Infection Control Lecture Outline
Definition of Infection
●​ Occurs when microorganisms capable of producing disease invade the body.
Chain of Infection
1.​ Infectious Agents
○​ Pathogens
○​ Normal flora that become pathogenic
2.​ Reservoir (Where pathogens live and multiply)
○​ Living: Humans, animals, insects
○​ Non-living: Food, floors, equipment, contaminated water
3.​ Portal of Exit
○​ Via bodily fluids
○​ Coughing, sneezing, diarrhea
○​ Seeping wounds
○​ Tubes, IV lines
4.​ Mode of Transmission
○​ Contact:
■​ Direct: Touching, kissing, sexual contact
■​ Indirect: Contact with a fomite (contaminated object)
○​ Droplet: Cough, sneeze
○​ Airborne: Via air conditioning, sweeping
5.​ Portal of Entry
○​ Eyes, nose, mouth, vagina, cuts, scrapes
○​ Wounds, surgical sites, IV or drainage tube sites
○​ Bites from a vector
6.​ Susceptible Host
○​ Person with inadequate defense
○​ Four determining factors:
■​ Number of organisms
■​ Virulence
■​ Ability to survive in host’s environment
■​ Host’s defenses
Stages of Infection
1.​ Incubation: From time of infection until manifestation of symptoms; can infect others.
2.​ Prodromal: Appearance of vague symptoms; not all diseases have this stage.
3.​ Illness: Signs and symptoms present.
4.​ Decline: Number of pathogens declines.
5.​ Convalescence: Tissue repair, return to health.
Classification of Infections
By Location
●​ Local: Limited to one region in the body (e.g., urinary tract infection).
●​ Systemic: Spread via blood or lymph, affects multiple regions (e.g., septicemia).
By Duration
●​ Acute: Rapid onset, short duration (e.g., cold, appendicitis, pneumonia).
●​ Chronic: Slow development, long duration (e.g., osteomyelitis, Lyme Disease).
●​ Latent: Infection present with no discernible symptoms (e.g., HIV/AIDS, TB).
Practice Question:
A client living with AIDS develops oral hairy leukoplakia, an infection caused by the
Epstein-Barr virus. The leukoplakia is considered a:
1.​ Nosocomial infection
2.​ Primary infection
3.​ Systemic infection
4.​ Secondary infection​
Answer: 4 – The primary HIV infection leads to immunocompromise, allowing secondary
infections.
Healthcare-Associated Infections (HAIs)
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Acquired as a result of healthcare.
Manifests 48 hours after admission or within 30 days of discharge.
Cost to healthcare system: $28-45 billion/year.
Leading cause of death.
Estimated 1.7-2 million HAIs per year, with 90,000 deaths.
Hospitals must publicly report HAI rates.
Federal pay-for-performance measure: Medicare does not reimburse for HAIs.
Increased during COVID (2020-2021), decreased 2021-2022.
Types of HAIs
●​ Exogenous: Acquired from healthcare environment/personnel.
●​ Endogenous: Normal flora multiply and cause infection (e.g., E. coli in urinary tract).
Common HAIs
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Surgical Site Infection (SSI)
Central Line-Associated Bloodstream Infection (CLABSI)
Catheter-Associated Urinary Tract Infection (CAUTI)
Hospital-Acquired Pneumonia (HAP)
Ventilator-Associated Pneumonia (VAP)
Methicillin-Resistant Staphylococcus Aureus (MRSA)
Clostridium Difficile (C. Diff)
Practice Question:
Which of the following actions violates proper handwashing principles?
1.​ Washing hands for 1 min
2.​ Shaking hands dry over the sink
3.​ Using warm, not very hot water
4.​ Using agency-provided soap​
Answer: 2 – Shaking hands dry allows bacteria to remain.
Body’s Defenses Against Infection
1.​ Primary Defenses: Skin, mucous membranes, cilia, stomach acid.
2.​ Secondary Defenses: Inflammatory response.
○​ Phagocytosis
○​ Complement cascade
○​ Inflammation
○​ Fever
3.​ Tertiary Defenses: Immune response.
○​ Humoral immunity: B-cell production of antibodies.
○​ Cell-mediated immunity: Direct destruction of infected cells by T-cells.
Factors That Increase Infection Risk
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Developmental stage
Breaks in the skin
Chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit immune response
Medical procedures
Preventing Infection: Medical Asepsis
●​ State of cleanliness to decrease infection spread.
●​ Key practices:
○​ Maintain clean environment.
○​ Maintain hand hygiene.
○​ Follow CDC guidelines.
Handwashing Guidelines
●​ At least 20 sec (nonsurgical); 2-6 min (surgical).
●​ Use soap and warm water, friction, rinse thoroughly.
●​ C. Diff/Norovirus/Rotavirus requires soap & water (not alcohol-based hand rubs).
Surgical Site Infection (SSI) Prevention
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Sterile technique/field.
Antibiotics, CHG baths.
Blood glucose control.
Avoid shaving surgical sites (use clipping).
General Principles of Sterile Fields
●​ Above waist level only.
●​ 1-inch border considered contaminated.
●​ Keep field in view and monitor constantly.
CLABSI Prevention
●​ “Scrub the Hub” with Chlorhexidine (never reuse).
●​ Remove central line ASAP when no longer needed.
CAUTI Prevention
●​ Limit catheter use to necessity.
●​ Longest indwelling = highest risk.
●​ Sterile technique during insertion.
VAP Prevention
●​ Hand hygiene.
●​ Elevate HOB (Head of Bed).
●​ Oral hygiene.
●​ Daily sedation vacation.
●​ Assess readiness to wean from ventilator.
Standard Precautions
●​ Protects healthcare workers & patients.
●​ Decreases pathogen transmission.
Contact Precautions
●​ Pathogen spread by direct/indirect contact.
●​ Examples: Draining wounds, secretions, bodily fluids.
