safety and infection control
Terms
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What is ESR?
What does it indicate? - erythrocyte sedimentation rate -- greater than 15-20 indicates inflammation
- What are most nosocomial infections caused by?
- staphylococcus aureus
-
Chickenpox
incubation period?
Assessment?
what is rash like?
Transmission? -- precautions?
Nursing considerations? -
slight fever, tired, anorexia
rash -- pruritic, all three stages present
transmission - spread by direct contact, droplet
NI: isolate till crusted -- no aspirin -- calamine -
Diphtheria
Incubation period?
Assessment?
transmission?
Precautions? -
prodromal -- resembles cold -- white gray pharyngeal membrane
transmission -- direct contact, through carrier
NI: droplet precautions until 2 negative nose and throat cultures -- complete bedrest -- suctioning - respiratory distress -
Pertussis
Assessment?
Transmission?
Precautions?
NI? -
prodromal -- URI 1-2 weeks -- whooping cough (night)
Transmission: direct contact, droplet
NI: isolation during mucousy period (catarrah)
encourage fluid, high humidity, restful environment, suction -
**Rubella -- other name?
incubation
Assessment?
transmission?
Precautions -
Other name -- german measles
Asessment -- low grade fever, tired, maculopapular rash that begins on face and spread to entire body - petechial spots may occur on soft palate
NI: isolate from pregnant women, symptoms subside first day after rash appears,
Transmission: droplet -
Rubeola -- other name?
incubation? communicable?
Assessment?
Precautions? -
Other name -- measles
communicable 4 days before and 5 days after rash
assessment -- fever, malaise, cough and koplik spots -- then rash begins behind ears and spread down -- turn brownish
NI: respiratory precautions, dim lights -- isolate till 5th days -- airborne precautions -
Scarlet fever
Caused by?
incubation?
communicable?
Transmission?
Assessment?
NI? -
Caused by group A, beta-hemolytic streptococci
communicable -- during incubation and clinical illness
Transmission -- direct, droplet -- inegstion of contaminated food or milk
Assessment: abrupt high fever, fluelike -- red find papular rash in axilla, groin,neck that spread to body, tongue coated and papillae become red and swollen (strawberry tongue), tonsils and pharynx swollen
NI: respiratory, bed rest, fluids, droplet till 24 hours after antibiotics, fluids, soft diet -
Mono
cause?
incubation?
communicable? HOW?
Assessment?
NI: -
Cause -- epstein barr virus
communicable -- before onset to 6 months after
Assessment: fever, sore throat, ab pain, lypmph and hepatosplenomegaly
NI: watch for splenic rupture (ab pain, LUQ pain, left shoulder pain) -- family don't share cups, etc. -
Tonsillitis
Cause?
Treatment?
Complications? -
Cause -- positive GpA Strep
TX -- antibiotics
Complications -- rheumatic fever, glomerulonephritis -
Mumps
incubation?
communicable? How?
Transmission?
Assessment?
NI? -
communicable -- immediately before and after swelling begins -- through saliva
transmission -- direct contact, droplet
Assessment: -- fever, HA, anorexia, earache followed by parotid gland swelling, orchitis (infl. of testes)
NI: respiratory, bedrest till swelling subsides, soft foods, orchitis -- apply warmth and tight fitting underwear -
Roseola
caused by?
incubation?
Assessment?
NI: -
Caused by herpes virus incubation 5-15 days
assessment? fever for 3-5 days followed by rash 1-2 days(blanches),
NI: Supportive -
Poliomyelitis
Cause?
Incubation?
Transmission?
Assessment?
NI: -
Caused by enteroviruses
transmission -- oral secretions and feces
transmission -- direct contact with person, fecal/oral and oropharyngeal routes
Assessment: fluelike followed by sore and stiff and paralysis
NI: enteric precautions, bed rest, respiratory, physical therapy -
Fifth Disease?
Cause?
Incubation?
assessment?
NI? -
Caused by HPV
incubation? 4-14 days -
Airborne precautions include what?
What diseases are airborne? -
private room -- negative air pressure -- 6-12 exchanges/hr
door closed
mask on patient if transported
Diseases: measles, tubercolosis, varicella, disseminated zoster (shingles) -
Droplet precautions
Transport of pt.
Examples of diseases? -
Private room -- shared only if same infection
spatial separation of 3 feet between pt. and visitors
door can stay open
mask on patient if transported
Examples: streptococcus, pnemonia, meningitis caused by H. influenza type b mumps -
contact precautions?
