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TYPES OF DRESSINGS

transparent film (description)


adhesive plastic, semipermeable,
nonabsorbent dressings allow
exchange of oxygen between
atmosphere and wound bed,
impermeable to water and bacteria

transparent film (purpose)


provide protection against
contamination and friction; to
maintain a clean, moist surface that
facilitates cellular migration; to
provide insulation by preventing fluid
evaporation; facilitate wound
assessment

transparent film (indications)


IV dressing, central line dressing,
superficial wounds, pressure ulcers
stage I

transparent film (examples)


bioclusive, Op-site, polyskin,
tegaderm

impregnated nonadherent
(description)
woven or nonwoven cotton or
synthetic materials are impregnated

with petrolatum, saline, zinc-saline,


antimicrobials, or other agents;
require secondary dressings to secure
in place, retain moisture, and provide
wound protection

impregnated nonadherent (purpose)


to cover, soothe, and protect partial
and full-thickness wounds without
exudate

impregnated nonadherent
(indications)
postoperative dressing over
staples/sutures, superficial burns

impregnated nonadherent
(examples)
adaptic, aquaphor gauze, carrasyn,
xeroform dressings

hydrocolloids (description)
waterproof adhesive wafers, pastes,
or powders; wafers designed to be
worn 7 days, consists of 2 layers,
inner adhesive layer has particles
that absorb exudates and form
hydrated gel over the wound; outer
layer provides an occlusive seal

hydrocolloids (purpose)
absorb exudate; to produce a moist
environment that facilitates healing
but does not cause maceration of
surrounding skin; protect the wound
from bacterial contamination, foreign
debris, and urine or feces; prevent
shearing

hydrocolloids (indications)
pressure ulcers stage II-IV, autolytic
debridement of eschar, partialthickness wounds

hydrocolloids (examples)
comfeel, duoDERM, replicare, restore,
tegasorb

clear absorbent acrylic (description)


transparent, absorbent wafer
designed to be worn 5-7 days; acrylic
layer absorbs exudates and
evaporates the excess off the
transparent membrane

clear absorbent acrylic (purpose)


maintains a transparent membrane
for easy wound bed assessment,
provides bacterial and shearing
protection, maintains moist wound

healing; can be used with alignates to


provide packing for deeper wound
beds

clear absorbent acrylic (indications)


pressure ulcers, skin tears, venous
stasis ulcers, surgical wounds,
wounds undergoing chemical
debridement agents

clear absorbent acrylic (examples)


tegaderm absorbent

hydrogels (description)
glycerin or water-based, nonadhesive,
jelly-like sheets, granules, or gels;
oxygen permeable unless covered by
a plastic film; requires secondary
occlusive dressing

hydrogels (purpose)
to liquefy necrotic tissue or slough,
rehydrate wound bed and fill in dead
space

hydrogels (indications)
pressure ulcers, skin tears, partialthickness wounds

hydrogels (examples)

carrasyn, elasto-gel, NU-gel, purilon,


tegaderm, vigilon

polyurethane foams (description)


nonadherent hydrocolloid dressing,
edges need to be taped down or
sealed, require secondary dressings
to obtain occlusive environment,
surrounding skin must be protected
from maceration, easy to cut and fit
to wound bed

polyurethane foams (purpose)


absorb up to heavy amounts of
exudate, provide and maintain moist
healing, provide thermal insulation

polyurethane foams (indications)


light to highly exudating wounds,
pressure ulcers, skins tears, venous
stasis ulcers, surgical wounds,
wounds undergoing chemical
debridement agents

polyurethane foams (examples)


allevyn, curafoam, flexzan, lyofoam,
vigiFOAM

alignates/exudate absorbers
(description)

nonadherent dressings of powder,


beads or granules, ropes, sheets, or
paste; conform to wound surface and
absorb up to 20 times their weight in
exudate; require secondary dressing

alignates/exudate absorbers
(purpose)
provide moist wound surface by
interacting with exudate to form
gelatinous mass; absorb exudate;
eliminate dead space or packs
wounds; support debridement

alignates/exudate absorbers
(indications)
pressure ulcers, skin tears, venous
stasis ulcers, surgical wounds,
wounds undergoing chemical
debridement agents

alignates/exudate absorbers
(examples)
algiderm, curasorb, debrisan,
kaltostat, sorbsan

collagen (description)
gels, pastes, powders, granules,
sheets, sponges derived from animal
sources (usually cow or pig)


collagen (purpose)
assists with stopping bleeding, helps
recruit cells into the wound and
stimulates their proliferation to
facilitate healing

collagen (indications)
clean, moist wounds

collagen (examples)
biostep, cellerate RX, NU-gel,
promogran

Learnig Objectives:
Theory
-List the Stages of an infectious process
-Identify 5 ways to decrease the occurrence of health careassociated infections (HAIs)
-Explain how Transmission-Based Precautions are used with
Standard Precautions
-Describe how proceedures for Airborne Precautions differ
from those for Droplet Precautions
-Discuss the special requirements for airborne precautions
when the patient has pulmonary tuberculosis
-Compare infections prevention and control proceedures
appropriate for the hospital with those used in the home
-List techniques for handling specimens, disposing dirty
linen, trash, & sharps; & cleaning the equipment in the
isolation setting
-Give 3 examples of nursing measures used for
phychosocial care of a patient in isolation
-State the 4 rules of surgical asepsis