Medication Administration Lecture Outline
Importance of Medication Administration
●​ Patient safety is the primary concern!
●​ Up to 98,000 Americans die annually due to preventable medical errors (Institute of
Medicine).
●​ Preventable adverse drug events cause 1 in 5 injuries or deaths in hospitals (AHRQ).
●​ At least 1.5 million Americans are affected yearly by medication errors (Institute of Medicine,
2006).
Case Study: Medication Errors
●​ 36-year-old female presents to ED with severe left flank pain (rated 10/10) and nausea.
●​ Medications administered:
○​ Toradol 30mg IVP (anti-inflammatory for pain)
○​ Zofran 4mg IVP (antiemetic)
○​ Morphine Sulfate 4mg IVP (no relief)
○​ Dilaudid IVP administered: 1mg, 1mg, 2mg, 1mg over 1 hr 20 min.
●​ Outcome & Nursing Considerations:
○​ Monitoring, reassessment, potential overdose risk.
Where & Why Medication Errors Occur
1.​ Prescribing/Ordering
○​ Clarify unclear orders.
○​ Computerized Physician Order Entry (CPOE).
○​ Assess medication appropriateness.
2.​ Transcribing (Replaced by CPOE)
○​ Avoid unsafe abbreviations.
3.​ Dispensing
4.​ Administration
○​ Nurses are the last barrier against medication errors.
○​ Must follow the 10 Rights of Medication Administration.
10 Rights of Medication Administration
1.​ Right Medication
2.​ Right Dose
3.​ Right Client
4.​ Right Route
5.​ Right Time
6.​ Right Documentation
7.​ Right Client Education
8.​ Right to Refuse
9.​ Right Assessment
10.​ Right Evaluation
Safe Medication Administration
●​ Review hospital policy/procedure.
●​ Perform 3 medication checks before administration:
1.​ When taking meds from the Omnicell.
2.​ Before entering the patient’s room, compare with eMAR.
3.​ In the patient’s room before administering.
●​ Explain medications to the patient and listen if they question something.
Safe Clinical Preparation in Nursing School
1.​ Research patient chart:
○​ Admitting diagnosis
○​ Medical history
○​ Labs
○​ Medications ordered (review eMAR)
2.​ Look up medications:
○​ Drug class, action, indication
○​ Safe dose range
○​ Side effects/adverse reactions
○​ Nursing considerations
3.​ Check for:
○​ Safe dosage
○​ Drug interactions/allergies
○​ IV compatibility & dilution needs
○​ Administration rate & route
○​ Flushing between IV medications
Administering Medications Safely
●​ Follow organizational policies.
●​ Assess changes in condition before giving meds:
○​ NPO status
○​ Blood glucose (for insulin)
○​ Lab results
○​ Adverse effects
●​ Perform head-to-toe assessment prior to med administration.
●​ Monitor for adverse effects post-administration (onset of action).
●​ PRN Medications:
○​ Document assessment before and after administration.
○​ Example (Pain): Assess pain/sedation level before giving, reassess and document
response after.
Practice Scenario: Mr. Smith
Patient: 62-year-old male with fever/chills, diabetic foot ulcer, cellulitis.
●​ Medications: IV Normal Saline + 10mEq KCl @ 125cc/hr.
●​ Past Medical History:
○​ Hypertension
○​ Type 2 Diabetes Mellitus
○​ Heart Failure
●​ Nursing considerations:
○​ Monitor for adverse effects.
○​ Assess medication appropriateness.
○​ Evaluate therapeutic response.
Nutrition Lecture Outline
What is Nutrition?
●​ Study of food: How it affects the human body and influences health.
●​ Essential for wellness: Poor nutrition contributes to disease.
●​ Metabolism: The body’s process of converting food into energy.
Reliable Sources of Nutritional Information
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Dietary Reference Intakes (DRIs)
USDA Dietary Guidelines (updated every 5 years)
MyPlate (choosemyplate.gov)
Nutritional Labels
Dietary Reference Intakes (DRIs)
●​ Estimated Average Requirement: Nutrient intake to meet needs of 50% of people.
●​ Recommended Dietary Allowance (RDA): Nutrient intake sufficient for 98% of healthy
individuals.
●​ Adequate Intake (AI): Estimated nutrient intake based on observed data.
●​ Tolerable Upper Intake Level (UL): Maximum daily intake without adverse effects.
●​ Acceptable Macronutrient Distribution Range (AMDR): Range for protein, fats, carbs to
reduce chronic disease risk.
USDA Dietary Guidelines for Americans
●​ Adopt a balanced eating pattern:
○​ Limit fats
○​ Include fat-free/low-fat dairy
○​ Eat fresh fruits and vegetables
○​ Consume whole grains
○​ Choose nutrient-dense foods
○​ Engage in physical activity daily
○​ Limit salt, alcohol, and unsafe foods
Nutrition Facts Label (Figure 24-2, pg. 930)
●​ Macronutrients vs. Micronutrients
●​ Portion size, calorie count, and nutrient content
Metabolism
●​ Converts food into chemical energy:
○​ Anabolism: Building larger molecules (e.g., protein synthesis).
○​ Catabolism: Breaking down molecules for energy (e.g., digestion).
Energy Nutrients
Macronutrients
●​ Carbohydrates: Primary energy source, spares protein, enhances insulin secretion.
●​ Proteins: Tissue building, metabolism, immune function, fluid balance, acid-base balance.
●​ Lipids (Fats): Energy source, essential nutrients, insulation, satiety.
Micronutrients
●​ Vitamins: Essential for metabolism and disease prevention.
●​ Minerals: Regulate body functions (Major & Trace minerals).
●​ Water: Essential for chemical processes, transport, and tissue formation.
Examples of Nutrient Deficiencies
●​ Vitamin Deficiencies:
○​ Vitamin D: Bone health (sources: fish, fortified milk, sunlight).
○​ Folic Acid: Prevents neural tube defects in pregnancy.
