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Safety

Safety. Body Substance Isolation Universal Precautions. Designed to protect both workers and patients from pathogen in any body substance. Gloves Wash hands Gowns if splashing possible Eye protection Special bagging and handling of contaminated articles Sharps containers. Washing hands.

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Safety

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  1. Safety

  2. Body Substance IsolationUniversal Precautions • Designed to protect both workers and patients from pathogen in any body substance. • Gloves • Wash hands • Gowns if splashing possible • Eye protection • Special bagging and handling of contaminated articles • Sharps containers

  3. Washing hands • Most important basic preventative technique to interrupt cycle of transmission • Prevent noscomial infections • Maintain a safe clean environment • Provide safety for nurse and prevent cross contamination of patients

  4. Gown – • To protect clothing from soiling, from microorganisms and protect patient • To protect nurse from contracting infection from patient • To prevent staff from exposing an immunocompromised patient

  5. Mask – • Fit snuggly and securely over nose and mouth • Change every 20 – 30 min if moist • To protect staff from inhaling microorganisms spread by airborne droplets • To prevent inhaling microorganisms if resistance is low • To discourage wearer from touching nose, mouth or eyes

  6. Double bagging – • Place contaminated items in one bag then that bag is placed into a clean bag that is held outside of the isolation room. • Isolation type – depends on the microorganism. Uses barriers to prevent transmission.

  7. Teaching • Disease transmission • Why isolation is needed • How family must dress • Handwashing

  8. ADL’s

  9. Mouth Care • To maintain healthy state of mouth, teeth gums and lips • Removes food particles, plaque, and bacteria. • Massages gums, relieves discomfort from odors and tastes • Gives a sense of well being and stimulates appetite.

  10. Risk for Oral Disorders • Lack of knowledge • Inability to perform oral care • Alteration in integrity of teeth, and mucosa from treatments or disease • Paralyzed, seriously ill, unconscious, disoriented, diabetic, NPO, radiation or chemo, oral surgery

  11. Special Mouth Care • Brownish material (sordes) has collected on tongue and teeth – caused by some diseases • Pt breathes thru mouth • Fluid restriction or NPO • Pt needs to be encouraged to increase oral intake • Nonresponsive or paralysis • NG tube • Receiving Oxygen • Can’t control secretions

  12. Brushing • Teach • Brush after meals • Hold brush 45 degree angle • Brush front and back and top • Use floss for sides

  13. Dentures • EXPENSIVE • Broken easily – hold over a soft cloth • Give gum and tongue care • Replace uppers first • Moisten first • Observe for loose fit, gums for tenderness • Teach – cleaning, storage (enclosed labeled cup with water), don’t wrap in tissues and place under pillow or on a tray.

  14. Personal Hygiene • Self care measures people use to maintain health – includes care of skin, hands, feet, hair, eyes, ears, nose, mouth, back and perineum

  15. Factors the Influence Personal Hygiene • Physical condition • Personal preference • Cultural variations • Knowledge • Socio economic status • Social practices • Body image • Must be non-judgmental

  16. Complete bath – for patient totally dependent • Partial bath – pt is encouraged to bathe what they can reach • Towel – Bag bath – 8 – 10 face cloths in bag. Moistened with nonrinsable cleaner • Tub or shower – if order for ambulation (in hospital) • Sitz – for rectal or vaginal surgeries – after birth – for healing and pain relief • Tepid sponge bath – to decrease temperature • Medicated – oatmeal, cornstarch, Burow’s solution, sodium bicarb, - to decrease tension, and relieve pruritis

  17. Purpose – cleanse skin, apply medication, stimulate circulation, improve self image, decrease body odor, promote ROM, demonstrate caring, reduce potential for infection, provide refreshed and relaxed feeling. • Even if client does not receive a daily bath they should get face, underarms, chest, back and peri care. • Elderly patients should not receive a bath daily as it dries skin. They don’t perspire as much, have decreased sebum production.

  18. Water temperature should be 110 – 115 degrees • Gather supplies, do mouth care, prepare bed and apply bath blanket then get water. • Eyes and face should be washed first. • Peri area is last • During the bath the nurse can do the following observations – skin color, texture, thickness, turgor, temperature, hydration, integrity, mood and attitude.

  19. Backrub should be given after bath with warm lotion. Results of backrub – relaxation, relief of muscle tension, and stimulation of circulation • If patient taking a shower tell not to lock door

  20. Hand and Feet Care • Clean nails – after patients hands in water • Best to file nails • Nurses can cut nails as long as no complications – diabetes, impaired circulation, thick nails, hemophilia and blood thinners.

