Nursing Concepts Section 1

Chapter 31:
o Microorganisms exist everywhere
Resident flora of the human body are beneficial
Responsibility of the nurse is not identify, prevent, control, and
teach patient to prevent infection of MO
o Disease is a detectable alteration in normal tissue function
o Infection is the invasion of body tissue by microorganisms and the
proliferation of that MO
o Pathogenicity: (how a MO causes disease) ability to produce disease
o Virulence: the power and degree of pathogenicity possessed by a MO
o Asepsis: freedom from disease causing organisms
Therefore the aseptic techniques are used by nurses to prevent
sepsis
2 Types of Aseptic Techniques:
Medical: all practices intended to confine specific MO to a
specific area, limiting the number, growth, and
transmission of MO; clean technique
o EX: washing hands, confinement, wearing PPE,
wiping tables, mop floors, changing bed linens,
dressing a wound
Surgical: Sterile technique; all practices to keep an area
or object free of all MOs
o Includes practices that destroy all MO and spores
o Types of Microorganisms:
Bacteria: most common infection causing MO; transported
through air, water, food, soil, body tissues, and fluids.
Viruses: must enter living cells to reproduce, rhinovirus,
hepatitis, herpes, and HIV.
Fungi: yeasts and molds; normal flora in vagina.
Parasites: live on other living organisms; protozoa causing
malaria, helminthes (worms), and arthropods (ticks, fleas,
mites)
o Types of Infection:
Local: limited to a specific part of the body
Inflammation, erythema, edema, heat, drainage, pain
Systemic: spread and damage of different body parts
Fever, increased WBC count, lymph node enlargement
Acute: appear suddenly or last short period of time
Chronic: occur slowly, over a very long period of time, and may
last many months or years
Periods of remission and exacerbation
o 2010 National Patient Safety Goals:

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Originated as a result of the institute of medicines report To Err
is human (2000): focus is on a system wide solutions and
changes
The goals dont just support prevention of errors but also
change the entire HC culture
Change the reporting of errors and focus on analyzing the
system to find out why error was made
Nosocomial Infections: delivery of HC services in a hospital
Can either be: Endogenous (own body MO) or Exogenous
(outside environmental MO)
Factors that will increase risk of nosocomial infections:
Length of time stayed in hospital
Number of HC providers giving care
Specific therapies provided
Iatrogenic Infections: those that are a direct result of diagnostic or
therapeutic procedures
EX: placement of a catheter is not done properly and patient
contracts a urinary infection
Why are we concerned with HC associated infections
CDC estimates overall annual direct medical costs to hospitals
in US to range from 28.4 to 33.8 billion dollars
These infections are causing:
Increased length of patients time in hospital
Increased death rates
Increased disabilities
Chain of infection: (Can be broken at any link in the chain)
Etiological agent: the microorganism itself
Reservoir (source): mosquito carrying malaria
Portal of Exit from reservoir: (could be same PO of entry) person
spreading the flu
Method of transmission: direct/indirect contact or airborne
Portal of Entry to susceptible host
Susceptible host: vaccines give immunity
Body Defenses
Nonspecific Defenses:
Anatomic and physiologic barriers
o Acts same no matter MO
o Skin is the first defense, cilia of resp. tract, Blymphocytes, antigens leading to antibodies
Inflammatory Response: defensive response that
destroys or dilutes the injurious agent, prevents
further spread of injury, and promotes repair

