• Explain isolation procedure
• Encourage verbalization of feelings
• Be empathic
• Permit visitors
• Support coping mechanisms
• Visit pt