Remember the Mnemonics : "ABCDE" in evaluating or assessing a lesion
Asymmetry
Border
Color and
Configuration
Diameter and
Drainage
Evolution or progression of the lesion
Showing posts with label free nclex-rn review. Show all posts
Showing posts with label free nclex-rn review. Show all posts
Contact Precautions
In addition to Standard Precautions, Special Organisms Precautions are initiated and maintained to interrupt the transmission of epidemiologically significant microorganisms known to be spread by contact. These precautions are intended to reduce the colony count of bacteria on horizontal surfaces and in the immediate vicinity of the patient.
Special Organism Precautions (SOP) will be instituted on a case-by-case basis at the discretion of the Infection Control staff, Infectious Disease staff and/or Medical or Nursing staff. Instances in which special organism precautions apply are as follows:
• When a patient is colonized and/or infected with multiple drug-resistant organisms, or organisms that are not treatable with the usual antibiotics, i.e., vancomycin-resistant enterococcus (VRE), multi-drug resistant gram-negative rods, etc.
• When a particular organism is identified as being potentially hazardous because of its pathogenicity, virulence, or epidemiologic characteristics. e.g. rotavirus, Salmonella sp., Shigella sp . etc.
• For other organisms, these procedures may be instituted or modified at the discretion of IC staff (e.g. smallpox/vaccinia, Severe Acute Respiratory Syndrome (SARS).
I. POLICY for patients with diseases requiring ONLY the institution of Special
Organism Precautions/Contact Precautions. NOTE: Infection Control will
be notified by phone by Microbiology when a specimen is positive for VRE
or rotavirus. The Microbiology Lab will screen for vancomycin resistance in
enterococcus isolates from in-patients and selected out-patient services.
A. HANDWASHING
Handwashing for at least 10 seconds with an antimicrobial soap, or
alcohol gel use is required:
1. Between patient contacts
2. Following removal of gloves/other protective equipment in the
room.
3. Patients should be instructed in handwashing and the need for
precautions.
B. PERSONAL PROTECTIVE EQUIPMENT
1. Wear gloves for all contact with the patient, the patient's bedside
equipment, and the patient's environment.
a. Change gloves between distinctive tasks (e.g. wound care, perineal
care, suctioning).
b. Gloves must always be removed before leaving the room.
2. Wear a disposable gown for direct contact with the patient or the
environment if the patient is incontinent, or has diarrhea or a
draining wound.
a. Gowns may be worn one time only, then disposed of in the
regular (non-biohazardous) waste.
b. Cloth gowns may be substituted if there is no risk of splash
3. As per Standard Precautions, wear a mask and protective eyewear
when performing procedures that generate aerosols (Standard
Precautions)
C. PATIENT PLACEMENT
1. Place the patient in a private room.
2. Post "Special Organism Precaution" Stop sign on or next
to the door of the patient's room. The name of the infecting organism
may NOT be written on the sign.
3. A negative air pressure room is not required. The door may remain
open.
4. Patients who are currently on isolation precautions for any infection
may not be admitted to the Comfort Care Suites. Any questions
regarding this policy may be addressed to the Department of Hospital
Epidemiology and Infection Control.
5. It is not necessary to place patients on Special Organism Precautions
in a private room while they receive hemodialysis in the Acute
Hemodialysis Unit (AHU). A Special Organism Precautions isolation
sign should be placed at the foot of the patient's bed. Staff should
adhere to all other practices outlined in this policy including
appropriate use of barriers and task oriented use of gloves.
D. ENVIRONMENT
1. Provide the patient with his or her own equipment. The
equipment should not be shared (unless it is disinfected properly)
between patients. Examples include but are not limited to electronic
thermometer, blood pressure cuff, manometer, stethoscope, IV pole,
wheelchair, or gurney. For pediatric patients with stool-borne
pathogens (e.g. VRE, rotavirus, etc.) that require diaper weighing for
I & O measurement, a dedicated scale in the room is required.
2. Nursing staff should use an EPA-APPROVED DETERGENT/
DISINFECTANT to wipe down high touch surfaces once a day.
At a minimum, this cleaning should include bed rails, over bed table,
night stand, as well as the surfaces of electronic equipment,
respiratory therapy equipment, and other items that come in physical
contact with the patient. In critical care units, or units where there is
a high endemic rate of the organism, the wipe down should be
repeated each shift.
