Question

Define medical asepsis.

Define surgical asepsis.

List the important rules of sterile fields.

When would you anticipate needing sterile gloves?

Why do you wear clean gloves?

For each of the following isolation types, describe what PPE you will use, why you use it, other instructions, and types of microbes that may require it: Contact, Droplet, Airborne, Standard.

Describe the difference between stage 1, 2, 3, and 4 pressure ulcers in your own words.

What steps do nurses take when removing sutures and staples to prevent evisceration?

Describe when you would apply heat to a wound? cold to a wound? What safety principles would you apply for each?

Why would a nurse irrigate a wound?

Define CAUTI.

What assessments should a nurse make to determine if an indwelling catheter is necessary?

What is the difference between a straight and indwelling catheter?

What instructions does a nurse provide to a patient prior to obtaining a clean catch urine specimen?

How do you calculate I/O for a patient undergoing continuous bladder irrigation?

What are the important steps of catheter care?

How do you assist an adult to eat who has dyspagia? blindness?

What position do you place a patient in when administering an enema and why?

What symptoms do you assess for when administering enemas and how do you respond to them?

Why would a patient need a PEG tube? NG tube?

What is the best way to check placement of a PEG/NG tube?

How do you protect the skin around an ostomy?

Answer 1

The term sepsis means its a stage of infection and asepsis means absence of infection (the absence of bacteria,viruses and other micro-organisms or otherwise we can say that the asepsis is a state of being free from infection (not septic).

In the health care field all are vulnerable to get infection that is hospital acquired including the patient,visitors,health care providers and other staff in the hospital if not following the aseptic techniques.It is very important to follow a strict aseptic techniques in each and every procedures carrying out to the patient by the health care providers and other health team members

*Medical asepsis:

Medical asepsis is the state of being free from disease causing micro-organisms.Medical asepsis is often referred to as clean techniques.Medically aseptic techniques are used to maintain medical asepsis eg:hand washing

*Surgical asepsis:

Surgical asepsis is the absence of all microorganisms within any type of invasive procedure.It is the exclusion of all microorganisms before they can enter an open surgical wound or contaminate a sterile field during the surgery(eg:sterilization of all instruments,drapes,surgical hand scrub with an antimicrobial agent,wearing of surgical gown,surgical gloves etc)

*Sterile gloving is needed during each invasive procedure,contact with sterile sites or surgical sites,non-intact skin and mucous membrane.Sterile gloving should be dne during:

• any surgical procedure
• Vaginal delivery
• Catheterization
• Lumbar puncture
• Central venous access

*Clean gloves can be used before an aseptic procedure.Clean gloving can be done before contact with blood or body fluids,non intact skin,body secretions,excretions,mucous membranes or the equipments or the surfaces contaminated with blood or body fluids.

*Contact infection isolation techniques:

• Wear gloves when touching the patient
• Remove gloves after each use and discard it
• Wash hands after removing the gloves
• Wear a fluid resistant gown

*Droplet infection isolation techniques:

• Wear gloves
• Weargown
• Surgical mask to cover the nose and mouth
• Googles and face shieldsmay be used to prevent body fluids contact with the mucous membrane of the eyes

*Airborne infection isolation:

• Gloves protectsz the hand
• gowns protect the clothing andx skin
• Masks and respirators protect mouth and nose
• googles protect eyes
• face shield protects the entire face

*Standard precautions:

• Hand hygeine
• wear mask
• prevent needle stick injury
• cleaning and dis-infection
• Proper waste disposal

*Stages of pressure ulcers:

Stage I:There may be reddness of skin that is localized in nature over the bony prominence.Skin is intact.Pressure area is darkely pigmented and may not have any blanching

Stage II: Partial loss dermis resulting in a shallow open ulcer.The wound is pink or red in color and there is no slough

Stage III: The ulcer may get worse and extend in to the tissue beneath the skin in to the fat tissue but not to muscle,bone or tendon

Stage IV: The ulcer could be very deep.Some times it may form as an blood blister.The sores may extend to the muscle and bone causing extensive damage

*Suture or staples removal:

• Clean the suture or staples site with antimicrobial solution
• when removing the suture make sure to remove all suture material
• when removing the staples gently remove it and remove the alternate staples,then assess the wound for dehiscence
• After remove the suture or staple apply a sterile gauze,if any dehiscence occurcover the wound with sterile gauze saturated with sterile 0.9% of sodium chloride solution and inform to the physician
• Do not lift the staple remover while squeezing the handle
• Do not remove the remaining sutures or staples if dehiscence occurs

