PPE

Personal Protected Equipment

Equipment worn to minimize exposure to hazards that cause serious

workplace injuries and illnesses.
These injuries and illnesses may result from contact with chemical,
radiological, physical, electrical, mechanical and workplace hazards.
Examples of PPE
• > hand protection (gloves)
• >foot protection (safety boots, shoe cover,
• >eye protection ( glasses and googles, face shields)
• >protective hearing devices (earplugs, muffs)
• >hard hats (helmets, head cover)
• >respirators
• >full body suits
• >mask
Importance of PPE
• Will protect you against various hazardous conditions
• It prepares you for health and safety risk and gives you extra protection in the event of
an accident or against elements.
• Guaranteeing health and safety to the waste disposal workers in treatment or in
disposal sites
• Major step in the prevention of personal injury and cross infection when cleaning
• Prevent head injuries, eye injuries.
• Used by healthcare providers to protect themselves from injury or infection during
emergency.
• Used in healthcare settings to create barrier between healthcare workers and
infectious agent from patient and to reduce the risk of transmitting microorganism
from healthcare workers to patients
INFECTION CONTROL
• Prevents or stops the spread of infections in healthcare settings.
• An infection occurs when germs enter the body, increase in number and cause reaction to the body
• Three things are necessary for infection to occur:
• Source- places where infectious agents (germs) lives (surface,
• human skin, sinks, things, indwelling medical devices, dust
• Susceptible person -with a way for a germ to enter the body
• weak immune system, not vaccinated
• underlying medical conditions
• Transmission- a way germs are moved to susceptible person.
• contact move germs by touch
• spray and splashes occurs when infected person coughs or sneezzes
• inhalation occurs when germs survive on air currents and reach susceptible person
• sharp injuries.
 Health Protocols
Set of instructions to be followed, or a method
which should be followed to control a certain
disease.
Example: If you're holding an event there should be health protocols
to follow
>social distancing on floor plan
>consider pre registration
> manage the entry flow
>employ no mask no entry
> regular sanitation of the venue
> stay updated on the latest health protocols
> go cashless
> opt for package meals.
Standard precautions for infection control
2 Tiers recommended precautions to prevent the spread of infection in health settings