●​ Mineral Deficiencies:
○​ Calcium: Risk for osteoporosis.
○​ Iron: Risk for anemia.
○​ Magnesium: Linked to hypertension and cardiovascular disease.
○​ Fluoride: Prevents dental cavities.
○​ Iodine: Prevents goiter.
Energy Balance Concepts
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Calories: Measure of energy.
Basal Metabolic Rate (BMR): Energy needed at rest.
Total Energy Needs: BMR + physical activity.
Imbalance leads to undernutrition or obesity.
Factors Affecting Nutrition
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Developmental stage (infants, toddlers, school-age, adolescents, adults, older adults).
Knowledge and lifestyle choices.
Culture and religious dietary restrictions.
Disease processes and functional limitations (diabetes, GI disorders, bariatric surgery).
Medications affecting appetite and nutrient absorption.
Special Diets
Diets Modified by Consistency
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Clear liquid: Water, broth, tea, clear juice, popsicles.
Full liquid: Includes all clear liquids plus milk, soups, puddings.
Mechanical soft: Easy-to-chew foods, chopped or ground meat.
Pureed: Blended food for patients with swallowing difficulties.
Diets Modified for Disease
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Calorie-restricted: For weight management.
Sodium-restricted: For hypertension and fluid retention.
Fat-restricted: For high cholesterol or gallbladder disease.
Diabetic: Manages carbohydrates and glucose levels.
Renal: Limits fluids, potassium, phosphorus for kidney disease.
Protein-controlled: For liver/kidney disease.
Ketogenic: High-fat, low-carb for epilepsy or weight loss.
Antigen-avoidance: Avoids allergens (e.g., gluten-free for celiac disease).
Calorie-protein push: Increases intake for healing and growth.
Screening for Nutritional Problems
●​ Screening assessment: Height, weight, BMI, dietary history.
●​ Focused nutritional assessment: Weight history, diet, labs.
●​ Clinical Signs of Malnutrition:
○​ Weight loss
○​ Muscle wasting
○​ Poor wound healing
○​ Fatigue, weakness
Urinary Elimination Lecture Outline
Urinary System Overview
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Kidneys: Filter and regulate body fluids.
Nephrons: Form urine.
Ureters: Transport urine to the bladder.
Bladder: Stores urine.
Urethra: Transports urine out of the body.
Normal Urination Patterns
●​ 50-60 mL of urine per hour (approximately 1500 mL per day).
●​ Most people void 5-6 times per day.
Factors Affecting Urinary Elimination
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Age (infants vs. older adults)
Personal, sociocultural, and environmental factors
Lifestyle
Medications (diuretics, narcotics, antihypertensives)
Surgery & anesthesia
Pathological conditions (diabetes, kidney disease, infections)
Common Urinary Problems
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Anuria: Less than 100 mL of urine in 24 hours.
Dysuria: Painful or difficult urination.
Hematuria: Blood in urine.
Nephrotoxic: Substances that damage kidneys.
Nocturia: Frequent nighttime urination.
Oliguria: Less than 400 mL of urine in 24 hours.
Polyuria: Excessive urination.
Proteinuria: Protein in urine.
Pyuria: Pus in urine.
Urgency: Sudden, intense need to urinate.
Nursing Assessment for Urinary Elimination
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Usual voiding pattern
Appearance of urine (color, clarity, odor)
Urinary aids (e.g., catheters, urinals)
Physical assessment:
○​ Kidneys: Palpate costovertebral angle.
○​ Bladder: Palpate for distention.
○​ Urethra & Perineal Area: Check for redness, discharge, odor.
Intake & Output (I&O) Measurement
●​ Intake: Oral fluids, IV fluids, tube feedings.
●​ Output: Urine, GI losses (vomiting, drainage), wound drainage.
●​ When to measure: At the end of every shift (minimum); hourly in ICU settings.
Laboratory and Diagnostic Tests
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Blood Urea Nitrogen (BUN): Normal range 8-21 mg/dL.
Creatinine: Normal range 0.5-1.5 mg/dL.
Urinalysis: Tests for infection, glucose, ketones, proteins.
Cystoscopy: Direct visualization of bladder and urethra.
Cystometry: Evaluates bladder function and muscle/nerve activity.
Intravenous Pyelogram (IVP): Uses contrast dye to visualize urinary structures.
Common Urinary Elimination Problems
1.​ Urinary Tract Infection (UTI)
○​ Symptoms: Dysuria, frequency, urgency, hematuria, fever.
○​ Prevention: Hygiene, hydration, voiding after intercourse.
2.​ Urinary Retention
○​ Causes: Obstruction, neurological issues, medications.
○​ Nursing interventions: Bladder scans, straight catheterization.
3.​ Urinary Incontinence
○​ Types:
■​ Stress incontinence: Weak pelvic muscles, leakage with
coughing/sneezing.
■​ Urge incontinence: Overactive bladder, sudden urge to urinate.
■​ Overflow incontinence: Bladder overfills, leaks due to incomplete emptying.
■​ Functional incontinence: Physical or cognitive impairments prevent timely
bathroom access.
Nursing Interventions for Urinary Elimination
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Assist with toileting (bedpan, urinal, commode, scheduled voiding).
Encourage hydration and proper nutrition.
Promote hygiene to prevent infections.
Catheterization (only when necessary).
Types of Urinary Catheters
●​ Indwelling (Foley) catheter: Continuous drainage.
●​ Straight catheter: Used for intermittent drainage.
●​ External catheter: Condom catheter for males.
When to Use a Catheter
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Sterile specimen collection.
Bladder drainage due to retention or obstruction.
Measuring post-void residual (PVR).
Preventing skin breakdown in incontinent patients.
End-of-life comfort care.
Urinary Diversion (Urostomy)
●​ Surgically created opening for urinary elimination.
●​ Required if bladder is removed due to cancer, trauma, or disease.
●​ Types:
○​ Cutaneous ureterostomy: Ureters drain directly to an abdominal stoma.