3. Quaternary Ammonium Compound (e.g. A456N or 3M Quat) is
currently available for the purposes of disinfection. Cleaning cloths
used in the room should not be used to lean other patients' rooms
and equipment. They should be laundered before reuse or discarded.
4. When the known VRE patient is transferred, please send signage,
supplies and patient dedicated equipment with the patient.
5. Upon discharge the room will be cleaned in accordance with the
PSA Cleaning Procedure. Cupboard supplies that have not been
opened and are intact may be left in the room for future use.
6. Waste disposal, spill management, linen and food trays are handled
in the same way for all patients, regardless of precaution category.
Isolation trays are not required. After patient use, both linen and food
trays are sent directly for cleaning and disinfection.
E. PATIENT TRANSPORT/AMBULATION
1. Nursing will notify Receiving Departments of any patients on
Special Organism Precautions.
2. Patients may walk in hall wearing a clean cover gown if they have
been instructed in handwashing, are continent, and able to cooperate
with procedures.
a. Diapered patients must be supervised when out of the room.
b. Pediatric patients may go to the playroom, the teen room and the
schoolroom with Infection Control/Child Life approval.
3. For patient transport, the following guidelines apply :
a. Wear gloves only if you are physically moving the patient from
the bed or gurney. Wear gloves and a gown only if the patient
is incontinent, or has diarrhea or a draining wound.
b. You must remove the gown and gloves in the room, wash your
hands, and then bring the patient to the receiving unit.
c. After transportation is complete, the gurney or wheelchair must be
wiped with a disinfectant.
4. For staff of procedure/diagnostic areas and practices, the
following guidelines apply:
a. Handwashing for at least 10 seconds with an antimicrobial soap,
or alcohol gel use is required:
1. Between patient contacts,
2. Following removal of gloves/other protective equipment in the
room.
.
b. Personal Protective Equipment
1. Wear gloves for all contact with the patient, the patient's
bedside equipment, and the patient's environment. Change
gloves between distinctive tasks (for example, wound care,
perineal care,suctioning). Gloves must always be removed
before leaving the room.
2. In the patient setting, wear a disposable gown for direct
contact with the patient, if the patient is incontinent, or has
diarrhea or a draining wound.
a. Gowns may be worn one time only, then disposed of in the
regular (non-biohazardous) waste.
b. Cloth gowns may be substituted if there is no risk of splash.
c. As per Standard Precautions, wear a mask and protective
eyewear when performing procedures that generate aerosols
3. Provide the patient with his or her own equipment.
The equipment should not be shared (unless it is
disinfected properly) between patients. Examples include
but are not limited to electronic thermometer, blood
pressure cuff, manometer, stethoscope, IV pole,
wheelchair, or gurney.
4. Staff should use an EPA-APPROVED DETERGENT/
DISINFECTANT to wipe down potentially contaminated
equipment that has been in direct contact with the
patient.
5. Quaternary Ammonium Compound such as A456N, or a
premixed agent such as Cavacide iscurrently available for the
purposes of disinfection. Cleaning cloths used in the room
should not be used to clean other patients' rooms and
equipment.
F. VISITORS/STAFF
1. Traffic should be limited to only essential staff/visitors.
2. All visitors shall be instructed in proper handwashing technique.
Visitors that participate in direct patient care shall be instructed in
gowning and gloving, if the patient is incontinent, diapered, or
has diarrhea or a draining wound.
3. Visitors may be referred to Infection Control or given written
educational material.
G. PATIENT TRANSFER/DISCHARGE
1. For patients being transferred to another facility, Infection Control,
discharge planner or physician shall notify the receiving institution
whenever possible.
2. If requested by Admitting, Medical Records or floor personnel, a list
of patients on SOP will be provided by the Infection Control
Department.
H. DISCONTINUATION OF PRECAUTIONS FOR A PATIENT WITH A
HISTORY OF VRE
1. IC consultation must be obtained prior to VRE screening for the
purpose of discontinuing SOP.