Learning Objectives:
Clinical Practice

-Use Standard Precautions when caring for a patient


-Utilize Transmission-Based Precautions when caring for
patients
-Properly bag & remove soiled linens & trash from an
isolation room
-Teach a patient or family member how to properly dispose
of soiled items at home
-Demonstrate performance of surgical scrub

Four Stages in the infectious Process:


-Stage 1: Incubation period
^begins when organism first enters the body and lasts
until the onset of symptoms; infection can be transmitted
during this stage
-Stage 2: prodromal period
^short time from onset of vague symptoms to the onset of
specific disease symptoms; THIS STAGE IS HIGHLY
INFECTIOUS
-Stage 3: the illness period
^localized and systemic symptoms appear
^fever, headache, malaise, & disease specific symptoms
(e.g. leukocytosis, rash, swelling, wound drainage,
diarrhea, & vomiting)
^ severity & duration depend on virulence of pathogen &
person's susceptibility
-Stage 4: the convalescent stage
^begins when symptoms begin to subside & continues
until person returns to normal

Health Care-Associated Infections (HAIs)


-Transmitted while recieving health care services
- Health care workers can also contract an HAI
-PATIENTS at GREATEST RISK include those with:
^surgical incisions with or wothout drains
^artificial airways
^urinary catheters
^intravenous (IV) lines
^implanted prosthetic devices
^repeated injections or vanipunctures
^compromised immune systems

Infection Prevention & Control


-Use medical & surgical asepsis, Standard Precautions, &
Transmission-Based Precautions
-Strict aseptic technique:
^used in invasive diagnostic and therapeutic proceedures
(IV/urinary catheters, surgical procedures)

-Isolation used to prevent contact between patient & others


-Infection prevention and control involves:
^monitoring diagnostic reports related to infection
^observing patient for signs of infection
^implementing proceduresto contain microorganisms
^properly handling, sterilizing, or disposing of
contaminated items
^using approved sanitation methods
^recognizing individuals at high risk for infection &
implementing appropriate protection

Current Standards
-Teir 1: Standard Precautions:
^delineate methods for avoiding direct contact with body
secretions except sweat
-Teir 2: Transmission-Based Precautions:
^interrupting mode of transmission by identifying specific
secretions that might be infective
^used alone or in combination but always in addition to
Standard Precautions

Transmission-Based Precautions
-Standard Precautions = for all patients
-Airborne Precautions = measles, varicella, TB (special
mask) [my chicken hez TB]
-Droplet Precautions = meningitis, pneumonia, diptheria
[SPIDERMAN]
-Contact Precautions = GI, skin, wound infection, RSV,
herpes simplex [MRS WEE & VCHIPS]

Guidelines for Patient Care Contact


-Never touch anything with bare hands that comes from a
body surface or cavity
-Gloves are to be worn for contact with body fluids of any
sort including: saliva, urine, feces, & blood
-The only times gloves are not worn is for contact with
intact skin or unsoiled articles

Application of Nursing Process


-Assessment (data collection):
^assess for signs of infection that may require
Transmission-Based Precautions
^wounds should be assessed each shift for infection
^monitor the patient's temperature
^admission lab studies may indicate infection
-Nursing diagnosis:

^risk for infection, r/t surgical wound, open wound, or


weakened condition

Planning
-Expected outcomes would include "No health careassociated infection is evident"
-When using Transmission-Based Precautions that require
putting on personal proctective equipment (PPE), the nurse
must prepare before each entry into the patient's room

Implementation:
-Patient teaching is needed on disease process, modes of
transmission, & precautions to prevent spread of infection
-Standard Precautions used for each contact with patient
-Hand hygiene:
^MOST IMPORTANT in preventing infection transmission
^before & after contact with patient, wound care, or
invasive procedure
^before donning gloves & after removing them
-PPE:
^disposable gloves
^masks
^gown
^gloves
^goggles/face shield

General Guidlines for Isolation Precautions:


-Specimen removal:
^label specimen container before entering the room,
collect specimen & place it in a leakproof container without
contaminating the outside
-Linens:
^handel as little as possible, roll up & place inside linen
hamper inside patient's room
-Trash:
^disposable soiled equipment should be placed in plastic
bags lining the waste receptacle; a bihazard (red) bad may
be needed
-Sharps:
^never recap a needle before disposal; all sharps are
dropped into a sharps container, which are replaced when
2/3 full
-Other equipment:
^reusable equipment cleaned if visibly soiled, then sent to
central supply to be disinfected
-Natural defenses:
^institute measures to enhance the patient's natural body

defense, such as protect intact skin; promote a balanced


diet; provide opportunity for sleep; decrease stress
Patient placement:
^patients who need Transmission-Based Precautions
should be placed in a private room or with another patient
infected with the same organism
-Transporting the patient:
^avoid unless absolutely neccessary; patient is given
standard mask to wear outside the room

Infection Prevention & Control at Home


-Keep clothing and linens away from others until washed
-Teach patient & family proper hand hygiene techniques
-Disinfect bathroom with 1:10 bleach/water solution
-Wash dishes in scalding water & let air dry
-Use heavy plastic jug with secure top to hold needles
-Use clean gloves for wound care or dressing changes, &
teach family how to remove soiled gloves
-clean patient's room frequently

Protective Isolation
-Patient in special room with own ventilation system
-No one with active infection allowed in patient's room
-Remain aware of your facility's policies and procedures
regarding protective isolation, & follow them at all times

Psychological Aspects of Isolation


-The patient in Transmission-Based isolation Precautions is
at risk for decrease in self-esteem & sensory deprivation
-Signs:
^boredome
^slow thought
^disorganized thoughts
^excessive sleeping during the day
^anxiety
^hallucinations
^panic attacks

Infection Prevention & Control for the Nurse


-OSHA regulations protect health care workers from
exposure to bloodborne pathogens in the workplace
-3 main modes of occupational exposure to bloodborne
pathogens are:
1) Puncture wounds from contaminated needles or other
sharps
2) Skin contact, allowing blood, body fluids, & other

potentially infectious materials to enter through damaged


or broken skin
3) Mucuous membrane contact, allowing infectious
materials to enter through the mucuous membrane of the
eyes, mouth, & nose

Surgical Asepsis
-4 rules for surgical asepsis:
1) Know what is sterile
2) Know what is NOT sterile
3) Separate sterile from unsterile
4) Remedy contamination immediately
-Goal: keep an area free from microorganisms

Surgical Scrub
-More lengthy & vigorous that regular hand hygiene
-Remove as many microorganisms as possible without
damaging the skin
-Timing based on actual time spent scrubing, not including
rinse time
-Usually 2-4 minutes
-Brushless technique with antimicrobial agent may be used

Opening Sterile Packages:


-Perform hand hygiene
-Open sterile package away from body
-Touch only the outside wrapper
-Do NOT reach across a sterile field
-Always face the sterile field
-Allow at least 6 inches between the body & the sterile field

Evaluation
-Patient recovering without additional instances of infection
from other organisms or infection of other body areas
-Assessing whether the patient's infection has been
transmitted to any health care worker or any other patient
on the unit or in the hospital

Question 1:
During which stage of infection would a patient be
irritable, fatigued, experience malaise, have an elevated
temperature, & be considered highly infectious?
a) Incubation period
b) Prodromal period
c) Ilness period
d) Convalescent period

Answer:
b) Prodromal period
(Stage 2)

Question 2:
Mary is taking care of a patient with tuberculosis. What
specific type of precautions should Mary take?
a) Standard Precautions
b) Airborne Precautions
c) Droplet Precautions
d) Contact Precautions
Answer:
b) Airborne Precautions
(remember My Chicken Hez TB)

Question 3:
When taking care of a known tuberculosis patient, the
nurse must wear:
a) Sterile gloves
b) Sterile gown
c) Particulate filter mask
d) Shoes covers
Answer:
c) Particulate filter mask

Question 4:
When opening a sterile package, a nurse should do all of
the following EXCEPT:
a) Select a moist tabletop at eye level.
b) Wash hands and obtain equipment.
c) Open packages away from the body, opening the distal
flap first.
d) Lift the front flap up and toward the body, handling
only the outside of the wrapper.
Answer:
a) Select a moist tabletop at eye level