*Heat and cold application to a wound:

Hot application will helps in the dilation of blood vessels and improves the bllod flow to the particular area that brings oxygen and other nutrients to the area promotes the healing process

when heat is applying to a sore area it should not :

• applied directly to the skin that means wrapped in a thin towel
• apply heat for longer than 20 minutes
• apply if the area is swollen
• apply over open wounds or stitches

Cold therapy slows down blood flow to an injury.It helps to reduce the swelling and pain in the area.It should mainly applied after an injury to control bleeding,reduce inflammation and promote healing

When applying cold it should not directly placed over the skin,it shoul be covered with a thin towel

it should not be left not more than 20 minutes and can be applied again after 10 minutes

*Wound irrigaton:

It is a procedure of steady flow of a solution across an open wound surface

• helps to maintain wound hydration
• remove deeper debris
• helps to assist with the visual examination

it is an effective method to cleansing the wound to prevent infection and prevent further complication of wound

*CAUTI stands for catheter associated urinary tract infection.It is defined as urinary tract infection that occurs to the person with an indwelling urinary catheter

*Indication for an Idwelling catheter:

• Acute urinary retention
• Urinary incontinence
• In case of continuous bladder irrigation
• Hygeinic care of bed-ridden patient
• Post surgery(if the patient is in the effect of epidural anasthesia)
• Acute bladder oulet obstruction
• In case of critically ill patient to measure the out put

*Straight and indwelling catheter:

A straight urinary catheter is a hollow rubber tube inserted through the urethral opening in to the bladder to empty urine once

An indwelling urinary catheter is one that is left in place

*Instructions for thecollection of a clean catch urinespecimen:

• Wash the hands with soap and water
• Wash and clean the genital area
• urinate small amount of urine into the toilet bowl,then stop the flow of urine
• Hold the specimen bottle few inches apart from the genital area
• urinate until the bottle is about half full
• finish urinating into the toilet bowl

*Calculation of intake and output for a continuous bladder irrigation:

input - output = true urine

that means the difference between the fluid infused and volume returned is the true urine that should be record on the fluid balance chart.

In the fluid balance chart record the volume infused,volume returned with the date and time

*Important steps of catheter care:

• check the area around the urethra for any inflammation,signs of infection
• make sure that the urine is flowing out of the catheter in to the drainage bag
• make sure that the urinary drainage bag is below the level of bladder
• clean the area around the urethra with a mild antiseptic solution
• clean the area around the drainage tube twice each day
• does not drag or pull on the drainage tube

*Assist with feeding of a adult patient who has dysphagia? Blindness

• when aasist to eat a dysphagia patient make sure that the consistency of food is correct
• the consistency of food should be depend upon the the ability to chew and swallow
• the food should be as moist as possible ant to avoid crunchy type of food
• encourage to eat moist and soft foods
• prefer the food according to their choice
• it should not be too hot or too cold
• recommend the food rich in flavours that helps to improves the hungry and digestion

*Position of patient while administering enema

The patient should be placed on left side,with the knees drawn to the abdomen.This will helpul in the easy passage of enema solution into the rectum and this position will aid in the enema distribution and retention

*Assessment of symptoms during enema administration

Assess for any additional bowel sounds or movements.Explain the patient regarding how it acts

*PEG tube and NG tube:

NG tube stands foe Nasogastric tube is often used for short term tube feeding if the patient cannot eat or drink enough through the mouth,a tube is placed to the stomach through nose with out any surgery

PEG tube stands for Percutaneous Endoscopic Gastrostomy.:

If the patient cannot tolerate the food through orally for a long time or for a serious reasons if the patient is unable to eat ,a feeding tube is placed in to the stomach through abdominal wall by a simple surgery

*Checking the placement of PEG/NG tube:

Attach a 60cc syringe to the end of the feeding tube to aspire the gastric contents or lower the open end of the tube in to a cup of water if bubbles indicates that tube is in place

*Ostomy skin protection

A good care is needed to protect the skin from getting irritated and prevent infection.During the inspection if the skin under the pouch is red,or irritated:

• Gently remove the pouch
• clean the skin under the pouch with water
• Dry the site throughly otherwise it may cause further irritation or chance of infection
• Sprinkle ostomy powder on the skin and wipe off any extra powder
• Replace the pouch
• continuous inspection is needed