2. The Screening Procedure is as follows:
a. Physician/Nurse/Microbiology staff will call IC department for
approval.
b. Obtain a culture from previous VRE (+) site. If this culture is (-)
proceed to the next step.
c. Obtain three perianal swabs, one week apart. Under certain
circumstances the usual one week interval between cultures may
be altered with IC approval.
d. Culture procedure:
1. Perianal area should be swabbed thoroughly using a dry sterile
swab.
2. Place swab in culture tube without media.
3. Write on requisition "Screen for VRE" and "Infection Control
approved".
e. When three, consecutive perianal swabs are negative, SOP may
be discontinued. Infection Control must be notified.
3. If all three perianal swabs cannot be obtained during the same
admission, the process can be continued in the outpatient setting or
during the patient's next admission. Results from the outpatient
setting or another facility must be documented and made available to
Infection Control.
I. READMISSION OF PATIENTS WITH A HISTORY OF VRE
1. Patients who have culture confirmed VRE will have a
"Alert" placed on their electronic hospital record by the
Infection Control Department. This alert will cause a text message
stating "SPECIAL ORGANISM PRECAUTIONS IF ADMITTED"
2. The person performing the admission procedure for a patient with
this alert should phone the charge nurse of the receiving unit to
relay the following information so that SOP will be initiated by floor
staff:
a. Patient Name
b. Patient medical record number
c. Patient is to be put on Special Organism Precautions upon arrival
on the unit.
3. Once a patient has successfully cleared a VRE infection/colonization
as demonstrated by the above screening procedure, the SOP
“alert” will be removed by Infection Control staff.
4. Quality control checks on the system will be performed periodically
by Infection Control.
II. POLICY: Special Organism Precautions are implemented in a MODIFIED
form for certain diseases transmitted via contact as well as other routes.
A. Patients with suspected or confirmed smallpox, or complications from
the smallpox vaccine (vaccinia) require Special Organism/Contact
Precautions AND Airborne/AFB isolation.
B. Patients with suspected or confirmed Severe Acute Respiratory
Syndrome (SARS) require Special Organism/Contact Precautions AND
Airborne/AFB isolation.
Special Organism Precautions (SOP) will be instituted on a case-by-case basis at the discretion of the Infection Control staff, Infectious Disease staff and/or Medical or Nursing staff. Instances in which special organism precautions apply are as follows:
• When a patient is colonized and/or infected with multiple drug-resistant organisms, or organisms that are not treatable with the usual antibiotics, i.e., vancomycin-resistant enterococcus (VRE), multi-drug resistant gram-negative rods, etc.
• When a particular organism is identified as being potentially hazardous because of its pathogenicity, virulence, or epidemiologic characteristics. e.g. rotavirus, Salmonella sp., Shigella sp . etc.
• For other organisms, these procedures may be instituted or modified at the discretion of IC staff (e.g. smallpox/vaccinia, Severe Acute Respiratory Syndrome (SARS).
I. POLICY for patients with diseases requiring ONLY the institution of Special
Organism Precautions/Contact Precautions. NOTE: Infection Control will
be notified by phone by Microbiology when a specimen is positive for VRE
or rotavirus. The Microbiology Lab will screen for vancomycin resistance in
enterococcus isolates from in-patients and selected out-patient services.
A. HANDWASHING
Handwashing for at least 10 seconds with an antimicrobial soap, or
alcohol gel use is required:
1. Between patient contacts
2. Following removal of gloves/other protective equipment in the
room.
3. Patients should be instructed in handwashing and the need for
precautions.
B. PERSONAL PROTECTIVE EQUIPMENT
1. Wear gloves for all contact with the patient, the patient's bedside
equipment, and the patient's environment.
a. Change gloves between distinctive tasks (e.g. wound care, perineal
care, suctioning).
b. Gloves must always be removed before leaving the room.
2. Wear a disposable gown for direct contact with the patient or the
environment if the patient is incontinent, or has diarrhea or a
draining wound.
a. Gowns may be worn one time only, then disposed of in the
regular (non-biohazardous) waste.
b. Cloth gowns may be substituted if there is no risk of splash
3. As per Standard Precautions, wear a mask and protective eyewear
when performing procedures that generate aerosols (Standard
Precautions)
C. PATIENT PLACEMENT
1. Place the patient in a private room.
2. Post "Special Organism Precaution" Stop sign on or next
to the door of the patient's room. The name of the infecting organism
may NOT be written on the sign.