○​ Ileal conduit: Part of the intestine used to create a new bladder.
○​ Continent urinary reservoir: Internal pouch created from the intestine.
○​ Neobladder: Artificial bladder replacement connected to the urethra.
Urinary Stoma Care
●​ Normal stoma appearance: Deep pink to brick red, shiny, moist.
●​ Assess surrounding skin for irritation or breakdown.
Nursing Diagnoses Related to Urinary Elimination
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Impaired urinary elimination
Risk for infection
Urinary retention
Altered urinary pattern
Can be linked to:
○​ Anxiety (urgency, incontinence fears)
○​ Acute pain (due to UTI, retention)
Bowel Elimination Lecture Outline
Overview of Bowel Elimination
●​ Essential for removing waste products.
●​ Maintains fluid and electrolyte balance.
●​ Involves:
○​ Upper GI Tract: Mouth, pharynx, esophagus, stomach.
○​ Small Intestine: Duodenum, jejunum, ileum (digestion and absorption).
○​ Large Intestine (Colon): Cecum, ascending, transverse, descending, sigmoid colon.
○​ Rectum and Anus: Stores and eliminates stool.
Normal Bowel Function
●​ Stool composition: 75% water, 25% solids.
●​ Transit time affects consistency:
○​ Slow movement → more water absorbed → dry, hard stool.
○​ Fast movement → less water absorbed → watery stool.
●​ Normal bowel movement frequency: Several times a day to once a week.
●​ Hospitalized patients may have a BM every 3 days.
Factors Affecting Bowel Elimination
●​ Developmental Stage
○​ Infants: Meconium (first stool, sticky and black-green).
○​ Children: Toilet training by age 2-3 years.
○​ Adults: Diet and activity level affect regularity.
●​ Personal & Sociocultural Factors
○​ Privacy, stress, schedules.
●​ Nutrition, Hydration & Activity
○​ Regular eating schedule & fiber intake promote healthy elimination.
○​ Fluids (1500-2000 mL/day) prevent constipation.
○​ Exercise stimulates peristalsis.
●​ Medications & Probiotics
○​ Opioids & anticholinergics → constipation.
○​ Antibiotics → diarrhea.
○​ Probiotics may restore gut flora.
●​ Surgery & Procedures
○​ Anesthesia slows peristalsis.
●​ Pregnancy
○​ Hormonal changes & baby’s pressure cause constipation.
●​ Pathological Conditions
○​ Neurological diseases, obstructions, and GI disorders impact elimination.
Common Bowel Elimination Problems
Constipation
●​ Causes: Low fiber/fluid intake, inactivity, medications, stress.
●​ Symptoms: Hard stools, infrequent BMs, straining.
●​ Interventions:
○​ Increase fiber, fluids, and activity.
○​ Use stool softeners or laxatives if needed.
Diarrhea
●​ Causes: Infection, antibiotics, stress, GI disorders.
●​ Symptoms: Loose, watery stools, cramping, urgency.
●​ Interventions:
○​ Rehydrate (oral or IV fluids).
○​ Identify cause & modify diet (BRAT diet: bananas, rice, applesauce, toast).
Fecal Impaction
●​ Causes: Untreated constipation, prolonged bedrest.
●​ Symptoms: No BM for several days, oozing stool, abdominal pain.
●​ Interventions:
○​ Digital removal (manual disimpaction if necessary).
○​ Enemas, stool softeners, increased fluids.
Flatulence
●​ Causes: Swallowed air, foods (beans, cabbage), inactivity.
●​ Symptoms: Abdominal distention, gas pain.
●​ Interventions:
○​ Encourage ambulation, dietary modifications.
○​ Anti-gas medications (simethicone).
Bowel Incontinence
●​ Causes: Neurological impairment, injury, surgery.
●​ Symptoms: Involuntary stool leakage.
●​ Interventions:
○​ Bowel training, skin care, protective garments.
Bowel Diversions
Definition
●​ Surgically created opening for waste elimination due to cancer, trauma, disease.
●​ May be temporary (healing period) or permanent (irreversible damage).
Types of Bowel Diversions
●​ Ileostomy
○​ Stoma formed from ileum, bypasses colon.
○​ Liquid stool, continuous drainage.
○​ Kock pouch (continent ileostomy) allows self-drainage.
○​ Total colectomy with ileoanal reservoir connects ileum to rectum.
●​ Colostomy
○​ Location affects stool consistency:
■​ Ascending colon → liquid stools.
■​ Transverse colon → loose, pasty stool.
■​ Descending/sigmoid colon → formed stools (can be regulated by
irrigation).
Diagnostic Tests for Bowel Function
●​ Indirect Visualization
○​ X-rays, ultrasounds, CT, MRI.
●​ Direct Visualization (requires preparation, sedation):
○​ Esophagogastroduodenoscopy (EGD): Views upper GI tract.
○​ Sigmoidoscopy: Views sigmoid colon and rectum.
○​ Colonoscopy: Views entire colon.
●​ Lab Tests:
○​ Fecal occult blood test (FOBT/Guaiac test): Checks for hidden blood in stool.
○​ Stool cultures: Detect bacteria, parasites.
Nursing Assessment for Bowel Elimination
●​ History: Normal patterns, medications, diet, lifestyle.
●​ Physical Exam:
○​ Inspection
○​ Auscultation (high-pitched, 5-15 gurgles/min is normal).
○​ Percussion & Palpation (distension, tenderness).
●​ Stoma Assessment:
○​ Healthy stoma: Pink to brick red, moist.
○​ Report pale, black, or dry stomas immediately.
Nursing Interventions for Bowel Elimination
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Privacy: Ensure a comfortable environment.
Timing: Encourage a routine (e.g., after meals).
Diet: Increase fiber and fluid intake.
Exercise: Encourage ambulation.
Medications: Use laxatives, anti-diarrheal agents appropriately.
Manage Flatulence: Modify diet, encourage movement.
