gloves

hand hygeine

mask

gown

hand hygeine and save paper towel for door, dispose in pt room

An

INFECTIOUS AGENT, which resides in a

RESERVOIR, leaves said resovoir via a 

PORTAL OF EXIT via a particular

MODE OF TRANSMISSION and, through a

PORTAL OF ENTRY, infects a

SUCCEPTIBLE HOST

All links must occure for infection

Airborne -- pathogens suspended on evaporated droplets

Droplet -- within 3 feet eg sneezing, coughing, suctioning

Contact -- direct skin to skin, or indirect skin to item to skin

Less stringent than surgical aspesis

Use of disinfectants, antiseptics,etc

Assume microorganisms are everywhere, except sterilized

standard precautions apply

keep clean

clean to dirty when cleaning

can use nonantimicrobial soap (unlike surgical asepsis), antimicrobial soaps, or hand gels

Hand gels

rub at least 15 sec UNTIL DRY, must be dry to work

quarter to golf ball size as directed

Removal of microorganisms and protection of such sterile state

Physical removal - boiling, radiation, steam, dry heat, 

Chemical like ethylene gas

Many ways sterility is contaminated, like if questionable, past expiration, outer 1 inch marging, MOISTURE, left unattended, crossing over field, below waist, turning back on field

CDC 2007

= Respiratory Hygeine 

Applys to ALL

Cover mouth with tissue and dispose, wear mask, turn head, stay 3 feet from others, disinfect hands

suctioning

irrigating wound (face shield)

inserting hemo lines

any potential for splashes

Labor and delivery

burn units

puncturing patients

sterile dressings

Hair covers

mask

eyewear

shoe covers

sterile gown

sterile gloves

hands are covered with gown, preferred technique for surgical aspesis

vs open gloving (we learn this, for sterile procedures requiring only sterile gloves)

Negative air pressure, must keep room air separate

N95 respirator

TB

Measles (rubeola)

Chickenpox

SARS

Private room or similar infected pt

Mask always within 3 feet of client

Flu

Rubella

strepto pneumonia

meningococcal meningitis

whooping cough

priavte room preferred, can be with other pt but must be at least 3 feet away

gloves, gown (usually)

intestinal infections

wound infections that are resistant

gas gangrene

acute diarrhea

viral conjunctivitis

drainiong abcesses

Private room or with similar infected pt

resemble bacteria, but must remain in host to survive

eg lyme disease in ticks

vector borne

protein without nucleic acid, normal brain prions exist to protect brain, but when mutated, can be infectious

possible cause of alzheimers, parkinsons, etc....

destroy or supress growth

include antiseptics, disinfectants and anti-infective drugs

bacteriostatic agents

inhibit growth, DO NOT KILL, pathogens

eg ALCOHOL

So how do alcohol gels clean hands if bacteria are not killed? Hmmmm.....

germicides

kills active pathogens, but NOT SPORES

eg bleach, phenol, formaldehyde

Rarely applied to skin

Do not destory them, they affect replication

Therefore, person still infected and contagious

without soap and water

gels, foams

visibly soiled

before eating

after using restroom

possible spore exposure

For regular hand washing, can have wedding band

For surgical scrub, NO JEWELRY

colonization no signs or sx

both contagious

incubation - no s/s

prodromal - minor s/s, vague (fatigue, headache, etc)

acute

convalescense

resolution

cough etiquette

safe injection practices

infection control for lumbar punctures

pain

decreased function

redness

warmth

swelling

Are 4

Sharp - painful and bloody

Enzymatic - Santyl, requires dressing

Autolytic - must be infection free and small

Mechanical - wet-to-dry dressing, hydroptherapy, irrigation, etc.

Absorb drainage

Keep clean

Control bleeding

Prpotect from further injury

Hold in meds

Maintain moist environment

Open - gravity, passive

Closed - neg pressure - HEMOVAC and JACKSON-PRATT (JP)

• Inflammation 2-5 days - limits local damage, removes injured cells/debris, preparation for healing
• Proliferation 2-21 days - granulation tissue, grows from outside inward
• Remodeling 6 mo - 2 years - wound contracture and scar formation

Pressure sores for example

Fills in with granulation tissue

Mostly from surgery when too much swelling to close

Allow to remain open for a while, then later close up

These are usually "great big wounds"

• 1st is always PAIN
• type dressing removed
• S/S infection
• location
• drainage - type (serous, serosanguinous, sanguinous, purulent) and amount (scant, moderate, saturated)
• size
• tunneling/undermining
• type of tissue present (granulation, eschar/necrotic, slough)
• surrounding tissue- bruising, edema, boggy from maceration, signs of decreased blood flow like pallor, mottled, coolness
• edges approximated? 
• odor (malodorous or without odor)
• dressing appied
• how left patient
• consider also diet, oxygenation, health status, drugs (esp. immunosuppressants), stress, age, etc

inspection

auscultation

palpation

• would comes open after being closed
• if happens, bed to 45 to decrease pressure, moisten sterile gauze with saline, cover, and call dr/surgeon
• commonly caused from increased pressure, obesity, poor wound healing/circulation/diabetes