3. A negative air pressure room is not required. The door may remain
open.
4. Patients who are currently on isolation precautions for any infection
may not be admitted to the Comfort Care Suites. Any questions
regarding this policy may be addressed to the Department of Hospital
Epidemiology and Infection Control.
5. It is not necessary to place patients on Special Organism Precautions
in a private room while they receive hemodialysis in the Acute
Hemodialysis Unit (AHU). A Special Organism Precautions isolation
sign should be placed at the foot of the patient's bed. Staff should
adhere to all other practices outlined in this policy including
appropriate use of barriers and task oriented use of gloves.
D. ENVIRONMENT
1. Provide the patient with his or her own equipment. The
equipment should not be shared (unless it is disinfected properly)
between patients. Examples include but are not limited to electronic
thermometer, blood pressure cuff, manometer, stethoscope, IV pole,
wheelchair, or gurney. For pediatric patients with stool-borne
pathogens (e.g. VRE, rotavirus, etc.) that require diaper weighing for
I & O measurement, a dedicated scale in the room is required.
2. Nursing staff should use an EPA-APPROVED DETERGENT/
DISINFECTANT to wipe down high touch surfaces once a day.
At a minimum, this cleaning should include bed rails, over bed table,
night stand, as well as the surfaces of electronic equipment,
respiratory therapy equipment, and other items that come in physical
contact with the patient. In critical care units, or units where there is
a high endemic rate of the organism, the wipe down should be
repeated each shift.
3. Quaternary Ammonium Compound (e.g. A456N or 3M Quat) is
currently available for the purposes of disinfection. Cleaning cloths
used in the room should not be used to lean other patients' rooms
and equipment. They should be laundered before reuse or discarded.
4. When the known VRE patient is transferred, please send signage,
supplies and patient dedicated equipment with the patient.
5. Upon discharge the room will be cleaned in accordance with the
PSA Cleaning Procedure. Cupboard supplies that have not been
opened and are intact may be left in the room for future use.
6. Waste disposal, spill management, linen and food trays are handled
in the same way for all patients, regardless of precaution category.
Isolation trays are not required. After patient use, both linen and food
trays are sent directly for cleaning and disinfection.
E. PATIENT TRANSPORT/AMBULATION
1. Nursing will notify Receiving Departments of any patients on
Special Organism Precautions.
2. Patients may walk in hall wearing a clean cover gown if they have
been instructed in handwashing, are continent, and able to cooperate
with procedures.
a. Diapered patients must be supervised when out of the room.
b. Pediatric patients may go to the playroom, the teen room and the
schoolroom with Infection Control/Child Life approval.
3. For patient transport, the following guidelines apply :
a. Wear gloves only if you are physically moving the patient from
the bed or gurney. Wear gloves and a gown only if the patient
is incontinent, or has diarrhea or a draining wound.
b. You must remove the gown and gloves in the room, wash your
hands, and then bring the patient to the receiving unit.
c. After transportation is complete, the gurney or wheelchair must be
wiped with a disinfectant.
4. For staff of procedure/diagnostic areas and practices, the
following guidelines apply:
a. Handwashing for at least 10 seconds with an antimicrobial soap,
or alcohol gel use is required:
1. Between patient contacts,
2. Following removal of gloves/other protective equipment in the
room.
.
b. Personal Protective Equipment
1. Wear gloves for all contact with the patient, the patient's
bedside equipment, and the patient's environment. Change
gloves between distinctive tasks (for example, wound care,
perineal care,suctioning). Gloves must always be removed
before leaving the room.
2. In the patient setting, wear a disposable gown for direct
contact with the patient, if the patient is incontinent, or has
diarrhea or a draining wound.
a. Gowns may be worn one time only, then disposed of in the
regular (non-biohazardous) waste.
b. Cloth gowns may be substituted if there is no risk of splash.
c. As per Standard Precautions, wear a mask and protective
eyewear when performing procedures that generate aerosols
3. Provide the patient with his or her own equipment.
The equipment should not be shared (unless it is
disinfected properly) between patients. Examples include
but are not limited to electronic thermometer, blood
pressure cuff, manometer, stethoscope, IV pole,
wheelchair, or gurney.
