🧼 Infection Control, Safety, and Medication Basics — Nursing Summary

🦠 Infection Control

Prevent the Spread of Infection

• Hand Hygiene: The most important action to prevent infection.
• Destroy Spores: Use heat (sterilization) to eliminate all microorganisms, including spores.
• Cleanliness: Principle inspired by Florence Nightingale — keep the environment clean and sanitary.

Stages of Infection

1. Incubation: Time between pathogen entry and first symptom.
2. Prodromal: Early, nonspecific symptoms appear (malaise, fatigue).
3. Illness: Full signs and symptoms of infection.
4. Convalescence: Recovery period; body returns to normal.

Chain of Infection

1. Infectious Agent: Microorganisms (bacteria, viruses, fungi, parasites).
2. Reservoir: Place where the agent lives and multiplies (humans, animals, objects).
3. Portal of Exit: Pathway for the agent to leave the reservoir (respiratory secretions, wounds, body fluids).
4. Mode of Transmission: How it spreads (direct contact, airborne, contaminated food/water).
5. Portal of Entry: Entry route into new host (respiratory tract, mucous membranes, broken skin).
6. Susceptible Host: Individual at risk (elderly, immunocompromised, infants).

➡️ Note: Portal of entry and exit are often the same.

🦠 Scenario: The Common Cold in a Classroom

1. Infectious Agent:

The rhinovirus, a type of virus that causes the common cold.

2. Reservoir:

The virus lives and multiplies in the respiratory tract of an infected student.

3. Portal of Exit:

When the student coughs or sneezes, droplets containing the virus leave through respiratory secretions (nose and mouth).

4. Mode of Transmission:

Another student touches a desk or doorknob contaminated with the virus, and later touches their nose or mouth — this is indirect contact transmission.

5. Portal of Entry:

The virus enters the new student’s body through the mucous membranes of the nose and mouth.

6. Susceptible Host:

The second student has a weakened immune system due to lack of sleep and stress from exams, making them more vulnerable to infection.

Transmission-Based Precautions

Droplet Precautions

• Room: Regular room (no negative pressure).
• PPE: Mask; ensure no other patient shares the room.

Contact Precautions

• Situation Example: Patient with diarrhea; stool contaminates bed and bedside table.
• PPE: Gloves, gown, mask, and shoe protectors if floor is soiled.

⚠️ Safety and Fall Precautions

• Fall Risk: Place patient on fall precautions.
• Color for Fall Risk: Yellow.⚠️
• Safety Measures:
• Use non-slip socks (non-skid footwear).
• Keep environment clutter-free and well-lit.

• Ensure call light and personal items are within reach.

Home Safety

• House with Toddler:
• Cover electrical outlets.
• Use childproof locks on cabinets.
• Remove small or sharp objects.
• Car seat must be in back seat, properly secured.
• Child with Bicycle:
• Must wear helmet and protective pads.

💊 Medication Administration

Idiosyncratic Reaction

• The patient reacts opposite to what is expected.

Example: A sedative causes excitement instead of sleepiness.

Allergies

• Always ask if the patient has allergies.
• Ask “What does the reaction look like?”

→ Helps determine if it’s a true allergy, a side effect, or an expected effect.

Rights of Medication Administration (7 Rights)

1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
6. Right documentation
7. Right indication/reason

My Mnemonic: Patients Must Do Right Things In Daily

Check 3 times:

1.When taking the drug out.

2.When entering the patient’s room.

3.Before administering to the patient.

✅ Always check the Medication Administration Record (MAR) against the provider’s order.

Narcotics / Controlled Substances

• Math on exams: Simple calculations — no calculator needed.
• Co-signing:
• Another nurse must witness and co-sign when wasting a narcotic.
• If another nurse says:

“I can’t give this narcotic, can you give it?” → This means the nurse has a narcotic restriction; you must administer it yourself.

• Nurses with substance-use problems:
• Can work under supervision.
• But, they Cannot handle narcotics or witness narcotic waste.

💊 Side Effects vs. Adverse Effects

🧼 Immobilization, Falls

Scientific Knowledge Base

• Balance and Alignment:

→ Reduces stress on the musculoskeletal system.

• Gravity and Friction:

→ Involved in moving the patient.

