ATI-leadership

Common errors= meds, diagnostic testing, surgical errors, HCI, hand-off & care
QSEN- helps with knowledge and skills/ attitudes that accompany this competency
-for infectious & hazardous materials
-safe use of equipment
-accident and injury prevention
-home safety
-ergonomic principles
The 6 specific competencies
1. Patient centered care
-provision of caring & compassionate, culturally sensitive care
2. Team work & collaboration
-work w/ many other people to achieve continuity of care and positive client
outcomes
3.EBP
4. Quality improvement
5. Safety
6. Informatics
-develop a culture of safety lower number of adverse events
Adverse events risk management to help identify and prevent
-hazards, track the occurrence of negative client incidents and help manage the hazards
RISK MANAGEMENT
-service occurrences
-relate to client services, and can include a slight delay in service or
unsatisfactory
-near misses
-situations where negative outcome almost occurs
-serious incidents
-reported include minor injuries, loss of equipment or property or a significant
service interrupted
-sentinel events
-failure to rescue
-most severe. Client develops a complication that leads to death. Client
indicators that were missed by one or more health care personnel that indicated
that a complication was occurring
*if needlestick occurs report to facility risk management & policy/ state law
-IR filed
-get tested (nurse & client) for hep & HIV
JCO poor communication is a key factor in majority of sentinel events
IOMTo Err is Human
-frequency of unnecessary deaths & preventable medical errors
-identified system failure as a major factor
-need to redesign provision of client care and improve education of students
Hazardous Materials
-employees have the right to refuse to work in hazardous working conditions if there is a
clear threat to their health
-should follow OSHA
-make protective gear accessible  antineoplastic meds, sterilization chemicals
-document an employee’s level of exposure over time (radiation from x-rays)
-education & recertification
-SDS level of toxicity, handling and storage guidelines, first aid & containment
measures
-HAZMAT response team
-decontaminate affected individuals as much as possible
-gloves, gown, mask & shoe covers to protect self
-carefully & slowly remove contaminated clothing so that deposited material
does not become airborne
-w/ few exceptions, water is the universal antidote.
-biological hazardous materials, wash skin w/ copious amounts of water
and antibacterial soap
-place contaminated materials into large plastic bags and seal them
Safe use of Equipment
-checking equipment is accurately set and functioning properly o2, ng suction
-electrical equipment is grounded
-life-support equipment is plugged into outlets designated to be powered by backup
generators
-all pumps have free-flow protection
-equipment should be reg. inspected by engineering or maintence department
-Pediatric & older adult clients are at greater risk
Seizure Precautions
-assign room close to nurses station & inserting a peripheral IV
-o2, oral airway, suction is at bedside and working
-educate pt on precautions out of bed
**provide monitoring and treatment as indicated.
Seclusion rooms for behavioral pts
Restraints
-prescription must state
-type, reason, location, how long it can be used & type of behaviors
demonstrated by client
**limited to 8hrs. adult
**limited to 2hrs  9-17yr
**limited to 1hr  younger then 9
Carbon monoxide n/v, headache, weakness & unconsciousness
-ensure proper ventilation when using fuel-burning devices (lawn mowers, wood-
burning & gas fireplaces, charcoal grills)
-have gas-burning furnaces, water heaters, chimneys, flues & appliances inspected
annually
 -flues and chimneys should be unobstructed
-install and maintain carbon monoxide detectors
IR
-med errors
-procedure/ tx errors
-equipment-related injuries/errors
-needlestick injuries
-client falls/injuries
-visitor/volunteer injuries
-threat made to client or staff
-loss of property (dentures, jewelry, personal wheelchair)
Biological incidents -pg. 70 in leadership (ATI)?
Chemical Incidents
-remove the offending chemical by undressing the client and removing all identifiable
matter
-provide immediate and prolonged irrigations of contaminated areas
-skin w/ water (except dry chemicals  lye or white phosphorus)
-brush agent off of clothing and skin
-gather specific hx of injury (name & concentration of the chemical, duration of
exposure)
-ABC’s !!!
Radiological incidents
-floors, furniture, air vents & ducts should be covered
-water resistant gowns, double-glove & fully cover bodies w/ caps, booties, masks, &
goggles
Asepsis
-absence of illness-producing micro-organisms. **HAND hygiene is the primary behavior
Medical
-precise practices to reduce the number, growth, and spread of micro-orgs
-oral medication, ng tubes, personal hygiene
Surgical
-parenteral medication, urinary caths, surgical procedures, sterile changes
Sterile Field
*prolonged exposure to airborne micro-organisms can make sterile items non-sterile
-don’t cough, sneeze or talk over sterile field
-only sterile items in sterile field
-outer wrappings & 1-inch edges of packaging that contains sterile items are not
sterile.