4. Staff should use an EPA-APPROVED DETERGENT/
DISINFECTANT to wipe down potentially contaminated
equipment that has been in direct contact with the
patient.
5. Quaternary Ammonium Compound such as A456N, or a
premixed agent such as Cavacide iscurrently available for the
purposes of disinfection. Cleaning cloths used in the room
should not be used to clean other patients' rooms and
equipment.
F. VISITORS/STAFF
1. Traffic should be limited to only essential staff/visitors.
2. All visitors shall be instructed in proper handwashing technique.
Visitors that participate in direct patient care shall be instructed in
gowning and gloving, if the patient is incontinent, diapered, or
has diarrhea or a draining wound.
3. Visitors may be referred to Infection Control or given written
educational material.
G. PATIENT TRANSFER/DISCHARGE
1. For patients being transferred to another facility, Infection Control,
discharge planner or physician shall notify the receiving institution
whenever possible.
2. If requested by Admitting, Medical Records or floor personnel, a list
of patients on SOP will be provided by the Infection Control
Department.
H. DISCONTINUATION OF PRECAUTIONS FOR A PATIENT WITH A
HISTORY OF VRE
1. IC consultation must be obtained prior to VRE screening for the
purpose of discontinuing SOP.
2. The Screening Procedure is as follows:
a. Physician/Nurse/Microbiology staff will call IC department for
approval.
b. Obtain a culture from previous VRE (+) site. If this culture is (-)
proceed to the next step.
c. Obtain three perianal swabs, one week apart. Under certain
circumstances the usual one week interval between cultures may
be altered with IC approval.
d. Culture procedure:
1. Perianal area should be swabbed thoroughly using a dry sterile
swab.
2. Place swab in culture tube without media.
3. Write on requisition "Screen for VRE" and "Infection Control
approved".
e. When three, consecutive perianal swabs are negative, SOP may
be discontinued. Infection Control must be notified.
3. If all three perianal swabs cannot be obtained during the same
admission, the process can be continued in the outpatient setting or
during the patient's next admission. Results from the outpatient
setting or another facility must be documented and made available to
Infection Control.
I. READMISSION OF PATIENTS WITH A HISTORY OF VRE
1. Patients who have culture confirmed VRE will have a
"Alert" placed on their electronic hospital record by the
Infection Control Department. This alert will cause a text message
stating "SPECIAL ORGANISM PRECAUTIONS IF ADMITTED"
2. The person performing the admission procedure for a patient with
this alert should phone the charge nurse of the receiving unit to
relay the following information so that SOP will be initiated by floor
staff:
a. Patient Name
b. Patient medical record number
c. Patient is to be put on Special Organism Precautions upon arrival
on the unit.
3. Once a patient has successfully cleared a VRE infection/colonization
as demonstrated by the above screening procedure, the SOP
“alert” will be removed by Infection Control staff.
4. Quality control checks on the system will be performed periodically
by Infection Control.
II. POLICY: Special Organism Precautions are implemented in a MODIFIED
form for certain diseases transmitted via contact as well as other routes.
A. Patients with suspected or confirmed smallpox, or complications from
the smallpox vaccine (vaccinia) require Special Organism/Contact
Precautions AND Airborne/AFB isolation.
B. Patients with suspected or confirmed Severe Acute Respiratory
Syndrome (SARS) require Special Organism/Contact Precautions AND
Airborne/AFB isolation.
Types of Coping Mechanisms
1. Compensation - extra effort in one area to offset real or imagined
lack in another area
Example: Short man becomes assertively verbal and excels in business.
2. Conversion - A mental conflict is expressed through physical symptoms
Example: Woman becomes blind after seeing her husband with another woman.
3. Denial - treating obvious reality factors as though they do not exist because
they are consciously intolerable
Example: Mother refuses to believe her child has been diagnosed with leukemia.
"She just has the flu."
4. Displacement - transferring unacceptable feelings aroused by one object
to another,more acceptable substitute
Example: Adolescent lashes out at parents after not being invited to party.
5. Dissociation - walling off specific areas of the personality from consciousness
Example: Adolescent talks about failing grades as if they belong to
someone else;jokes about them.