Nursing Knowledge Base

• Mobility: Refers to a person’s ability to move about freely.
• Immobility: Refers to the inability to move about freely.
• Bed Rest

Effects of Muscular Deconditioning

• ➢ Disuse Atrophy
• ➢ Physiological
• ➢ Psychological
• ➢ Social

🩺 Range-of-Motion Alterations

🩺 Systemic Effects of Immobility

1. Metabolic Changes

• Endocrine Metabolism: affecting metabolism and nutrient use.

🩹 Example: Decreased appetite and slower wound healing due to reduced metabolic rate.

• Calcium Resorption:

→ Patient loses bone calcium as bones break down faster than they rebuild.

🩹 Example: Prolonged bed rest may lead to hypercalcemia and risk for pathological fractures.

• Gastrointestinal (GI) Function:

↓ Peristalsis → constipation, slowed digestion, decreased appetite.

🩹 Example: Postoperative patients often experience constipation from inactivity and narcotics.

2. Respiratory Changes

• Atelectasis:

Partial or complete lung collapse caused by fluid buildup or lack of deep breathing.

🩹 Example: A patient lying supine all day may develop diminished breath sounds and crackles at lung bases.

• Hypostatic Pneumonia:

Inflammation of the lungs from stasis of secretions.

🩹 Example: An immobilized patient who does not perform coughing and deep-breathing exercises develops a productive cough with yellow sputum.

3. Cardiovascular Changes

• Orthostatic Hypotension:

Drop in blood pressure when moving from lying to sitting/standing position.

🩹 Example: Patient feels dizzy or lightheaded when first getting out of bed after several days of bed rest.

• Increased Cardiac Workload:

Heart must work harder to pump blood in the supine position.

🩹 Example: Edema and distended neck veins from fluid retention in a bedbound patient.

• Thrombus Formation (DVT):

Blood clots form due to venous stasis and hypercoagulability.

🩹 Example: Swelling, warmth, or redness in the calf of an immobile patient.

4. Musculoskeletal Changes

• Disuse Atrophy:

Muscles weaken and shrink from lack of activity.

🩹 Example: A patient’s quadriceps become smaller and weaker after two weeks in bed.

• Joint Contractures:

Permanent tightening of muscles, tendons, or joints.

🩹 Example: Patient develops foot drop from extended plantar flexion without proper support.

• Bone Demineralization:

Calcium loss increases fracture risk.

🩹 Example: A bedridden older adult develops brittle bones and fractures easily when repositioned.

5. Urinary Elimination Changes

• Urinary Stasis:

Gravity and lack of movement allow urine to pool in the bladder or kidneys.

🩹 Example: A patient develops a urinary tract infection (UTI) from stagnant urine.

• Renal Calculi (Kidney Stones):

Calcium from bone resorption accumulates in urine.

🩹 Example: Bedridden patient complains of flank pain due to small kidney stones.

6. Integumentary Changes

• Pressure Ulcers (Decubitus Ulcers):

Tissue ischemia from prolonged pressure on bony areas.

🩹 Example: A sacral sore develops in a patient who has not been repositioned every 2 hours.

• Skin Breakdown:

Moisture, friction, and shear increase the risk of skin tears.

🩹 Example: Friction injury on heels from sliding down in bed.

7. Psychosocial Effects

• Emotional and Behavioral Changes:

Boredom, depression, withdrawal, and decreased social interaction.

🩹 Example: Patient becomes unmotivated and avoids eye contact with staff after several days in isolation.

• Sleep-Wake Disturbances:

Lack of natural light and activity disrupt circadian rhythm. 🩹 Example: Patient sleeps all day and is awake most of the night.

• Decreased Independence:

Loss of self-esteem from relying on others for basic care.

🩹 Example: Patient expresses frustration and embarrassment needing help with toileting.

🧠 Quick Quiz 1 (1 of 2)

Question:

You notice a respiratory change in your immobilized postoperative patient. The change you note is most consistent with:

A. Atelectasis

B. Hypertension

C. Orthostatic hypotension

D. Coagulation of blood

✅ Correct Answer: A. Atelectasis

🩺 Nursing Process: Assessment (1 of 2)

Mobility Assessment

Evaluate the patient’s ability to move and maintain proper alignment. Key areas to assess include:

• Range of Motion (ROM)
• Planes of the Body
• Gait
• Exercise Pattern
• Body Alignment
• Standing:
• Sitting:
• Lying:

🛏️ Nursing Process: Assessment (2 of 2)

Immobility Assessment

Evaluate the systemic effects of immobility and identify risk factors. Assess each system:

• Metabolic System: Appetite, weight loss/gain, lab values (albumin, electrolytes).
• Respiratory System:
• Cardiovascular System: Heart rate, blood pressure, presence of edema or DVT signs.
• Musculoskeletal System:
• Integumentary System: Skin color, turgor, temperature, presence of redness or breakdown.
• Elimination System: Intake/output, bowel sounds, constipation, urinary retention.
• Psychosocial Assessment: Emotional state, mood, motivation, coping ability.
• Developmental Assessment: Age-appropriate motor function and independence levels.

