NSE 22 Protection and Safety Module Questions (Use Ctrl + F to quickly navigate the content for specific information)

(Use Ctrl + Click on the table of contents to immediately find the answers to specific questions)

Contents 1. ................................................................................................................................................................... 4
EXPLAIN THE FALLS RISK ASSESSMENT TOOLS . ..................................................................................... 4 2. ................................................................................................................................................................... 5 IDENTIFY HOW DATA FROM FALLS RISK ASSESSMENT CAN BE USED TO DESIGN FALLS PREVENTION PROGRAMS . ................................................................................................................................................. 5 1. ................................................................................................................................................................... 5 EXPLAIN THE ROLE OF VACCINES IN THE PREVENTION OF INFECTION AND PERSONAL
RESPONSIBILITY IN RELATION TO INFECTION AT WORK INCLUDING AGENCY SPECIFIC GUIDELINES. 5

2. ................................................................................................................................................................... 5 DEFINE AND EXPLAIN H1N1, SARS, C-DIFFICILE, ESBL, MRSA, VRE, TB IN RELATION TO: ....... 5 3. ................................................................................................................................................................. 10 EXPLAIN IMPORTANCE OF HAND HYGIENE/HAND WASHING AND REVIEW PROCEDURE FOR HAND WASHING. ................................................................................................................................................... 10 4. ................................................................................................................................................................. 10 DIFFERENTIATE BETWEEN REGULAR AND BIOHAZARD WASTES AND IDENTIFY AGENCY SPECIFIC DISPOSAL PROCEDURES . ......................................................................................................................... 10 5. ................................................................................................................................................................. 11 EXPLAIN THE FIRST AID RESPONSE TO EXPOSURE TO BLOOD AND BODY FLUIDS AND/OR SHARPS AND FOLLOW - UP REPORTING AND ASSESSMENT PROCEDURES . ........................................................ 11 6. ................................................................................................................................................................. 11 EXPLAIN THE LEARNING/TEACHING NEEDS OF CLIENTS AND FAMILY MEMBERS RELATED TO ISOLATION . ................................................................................................................................................. 11

7. ................................................................................................................................................................. 12 EXPLAIN THE PSYCHOLOGICAL NEEDS OF THE CLIENT IN ISOLATION . ............................................... 12 8. ................................................................................................................................................................. 12 STATE WHAT EQUIPMENT SHOULD BE DEDICATED FOR AN ISOLATION ROOM. ............................... 12 9. ................................................................................................................................................................. 12 EXPLAIN THE RATIONALE FOR PERSONAL PROTECTIVE EQUIPMENT AND DEMONSTRATE THE TECHNIQUE OF : .......................................................................................................................................... 12 10. ............................................................................................................................................................... 12 DESCRIBE HOW YOU WOULD TRANSPORT A CLIENT TO A TEST OR APPOINTMENT WHO IS ON ISOLATION PRECAUTIONS . ....................................................................................................................... 12 11. ............................................................................................................................................................... 13 IDENTIFY THE PRECAUTIONS USED WHEN A CLIENT REQUIRES PROTECTIVE/REVERSE ISOLATION . .................................................................................................................................................................... 13 12. ............................................................................................................................................................... 13 IDENTIFY YOUR AGENCY S POLICIES FOR ISOLATION. .......................................................................... 13 1. ................................................................................................................................................................. 13 EXPLAIN THE NURSING ASSESSMENT, PLANNING, AND INTERVENTIONS IN CARING FOR CLIENTS WITH COGNITIVE AND SENSORY IMPAIRMENT ( S). .................................................................................. 13 1. ................................................................................................................................................................. 14 IDENTIFY ABUSIVE VERBAL, PHYSICAL , PSYCHOLOGICAL , AND INSTITUTIONAL BEHAVIOURS THAT MAY OCCUR IN NURSING PRACTICE . ....................................................................................................... 14 2. ................................................................................................................................................................. 14 REVIEW THE POSITION TAKEN BY THE COLLEGE OF NURSES OF ONTARIO. ..................................... 14 1. ................................................................................................................................................................. 14 REVIEW THE PROS AND CONS OF THE USE OF RESTRAINTS. INCLUDE THE LEGAL , ETHICAL, NURSING, AND MEDICAL ISSUES INVOLVED. .......................................................................................... 14 2. ................................................................................................................................................................. 14

REVIEW THE COLLEGE OF NURSES OF ONTARIO S PRACTICE EXPECTATIONS REGARDING THE USE OF RESTRAINTS . ........................................................................................................................................ 14 3. ................................................................................................................................................................. 15 IDENTIFY ALTERNATIVES TO RESTRAINTS . ............................................................................................. 15 TEST YOURSELF ................................................................................................................................... 15