Fecal Collection Devices: Rectal tubes, pouch systems for incontinence.
Nursing Diagnoses Related to Bowel Elimination
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Constipation
Diarrhea
Bowel incontinence
Impaired comfort r/t abdominal distention
Risk for impaired skin integrity (if incontinence present)
Nursing Process Lecture Outline
Clinical Reasoning
●​ Definition: Synthesizing knowledge and experience to develop a plan of care.
●​ Requires:
○​ Knowledge
○​ Experience
○​ Critical thinking skills
○​ Conceptual understanding of patient problems
Importance of Clinical Reasoning
●​ Essential for safe nursing care.
●​ Rapidly changing healthcare environment demands strong clinical judgment.
●​ Failure in clinical reasoning can lead to poor patient outcomes.
What is Critical Thinking?
●​ Combination of:
○​ Reasoned thinking
○​ Openness to alternatives
○​ Reflection
○​ Seeking truth
Practice Question
The most correct definition of critical thinking is:
1.​ A problem-solving process used to prove others wrong.
2.​ An examination of one’s beliefs to defend them.
3.​ Purposeful, analytical thinking that results in a reasoned decision.
4.​ Rational thinking that leads to the one correct answer.
Answer: 3 – Critical thinking is deliberate, purposeful, and analytical.
Critical Thinking Skills
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Gathering objective information.
Recognizing the need for more information.
Evaluating source credibility.
Identifying knowledge gaps.
Separating relevant from irrelevant data.
Making inferences and exploring solutions.
Prioritizing and ranking information.
Why is Critical Thinking Important in Nursing?
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Nurses face complex situations.
Every client is unique.
Nursing is fast-paced.
Scientific knowledge changes constantly.
Critical thinking links directly to evidence-based practice.
Critical Thinking Attitudes
●​ Intellectual autonomy
●​ Intellectual curiosity
●​ Intellectual humility
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Intellectual empathy
Intellectual courage
Intellectual perseverance
Fair-mindedness
Confidence in reasoning
Practice Question
A new nurse questions a standard care practice that seems outdated. This
demonstrates:
1.​ Intellectual humility
2.​ Intellectual autonomy
3.​ Intellectual courage
4.​ Fair-mindedness
Answer: 2 – Critical thinkers question traditional practices based on evidence.
Critical Thinking Model
●​ Five steps:
1.​ Contextual awareness
2.​ Inquiry
3.​ Considering alternatives
4.​ Analyzing assumptions
5.​ Reflecting skeptically & deciding what to do
Full-Spectrum Nursing
●​ Thinking: Knowledge, problem-solving.
●​ Doing: Skills, interventions.
●​ Caring: Self-awareness, ethics, interpersonal skills.
Discussion Prompt
If a nurse could be expert in only one of the three (Thinking, Doing, or Caring), which
would be most important? Why?
Nursing Process & Critical Thinking
●​ Interrelated concepts.
●​ Nursing process is a structured problem-solving approach.
●​ Facilitates clinical decision-making.
Steps of the Nursing Process
1.​ Assessment – Recognizing cues, obtaining data.
2.​ Diagnosis – Identifying patient problems.
3.​ Planning – Setting goals and expected outcomes.
4.​ Implementation – Taking action.
5.​ Evaluation – Assessing effectiveness.
Nursing Assessment
Types of Data
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Subjective: What the patient says.
Objective: Observable and measurable data.
Primary: Directly from the client.
Secondary: From records or others.
Types of Assessments
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Initial
Ongoing
Comprehensive
Focused
Special needs (e.g., nutritional, pain, cultural, spiritual, psychosocial)
Practice Question
A client is weighed at admission and reports it is incorrect. What should the nurse do
first?
1.​ Explain how weight gain occurs.
2.​ Recalibrate and re-weigh the client.
3.​ Document the weight as 200 lbs.
4.​ Re-weigh the client in 2 hours.
Answer: 2 – Validate data if discrepancies exist.
Validating Data
●​ Necessary when:
○​ Subjective & objective data don’t match.
○​ Client’s statements vary.
○​ Data is outside the normal range.
○​ Measurement factors interfere.
Diagnostic Reasoning
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Analyze & interpret data.
Identify health problems.
Prioritize issues.
Develop a nursing diagnosis.
Analyzing Data
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Identify significant cues.
Cluster related data.
Identify gaps/inconsistencies.
Make inferences.
Verify findings with the patient.
Example Case Study
Patient Data
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78-year-old patient, day 5 post-hernia repair.
History: COPD, Diabetes Mellitus Type II.
Symptoms: Coughing yellow-green sputum, fever (101.5°F), O2 sat 86%, crackles in LLL.
Other Findings: Redness & tenderness in calf, hypoactive bowel sounds, no BM in 5 days.
Potential Problems Identified
●​ Risk for pneumonia (due to COPD, post-op immobility, crackles, low O2 sat, fever).
●​ Risk for DVT (redness & tenderness in calf, post-op immobility).
●​ Risk for constipation (post-op, decreased mobility, no BM in 5 days).
Nursing Diagnosis
●​ Definition: Clinical judgment about an individual’s response to health conditions.
●​ NANDA-I Official Definition:
○​ “A clinical judgment about individual, family, or community
experiences/responses to actual or potential health problems/life processes.”
Creating a Nursing Diagnosis Statement
●​ Example: Risk for Impaired Gas Exchange r/t decreased alveolar-capillary oxygen diffusion
as evidenced by O2 sat 86%, crackles in LLL, productive cough.
Activity, Mobility, and Safety Lecture Outline
Principles of Body Mechanics – Keeping Yourself Safe
●​ Key Concepts:
○​ Body alignment
○​ Balance
○​ Coordination
○​ Joint mobility
Body Mechanics: Avoiding Injury
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Use proper alignment.
Maintain a wide base of support.
Avoid bending and twisting.
Squat to lift, keeping objects close.
Raise beds when working with patients.