🧾 Nursing Process: Diagnosis

Identify actual or potential problems related to mobility and immobility:

• Risk for Disuse Syndrome = Pt in bed for long period of time.
• Happen when the body is inactive for too long. When a person stays in bed or doesn’t move much—like after surgery, injury, or illness. This can lead to complications such as pressure ulcers, constipation, blood clots, pneumonia, and depression. Nurses focus on preventing these issues by encouraging movement, doing range-of-motion exercises, keeping the skin clean and dry, helping with good nutrition, and checking for early signs of weakness or breakdown.
• Impaired Physical Mobility
• Impaired Airway Clearance
• Impaired Sleep
• Risk for Impaired Skin Integrity
• Risk for Constipation
• Social Isolation
• Through the Patient’s Eyes:

Always consider the patient’s perspective, feelings, and goals in care planning.

🗂️ Nursing Process: Planning

Focus on creating individualized and measurable goals.

Key Components:

• Goals and Outcomes:
• Setting Priorities:

Address physiological needs first (e.g., airway, safety, skin).

• Teamwork and Collaboration:

Work with physical therapists, occupational therapists, dietitians, and family members to promote mobility and recovery.

Acute Care

Metabolic Interventions

• Provide a high-protein, high-calorie diet with vitamin B and C supplements to support tissue repair and energy needs.

Respiratory Interventions

• Chest Physical Therapy (CPT): Helps mobilize and clear respiratory secretions.
• Instruct the patient to cough and deep breathe every 1 to 2 hours to expand the lungs and prevent atelectasis.
• Provide chest physiotherapy as ordered to loosen mucus and improve ventilation.

Cardiovascular

Focus on preventing complications caused by reduced activity or bed rest.

• Reducing Orthostatic Hypotension:

Have the patient change positions slowly (lying → sitting → standing).

• Reducing Cardiac Workload:

Avoid Valsalva maneuver; teach the patient not to hold their breath during movement or toileting.

• Preventing Thrombus Formation:

Encourage leg exercises, early ambulation, and adequate hydration.

• Devices:

Use SCDs (Sequential Compression Devices), TED hose (thromboembolic stockings), and perform leg exercises regularly.

Maintaining Musculoskeletal Function

Positioning Techniques

Proper positioning maintains alignment, prevents pressure injuries, and supports comfort.

• Supported Fowler’s Position – Head of bed elevated 45–60°; promotes lung expansion.

• Supine Position – Patient lies flat on back with head, neck, and spine aligned.
• Prone Position – Patient lies on abdomen; promotes drainage and prevents hip flexion contractures.
• Side-Lying (Lateral) Position – Reduces pressure on bony prominences; promotes comfort.
• Sims’ Position – Combination of side-lying and prone; useful for enemas and perineal care.

Moving Patients

Nurses must ensure safe mobility while preventing complications:

• Preventing Injury to the Integumentary System:

Use draw sheets, reposition every 2 hours, and avoid friction or shear.

• Elimination System:

Encourage fluids and proper positioning to promote bladder and bowel emptying.

• Psychosocial Health:

Encourage social interaction, conversation, and participation in self-care.

• Developmental Health:

Support age-appropriate independence and confidence in movement.

Restorative and Continuing Care

• Instrumental Activities of Daily Living (IADLs):

Encourage independence in tasks such as dressing, eating, and grooming.

Intensive specialized therapy, such as occupational or physical therapy, may be required.

• Walking and Exercise
• Psychotherapy

🧠 Evaluation

• It is essential to obtain the patient’s feedback on the plan of care and their comfort or progress.

⚠️ Safety Guidelines for Nursing Skills

• Determine the amount and type of assistance required for safe positioning.
• Raise the side rail on the opposite side of the bed from where you are standing.
• Arrange equipment to avoid interference during movement or positioning.
• After repositioning, evaluate body alignment and check for pressure areas or skin risks.