Part 1: Accidents and their Prevention Module Questions 1. EXPLAIN THE FALLS RISK ASSESSMENT TOOLS. Description of the Falls Risk Assessment Tool It is used to identify possible hazards that can lead to falls Falls risk assessment tools vary with healthcare agencies Choosing the appropriate risk assessment tool must be based on the situation Example of a Falls Risk Assessment Tool TABLE 37-1 Fall Assessment Tool Instructions: Circle the score for the risk factor(s) that corresponds to the client. The tool should be administered upon admission to the facility or agency and again at specified intervals and when warranted by changes in the client's health status. Scores of 15 and higher indicate high risk; preventive measures should be implemented for these clients. Date Initial Reassessed Client Factors Date Admit Score Score History of falls 15 15 Confusion 5 5 Age (over 65) 5 5 Impaired judgement 5 5 Sensory deficit 5 5 Unable to ambulate independently 5 5 Decreased level of cooperation 5 5 Increased anxiety/emotional lability 5 5 Incontinence/urgency 5 5 Cardiovascular/respiratory disease affecting 5 5 perfusion and oxygenation Medications affecting blood pressure or level of 5 5 consciousness Postural hypotension with dizziness 5 5 Environmental Factors First week on unit/facility/service, etc. 5 5 Attached equipment (e.g., intravenous pole, 5 5 chest tubes, appliances, oxygen, tubing) Other Risk Assessment Tools Morse fall Scale is used widely in acute care settings, both in hospital and long-term care inpatient settings. The MFS requires assessment of a clients fall risk factors once

admitted, after a fall, with a change in status, and during discharge or transfer to a new setting. Stratify (St. Thomas Risk Assessment Tool in falling Elderly Inpatients) is used to observe clinical fall risk factors in the elderly and also determine the chance of falling. Hendrich II fall Risk Model is used both nationally and internationally to find patients at risk for falls. 2. IDENTIFY HOW DATA FROM FALLS RISK ASSESSMENT CAN BE USED TO DESIGN FALLS PREVENTION PROGRAMS . Data is clustered, analyzed, and integrated to form diagnoses and interventions. Part 2: Prevention and Control of Infection Module Questions 1. EXPLAIN THE ROLE OF VACCINES IN THE PREVENTION OF INFECTION AND PERSONAL
RESPONSIBILITY IN RELATION TO INFECTION AT WORK INCLUDING AGENCY SPECIFIC GUIDELINES.

2.

Vaccines eliminate the susceptible host aspect of the chain of pathogen transmission Follow infection control guidelines: (1) prevent spread of pathogens

DEFINE AND EXPLAIN H1N1, SARS, C-DIFFICILE, ESBL, MRSA, VRE, TB IN RELATION TO: a. history of exposure, b. mode of transmission (i.e. airborne, droplet & contact), c. laboratory screening tests, d. the implications for health care personnel, clients, and visitors in both hospital and community settings.

H1N1

Symptom

Cold

H1N1 Flu Fever is usually present with the flu in up to 80% of all flu cases. A temperature of 38C (100.4F) or higher for 3 to 4 days is associated with the flu.

Fever

Fever is rare with a cold.

A nonproductive A hacking, (non-mucus productive producing) (mucuscough is Coughing producing) usually cough is often present with present with a the flu cold. (sometimes referred to as dry cough). Severe Slight body aches and aches and pains are pains can be common with part of a cold. the flu. Stuffy nose is commonly Stuffy nose present with a is not cold and commonly typically present with resolves the flu. spontaneously within a week. Chills are uncommon with a cold. 60% of people who have the flu experience chills.

Aches

Stuffy Nose

Chills

Exhaustion is Exhaustion is Exhaustion fairly mild with moderate to a cold. severe with

the flu. Sneezing is Sneezing is commonly Sneezing not common present with a with the flu. cold. The flu has a rapid onset within 3-6 Cold hours. The Sudden symptoms flu hits hard onset of tend to and includes Symptoms develop over sudden a few days. symptoms like high fever, aches and pains. A headache is very A headache is common with fairly Headache the flu, uncommon present in with a cold. 80% of flu cases. Sore Throat Sore throat is Sore throat is not commonly commonly present with a present with cold. the flu.

Chest Chest discomfort is Chest discomfort is mild to Discomfort often severe moderate with with the flu. a cold.

A new strain of influenza Spread through droplet transmission Dont cough and sneeze anywhere other than the sleeves and tissue

Sanitize hands and use disinfectants Encourage people to stay at home if sick

MRSA, VRE, C-Difficile Refer to NSE 12 Winter Week 3 ppt.