Push rather than lift when possible.
Get assistance when needed.
Factors Affecting Mobility and Activity
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Developmental stage
Nutrition
Lifestyle/activity level
Environmental factors
Baseline health and medical history
Assessment
●​ Complete a medical and nursing history.
●​ Perform a physical assessment.
Practice Question
For an immobile client, what is the priority nursing intervention? A. Encourage a
high-fiber diet with extra fluids.​
B. Administer PRN sleep medication.​
C. Have the client use an incentive spirometer every 2 hours.​
D. Massage the client’s legs every hour.
Answer: C – Prevents atelectasis, improving oxygenation, a priority need.
Promoting Activity
●​ Encourage highest level of activity possible and appropriate.
●​ Considerations:
○​ Provider’s order
○​ Surgical/procedural restrictions
○​ Current diagnoses & past medical history
○​ Nurse’s assessment of patient’s condition
Promoting Safe Positioning and Movement
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Proper alignment in bed.
Use range of motion exercises.
Support with pillows, wedges, side rails, trapeze bars, footboards.
Assess need for assistive devices (e.g., gait belt, walkers, mechanical lifts).
Positioning and Moving Patients in Bed
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Moving up in bed
Turning in bed
Logrolling
Common positions:
○​ Fowler’s
○​ Lateral
○​ Prone
○​ Sims
○​ Supine
Assisting with Ambulation
●​ May require conditioning exercises.
●​ Ensure use of appropriate assistive devices.
●​ Physical Therapy (PT) evaluation may be needed
○​ Often the doctor has ordered it after certain procedures with knee and hip
replacements, or open heart surgery
Case Study
Patient: Female, immobile for 2 months prior to spinal fusion surgery.
●​ Post-op: Patient wants to get out of bed, but the surgeon orders bed rest for 2 days.
●​ Assessment Priorities:
○​ Baseline mobility status
■​ How deconditioned are they? And what's led to that?
○​ Surgical restrictions
○​ Fall risk assessment
○​ Pain level
○​ Health History
■​ Are they obese?
■​ How old are they?
Effects of Immobility
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Duration of inactivity
Baseline health status & medical history
Acuity of current diagnosis
Sensory awareness
Risks of Immobility
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Deep vein thrombosis (DVT)
Impaired gas exchange
Muscle atrophy
Joint contractures
Pressure injuries
Depression and anxiety
○​ Elderly
○​ Respiratory
issues
Safety Hazards in
Healthcare Facilities
●​ Never Events (serious
reportable errors in patient
safety)
●​ Root Cause Analysis
(identifying why errors
occur)
●​ Culture of Safety
(promoting error
prevention and teamwork)
Common Safety Hazards
●​ Falls
○​ Prevention: Risk assessments, environmental safety, clean dry floors, patient
education.
●​ Alarm Fatigue
●​ Equipment-Related Accidents
●​ Fires & Electrical Hazards
●​ Restraints
●​ Mercury Poisoning
Practice Question
What should the nurse do when implementing restraints? A. Restrain all confused clients to
prevent falls.​
B. Tie the restraint to the bottom of the side rail.​
C. Ensure the provider renews the order every 24 hours.​
D. Release restraints and provide skin care once per shift.
Answer: C – Provider must renew restraint orders every 24 hours.
Supporting a Culture of Safety
●​ How to contribute:
○​ Complete incident reports when necessary.
○​ Report near misses to improve safety.
○​ Communicate product concerns to supervisors.
○​ Identify issues in practice to improve patient outcomes.
Case Study Discussion
Do teamwork and collaboration improve workplace safety? Why or why not?
Safety Hazards for Healthcare Workers
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Back injury (Use safe lifting practices)
Needlestick injury (Use sharps containers, avoid recapping needles)
Radiation injury (Wear lead shielding when necessary)
Violence (Be aware of workplace safety policies)
Common Nursing Diagnoses Related to Safety
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Hyperthermia
Hypothermia
Risk for Aspiration
Risk for Falls
Risk for Contamination
Safety Lecture Outline
Definition of Safety
●​ Condition of being safe from harm, injury, or loss.
●​ Basic human need.
●​ Nurses are responsible for ensuring safety of:
○​ Clients (in hospitals, communities, and homes).
○​ Healthcare workers, including themselves.
Developmental Factors Affecting Safety
Infants & Toddlers
●​ Unable to recognize danger.
●​ Explore the environment through touch.
●​ Totally dependent on caregivers.
Preschoolers
●​ Play extends to outdoors.
●​ More adventurous, increasing risk.
School-Age Children
●​ Try new activities without practice.
●​ Spend more time outside the home.
●​ Risk of stranger danger.
Adolescents
●​ Risk-taking behaviors increase.
●​ False confidence; feel indestructible.
●​ Lack of adult judgment.
Adults
●​ May face workplace injuries.
●​ Lifestyle choices impact health and safety.
●​ Strength and stamina may decline, or fitness may be maintained.
Older Adults
●​ Loss of muscle strength & joint mobility.
●​ Slowed reflexes.
●​ Sensory impairments.
Practice Question
For adolescent safety education, which topic is most important? A. Smoking cessation​
B. Sports injuries​
C. Alcohol abuse​
D. Driver’s education
Answer: D – Motor vehicle accidents are the leading cause of adolescent deaths.
Individual Factors Affecting Safety
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Lifestyle choices (e.g., substance abuse, poor diet, reckless behavior).
Cognition (e.g., confusion, memory impairment).
Sensory perception (e.g., vision, hearing loss).
Communication ability (e.g., language barriers, speech deficits).
Mobility status (e.g., weakness, paralysis, fall risks).
Physical & emotional health (e.g., stress, mental health disorders).
Safety awareness (e.g., lack of knowledge about hazards).
Safety Hazards in the Home
Poisoning
●​ Risks: Household chemicals, lead, medications, cosmetics.
●​ Prevention: Lock cabinets, store poisons high, keep Poison Control number available.
