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NUR 121 L Standard Precautions For all Patient Care Handwashing is not required in: Talking to patient. Adjusting IV fluid rate or non-invasive equipment. Handwashing is required to the following procedures: Examining pt. without touching blood, body fluids, mucuous membrane. Examining pt. including contact with blood, body fluids, mucous membrane. Drawing blood. Inserting Venous Access. Suctioning. Inserting face or body catheters. Handling soiled waste, linen, other materials. Intubation Inserting arterial access. Endoscopy. Operations and other procedures which produce which produce which produce extensive splattering of blood or body fluids. Gloving is required to the following procedures: Examining pt. including contact with blood, body fluids, mucous membrane. Drawing blood. Inserting Venous Access. Suctioning. Inserting face or body catheters. Handling soiled waste, linen, other materials. Inserting arterial access. Endoscopy. Operative and other procedures which produce which produce which produce extensive splattering of blood or body fluids. Gowning, mask, eyewear is required to the following procedures: Use gown, mask, eyewear if bloody body fluid splattering is likely. Use gown, mask, eyewear only if waste or linen are extremely contaminated and splattering is likely. Suctioning. Inserting face or body catheters. Handling soiled waste, linen, other materials. Inserting arterial access. Endoscopy. Operative and other procedures which produce which produce which produce extensive splattering of blood or body fluids. Exiting Client’s Room Utilizing Standard precautions Remove gown by first untying string at the waist. Remove first glove by pulling it off so glove turns inside out. Place rolled-up glove in palm of second hand and remove second glove. Untie gown at neck and take off gown by pulling down from shoulders. Turn gown inside out as it is being pulled off. Dispose of gown in linen hamper/ for disposable gown place dirty gown in garbage bag. Remove protective eyewear , if worn and mask. Wash hands in room or use antiseptic gel. After exiting room, repeat hand hygiene. Dispose of all soiled equipment or contaminated material in appropriate receptacle. Clinical Alert Disposal precautions Secretions Client should be instructed to expectorate into tissue held close to mouth. Suction catheters and gloves should be disposed of in impervious, sealed bags. Excrement Excrement should be disposed of by flushing into sewage system. Strict attention should be paid to careful hand hygiene; disease can be spread by oral-fecal route. Blood Needles and syringes should be disposable. Used needles should not be recapped. They should be place in a puncture –resistant container that is prominently labeled “ isolation” . Specimens should be labeled “ blood precaution”. HIV-HBV Clinical Alert Sample protocol for accidental contact with blood or bloody fluids. Any percutaneous or mucocutaneous exposure should receive immediate first aid. Apply immediate first aid to site. Needle stick or puncture wound: Scrub area vigorously with soap and water for 5 minutes. Oral mucous membrane exposure. Rinse area several times with water. Ocular exposure: irrigate immediately with water or normal saline solution. Human Bite: Cleanse wound with povidone iodine and sterile water. Report unusual occurrence to the charge nurse or supervisor. Complete an unusual occurrence form and follow-reporting requirements mandated by OSHA. Follow facility protocol for emergency care, If risk assessment indicates, follow PEP Protocol. Document circumstances of exposure , post exposure management, counseling and follow-up procedures in health care worker’s confidential medical file. The CDC has now approved rapid result tests for HIV. Most people exposed to HIV developed antibodies within 2-8 week, but two minutes will know the results from one of thsese new diagnostics tests. Basic and Expanded HIV Exposure Prophylaxis Regimens Basic – Occupational HIV exposures for which there is a recognized transmission risk. Drug Regimen: 4 weeks (28 days) of both Zidovudine 600 mg every day in 2 or 3 divided doses and Lamivudine 150 mg twice a day. Now available combined as Comvibar single tablet given 2x daily. Expanded – Occupational HIV exposures that pose an increased for for transmission (e.g. larger volume of blood and/or higher virus titer in blood. Drug Regimen: Basic regiment plus either Indinavir 800 mg every 8 hours on an empty stomach or Nelfinavir 750 mg three times a day with meals or snacks. Preparing for Isolation Equipment Specific equipment depends on isolation precaution system used. Soap and running water. Isolation cart containing mask, gowns, plastic bags, isolation tape. Linen hamper and trash can, when needed. Paper towels Door card indicating precautions. Procedure Check physician’s order for isolation. Obtain isolation cart from central supply, if needed. Check that all necessary equipment to carry out the isolation order is available. Place isolation card/signage on the client’s door. Ensure that linen hamper and trash cans are available, if needed. Explain purpose of isolation to client and family. Instruct family in procedures required. Wash hands with antimicrobial soap or use alcoholbased gel before and after entering isolation room. Clinical Alert Respiratory N95 or HEPA (High –Efficiency particulate Air) masks are recommended for suspected or confirmed multidrug-resident tuberculosis. Masks are fitted to worker. Wear mask until it becomes difficult to breathe. This indicates mask is clogged. When not in use, store mask in zip-lock bag in safe area. Masks are expensive and can be used repeatedly until it is difficult to breath though them. Some isolation gowns do not tie at the neck, they slip over the head. When removing this gown, pull shoulders forward to loosen the