TB Hours of exposure Airborne transmission Assessed through a TB skin test or thoracentesis (invasive procedure that extracts fluid or air from the pleural space by using a certain needle) Assess for active TB by acquiring a smear and an x-ray Blood tests are used for certain situations

Severe Acute respiratory Syndrome (SARS) Effects are visible 2-7 days after exposure Wash hands, wear gloves, including an N95 respiratory mask, eye protection and face shields, and gowns Accommodate the client with one of the four options that are prioritized from top to bottom: 1. Remove air to the outside of the building and prevent it from entering the intake ducts, and use a filter system for returning air 2. Single patient room with toilet, bathing, and handwashing unit 3. Group the SARS-client with an exhaust system and air supply 4. Keep the door closed when the client is present and absent

ESBL ESBL http://www.tegh.on.ca/bins/ content_page.asp?cid=320-102 bacteria that are found in the bowel, urine, blood, skin wounds or sputum bacteria produce enzymes that break down some antibiotics making it useless can be detected on routine culture of blood, sputum, urine, or stool specimens and in rectal or wound swabs treated with antibiotics the bacteria are sensitive to, but colonization of the bowel is not treated as it does not cause illness Contact Transmissio n (direct and indirect) the patient will be isolated in a private room people providing your care will wear a gown and gloves everyone who might help you should wash his or her hands after contact with you

ESBL http://www.tegh.on.ca/bins/content_page.asp?cid=3-20-102 bacteria that are found in the bowel, urine, blood, skin wounds or sputum bacteria produce enzymes that break down some antibiotics - making it useless can be detected on routine culture of blood, sputum, urine, or stool specimens and in rectal or wound swabs treated with antibiotics the bacteria are sensitive to, but colonization of the bowel is not treated as it does not cause illnessContact Transmission (direct and indirect) the patient will be isolated in a private room people providing your care will wear a gown and gloves everyone who might help you should wash his or her hands after contact with you 3. EXPLAIN IMPORTANCE OF HAND HYGIENE/HAND WASHING AND REVIEW PROCEDURE FOR HAND WASHING. Hand hygiene inhibits the spread of pathogens. Refer to Skill 33-1 in the Potter & Perry textbook. 4. DIFFERENTIATE BETWEEN REGULAR AND BIOHAZARD WASTES AND IDENTIFY AGENCY SPECIFIC DISPOSAL PROCEDURES . Three waste streams: regular, biohazardous (yellow), and pathological (red).

5. EXPLAIN THE FIRST AID RESPONSE TO EXPOSURE TO BLOOD AND BODY FLUIDS AND/OR SHARPS AND FOLLOW -UP REPORTING AND ASSESSMENT PROCEDURES . Adhere to Tier1/standard/routine precautions which involve wearing protective clothing, handwashing, equipment cleaning, and disposal. TABLE 33-7 Centers for Disease Control and Prevention Isolation Guidelines Standard Precautions (Tier One) Standard precautions apply to blood, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes. Hands are washed between client contacts; after contact with blood, body fluids, secretions, and excretions and after contact with equipment or articles contaminated by them; and immediately after gloves are removed. (Refer to your agency's policy for use of alcoholbased waterless antiseptics.) Gloves are worn when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items. Gloves should be removed and hand hygiene performed between care of clients. Gloves should also be changed between procedures on the same client and after contact with material that may be highly contaminated. Masks, eye protection, or face shields are worn if client care activities may generate splashes or sprays of blood or body fluid. Gowns are worn if soiling of clothing is likely from blood or body fluid. Remove used gowns as soon as possible. Perform hand hygiene after removing your gown. Client care equipment is properly cleaned and reprocessed, and single-use items are discarded. Contaminated linen is placed in a leak-proof bag and handled in a manner that prevents skin and mucous membrane exposure. All sharp instruments and needles are discarded in a puncture-resistant container. Safety devices must be enabled after use to prevent injury. Never recap a used needle. A private room is unnecessary unless a client's hygiene is unacceptable. Check with an infection-control professional. 6. EXPLAIN THE LEARNING/TEACHING NEEDS OF CLIENTS AND FAMILY MEMBERS RELATED TO ISOLATION . They need to understand the condition Know reasons for isolation Be informed about infection control Visitors must be taught protection guidelines against the risks of isolation