-touch sterile materials only with sterile gloves
**MICROBES CAN MOVE BY GRAVITY FROM A NON-STERILE ITEM TO A STERILE ITEM
-don’t reach across, turn your back & hold items to add to a sterile field at a min.
of 6 inch. Above
-clean a area above waist level in client’s environment to set up field
 -check that all packages are dry and intact and have a future expiration date. Any
chemical tape must show the appropriate color change
-make sure an app. Waste receptacle is nearby
Pathogens
-bacteria
-staph. Aureus, e. coli, mycobacterium tb
-viruses
-organisms that use the host’s genetic machinery to reproduce (HIV, hep, herpes
zoster, herpes simplex virus
-fungi
-molds & yeasts (candida albicans, aspergillus)
-prions
-protein particles (Creutzfeldt-jakob)
-parasites
-protozoa (malaria, toxo) & helminths (flatworms, roundworms) Flukes
(schistosoma)
Native Immunity
-restricts entry or immediately responds to a foregin organism (antigen) through
activation of phagocyctic cells, complement and inflammation
Passive antibodies are produced by an external source
-temporary immunity that does not have memory of past exposures
-intact skin, the body’s first line of defense
-mucous membranes, secretions, enzymes, phagocytic cells & protective
proteins
-inflammatory response w/ phagocytic cells, the complement system, and
interferons to localize the invasion and prevent its spread
Specific Adaptive Immunity
-allows the body to make antibodies in response to a foreign organism. This reaction
directs against an identifiable micro-organism
Active antibodies are produced in response to an antigen
-requires time to react to antigens
-provides permanent immunity
-involves B & T-lymphocytes
-produces specific antibodies against specific antigens
Portal of Exit
Resp. tract (droplet & airborne)- tb & strep
Gastro- salmonella, hep. A
Urinary- e. coli, hep A, HSV & HIV
Skin/mucous- HSV & varicella
Blood/Body- HIV & hep b/c
Transplacental

Stages of infection
 Incubation- interval between the pathogen entering the body & the presentation of the
first finding
Prodromal stage- interval from onset of general findings to more distinct findings,
during this time the pathogen multiplies
-nonspecific manifestations of the infection
Illness stage- interval when finding specific to the infection occur
-experiences manifestations specific to the infection
Convalescence- interval when acute findings disappear, total recovery taking days to
months
-fade
Risk Factors for infection
-inadequate hand hygiene
-immunocompromised
-who have surgery
-indwelling devices
-a break in the skin body’s best protection against infection
-poor o2
-impaired circulation
-chronic or acute disease (diabetes, adrenal insufficiency, renal failure, hepatic failure or
chronic lung disease)
-caregivers using medical or surgical asepsis that does not follow the established
standards
-clients who have poor personal hygiene or poor nutrition, smoke, or consume excessive
amounts of alc & those experiencing stress
-crowded environment
**older adult clients have a slowed response to antibiotic therapy, slowed immune
response, loss of subc. Tissue and thinning of the skin, decreased vascularity and slowed
would healing, decreased cough and gag reflex, chronic illnesses, decrease gastric acid
production, decreased mobility, bowel and bladder incontinence, dementia, & greater
incidence of invasive devices
-poor lifestyle choices
-poor sanitation, different country, and parasitic diseases
Health care associated infections
-icu
-best way to prevent is through frequent and effective hand hygiene
-urinary tract (common area)  e. coli, staph. Aureus & enterococci
-surgical wounds, resp. tract & bloodstream
-iatrogenic infection diagnostic or therapeutic procedure
-HAIs are not always preventable and are not always iatrogenic
-use EBP to prevent HAIs due to multidrug-resistant organisms
-inflammation is the body’s local response to injury or infection LOCAL
1. redness, warmth of the area on palpation, edema, pain or tenderness, loss of use of
the affected part (inflammatory response local infection)
 2. serous (clear), sanguineous (rbcs), purulent (leukocytes & bacteria)  micro-
organisms are killed. Fluid that contains dead tissue cells and WBCs accumulates
3. damaged tissue is replaced by scar tissue. New cells take on characteristics that are
similar in structure & function to the old cells
-Labs
-leukocytosis greater than 10,000
-increases in specific of WBCs on differential (late shift= an increase in neutrophils)
-elevated erythrocyte sedimentation rate over 20mm/hr; an increase indicates an active
inflammatory process or infection
-presence of micro-organisms on culture of the specific fluid/area
-SYSTEMIC
-fever, malaise, increase in pulse and resp. rate
Medications
-Antipyretics (Tylenol & aspirin)  fever & discomfort as prescribed
-monitor fever to determine effectiveness
-document the client’s temp. fluctuations on the medical record for trending
-Antimicrobial therapy kills or inhibits the growth of micro-organisms (bacteria, fungi,
viruses, protozoans). Either kill pathogens or prevent their growth
-administer antimicrobial therapy as prescribed
-monitor for medication effectiveness (reduced fever, increase in the level of
comfort, decreasing WBC count)
-maintain a medication schedule to ensure consistent therapeutic blood levels of
the antibiotic
Droplet
-plan & evaluate control and prevention stage
-determining public health priorities
-ensuring proper medical treatment
-monitoring for common-source outbreaks
-wear a mask w/in 3ft of the client
-place a surgical mask on the client if transportation to another department is
unavoidable
-wear a gown when performing care that might result in contamination from secretions
Infections of the renal and urinary system
Reanl system maintain fluid volume, removing waste, regulating bp, acid-base
balance, producing erythropoietin, & activating vit. D.
