NCLEX Precautions review; standard, contact, airborne, droplet

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Standard Precautions:
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1. wash your hands (*Most important step in infection control, prevents nosocomial infections) 2. DON gloves (before coming in contact with anything wet, i.e. broken skin, mucous membranes, blood, body fluids, soiled instruments, contaminated waste materials. 3. wash hands again upon removal of gloves and between patients
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Contact Precautions:
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Before entering: 1.wash hands 2. DON gown then gloves Upon entering: 1. use disposable equipment when possible 2. when not available clean and disinfect all equipment before removing from room Before leaving the patient’s room: 1. Remove gloves then gown 2. Wash hands
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Contact Precautions Transporting patient:
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1. PT should perform hand hygeine and wear a clean gown 2. For direct contact with pt, nurse or care provider should wear a gown and gloves. 3. Notify receiving area
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Common Microorganisms which require Contact Precautions :
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1. Antibiotic Resistant Organisms (Methicillin resistant Staphylococcus aureu (MRSA), Extended spectrum beta-lactamase (ESBL), Penicillin resistant Streptococcus pneumoniae (PRSP), Multi-drug resistant Pseudomonas aeruginosa (MDRP)) 2. Scabies 3. Herpes Zoster (Shingles) localized 4. Diarrhea, Clostrididum difficile
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Airborne Contact Precautions:
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Before entering: 1.Wash hands 2. Don N95 Respirator (Mask) 3. Don gown then gloves *Negative Pressure Isolation Room KEEP DOOR CLOSED Before leaving pt’s room: 1. Remove gloves then gown NOT N95 mask 2. Wash hands After leaving pt’s room: 1. Shut door 2. Wash hands 3. Remove N95 mask 4. Wash hands
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Airborne Contact Precautions Transporting patient:
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1. Patient must wear a surgical or procedure mask and a clean gown 2. Patient must wash hands 3. For direct contact with pt, nurse or care provider should wear a gown and gloves. 4. Notify receiving area
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Common Microorganisms which require Airborne Contact Precautions :
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1. Measles (Rubeola) 2. Tuberculosis (TB) 3. Chicken Pox (Varicella-Zoster virus) 4. Herpes Zoster (Shingles) disseminated
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Droplet Contact Precautions:
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Before Entering: 1. Wash Hands 2. DON Mask and Eye Protection 3. DON Gown then Gloves Before Leaving Pt’s Room: 1. Remove gloves then gown 2. Wash Hands 3. Remove eye protection and mask 4. Wash Hands
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Droplet Contact Precautions Transporting patient:
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1. Pt must perform hand hygeine 2. Pt must wear a surgical or procedure mask and clean gown 3. For direct contact with pt, nurse or care provider should wear a gown and gloves. 4. Notify receiving area
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Common Microorganisms which require Droplet Contact Precautions :
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1. Influenza (Flu) 2. Viral Respiratory tract infections (adenovirus, parainfluenza, rhinovirus, RSV) 3. Streptococcus group A pharyngitis, pneumonia, scarlet fever 4. Neisseria meningitidis invasive infections 5. H. Influenzae type b invasive infections 6. Pertussis 7. Rubella 8. Mumps
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Strict isolation is: Rules:
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used to prevent the transmission of all highly communicable diseases that are spread by both, contact or airborne routes of transmission. Examples of such diseases are chickenpox and rabies (1) Visitors must report to the nurses’ station before entering the room. (2) Door must be kept closed. (3) Gowns must be worn by all persons entering the room. (4) Masks must be worn by all persons entering the room. (5) Hands must be washed on entering and leaving the room. (6) Gloves must be worn by all persons entering the room. (7) Articles must be discarded or wrapped before being sent to Central Supply for disinfection or sterilization.
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Respiratory isolation is: Rules
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used to prevent transmission of organisms by means of droplets that are sneezed or breathed into the environment. Examples of such diseases are influenza and tuberculosis (1) Visitors must report to the nurses’ station before entering the room. (2) Door must be kept closed. (3) Gowns are not necessary. (4) Masks must be worn by any person entering the room unless that person is not susceptible to the disease. (5) Hands must be washed on entering and leaving the room. (6) Gloves are not necessary. (7) Articles contaminated with secretions must be disinfected.
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Protective isolation is: Rules:
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used to prevent contact between potentially pathogenic microorganisms and uninfected persons who have seriously impaired resistance. Patients with certain diseases, such as leukemia, who are on certain therapeutic regimens are significantly more susceptible to infections (1) Visitors must report to the nurses’ station before entering the room. (2) Door must be kept closed. (3) Gowns must be worn by all persons entering the room. (4) Masks must be worn by all persons entering the room. (5) Hands must be washed on entering and leaving the room. (6) Gloves must be worn by all persons having direct contact with the patient. (7) Articles must be handled according to local SOP.