7. EXPLAIN THE PSYCHOLOGICAL NEEDS OF THE CLIENT IN ISOLATION . Stimulate the clients senses by: (1) conversing, (2) providing a massage, ( 3) opening blinds and drapes, (4) removing excess tools, and (5) listening to the client. 8. STATE WHAT EQUIPMENT SHOULD BE DEDICATED FOR AN ISOLATION ROOM. The following equipment is needed for an isolation room: (1) toilet, (2) handwashing station, (3) bathing facility, (4) commodes, (5) dirty linen bag, and (6) a waste receptacle. The following equipment is used for VRE-clients and should not be shared with other clients: (1) a stethoscope, (2) sphygmometer, and (3) a rectal thermometer. 9. EXPLAIN THE RATIONALE FOR PERSONAL PROTECTIVE EQUIPMENT AND DEMONSTRATE THE TECHNIQUE OF : a. putting on personal protective apparel: gown, gloves, goggles, mask, face shield. b. handling equipment while in an isolation room. c. removing equipment, linens, and waste from an isolation room. d. removing personal protective apparel when leaving the room. Protective clothing is used to stop the possibility of contaminating individual uniforms. Also refer to box 33-13 in the Potter and Perry textbook. 10. DESCRIBE HOW YOU WOULD TRANSPORT A CLIENT TO A TEST OR APPOINTMENT WHO IS ON ISOLATION PRECAUTIONS . Prior to transferring a client from an isolation room, provide the person a gown and mask and bag and tissue Wear protective clothing

11. IDENTIFY THE PRECAUTIONS USED WHEN A CLIENT REQUIRES PROTECTIVE/REVERSE ISOLATION . Refer to the answer in Part 2 question 7. 12. IDENTIFY YOUR AGENCY S POLICIES FOR ISOLATION. Part 3: Caring for Sensory and Cognitively Impaired Clients Module Questions 1. EXPLAIN THE NURSING ASSESSMENT, PLANNING, AND INTERVENTIONS IN CARING FOR CLIENTS WITH COGNITIVE AND SENSORY IMPAIRMENT (S). Assessment Assess factors related to cognitive and sensory impairment Check current condition of senses and assess mental and physical status Determine influence of sensory alterations on ADL Assess the clients self-care behaviors that are focused on maintaining his or her senses Identify environmental risk factors that are related to sensory impairment Acquire information on assistive tools, medications, and check for suspected pain Gather data on the clients interdependence mode Understand how the client communicates Note nursing diagnoses related to sensory alterations: Impaired adjustment Impaired verbal communication Risk for injury Impaired physical mobility Self-care deficit, including bathing or hygiene, dressing or grooming, or toileting Situational low self-esteem Disturbed sensory perception Social isolation Disturbed thought processes Altered socialization Planning Select strategies that will help the client remain functional in the home Adapt therapies depending on whether sensory deficit is short or long term Involve the family in helping the client adjust to limitations Refer to appropriate health care professional and/or community agency

Allow the client to participate in planning Prioritize care based on safety Consider available resources

Interventions Involve the client and significant others in the nursing care Screen the client to prevent problems Utilize environmental safety devices and personal protective equipment Immunization Encourage interaction and set activities that stimulate and maintain sensory function Help the client with self-care routines related to maintaining sensory function

Part 4: Abuse in Nursing Practice Module Questions 1. IDENTIFY ABUSIVE VERBAL, PHYSICAL, PSYCHOLOGICAL , AND INSTITUTIONAL BEHAVIOURS THAT MAY OCCUR IN NURSING PRACTICE . Refer to the NSE 12 Fall Week 10 ppt. 2. REVIEW THE POSITION TAKEN BY THE COLLEGE OF NURSES OF ONTARIO. Refer to the NSE 12 Fall Week 10 ppt. Part 5: The Use of Restraints Module questions 1. REVIEW THE PROS AND CONS OF THE USE OF RESTRAINTS. INCLUDE THE LEGAL , ETHICAL, NURSING, AND MEDICAL ISSUES INVOLVED . Refer to the NSE 12 Fall Week 10 ppt. 2. REVIEW THE COLLEGE OF NURSES OF ONTARIOS PRACTICE EXPECTATIONS REGARDING THE USE OF RESTRAINTS . Refer to the NSE 12 Fall Week 10 ppt.

3. IDENTIFY ALTERNATIVES TO RESTRAINTS. Refer to the NSE 12 Fall Week 10 ppt. TEST YOURSELF Conference Discussion 1. You are caring for Mr. Huang who is on VRE isolation precautions and has a large decubitus ulcer on his coccyx. You notice another health care worker in Mr. Huangs room providing morning care without wearing PPE. When you question the health care worker regarding this practice, the person says, dont worry, Im only doing morning care, not touching the dressing. How would you respond to this comment? What would your next steps be in the following up of this incident?