●​ Treatment: Depends on poison type (antidotes, activated charcoal, emergency care).
Carbon Monoxide Poisoning
●​ Produced by burning fuels (gas, wood, oil, kerosene).
●​ Prevention: Install carbon monoxide detectors.
●​ Treatment: 100% humidified oxygen.
Scalds and Burns
●​ Causes: Hot water, grease, sunburn, cigarettes.
●​ Prevention:
○​ Guardrails by fireplaces.
○​ Turn pot handles inward.
○​ Use candles safely.
○​ Apply sunscreen.
○​ Be cautious with microwaved food.
Fires
●​ Causes: Cooking, electrical issues, smoking indoors.
●​ Prevention:
○​ Smoke alarms (check batteries regularly).
○​ Keep fire extinguishers in key locations.
○​ Avoid unattended candles.
○​ Practice fire drills.
Falls
●​ High risk in adults over 65.
●​ Common causes: Slippery floors, stairs, low toilet seats, high beds.
●​ Prevention:
○​ Non-slip shoes.
○​ Proper lighting.
○​ Grab bars in bathrooms.
○​ Remove tripping hazards (e.g., rugs, clutter).
Firearms Injuries
●​ Risks: Suicides, domestic violence, accidental discharge.
●​ Prevention:
○​ Secure firearms in locked storage.
○​ Educate children on firearm safety.
○​ Store ammunition separately.
Suffocation & Asphyxiation
●​ Risks: Drowning, choking, smoke/gas inhalation.
●​ High-risk age group: Children 0-4 years old.
●​ Prevention:
○​ Keep small objects out of reach.
○​ Cut food into small pieces.
○​ Avoid mobiles, strings, cords around infants.
○​ Supervise children around water.
○​ Learn and use the Heimlich maneuver.
Take-Home Toxins
●​ Sources: Workplace chemicals, asbestos, lead, mercury.
●​ Prevention:
○​ Follow workplace safety protocols.
○​ Remove contaminated clothing.
○​ Shower after work if needed.
○​ Wear gloves when handling toxic substances.
Safety Hazards in the Community
Motor Vehicle Injuries
●​ Causes: Distracted driving, alcohol use, pedestrian accidents.
●​ Prevention:
○​ Avoid phone use while driving.
○​ Use designated drivers when drinking.
○​ Wear seatbelts and use proper child restraints.
Pathogens
●​ Foodborne illness (caused by improper storage, handling, or cooking).
●​ Vector-borne diseases (transmitted by insects, animals).
●​ Prevention:
○​ Proper food handling and hygiene.
○​ Drain standing water to prevent mosquito breeding.
○​ Use insect repellents and protective clothing.
Pollution
●​ Air, water, noise, soil contamination.
●​ Prevention:
○​ Proper waste disposal.
○​ Use eco-friendly products.
○​ Carpool or use public transport.
○​ Wear ear protection in noisy environments.
Weather Hazards
●​ Prevention:
○​ Stay informed about weather alerts.
○​ Have an emergency plan.
○​ Identify safe shelter locations.
Safety in Healthcare Settings
General Safety Interventions
●​ Assess patient environment.
●​ Educate patients about safety practices.
●​ Evaluate risks & remove hazards.
Home Safety Interventions
●​ Know how to perform choking rescue (Heimlich maneuver).
●​ Prevent drowning risks (supervise around water).
●​ Reduce take-home toxin exposure.
Patient Education for Safety
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Motor vehicle safety.
Food safety.
Avoiding vector-borne diseases.
Reducing environmental hazards.
Weather safety preparedness.
1. Preventing UTIs
Which statement indicates a need for further teaching? A) "I should drink plenty of fluids to help flush
bacteria from my urinary system." B) "I will urinate after sexual intercourse to help prevent UTIs." C) "I
should always wipe from back to front after using the restroom." D) "I will avoid using scented
feminine hygiene products."
2. Preventing CAUTIs
Which action is most important to prevent catheter-associated urinary tract infections (CAUTIs)? A)
Replacing the catheter every 48 hours B) Emptying the drainage bag once it is full C) Keeping the
drainage bag below the level of the bladder D) Flushing the catheter with sterile saline daily
3. Opioid Side Effects
Which finding would require immediate intervention for a patient receiving opioids for pain
management? A) Respiratory rate of 8 breaths per minute B) Heart rate of 72 beats per minute C)
Blood pressure of 110/70 mmHg D) Patient reports nausea
4. Diarrhea & Electrolyte Balance
A nurse is caring for a patient with diarrhea for three days. Which lab value is the priority to assess?
A) Hemoglobin and hematocrit B) Sodium and potassium levels C) White blood cell count D) Blood
glucose level
5. Standard Precautions
Which nursing action demonstrates the correct use of standard precautions? A) Wearing gloves when
taking a patient’s blood pressure B) Disposing of used needles in a puncture-resistant sharps
container C) Washing hands only if gloves become visibly soiled D) Using a mask and gown for all
patient interactions
6. Patient Transfers
A nurse is repositioning a patient with left-sided weakness. Which action is most important for safety?
A) Using a gait belt when assisting the patient to stand B) Placing the wheelchair on the patient’s
weaker side C) Instructing the patient to use the stronger side first when transferring D) Encouraging
the patient to move independently
7. Preventing Post-Op Pneumonia
A post-operative patient is at risk for pneumonia. Which intervention is most effective in prevention?