(Open-Book Quiz)
Question 1:
Name & describe the stages of the infectious process.
(pg 234)
Answer:
-Stage 1: Incubation Period:
^begins when the organism first enters the body, & lasts
until onset of symptoms; period where organism multiplies;
period duration varies depending on type of organism; may

be infectious especially if viral


-Stage 2: Prodromal Period:
^short time from onset of vague symptoms to onset of
specific disease symptoms; patient may be irritable,
fatigued, experience malaise, and have elevated
temperature; HIGHLY INFECTIOUS STAGE; most people do
not realize they are ill during this stage
-Stage 3: Illness Period:
^localized & systemic symptoms appear; fever, headache,
malaise, & disease specific symptoms: rash, leukocytosis,
swelling, wound drainage, diarrhea, & vomiting; severity &
duration depend on virulence of pathogen & person's
susceptibility; stage where most people perceive they are
ill
-Stage 4: Convalescent Period:
^begins when symptoms begin to subside & continues
until the person returns to normal; duration may be days or
weeks depending on the type of organism & person's
overall health

(Open-Book Quiz)
Question 2:
What are the 2 premises underlying the current system of
isolation?
(pg 236)
Answer:
1) Infection may be present before the diagnosis is made
2) The greatest risk of transmitting infection for most
microorganisms comes from direct contact by the
caregiver's hands or equipment & supplies that have been
soiled by blood, body fluids, & other potentially infectious
materials

(Open-Book Quiz)
Question 3:
Why are the elderly at greater risk for infection?
(pg 237)
Answer:
-The elderly are at greater risk for infection because their
immune system is not as active as that of a younger
person

(Open-Book Quiz)
Question 4:
When treating patients, when do you implement Standard
Precautions & Transmission-Based Precautions?
(pg 236)

Answer:
-Use Standard Precautions for the care of ALL patients
-Use Transmission-Based Precautions for the care of
patients with known or suspected serious illnesses that can
be transmitted via airborne, droplet, or contact

(Open-Book Quiz)
Question 5:
According to the CDC guidlines, in what order do you don
personal protective equipment?
(pg 239)
Answer:
1) gown
2) mask/respirator
3) goggles/face shield
4) gloves

(Open-Book Quiz)
Question 6:
Summarize the guidlines for specimen preparation &
transportation.
(pg 239)
Answer:
-Verify the physician's orders and fill out the correct lab
requisition forms; label the side of specimen container with
patients information; put on gloves; explain what is needed
to patient; collect specimen without contaminating the
outside of the container; secure the lid;
disinfect visibly contaminated containers; place specimen
in laboratory biohazard transport bag & seal it; place lab
requistion forms in outside pocket of lab transport bag
before leaving the patient's room; remove gloves; wash
hands; send specimen to lab for processing

(Open-Book Quiz)
Question 7:
When transporting the isolation patient, what precautions
are recommended?
(pg 240)
Answer:
-Avoid transporting unless absolutely necessary
-Give patient standard mask to wear
-Take measures to prevent soiling of the environment
-Notify receiving department that patient is under the
particular type of Transmission-Based Precautions & any
additional precautions required ahead of time

(Open-Book Quiz)
Question 8:
While a patient is in Transmission-Based Isolation, how
can you prevent sensory deprivation?
(pg 243)
Answer:
-Listen to the patient's feelings
-Make positive comments on grooming & activity efforts
-Engage in meaningful conversation
-Make visitors feel welcome, & help them understand that
ther patient benefits greatly from their presence

(Open-Book Quiz)
Question 9:
List the 3 main modes of occupational exposure to
bloodborne pathogens
(pg 243)
Answer:
1) Puncture wounds
2) Skin contact
3) Mucous membrane contact

(Open-Book Quiz)
Question 10:
What must you do when it is apparent that a break in
surgical asepsis has occured?
(pg 252)
Answer:
-Point out and/or correct the error:
^begin scrub again
^discard & replace gloves & equipment

Droplet Precaution Mnemonic:


SPIDERMAN
-S= Sepsis, Scarlet fever, Streptococcal (group A)
pharyngitis
-P= Parvovirus B19, Pneumonia, Pertussis, Pneumonic
plague
-I= Influenza, Haemophilus Influenza (type B)
-D= Diptheria (pharyngeal)
-E= Epiglottitis
-R= Rubella (Measles)
-M= Mumps, Meningitis, Mycoplasma pneumonia,
Meningeal pneumonia

-A= Adenovirus
-N= Neisseria meningitidis

Airborne Precaution Mnemonic:


My Chicken Hez TB
-My= Measles (rubella)
-Chicken= Chicken Pox
-Hez= Herpes Zoster (Shingles)
-TB= Tuberculosis

Contact Precautions Mnemonic:


MRS WEE
-M= Multidrug-Resistant Bacterial Infections (MRSA, VRE,
ESBL, C. diff)
-R= Respiratory Infections (RSV)
-S= Skin Infections
-W= Wound Infections
-E= Enteric Infections (C. diff)
-E= Eye Infections (conjunctivitis)

Contact Precautions Mnemonic:


VCHIPS
-V= Varicella
-C= Cutaneous Diptheria
-H= Herpes Simplex
-I= Impetigo
-P= Pediculosis (lice)
-S= Scabies