3 systems (store and remove urine)
-ureter
-bladder
-urethra
UTIs infection of the urinary system (caused by e.coli, klebsiella, proteus,
pseudomonas, & staph. Saprophyticus)
-lower portion of the lower urinary tract (ureters, bladder, urethra, prostate)
-cystitis, urethritis, prostatitis
 **if left UNTREATED can lead to pyelonephritis & urosepsis septic shock &
death
Pyelonephritis infection of the kidney and renal pelvis
-upper UTI
-CT scan is used to detect
-Acute and chronic glomerulonephritis can develop from a SYSTEMIC INFECTION &
involves the glomeruli of the kidney or the area responsible for filtering particles from
the blood to make urine
Assessment
-alkaline urine promotes bacterial growth
-indwelling caths
-stool incontinence
-bladder distention
-urinary conditions (anomalies, stasis, calculi, residual urine)
-possible genetic links
-disease (diabetes)
Expected Findings
-lower back/ abdominal discomfort and tenderness over the bladder
-nausea
-urinary freq. and urgency
-dysuria, bladder cramping, spams
-feeling of incomplete bladder emptying or retention of urine
-perineal itching
-hematuria
-pyuria
-fever
-vomiting
-voiding in small amounts
-nocturia
-urethral discharge
-cloudy or foul-smelling urine
Older adult manifestations
-confusion
-incontinence
-loss of app
-nocturia and dysuria
-hypotension, tachyc., tachyp., and fever (indications of urosepsis)
Lab test U.A & urine culture and sensitivity
-bacteria, sediment, WBC & RBCs
-positive leukocyte esterase & nitrites (68-88%)
Nursing actions
-instruct the client regarding proper tech. for the collection of a clean-catch urine
-collect catheterized urine specimens using sterile tech
WBC count & differential
 -if urosepsis is suspected
-wbc = or greater than 10,000 w/ a shift to the left, indicating an increased
number of immature cells (neutrophils) in response to infection
Sexually transmitted infection testing
-STIs can cause manifestations of a UTI
-chlamydia, Neisseria, & herpes simplex  acute urethritis
-trichomoniasis or candida can cause acute vaginal infections
Patient-Centered Care
Nursing Care
-consult w/ provider regarding fluid restrictions if needed
-antibiotic meds
-recommend warm sitz bath 2-3x/day
-avoid use of indwelling caths
-clients who are preg. Require immediate and effective treatment to prevent
pyelonephritis that can result in preterm labor
Medications
-penicillin & cephalosporins are administered less freq. b/c the medication is less
effective & tolerated
-nitrofurantoin is an antibacterial medication where therapeutic levels are
achieved in urine only
Nursing Actions
-if sulfonamide is prescribed, ask client about ALLERGY TO SULFA
-advise clients taking fluoroquinolones or sulfonamides that sun-
sensitivity Is increased and suburn is a risk
**FULL GLASS OF WATER AND INCREASE FLUID precipitate in
renal tubules
-take w/ food
-monitor and report watery diarrhea that can indicate
pseudomembranous colitis
-Phenazopyridine
-bladder analgesic used to treat UTIs
-medication will TURN ORANGE
-med w/ food
-med will NOT treat the infection, but will relieve bladder discomfort
Interprofessional care
-consult w/ urology services for managing UTIs
Client Education
-drink 3L fluid daily
-bathe daily to promote hygiene
-empty bladder q3/4 hrs instead of waiting until the bladder is completely full
-pee before and after intercourse
-drink cranberry juice to decrease the risk of infection
**IF CHRONIC CYSTITIS SHOULD AVOID THIS
-empty the bladder as soon as there is an urgency to void
SBAR
S-name, age, admitting dx & current situation
B-medical hx, current medications & advance directives
A-client impression and sig. findings as labs, test, vitals
R-response to tx and what you would recommend