What types of diseases? -
private or with same infection
clean, nonsterile gloves when entering
dedicated equipment or clean and disinfect between patients
Examples of diseases: MRSA, pediculosis, scabies -
Tuberculosis
Assessment? -
Progressive fatigue
Nausea
anorexia weight loss
irregular mense
low-grade fever over period of time
night sweats
cough with sputum - dull aching chest -
Tuberculosis
Diagnostic -
Skin testing -- PPD (mantoux test) -- read 48-72 hours
10-mm induration = positive -- doesn't mean active disease is present, but indicates exposure to TB or presence of inactive disease
greater than 5mm with aids is positive
Multiple puncture Test (Tine) -- test read in 48-72, vesicle formation = positive, positive reactions verified by ppd
Sputum smear for acid-fast bacilli
Chest x-ray for all people with positive ppd -
Tuberculosis
How transmitted? - Aerosolization -- may lie dormant for years and come back with stress
-
Tuberculosis
Risk factors? -
contact
IV drug abuser
Institutions
Lower class
Immigrants (latin America, Asia, Africa) -
Tuberculosis
Treatment Plan -
notify state health department
6-9 months of INH therapy -- not if over 35 if low risk (+ skin test and x-ray - yes) because of liver damage
Chemotherapy -- INH, rifampin, ethambutol, streptomycin
Isolate 2-4 weeks (3 negative sputum) after drug therapy initiated -- sent home before this because family already exposed -
Tuberculosis
Teaching? -
Cover mouth and nose with tissue
Avoid exposure to dust, silicone
Full courase of meds
two or more cultures negative -- client no longer considered infectious -
Hepatitis
Assessment -
Jaundice
Anorexia
RUQ pain
clay-colored stools, tea colored urine
pruritis
AST ALT elevated
prolonged PT
percutaneous liver biopsy -
Hepatitis A
High Risk Group?
Transmission?
Daignostic?
Treatment?
NI? -
High Risk: young children, daycares, international travelers
Transmission: fecal oral/shellfish (contaminated waters)
Diagnostic -- culture in stool and detect in serum before onset
TX: gamma glubin early posexposure
NI -- no preparation of food -
Hepatitis B
High Risk group?
Transmission?
Diagnostic tests?
TX?
NI? -
High risk -- drug addicts, fetuses from infected moms, homosexual, dialysis pt., healthcare workers
Transmission: parenteral drug abuse sex, blood and body fluids
Diagnostic: blood
Tx: hep B vaccine -- HBIg
NI: Chronic carriers -- frequent -
Hepatitis C
High Risk?
Transmission?
diagnostic?
TX?
NI? -
frequent blood transfusions
international travelers
hemophilia clients
Transmission: contact with blood and bodily fluids
NI: great potential for chronic -
Hepatitis D
High Risk?
Transmission?
Diagnosis?
Where common? -
Risk: drug addicts
coninfects with Hep B
transmission -- close personal contact
Diagnostic test -- HD Ag in serum
common in mediteraneum and middle eastern -
Hepatitis E
High risk?
Transmission?
diagnostic?
NI?
Population group it affects?
Travelers from where? -
UNderdeveloped countries
Transmission: oral-fecal -- bad water
resembles A -- does not become chronic -- seen in young adult and travelers from asia, africa, mexico -
toxic hepatitis
risk group?
transmission?
treatment? -
elderly
Drug-induced --
Transmission: noninfectious inflammation of liver
NI: remove causative substance -- LOC - increase fluids -
Treatment for Hepatitis
precautions?
diet?
Medications? -
Bedrest for severe symptoms
contact precaution
diet -- low fat, high calorie, carb, protein -- no alcohol
Meds -- vitamin K -- antiemetics -- tigan or dramamine -- no compazine (hepatic toxic) -- steroids -
Hepatitis
Teaching? -
avoid alcohol and hepatic toxic drugs -- aspirin and sedatives
can't donate blood -
Lyme Disease
Assesment?
Stage 1
Stage 2
Stage 3 -
Stage 1 -- rash (bullseye) -- lymphadenopathy -- flulike
stage 2 -- (1-6 months if untreated) -- cardiac conductions problems, neuro (bells palsy - no permanent)
stage 3 -- arthralgias (several months later) -- may persist for years -
Lyme Disease
Treatment? -
Antibiotics -- doxycycline, ceftriaxone, azithromycin -- stage 1
IV penicillin later stages