A) Keeping the head of the bed flat B) Encouraging the use of an incentive spirometer C) Restricting
fluid intake D) Administering a cough suppressant
8. Bowel Obstruction
Which assessment finding is most concerning for a patient with a bowel obstruction? A) Hypoactive
bowel sounds B) Firm, distended abdomen C) Reports of constipation D) Soft, non-tender abdomen
9. Pressure Injury Risk
Which patient is at highest risk for pressure injury development? A) A 40-year-old post-op patient who
ambulates twice daily B) A 55-year-old with hypertension and diabetes C) A 70-year-old who is
bedbound and incontinent D) A 25-year-old recovering from a fractured arm
10. Hygiene & Diabetes
Which action by a UAP requires intervention? A) Washing the patient’s face before the perineal area
B) Using warm water and mild soap for perineal care C) Clipping the toenails of a diabetic patient D)
Assisting a patient with limited mobility with oral care
11. Medication Administration
Which action by the nurse is the best way to prevent medication errors? A) Checking the medication
label three times before administration B) Administering all medications within 30 minutes of
scheduled time C) Relying on verbal orders for medication changes D) Preparing medications for
multiple patients at the same time
12. Fall Prevention
Which intervention is most effective in preventing falls in hospitalized patients? A) Keeping all four
side rails up B) Placing frequently used items within reach C) Turning off the bedside call light D)
Removing non-slip socks to allow for better sensation
13. PPE Usage
Which personal protective equipment (PPE) should a nurse wear when caring for a patient with
suspected tuberculosis (TB)? A) Surgical mask B) N95 respirator C) Face shield and gloves D) Gown
and gloves
14. Hand Hygiene
Which statement by a nursing student indicates proper hand hygiene technique? A) "I only need to
wash my hands if they are visibly soiled." B) "I should wash my hands for at least 10 seconds before
patient contact." C) "Hand hygiene should be performed before and after every patient contact." D)
"Alcohol-based hand sanitizer is ineffective against all infections."
15. Post-Surgical Pain Management
A patient who had abdominal surgery is requesting more pain medication 30 minutes after receiving
an opioid. What should the nurse do first? A) Administer an additional dose as prescribed. B) Assess
the patient’s pain level and surgical site. C) Explain that the medication has not had time to take
effect. D) Contact the healthcare provider for a higher dose.
16. Fire Safety
What is the priority action if a fire breaks out in a patient’s room? A) Activate the fire alarm. B) Contain
the fire by closing the door. C) Rescue the patient from the room. D) Extinguish the fire with an
appropriate extinguisher.
17. Fall Risk
Which intervention should the nurse implement for a patient at high risk for falls? A) Assign the patient
to a room near the nurses' station. B) Place all four side rails up. C) Encourage the patient to
ambulate independently. D) Keep the bed in its highest position.
18. PPE Sequence
Which is the correct sequence for donning personal protective equipment (PPE)? A) Gloves, gown,
mask, goggles B) Gown, mask, goggles, gloves C) Mask, gloves, gown, goggles D) Goggles, mask,
gloves, gown
19. Isolation Precautions
A patient is admitted with suspected Clostridium difficile. What type of precautions should the nurse
use? A) Airborne precautions B) Droplet precautions C) Contact precautions D) Protective isolation
20. Safe Medication Administration
Before administering digoxin to a patient, the nurse should assess which vital sign? A) Respiratory
rate B) Heart rate C) Blood pressure D) Oxygen saturation
21. Preventing Pressure Injuries
A bedbound patient is at risk for pressure injuries. What is the best nursing intervention? A)
Encourage increased oral intake. B) Massage reddened areas to promote circulation. C) Turn the
patient every two hours. D) Apply heat packs to bony prominences.
22. Feeding a Dysphagia Patient
Which action is most important when assisting a patient with dysphagia? A) Offer large bites of food to
promote swallowing. B) Have the patient tuck their chin while swallowing. C) Encourage the patient to
drink liquids rapidly. D) Place the patient in a supine position during feeding.
23. Delegation to UAP
Which task can be safely delegated to an unlicensed assistive personnel (UAP)? A) Administering
oral medications B) Assessing a patient’s pain level C) Assisting with bathing and hygiene D)
Teaching a patient about fall prevention
24. Oxygen Safety
A patient using home oxygen asks for guidance on safety. Which statement indicates the need for
further teaching? A) "I will keep my oxygen tank at least five feet away from open flames." B) "I can
use Vaseline to keep my lips from getting dry." C) "I will ensure my oxygen tubing does not have
kinks." D) "I will turn off the oxygen tank when not in use."
25. Urinary Retention
A post-operative patient has not voided for eight hours. What should the nurse do first? A) Insert a
straight catheter per provider’s order. B) Encourage the patient to drink more fluids. C) Perform a
bladder scan. D) Administer a diuretic.
26. Blood Transfusion Reaction
Which symptom is most concerning for a patient receiving a blood transfusion? A) Increased thirst B)
Low back pain and chills C) Mild itching at the IV site D) Slight increase in temperature
27. Seizure Precautions
Which intervention is appropriate for a patient on seizure precautions? A) Place a padded tongue
blade at the bedside. B) Keep all four side rails up at all times. C) Maintain suction equipment at the
bedside. D) Restrain the patient to prevent injury.
28. Ethical Dilemma
A patient with terminal cancer refuses food and water. What is the best response by the nurse? A)
"You need to eat to keep up your strength." B) "I will contact your family to persuade you." C) "I
respect your decision and will provide comfort care." D) "The doctor will need to discuss this with you."
29. Post-Fall Assessment
A patient has fallen in their hospital room. What should the nurse do first? A) Assist the patient back to
bed immediately. B) Notify the healthcare provider. C) Assess the patient for injuries. D) Complete an
incident report.
30. End-of-Life Care
A hospice patient’s family asks how to know when death is near. Which sign should the nurse
mention? A) Increased appetite B) Decreased urine output C) Hyperactive reflexes D) Restlessness
and agitation
1.​ C
2.​ C
3.​ A
4.​ B
5.​ B
6.​ C
7.​ B
8.​ B
9.​ C
10.​ C
11.​ A
12.​ B
13.​ B
14.​ C
15.​ B
16.​ C
17.​ A
18.​ B
19.​ C
20.​ B
21.​ C
22.​ B
23.​ C
24.​ B
25.​ C
26.​ B
27.​ C
28.​ C
29.​ C
30.​ B