6. Fantasy - a conscious distortion of unconscious wishes and need to
obtain satisfaction
Example: A student nurse fails the critical care exam and daydreams about
her heroic role in a cardiac arrest.
7. Fixation - becoming stagnated in a level of emotional development in
which one is comfortable
Example: A sixty year old man who dresses and acts as if he were still
in the 1960's.
8. Identification - subconsciously attributing to oneself qualities of others
Example: Elvis impersonators.
9. Intellectualization - use of thinking, ideas, or intellect to avoid emotions
Example: Parent becomes extremely knowledgeable about child's diabetes.
10. Introjection - incorporating the traits of others
Example: Husband's symptoms mimic wife's before she died.
11. Projection - unconsciously projecting one's own unacceptable qualities
or feelings onto others
Example: Woman who is jealous of another woman's wealth accuses her
of being a gold-digger.
12. Rationalization - justifying behaviors, emotions, motives, considered
intolerable through acceptable excuses
Example: "I didn't get chosen for the team because the coach plays
favorites."
13. Reaction Formation - expressing unacceptable wishes or behavior by
opposite overt behavior
Example: Recovered smoker preaches about the dangers of second
hand smoke.
14. Regression - retreating to an earlier and more comfortable emotional
level of development
Example: Four year old insists on climbing into crib with younger sibling.
15. Repression - unconscious, deliberate forgetting of unacceptable or
painful thoughts,impulses, feelings or acts
Example: Adolescent "forgets" appointment with counselor to discuss
final grades.
16. Sublimation - diversion of unacceptable instinctual drives into personally
and socially acceptable areas.
Example: Young woman who hated school becomes a teacher.
lack in another area
Example: Short man becomes assertively verbal and excels in business.
2. Conversion - A mental conflict is expressed through physical symptoms
Example: Woman becomes blind after seeing her husband with another woman.
3. Denial - treating obvious reality factors as though they do not exist because
they are consciously intolerable
Example: Mother refuses to believe her child has been diagnosed with leukemia.
"She just has the flu."
4. Displacement - transferring unacceptable feelings aroused by one object
to another,more acceptable substitute
Example: Adolescent lashes out at parents after not being invited to party.
5. Dissociation - walling off specific areas of the personality from consciousness
Example: Adolescent talks about failing grades as if they belong to
someone else;jokes about them.
6. Fantasy - a conscious distortion of unconscious wishes and need to
obtain satisfaction
Example: A student nurse fails the critical care exam and daydreams about
her heroic role in a cardiac arrest.
7. Fixation - becoming stagnated in a level of emotional development in
which one is comfortable
Example: A sixty year old man who dresses and acts as if he were still
in the 1960's.
8. Identification - subconsciously attributing to oneself qualities of others
Example: Elvis impersonators.
9. Intellectualization - use of thinking, ideas, or intellect to avoid emotions
Example: Parent becomes extremely knowledgeable about child's diabetes.
10. Introjection - incorporating the traits of others
Example: Husband's symptoms mimic wife's before she died.
11. Projection - unconsciously projecting one's own unacceptable qualities
or feelings onto others
Example: Woman who is jealous of another woman's wealth accuses her
of being a gold-digger.
12. Rationalization - justifying behaviors, emotions, motives, considered
intolerable through acceptable excuses
Example: "I didn't get chosen for the team because the coach plays
favorites."
13. Reaction Formation - expressing unacceptable wishes or behavior by
opposite overt behavior
Example: Recovered smoker preaches about the dangers of second
hand smoke.
14. Regression - retreating to an earlier and more comfortable emotional
level of development
Example: Four year old insists on climbing into crib with younger sibling.
15. Repression - unconscious, deliberate forgetting of unacceptable or
painful thoughts,impulses, feelings or acts
Example: Adolescent "forgets" appointment with counselor to discuss
final grades.
16. Sublimation - diversion of unacceptable instinctual drives into personally
and socially acceptable areas.
Example: Young woman who hated school becomes a teacher.
Airborne Precautions Review
AIRBORNE/AFB PRECAUTIONS
(for M. tuberculosis and SARS (Severe Acute Respiratory Syndrome))
I. POLICY
In addition to Standard Precautions, Airborne/AFB Precautions are required
when a patient is suspected or known to have a disease transmitted by
airborne droplet nuclei. These evaporated droplets contain microorganisms
that remain suspended in the air and can be widely dispersed by air currents
within a room or over a long distance.