• > Standard precaution- set of infection prevention and control practices use for every patient encounter to
reduce the risk of transmission of blood borne and other pathogens from both recognize and unrecognized
sources. Basic level of IPC practices in preventing the spread of infectious agents.
• >Transmission based precautions- use in addition to standard precaution for patient with known or suspected
infection
• Minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed
infection status of the patient in any setting where healthcare is delivered. Includes:
• Hand hygiene
• Use of PPE
• Respiratory hygiene ( cough etiquette
• Sharp safety
• Safe injection practices ( aseptic technique )
• Sterile instrument and devices
• Clean and disinfected environmental surfaces.
Modes of transmission
• Direct contact
• > person to person contact transmission
• > droplet infections (common cold, flu)
• Indirect Contact
• > Airborne transmission- some organism can travel long distance
• and remain suspended in the air
• > contaminated objects
• > food and drinking water
• > Animal to person
• > animal reservoir (rabies)
• > insect bites
• > environmental reservoir soil, water, vegetation transfer to people.
Bioethical principles in times of emergency
Bioethics Greek bios means life, ethos moral nature behavior.
• Bioethics is important in nursing- It involves big picture moral
dilemmas face by medical community
• Nursing ethics- deals with individual ethical dilemma that arise from
situations between care giver and the patient.
• The field bioethics wrestles with question such as “what is the right
thing to do”
• Emergency Clinicians must be able to recognize bioethical dilemmas,
have action plans based on their readings and discussions and have a
method through which to apply clinical principles to clinical settings
•
4 Bioethical Principles
• Beneficence- Performing a deed that benefit someone
• provide benefit to a patient
• Non malificence- Hippocratic oath not harming the patient
• to help and do no harm
• Autonomy- a person should be free to make her/his own decision
• Justice- fairness in all allocation of resources and to physicians
obligations to patients. Most direct application of distributed justice is
triage.
Rapid Assessment (Head to Toe)
• What Is a Head to Toe Assessment?
• If you’re still in nursing school or you’re just getting started with your nursing journey, you may
ask yourself: What is a head-to-toe assessment? What does it include? How do I complete one?
• Simply put, a head to toe assessment is an exhaustive process that checks the health status of
all major body systems. It is a comprehensive physical examination that shines a light on a
patient’s needs and problems. Performing this assessment falls under an RN’s duties, although
sometimes a doctor or EMT might also do it. For the most part, head to toe assessments happen
during primary care visits or annual physical exams.
• When a patient comes into the medical facility with a particular complaint or health issue, the
more common approach will be a problem-focused assessment. This means that the
assessment process is fixated on specific care goals: the health problem has been identified, so
this type of examination has a narrower scope.
• The head to toe assessment is the opposite of that. It’s broader and concentrates on all aspects
of the body. Its length will vary depending on the patient and their overall health status.
Rapid Assessment (Head to Toe)
• What Equipment Should you Have Ready for a Head to Toe Assessment?
• Nurses who perform head to toe assessment must come in prepared. Some of the fundamental
pieces of equipment you should organize before conducting a head-to-toe evaluation are:
• Gloves
• Thermometer
• Scale
• Height wall ruler
• Penlight
• Stethoscope
• Blood pressure cuff
• Tongue depressor
• Sterile objects, both soft and sharp
• What Methods of Examination Do You Use in a Head to Toe Assessment?
• There are several procedures for performing a physical examination. While inspecting a patient in detail, you will use four main
methods. We’ll describe briefly what they are and what they entail.
• Inspection
• Always performed first, inspection also is the most repeated method of examination. You need to use your sight and smell to check
specific body areas for normal color, shape, and consistency.
• Palpation
• Touching the patient to sense abnormalities on (or in) the body is known as palpation. In the process of conducting a head-to-toe
assessment, you will employ two kinds of palpation: light and deep. Light palpation is gentle and gives information about skin texture
and moisture, fluids, muscle guarding, and some superficial tenderness the patient may be experiencing. On the other hand, deep
palpation explores the internal structures of the body to a depth of four to five centimeters. Using this technique, RNs can learn
more about organs and masses’ position, shape, mobility, and possible areas of discomfort.
• Percussion
• This third technique requires the nurse to tap on the patient’s body to produce sound vibrations. These sounds can confirm the
presence of air, fluid, and solids. It can also pinpoint organ size, shape, and position.
• Auscultation
• The last method of examination is auscultation. It implies listening to the heart, lungs, neck, or abdomen to gather information.
Direct auscultation is done with the unaided ear. Indirect auscultation requires the presence of amplification or mechanical devices,
such as a stethoscope.
• How Do You Start an Assessment?
• The first thing you need to do before starting an assessment per se is to build rapport with the patient. Introduce yourself,
explain what you will be doing, ask what brings them to the doctor’s office. Address any questions they may have before
you begin. Ask if there’s something you could do to make them more comfortable, like changing the room’s temperature
or the lighting. It’s essential to build a relationship with the patient before the actual physical examination begins.
• From the moment you walk into the room, you should start making mental notes of certain physical clues the patient
might display:
• Their general appearance (How does their hygiene, dress, affect seem?)
• Their posture (Do they seem to experience problems sitting/standing?Are they grunting during movement?)
• Is their speech clear or slurred?
• Are there any abnormal smells?
• Their alertness (Can they answer questions? Are they reluctant to speak?)
• Signs of distress (Do they seem visibly confused, pale? Do they have problems breathing? Are they avoiding eye contact?)
• Once you have established a relationship with the patient, you can begin the assessment.
• 1. General Overview