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o Pain, swelling, redness, heat, and impaired
function of part
Specific defenses:
o Antibody mediated defenses
o Cell mediated defenses
All three types of T-cells
Types of Immunity:
o Active: antibodies are produced by the body in response to antigen
Natural: antibodies formed in prescience of an active infection
in the body
Artificial: antigens (vaccines or toxoids) administered to
stimulate antibody production
o Passive: antibodies are produced by another source, animal, or
human
Natural: antibodies are transferred naturally from an immune
mother to her baby through the placenta or in colostrum (6 mo.
to 1 year)
Artificial: Immune serum (antibody) from an animal or another
human is injected
Factors increasing susceptibility to infection:
o Age: very young- immature immune system
Very old- decreased immune response, coexisting condition,
fragile skin
o Heredity: inherit diseases
o Level of stress: cortisol released which decreased immune response
o Nutritional status: proteins required to make antibodies
o Current medical therapy: antibiotics, anti-inflammatory, chemo
o Preexisting disease processes: COPD, diabetes
o Environmental factors
The Nursing Process Overview:
o Assessing: gathering all the information
Nursing history (subjective)
When were your last immunizations?
When did you last have a tb skin test?
What infections have you had in the past and how were
these treated? Have any reoccurred?
Are you taking antibiotics, anti-inflammatory
medications?
Have you had any recent procedure or therapy that
penetrated skin or body cavity?
What past surgeries?
Describe eating habits. Do you eat a variety of types of
foods?

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Do you take vitamins?

Rate the stress you experienced in the last 6 months
Have you experienced any loss of energy, loss of
appetite, nausea, headache, or other signs associated
with specific body systems?

Physical assessment (objective)

Localized swelling and redness
Pain or tenderness with palpation or movement
Palpable heat at the infected area
Loss of function of the body part affected, depending on
the site and extent of involvement
Laboratory data: what would you see
Elevated WBC count
Elevated ESR (rate at which RBCs settle)
Positive cultures
o Diagnosing: risk for infection= the state in which an individual is at
increased risk for being invaded by pathogenic MOs
First identify risk factors:
Inadequate primary defenses: broken skin, traumatized
tissue, decreased ciliary function, stasis of body fluids,
change in ph. of secretions, or altered peristalsis
Inadequate secondary defenses: such as leukopenia,
immunosuppression, decreased hemoglobin, or
suppressed inflammatory response
Examples of nursing diagnoses or collaborative problems that
may arise from presence of infection:
Potential complication of infection: fever
Imbalanced nutrition: less than body requirements if
client it too ill to eat adequately
Acute pain is experiencing tissue damage and discomfort
Impaired social interaction or social isolation
Anxiety if apprehensive regarding changes in life
activities resulting from infection or its TX
o Planning: goals for a patient susceptible to infection
Maintain or restore defenses
Avoid the spread of infectious organisms
Reduce or alleviate problems associated with the
infection
Mainly eliminate or decrease risk for infection
o Planning for home care: begins DAY 1
Such clients are at risk for reinfection

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Using the information gathered about home life, nurse
then tailors a home care plan
o Implementing:
Preventing nosocomial infections by meticulous use of
medical and surgical asepsis
Hand washing
Cleaning/disinfecting/sterilizing
Risk factors for poor adherence to recommended hand hygiene practices:
o Doctor status rather than a nurse
o Nursing assistant rather than nurse
o Male gender
o Before contact with patient environment
o Duration of contact with patient (< or equal to 2 minutes)
o Patient care in a non-isolation unit
o Hand washing agents causing irritation and dryness
o Insufficient time
o Lack of soap or paper towels
o Forgetfulness
Supporting defenses of a susceptible host:
o Hygiene- remove MO from personal and environment
o Nutrition- lots of proteins and fluids
o Fluid- help flush out body system
o Rest and sleep- restore sleep patterns
o Stress- teach stress reduction techniques
o Immunization- make sure they are up to date
Antiseptics vs. disinfectants
o Antiseptics: agents that inhibit the growth of some MO
o Disinfectants: agents that destroy pathogens other than spores
Sterilizing using:
o Moist heat (autoclave)
o Gas
o Boiling water
o Radiation
Infection control precautions:
o Designed to prevent the spread of infections or potentially dangerous
infectious MOs
o Reduce the chances that organisms in blood (bloodborne pathogens)
and potentially infections organisms from other body tissues will be
transmitted from client to other persons
Hand hygiene, use of personal protective equipment (PPE),
environmental controls, and respiratory hygiene/cough
etiquette
o Isolation: measures designed to protect spread of infections or
potentially inf. MO