• wound opens and organs fall out
• commonly caused from increased pressure, obesity, poor wound healing/circulation/diabetes

dress

debride

amount and color/type

asess insertion site for signs of infection

assess the mechanism to make sure is working

cold first to decrease inflammation for first 24-48 hours

then hot to increase circulation for healing

From distal to proximal

And don't cut off circulation

or CMST

This is what to assess when pt has cast or binder

Circulation - color, cap refill

Movement

Sensation

(Temperature - also assesses circulation)

Do this bilaterally to compare

scant

moderate

saturated

tool to assess risk for pressure sore

the lower the number the worse

4

NPUAP adds two more stages: pre-stage (suspected deep tissue injury) and unstageable

iodine, H2O2, sliver

inhibit or kill

within 7-10 days after surgery

obesity, distension from gas, pressure from coughing, vomiting, weakened integrity from previous surgeries in same area

hold dressings in place

support areas around wound to reduce pain

limit movement to promote healing

no

same with autolytic

Under 2, elderly, diabetic, comatose, neuro impaired

Apply no more than 20-30 min a time, and let recover at east 30 min

When removing a dressing that is taped, what direction should the tape be removed?

When reapplying, how should it be oriented?

Remove by pulling old tape toward the wound

Reapply by putting tape perpendicular to wound

1 - stretch of arteries

2 - volume of blood

3 - resistance heart must overcome (eg viscosity of blood)

male is 5-6 L

female is 4.5-5.5

1. blood voume
2. heart contractility
3. cardiac output
4. blood viscosity
5. peripheral resistance

blood viscosity

narrowing vessels from arterio/athero-sclerosis

arrythmias

MIs (tissue destruction)

HF - L, R and complete

Left sided - occurs first usualy

Backs up in lungs

Other types are R and complete (L and R)

position like legs crosses

full bladder

cold temp

certain drugs like nicotine, caffeine, etc

systolic 20 mmHg

diastolic 10 mmHg

• Difference bt systolic and diastolic
• Normal range is 30-50
• During exercise can be up to 100, will return in about 10 min
• Needed to perfuse tissues
• Can be low with heart failure, shock, aortic stenosis; most commonly is from error of measurement - If genuinely low, is accompanied by high pulse rate
• High values from HTN, hyperthyroidism, etc - if along with bradycardia, must report immed.

Bell for low pitched

Diaphragm for higher pitch

Hold arm up during inflation, lower after

Open/close fist after inflation

Mark pace found with perm marker

doc D

normal under 120/80

pre-HTN 120-139 OR 80-89

HTN1 140-159 OR 90-99

HTN2 160+ OR 100+

HF

anxiety

obesity

stroke

kidney disease

If there is also bradycardia

BC is associated with up intracranial pressure

34C or 93.2F

OR

43C or 109F

pale/cool skin

listessness

decreased pulse and RR

decreased mental state

diminished pain 

NIH says 60-100

AHA says 60-80

from diminished oxygenation:

• syncope or near syncope
• dizziness - this is usuay the first
• weakness
• fatigue
• SOB
• chest pain
• disturbed seep
• confusion/memory impaiment
• easiy tire

also from diminished oxygenation bc heart can't fill adequately:

• dizziness
• SOB
• lightheadedness
• palpitations
• chest pain
• syncope
• some no s/s at all

• larger the organism's size, slower
• women > men
• younger > old
• hormones
• pathology
• meds - e.g. digitalis slows rate

posterior tibial - back of ankle

dorsalis pedis - top of foot

2 persons needed to take both simultaneously

should be equal, if not = PULSE DEFICIT

• book says respiration is gas exchange, either internally and tissues or externally at alveoli
• book says ventilation is act of breathing
• lecture notes say the opposite.....

Pulse

rhythm - irreg, reg, regularly irreg

rate

volume - thready/weak, normal=strong, bounding

Pulse

rate

rhythm - reg, irreg, labored, etc

volume - deep, shallow, etc

is NOT 98.6!  There is a normal range, that is

96.4 to 99.1

rectal is 1 point higher than oral

ax/tymp are 1 point lower than oral

use red sheath

gloves

lube

1-1.5 inches toward umbilicus

remove ASAP if resistance

axilla not so much 

tympanic, quite

pull pinna back, up and out

correct angle to seal canal

S1 = clsoe of tricuspis and mitral valves after ventricles have filled

S2 = closing of pulmonic and aortic valves after systolic contraction

PMI is point of maximal impulse, in L 5th IC space at mid-clav line

Take for 1 min if irregular

Is used when there is heart problems

pulse deficit when doesn't match peripheral pulses (radial)

5th sound is silence

if no silence, record distolic when sound fades

obesity - larger cuff

nasal congestion - causes mouth breathing, can't do oral temp

mastectomy - affects lymph drainage, BP on same side can hurt and cause lymphedema

shell is at skin surface

core is internal, more significant bc must be within narrow range

Tympannic, close to brain

Temporal is also very accurate

1. prodromal - mild headache, lethargy, low appetite, muscle aches
2. onset phase - pale, shivering, feels cold
3. stationary phase - slushed skin and feels hot
4. resolution phase - sweating

0 - absent

1+ - thready

2+ - weak

3+ - normal

4+ - bounding

= peripheral reistance

force against which heart must pump

1 - clean slice

2 - natural healing, granulation tissue and epithelializaton

3 - intentially left open