• First, you obtain a general overview of the patient’s health state. These are the details to keep an
eye on in this phase of the assessment.
• Collect their vital signs. (It’s encouraged to ask permission before touching a patient. Also,
explaining what you are doing/what assessment you are performing will help the patient feel
more relaxed.)
• Check heart rate
• Measure blood pressure
• Take body temperature
• Pulse oximetry
• Respiratory rate
• Check pain levels
• Check height and weight and calculate their BMI
• 2. Hair/ Skin/ Nails
• Once you have a general overview, you can start from the top of the body and make your way down.
The assessment is called head to toe for a reason. Some things to look out for are:
• Hair distribution(even/uneven)
• Hair infestations (lice, alopecia areata)
• Bumps, nits, lesions on the scalp
• Tenderness on scalp
• Tenderness, lumps on the skin
• Lesions, bruising, or rashes on skin
• Temperature, moisture, and skin texture (is the patient pale, clammy, dry, cold, hot, flushed?)
• Edema
• Consistency, color, and capillary refill of nails
• Pressure areas
• 5. Nose
• Palpate nose and check symmetry
• Check septum and inside nostrils
• Patency of nares (patient can breath through each nostril)
• Check sense of smell
• Palpate sinuses
• 6. Mouth and Throat
• Check lips for color and moistness
• Inspect teeth and gums
• Examine tongue
• Inspect the inside of mouth
• Look at tonsils and uvula
• Assess hypoglossal nerve by asking patient to move tongue from left to right
• Check the patient’s ability to taste, to swallow, and their gag reflex
• 7. Ears
• Inspect for drainage or abnormalities
• Test hearing with whisper test
• Look inside ear: inspect the tympanic membrane and assess ear discharge
• Tuning fork tests (Weber’s Test, Rinne Test)
• 8. Neck
• Check neck muscles to be equal in size
• Palpate lymph nodes
• Check head movements and whether they happen with discomfort
• Observe neck range of motion.
• Check trachea placement
• Check shoulder shrug with resistance
• 9. Chest: Cardiovascular Assessment
• Listen to the heartbeat. Areas where to auscultate heart sounds: aortic, pulmonic, Erb’s point, Tricuspid,
Mitral
• Palpate the carotid and auscultate apical pulse
• 10. Chest: Respiratory Assessment
• Auscultate lung sounds front and back
• Observe chest expansion
• Ask about efforts to breathe/coughing
• Palpate thorax
• 11. Abdomen
• Inspect abdomen
• Listen to bowel sounds in all four quadrants
• Palpate all four quadrants of the abdomen to check for pain or tenderness
• Ask about bowel or bladder problems
• 12. Extremities
• Assess range of motion and strength in arms, legs, and ankles
• Assess sharp and dull sensation on arms and legs
• Inspect arms and legs for pain, deformity, edema, pressure areas, bruises
• Palpate radial pulses, pedal pulses
• Check capillary refill on fingernails/toenails
• Assess gait
• Assess handgrip strength and equality
• 13. Back area
• Inspect back and spine
• Inspect coccyx/buttocks
• Once you go through all these steps, the assessment is complete. Let your patient know that this stage of evaluation is
over. Make sure they don’t have any questions or concerns.
•
• Things to Keep in Mind While Performing a Head to Toe Assessment
• Document your findings
• Performing the head to toe assessment is a vital part of the nursing process. So is making sure you thoroughly
document your findings. Write down all relevant information you get from the assessment concise yet clear. Your
observations, translated in these notes, will make up the core of the subsequent care plan. It may be helpful to use
a head-to-toe assessment checklist to guarantee that you remember all the essential information and document
it.
• Communicate efficiently
• Efficient communication is the cornerstone of successful nursing care. When performing a head to toe assessment,
you should make use of this crucial skill. Ask for permission before touching a patient, explain what you are doing –
and why. Create a space where patients feel encouraged to ask questions, express worries or concerns.
• Bilateral symmetry
• Generally speaking, the human body is bilaterally symmetrical. Any unusual symmetry you may observe during
your examination is worthy of further consideration. Weakness on one side? Less ability to move the limbs on one
side of the body? These could be indicators of underlying neurological or musculoskeletal issues, so keep an eye
for noticeable differences between the body’s right and the left side.
BLS Basic Life Support
• -sequence of procedures performed to restore the circulation of oxygenated
blood after a sudden pulmonary or cardiac arrest until they are given full
medical care at a hospital
• It can be provided by trained medical personnel including paramedics and by
anyone who knows how to do it, anywhere, immediately without any other
equipment.
• Purpose of CPR maintaining circulation and oxygenation in order to maintain a
cardiac output to keep vital organs alive.
• Basic life support (BLS) includes recognition of signs of sudden cardiac arrest,
heart attack, stroke, and foreign body airway obstruction, and the
performance of cardiopulmonary resuscitation (CPR) and defibrillation with an
automated external defibrillator
• Chain of survival
• The American Heart Association has built its BLS protocol with the Chain of Survival in mind, a four-link process to maximize
the odds of a collapsed individual’s survival.
• The AHA defines these steps as:
• >Identifying an emergency and contacting emergency services
• >Immediate bystander CPR to maintain status until medical specialists arrive
• >Early use of a defibrillator, if necessary
• >Early ALS (Advanced Life Support) and care should the patient resuscitate.

• Common ailments include:

• Cardiac arrest
• Respiratory arrest
• Hypothermia
• Airway obstruction
• AHA guidelines for resuscitation include a number of steps focused on procuring advanced medical help and
securing additional help and responses from other bystanders.
• D – Check for danger
• R – Check for response
• S – Send or shout for help
• C – Deal with catastrophic hemorrhaging (serious bleeding)
• A – Open the airway and check for anything that might prevent breathing
• B- Check breathing by listening for breath and looking for chest movement
• C – Maintain circulation through CPR
• D – Identify disabilities, devices, damage, and dry to minimize risk from medicines, AED devices, and other first-
response treatments
• E – Consider the environment in terms of weather, physical location, crowds of people, etc.
• References:

• https://www.cdc.gov
• https://www.nurseslearning
• https://www.jhpiego.org
• https://www.nightingale.edu
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