This category of precautions includes the following diseases or infections:
tuberculosis (TB), SARS (Severe Acute Respiratory Syndrome) smallpox
and complications from the smallpox vaccine (generalized vaccinia,
erythema mulitforme, progressive vaccinia or eczemavaccinatum) and
Hemorrhagic fevers (Ebola, Lassa, Marburg).
II. HANDWASHING
Strict handwashing after contact with patient or items contaminated with
respiratory secretions is required.
III. PERSONAL PROTECTIVE EQUIPMENT (PPE)
A. Follow Standard Precautions
B. Wear an OSHA approved mask for Tuberculosis, such as the N95
mask/respirator for which you have been fit-tested or PAPR.
C. For patients who require 24-hour in-room observation (e.g., psychiatric or
incarcerated patients), the in-room sitter must use a PAPR or a fit tested
N-95 respirator. If the in-room sitter has been fit tested, they should bring
their own N-95 respirator, or the unit will provide a PAPR.
IV. PATIENT PLACEMENT
A. Place patient in a private room with monitored negative air pressure in
relation to surrounding areas, with a minimum of six (6) air exchanges
per hour.
B. Air from the room must be discharged outdoors or monitored with high
efficiency filtration of room air before circulated to other areas in the
hospital.
1. Use a designated negative pressure room whenever possible.
2. Nursing will notify Management when
precautions are discontinued.
C. The door to the patient's room must remain closed except for entry/exit.
D. Windows must remain closed.
E. Post "AFB/Airborne Precaution" Stop sign on or next to the door
of the patient's room. DO NOT write "Tuberculosis" or "TB" on the sign.
F. Obtain the Respiratory Protection cart from Material Services for
placement outside the patient's room.
G. Patients who are currently on isolation precautions for any infection may
not be admitted to the Comfort Care Suites. Any question regarding this
policy may be addressed to the Department of Hospital Epidemiology
and Infection Control.
V. ENVIRONMENT
Waste disposal, spill management, linen and food trays are handled in the
same way for all patients, regardless of precaution category.
VI. PATIENT TRANSPORT/AMBULATION
A. The patient must be confined to his/her room unless a procedure is
necessary which must be performed at a location outside the room.
B. The receiving department must be notified of the patient's diagnosis.
C. The patient must wear a surgical mask outside of the room when
transported to another department.
D. Patients who are discharged from the hospital but still considered
contagious must be instructed in the need for wearing a surgical mask.
VII. VISITORS
A. Visitors will wear a surgical mask that is secured and snugly fitted.
B. Symptomatic household or other contacts of patient should not
visit until medically cleared. If symptomatic contact must visit, mask
will be donned before entering the hospital and worn continuously while
in the facility.
VIII. DISCONTINUATION OF PRECAUTIONS
The patient room is to be left vacant for one hour if the patient is considered to be infectious and was not covering cough.