🛏️ Immobility — Class Notes

General Principles

• You don’t want the patient to remain immobile.
• Move the patient every 2 hours to prevent bed sores (pressure injuries) and muscle atrophy.

Musculoskeletal Considerations

• Contractures:

Occur when joints are left in poor positions for too long.

• Foot Drop:

Inability to lift the front part of the foot, causing toes to drag while walking.

1. Prevent with tennis shoes, foot boards, or ankle positioning devices.
2. → Heel protectors prevent ulcers but do not prevent foot drop.
• DTI (Deep Tissue Injury):

Early damage to tissue that may appear as dark or purple skin; prevent with heel pads and regular repositioning.

• Direct Trauma:

Be careful when handling patients after trauma; maintain alignment when repositioning in bed.

Positioning and Body Mechanics

• Semi-Fowler’s Position (30°): Keeps the head elevated to prevent aspiration.
• Friction and Shearing:
• Shearing: When the patient slides down in bed and skin stays in place while underlying tissue moves.
• Friction: When skin rubs against sheets or surfaces during movement.

👉 Always lift or use draw sheets instead of dragging to prevent skin injury.

• Evaluate body alignment after repositioning.
• Four bed rails = a restraint. Use only the necessary number for safety.

Respiratory Effects

• Pneumonia: Immobility causes stasis of fluids, leading to infection.
• Turn, cough, and deep breathe every 2 hours to prevent lung collapse and clear secretions.
• Semi-Fowler’s position helps lung expansion and reduces aspiration risk.

Urinary & Gastrointestinal Effects

• Urinary System:

Inactivity causes patients to hold urine, increasing risk for UTIs.

• GI System:

Lack of movement slows peristalsis → constipation.

Encourage fluids and fiber intake.

An immobile (bedridden) patient is at risk for constipation because of slowed peristalsis (movement of the intestines) due to lack of physical activity.

Psychosocial Effects

• Immobility leads to depression, social isolation, and decreased motivation. Encourage communication and family involvement.

Active vs. Passive Mobility

• Active: The patient performs movement independently.
• Passive: The nurse or caregiver assists the patient in moving joints.
• Encourage active movement as much as possible to maintain strength and independence.

Interdisciplinary Teamwork

• Physical Therapy: Mobility training and strengthening.
• Wound Care Nurse: For pressure injuries or ulcers.
• Respiratory Therapy: To prevent pneumonia and monitor oxygenation.
• Dietary Services: Nutritional support to maintain strength.
• Case and Social Workers: Help with discharge planning and home safety.

Health Promotion & Safety

• Do not allow family to move the patient unless trained — risk of nurse or patient injury.
• Assess the situation before moving the patient:
• How many staff members are needed?
• What assistive devices are required (e.g., Hoyer lift, transfer sheet, special mattresses)?

Cardiovascular Considerations

• Orthostatic Hypotension: Common after prolonged bed rest — have the patient rise slowly.
• Prevent Thrombus Formation
• Encourage leg exercises and movement.
• Use SCDs (Sequential Compression Devices): Mechanical devices that apply gentle, intermittent compression to the legs to improve circulation and reduce clot risk.
• Check for existing clots before applying SCDs — never use if DVT is suspected.
• Leg massage can help circulation but should not be performed if a clot is suspected.
• See textbook pages 902–903 for visuals of devices and preventive measures. (📖 OJO — review these illustrations!)
• SCD sleeves
• mobile compression devices (MCDs) (whole leg and calf)
• Notes:
• Remove compression stockings or SCD sleeves at least once per shift,
• Applying them can be delegated to Assistive Personnel (AP). AP can remove SCD sleeves before allowing a patient to get out of bed and report any abnormalities.

Other Important Points

• Bed Rest:
• Good: Promotes healing and recovery after surgery or trauma.
• Bad: Causes muscle disuse, weakness, depression, and loss of independence.
• Do not feed in supine (flat) position — risk for aspiration.
• Support the patient’s breasts and limbs with pillows when positioning.
• Encourage fluids to prevent constipation and dehydration.
• Restore function: The goal is to return the patient as close as possible to their original level of independence.

Goals & Evaluation

• Goals should be SMART:

Specific, Measurable, Achievable, Relevant, Time-bound.

• Evaluation Questions:
• Did I meet the goal?
• Is the patient improving?
• How much assistance does the patient still need?
• Always re-evaluate: Adjust care plan as needed to continue progress.