  21. Shaving • Male clients can shave themselves – nurses can help by gathering supplies • Clients should not use Razor if: on anticoagulants, disoriented, or depressed • Never shave a beard or mustache without written consent of the family.

  22. Hair Care • Important for self image, prevent tangling, increase circulation, distribute sebum, good exercise if patient can do it themselves • Shampoo needed if in accident, before and after EEG, treatment for lice • Methods- shower, chair in front of sink, cart, bed – with shampoo board

  23. African American hair does not need washed as frequently. Hair is usually dry and course – use their supplies or baby oil.

  24. Pediculosis

  25. Pediculosis • Lice infestation – a parasitic disorder of skin usually associated with poor living conditions and poor personal hygiene. But this is not always the case.

  26. Pediculli – lice obtain nutrition from blood and leave nits (eggs) on skin surface attached to shaft of hair • Head louse – attaches to hair shaft and lays 8 – 16 eggs per day. Can be seen best at back of neck as grey shiny oval bodies. • Body louse – found around neck, waist, and thighs. Found in seams of clothes. Severe pruritis and pinpoint hemorrhages are caused by bites • Pubic louse – looks like a crab with sharp pincers that attach to pubic hair. Transmission by sexual contact, bed clothing and bath towels.

  27. Transmission from contact • Itching causes scratches that can become infected

  28. Observations • Subjective – c/o pruritis, tenderness, difficulty wearing clothing • Objective – erythema, petechiae (pinpoint hemorrhages), and skin excoriation.

  29. Interventions • Kwell (lindane) or RID (pyrethren) • Clean every place pt had contact • Assess emotional needs • Health teaching

  30. Teaching • ID involved persons • Nature and transmission • Assess each family member • Teach to reduce pruritis • Clean furniture, bed, sheets, stuffed toys, and car seats to prevent reinfection.

  31. Skin Care • To be effective against disease and infection skin must be INTACT • Observation – color, rashes, lesions, ecchymosis, distribution of hair, temperature, texture, nails sweating, turgor, hydration.

  32. Color – • Pale - decreased hemaglobin • Jaundice – yellow - liver • Ruddy red • Cyanotic – blue • Mottled – spotted • Intact – no open areas • Turgor – pinch skin - tenting

  33. Patient problem that applies to every client regarding skin care – • impairment of skin integrity – actual or potential

  34. Ultimate goal in relation to skin – • PREVENTION of impairment

  35. Interventions – assessment, prevention, turn q 2 hours, bathe, skin care if incontinent, keep linens tight, dry and clean, • Encourage proper diet and fluids, ROM • Sheepskin, foam or special mattress to decrease pressure • Prevention of problems will decrease discomfort, decrease hospital stay and decrease cost of ongoing care.

  36. Decubitus Ulcers • Skin impairment • Risk: confined to bed or chair, limited mobility, incontinent, poor nutrition, chronically ill, elderly, spinal cord injury • Causes: pressure causes decreased blood flow leads to ischemia that leads to necrosis. Shearing, friction, moisture, cast, bedrest, lengthy illness

  37. Happens mainly on bony prominences. Sacrum, ischial tuberosities, trochanter, hips, heels, malleoli of ankles, shoulders, ear, back of head, knees, • Friction – rubbing of skin over a surface – may remove layers of tissue. • Shearing – layers of skin slide on each other – result in kinking or stretching of SQ blood vessels.

  38. Stage 1 • Threatening • Redness • Cell damage has occurred if skin fails to resume normal color when pressure is releaved • Interventions – assess, turn q 2 hours, keep skin clean and dry, special mattress • Eliminate cause

  39. Stage 2 • Inevitable • Red, blister or break in skin • Same interventions as stage 1

  40. Stage 3 • Ulcer stage • Skin impairment is shallow crater extending to sub q tissue – serous or purulent drainage • Not painful • Interventions same as stage 1&2 plus: assess size, color, odor and amount of drainage, monitor temperature, culture, medications to promote healing, questionable debridement, change dressing, antibiotics.

  41. Stage 4 • Traumatic & life threatening • Tissue, muscle and bone exposed • Odor infection leads to sepsis

  42. Treatment • BEST TREATMENT IS PREVENTION • Be alert for signs of pressure, c/o pain • Report and treat

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