NCLEX Review Apgar Scoring
Assess and document APGAR at 1 and 5 minutes
• Appearance
› Pink torso and extremities: Score = 2
› Pink torso, blue extremities: Score = 1
› Blue all over: Score = 0
• Pulse
› >100: Score = 2
› 100: Score = 1
› Absent: Score = 0
• Grimace (irritability)
› Vigorous cry: Score = 2
› Limited cry: Score = 1
› No response to stimulus: Score = 0
• Activity
› Actively moving: Score = 2
› Limited movement: Score = 1
› Flaccid: Score = 0
• Respiratory Effort
› Strong loud cry: Score = 2
› Hypoventilation, irregular: Score = 1
› Absent: Score = 0
Totals*
*8-10: normal; 4-6: moderate depression; 0-3: aggressive resuscitation
• Appearance
› Pink torso and extremities: Score = 2
› Pink torso, blue extremities: Score = 1
› Blue all over: Score = 0
• Pulse
› >100: Score = 2
› 100: Score = 1
› Absent: Score = 0
• Grimace (irritability)
› Vigorous cry: Score = 2
› Limited cry: Score = 1
› No response to stimulus: Score = 0
• Activity
› Actively moving: Score = 2
› Limited movement: Score = 1
› Flaccid: Score = 0
• Respiratory Effort
› Strong loud cry: Score = 2
› Hypoventilation, irregular: Score = 1
› Absent: Score = 0
Totals*
*8-10: normal; 4-6: moderate depression; 0-3: aggressive resuscitation
NCLEX-RN Review Crutch Walking
CRUTCH WALKING
A. Four-point sequence
1. Gait is slow but stable
2. Used when client can bear some weight on each leg
3. Technique
a. Move right crutch
b. Move left foot
c. Move left crutch
d. Move right foot
B. Three-point sequence
1. Client cannot bear any weight on one leg
2. The crutches completely support the affected leg
3. Technique
a. Move both crutches with the affected leg forward
b. Move unaffected leg forward
4. Use of mechanical aids to promote mobility
a. Crutches-support; balance feet, and legs during walking
A. keep tips of crutches 12 to 16 inches to side of feet
B. adjust handbars to allow 15 to 30 degrees of elbow flexion
C. use well fitting shoes with nonslip soles
D. use rubber suction tips on crutches
a. inspect weekly
b. replace when worn
E. may be used temporarily or permanently
F. teach client crutch walking
G. Cane-provides stability when walking and relieves pressure on weight-bearing joints
a. adjust cane with handle at level of greater trochanter, elbow flexed at 30 degree angle
b. teach client to hold cane close to body, and hold in hand on stronger side.
c. move cane at same time as the weaker leg.
d. Walker-assists in weight bearing and mobility
A. assists in weight bearing and mobility
B. teach client how to sit, stand and turn
C. Gait belt
a. leather or canvas belt around client's waist with handles
b. safety devices for ambulatory clients who may have some balance problems
5. Prosthetic devices - used to replace a missing body part
6. Brace - support for weakened muscles
A. Four-point sequence
1. Gait is slow but stable
2. Used when client can bear some weight on each leg
3. Technique
a. Move right crutch
b. Move left foot
c. Move left crutch
d. Move right foot
B. Three-point sequence
1. Client cannot bear any weight on one leg
2. The crutches completely support the affected leg
3. Technique
a. Move both crutches with the affected leg forward
b. Move unaffected leg forward
4. Use of mechanical aids to promote mobility
a. Crutches-support; balance feet, and legs during walking
A. keep tips of crutches 12 to 16 inches to side of feet
B. adjust handbars to allow 15 to 30 degrees of elbow flexion
C. use well fitting shoes with nonslip soles
D. use rubber suction tips on crutches
a. inspect weekly
b. replace when worn
E. may be used temporarily or permanently
F. teach client crutch walking
G. Cane-provides stability when walking and relieves pressure on weight-bearing joints
a. adjust cane with handle at level of greater trochanter, elbow flexed at 30 degree angle
b. teach client to hold cane close to body, and hold in hand on stronger side.
c. move cane at same time as the weaker leg.
d. Walker-assists in weight bearing and mobility
A. assists in weight bearing and mobility
B. teach client how to sit, stand and turn
C. Gait belt
a. leather or canvas belt around client's waist with handles
b. safety devices for ambulatory clients who may have some balance problems
5. Prosthetic devices - used to replace a missing body part
6. Brace - support for weakened muscles
NCLEX Review Positive Signs of Brain Death
Positive signs of brain death or brain damage
+Unresponsiveness to all stimuli
+Pupillary responses are absent
+All brain functions cease
+No eye movements are noted when cold water is instilled into the ears (caloric test).
+No corneal reflex is present
+No gag reflex is present
+Quick rotation of the patient's head from left to right (doll's eyes test) causes the eyes to remain fixed, suggesting brain death.
+No response to painful stimuli is present
+An apnea test reveals no spontaneous breathing
+EEG shows no brain activity or response
+Unresponsiveness to all stimuli
+Pupillary responses are absent
+All brain functions cease
+No eye movements are noted when cold water is instilled into the ears (caloric test).
+No corneal reflex is present
+No gag reflex is present
+Quick rotation of the patient's head from left to right (doll's eyes test) causes the eyes to remain fixed, suggesting brain death.
+No response to painful stimuli is present
+An apnea test reveals no spontaneous breathing
+EEG shows no brain activity or response
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