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Enteric precautions are: Rules:
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used to control diseases that can be transmitted through direct or indirect oral contact with infected feces or contaminated articles. Transmission of infection depends on ingestion of the pathogen. Examples of diseases requiring enteric precautions are dysentery and hepatitis. (1) Visitors must report to the nurses’ station before entering the room. (2) Gowns must be worn by all persons having direct contact with the patient. (3) Masks are not necessary. (4) Gloves must be worn by all persons having direct contact with the patient or with articles contaminated with fecal material. (5) Special precautions are necessary for articles contaminated with urine and feces. Articles must be disinfected or discarded
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Wound and skin precautions are: Rules:
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used to prevent the spread of microorganisms found in infected wounds (including burns and open sores) and contact with wounds and heavily contaminated articles. Conditions requiring these precautions include infected burns, infected wounds, and infections with large amounts of purulent discharge. Diseases that may require wound and skin precautions include herpes, impetigo, and ringworm. (1) Visitors must report to the nurses’ station before entering the room. (2) Gowns must be worn by all persons having direct contact with the infected wound. (3) Masks are not necessary except during dressing changes. (4) Gloves must be worn by all persons having direct contact with the infected area. (5) Special precautions are necessary for instruments, dressings, and linens. CAUTION: Only hospital personnel who have been vaccinated with poliomyelitis vaccine should have direct contact with patients who have active poliomyelitis.
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Blood precautions are: Rules:
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used to prevent acquisition of infection by patients and personnel from contact with blood or items contaminated with blood. Examples of diseases that require blood precautions (refer to Lesson 1) are HBV and HIV/AIDS
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Secretion precautions-lesions are:
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used to prevent acquisition of infection by personnel and patients from direct contact with wounds and secretion-contaminated articles. Some examples of diseases requiring these precautions are conjunctivitis, gonorrhea, and syphilis
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Secretion precautions-oral are:
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used to prevent acquisition of infection by personnel from direct contact with oral secretions. Some examples of diseases requiring these precautions are herpes areolas and scarlet fever.
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Excretion precautions are:
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used to prevent acquisition of infection by personnel and patients from direct contact with fecal excretions. Some examples of diseases requiring these precautions are poliomyelitis and staphylococcal food poisoning.
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If it’s not one of these 4 diseases and you know it’s HIGHLY contagious, it’s probably droplet, so know the 4 airborne are!
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(think: My Chicken Has TB) measles chicken pox Herpes zoster aka shingles TB
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airborne precautions, room considerations
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Remember: Private room or cohort w/ negative pressure w/ 6 – 12 air exchange/hr AND MASK. *N95* mask for TB.
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Droplet precautions
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SSS PPP IDER MMM AN *S* = Sepsis *S* = Scarlet Fever *S* = Streptococcal Pharyngitis *P* = Paravirus B19 *P* = Pneumonia *P* = Pertussis *I* = Influenza *D* = Diptheria (Pharyngeal) *E* = Epiglottitis *R* = Rubella *M* = Mumps *M* = Meningitis *M* = Mycoplasma or Meningeal Pneumonia *AN* = Adenovirus
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CONTACT precautions
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MRS WEE *M* = Multidrug Resistant Organism *R* = Respiratory Infection *S* = Skin Infections *W* = Wound Infections *E* = Enteric Infection (Clostridium Difficile) *E* = Eye Infections (Conjunctivitis)
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SKIN Infections:
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V CHIPS V-CHIPS *V* = Varicella *C* = Cutaneous Diptheria *H* = Herepes Zoster *I* = Impetigo *P* = Pediculosis *S* = Scabies
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AIRBORNE PRECAUTION: 5 microns Private room YES to cohort, 3ft separation PPE: Surgical Mask DSE: (Remember “Dropletism”) Diptheria Rubella Oral Pharyngitis Pertussis/ Pneumonia Legionnaire’s Disease Erythema infectiosum (5th disease) -contagious when no rash Tonsilitis Influenza Scarlet Fever Mumps/ Meningitis CONTACT PRECAUTION: Private room YES to cohort, 3ft separation Secretions: skin wounds, eyes, nose, ears Patient has own BP/Stet equipment PPE: Gloves and Gown DSE: RSV, MRSA, VRSA, VRE, CDAD, STD, Conjunctivitis, Impetigo ENTERIC PRECAUTION: Private room with bathroom facility YES to cohort PPE: Gloves and Gown DSE: Hep A, Shigella, Salmonella, Norwalk virus (improper/ contaminated food) Crytosporidiosis, Gardiasis (common in day care/ children) NEUTROPENIC PRECAUTION: Private room PPE: Mask DSE: Chemo/ Cancer patients, AIDS/HIV, Major burns/ surgery, SLE, Transplant patient taking 4C’s (Cellcept, Corticoidsteroids, Cytoxan, Cyclosporin)
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order in which the nurse should remove personal protective equipment(ppe) gloves, goggles gown mask
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note it’s in alpha order
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Diseases requiring enteric precautions
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C-diff Dysentery from infectious cause Hepatitis A

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