Velcro at the neck area. Remove gown in the same manner as you would tied at the neck. Removing Items from Isolation Room Place lab. Specimen in biohazard plastic bag. Dispose of all sharps in appropriate red plastic container in room. Place all linen in linen bag. Place re-usable equipment such as procedures trays in plastic bags. Equipment • I and O bedside Form • Client’s own graduated container •Bedpan, urinal or underseat basin for toilet “hat”. • Hourly inline urine measurement device for client requiring frequent monitoring. •Clean Gloves Preparation Explain to client purpose of keeping I and O record to client. Instruct client to keep record of all fluid taken orally. Keep an I and O record at bedside for the client to document intake Instruct client to void into bedpan, urinal, or underseat basin for toilet. Instruct client not to place toilet tissue in bedpan or defecate in bedpan. Procedure Fluid Intake 1. Measure all fluid intake (oral, IV Fluid, medications, and TF) according to hospital values. 2. Record Time and amount of fluids in the appropriate space in on bedside form. 3. Check bedside I and O record for approximate amounts of fluid containers. 4. Total 8 hour fluid intake on bedside I and O record. 5. Complete a 24-hour intake record by adding together all three 8-hour total. 6. Same goes for twelve hour shift intake. Add two 12 hour shift to get the 24 hour total. Fluid Output Don gloves to measure output from all sources. Empty urinal, bedpan, or drainage bag into into client’s graduated container To drain urine collection bag, use the client’s individual labeled graduated receptacle. Slide port opener clockwise to allow urine to drain and turn port opener to counterclock wise to close. Remove gloves and perform hand hygiene. Record time and amount of output on bedside I and O record. Complete 24 hour output record be adding together all immediate output totals during that 24-hour period, and place total on graphic sheet. Notify physician for any significant imbalance; more intensive monitoring maybe indicated. Documentation for Intake and Output Time and amount of all oral fluid intake. 8 hour totals of all IV and enteral fluids. 24 hour total of all fluid intake. Remove gloves and perform hand hygiene. Record time and amount of output on bedside I and O record. Complete 24 hour urine output record by adding together all immediate output totals during the 24 – hour period, and place total on graphic sheet. Notify physician of any significant imbalance, more intensive monitoring maybe included. Computing for I and O Practice Sheet provided. Bladder Irrigation Irrigating by Opening a Closed System. Smith pp. 785 – 786. - Equipment - Preparation - Procedure - Clinical Alert Irrigating a Close System. Smith pp. 786 – 787. Maintaining Continuous Bladder Irrigation. Smith pp. 787 – 788. Care of Suprapubic Catheter What is a suprapubic catheter? A suprapubic catheter is a bendable rubber tube that is inserted directly from the abdomen into urinary bladder to drain urine. A suprapubic catheter may be used in conditions where there is a problem passing urine. These problems may include an infection, obstruction, or an injury caused by trauma or surgery in the bladder. A spinal cord injury, diabetes, and certain medicines may also cause urinary retention. Males who have an enlarged prostate, and females who have a cystocele may also have problems draining urine. Suprapubic catheters may be used for long-term management of these conditions. How to clean the skin around suprapubic catheter? The opening created for the suprapubic catheter is called a stoma. Clean the skin around stoma every day. The following are directions for cleaning the skin around your stoma Suprapubic Catheter Instead of being passed up through the urethra as is usual, the supra pubic catheter is inserted through the abdominal wall just above the pubic bone and into the bladder. This is a minor surgical procedure and involves giving a local anaesthetic injected around the area before the insertion. More often, this procedure is carried out as part of a larger surgical procedure, ie. Prostatectomy, and will be inserted in the operating room when you are asleep. The medical term for "above" is "supra" hence Suprapubic, "above the pubic", in this case it is refering to where it is positioned. This can be a long term solution. Equipment Closed drainage system including a foley catheter tubing and bag. Catheter clamp and plug Dry sterile dressing and tape if ordered. Cleansing solution Clean gloves Sterile gloves. Preparation Gather all the items needed Cleansing Solution. Clean washcloth or sterile gauze bandage. Clean towel. New gauze bandage. Sterile (clean) medical gloves. Trash can. Remove the bandage and look at the site: Wash hands using soap, or use a hand cleaner. Put on clean gloves. Gently remove the bandage. Do this by supporting the skin around the stoma with one hand. With the other hand, gently remove any adhesive tape by pulling in the direction of hair growth. Throw the bandage away in the trash can. Look for problems such as redness, separation of skin, red spots and swelling. Report any skin changes to your caregiver. Throw away your used gloves. Wash your hands, and put on clean gloves. Clean the area with cleanser: Hold the end of the catheter tube in place to keep it from being pulled out while cleaning. Wash the catheter to remove blood or other material, moving away from the stoma. Rinse the stoma and the skin around it in a circular manner, moving away from the stoma. Pat the area gently with a clean towel to dry it. Throw away your used gloves. Wash hands, and put on clean gloves. If you use a bandage, apply a new one. Loop the catheter tubing and secure it well. Avoid kinking or blocking the tubing. Throw away your used gloves. Wash hands. Procedure Smith pp. 790. Documentation for Suprapubic cather care