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Category specific isolation precautions: strict, contact,
respiratory, tuberculosis, enteric, drainage/secretion,
blood/body.
Disease specific isolation precautions: private rooms with
special ventilation, client share room with other infected client,
gowning to prevent gross soilage of clothes
CDC (HICPAC) isolation precautions:
o Tier 1: Standard Precautions: used in the care of
ALL hospitalized
clients
Apply to blood, all bodily fluids, secretions, and excretions
except sweat, nonintact skin, and mucous membranes.
o Tier 2: Transmission Based Precautions: used in addition to SP
Airborne Precautions: serious illnesses transmitted by airborne
droplet nuclei smaller than 5 microns
Measles (rubeola), varicella, and tuberculosis
Patient must be in a AIIR room, if private room not
available place with other infected client, wear
respiratory device when entering, susceptible persons
should not enter, limit movement of patient outside the
room
Droplet Precautions: serious illness transmitted by partible
droplets larger than 5 microns
Diphtheria (pharyngeal), mycoplasma pneumonia,
pertussis, mumps, rubella, streptococcal pharyngitis,
pneumonia, or scarlet fever in infant and young children,
and pneumonic plague.
Private room or with other infected client, wear mask if
working within 3 feet, limited movement of client outside
the room
Contact Precautions: transmitted by direct contact or by
contact with items in clients environment
Gastrointestinal, respiratory, skin or wound infections or
colonization with multidrug resistant bacteria; specific
enteric infections such as C. diff and enterohemorrahagic
E. coli, shigella, and hepatitis A, for diapered or
incontinent clients, and highly contagious skin infections
such as herpes simplex virus, impetigo, pediculosis, and
scabies.
Client in private room or with infected client; wear gloves
as described in standard precautions; wear a gown when
entering room; limit movement outside of room; dedicate
use of noncritical client care equipment to single client
Compromised Clients:
o Those highly susceptible to infections

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o Have diseases such as leukemia or treatments such as

chemotherapy, that depress the clients resistance to infectious
organisms
o Have extensive skin impairments, such as severe dermatitis or major
burns which cannot be effectively covered with dressings.
o Treat these clients as transmission based clients
Psychological clients of isolation clients
o Risk for sensory deprivation: environment lacks normal stimuli for the
client for example, communication with others.
Signs: boredom, inactivity, slowness of thought, daydreaming,
increased sleeping, thought disorganization, anxiety,
hallucinations, and panic
o Risk for self esteem disturbance: perception of the infection itself or
to the required precautions, therefore they may feel not as good as
others and blame themselves for their sickness
Psychosocial needs of isolation clients:
o Regular communication
o Diversionary techniques
o Explain the isolation to the client
o Demonstrate warm accepting behavior
o Use least strict precautions indicated by the diagnosis or the clients
condition
Personal protective equipment
o Gloves
Protection again body substances: blood, urine, feces, sputum,
and nonintact skin
Reduce likelihood of nurses transmitting own endogenous MO
Reduce the change that the nurses hands will transmit MO from
client to the next
o Gowns: single use gowns are worn when nurse changes the dressings
of a client with extensive wounds
o Face masks: reduce risk for transmission of organisms by the droplet
contact and airborne routes and by splatters of body substances
o Eyewear: worn when body substances may splatter the face
o 3 Reasons for wearing PPE: protect healthcare provider, protect
patient from healthcare provider, and to protect other patients from
healthcare provider and other patients.
Disposal of Soiled Equipment and Supplies:
o Appropriate handling necessary to prevent exposure to health care
workers and the environment
Role of infection control nurse:
o Specially trained in the latest research and practices regarding
infection control and treating infection

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o May also be involved in employee educations and implementation of
current interventions
Steps to follow after an exposure to a bloodborne pathogen:
o Report incident immediately to appropriate personnel within agency
o Complete an injury/accident report
o Seek appropriate evaluation and follow up
Id and document the source individual when feasible and legal
Test source for hep:B and C and HIV
Making results of test available to source
Test blood of exposed nurse for same antibodies
Postexposure prophylaxis
Medical and psychological counseling regarding personal risk of
infection
o For puncture/laceration: allow some bleeding to drain the site but
dont squeeze tissues, wash/clean the area with soap and water,
initiate first aid and seek TX if indicated
o For mucous membrane exposure saline or water flush for 5-10
minutes