C.Diff
Bristol stool Type 6 or 7
•What is an acceptable stool sample by the lab?
At the time of admission;
Every shift thereafter; and
With any change in patient condition;
With any change in level of care; and
Following a fall.
•When is the Morse Fall Scale completed?
STAT RN places the Foley Catheter
•Who to call after a second attempt to place a Foley has occurred by a more experience nurse?
1. Scrupulous Hand Hygiene
2. Aseptic Technique
3. Vigorous Friction to Hubs & When Making & Breaking Connections (15-30 seconds and allow drying)
4. Ensure Patency
5. Remove as Soon as Possible
•What is embracing the CLABSI Bundle?
HAPI
•What is Hospital-Acquired Pressure Injury
- a localized injury to the skin and/or underlying tissue acquired during an inpatient hospital stay?
Suspected infection AND two of the following indicators:
Hypo- or hyperthermia (temp>38oC or <36oC)
Heart Rate >90
Tachypnea (RR>20, PCO2<32 or intubation for respiratory failure)
Leukocytes >12,000; <4,000 or more than 10% bands
Altered mental status
Hyperglycemia (plasma glucose >140 mg/dL or 7.7 mmol/L) in the absence of diabetes
•What is sepsis criteria?
Patient has had less than 3 stools in a 24-hour period.
•Who is a Patient that does not meet criteria for sending a stool sample for C. diff?
History of Falls, Medications, Secondary Diagnosis, Ambulatory Aid, Equipment, IV, Unsteady gait, Mental status change
•What are fall risk factors?
a. Urologic surgery or surgery on contiguous structures of the GU tract
b. Surgery within 24 hours
c. HOURLY assessment of urine output in patients in Critical Care
d. Mechanically sedated or intubated
e. Acute urinary retention and urinary obstruction
f. Assistance in healing of pressure ulcers stage 2 or greater, or skin grafts (selected patients with incontinence)
g. Comfort in End of Life care (at patient's request)
h. Neurogenic bladder (selected patients who have a chronic indwelling catheter
•What are indications for indwelling urinary catheter?
PRN
Q7 days for occlusive dressings
Routinely rounded on and changes performed by Vascular Access RN, STAT RN, ICU RN
•What are NWH Maintenance Standard for dressing change for central lines and midlines?
Advanced age, immobility, impaired perfusion, poor nutritional status, severe illness and diabetes
•What are some of the most important risk factors for developing pressure injuries?
(1) STAT RN – Comes to the ED, helps ED RN ensure timely completion of all Sepsis Flowsheet elements
(2) Hospitalist – Awaits call from ED provider to discuss antibiotics and work-up
(3) NSO and ICU Charge – Obtain patient info to prepare a room for patient
(4) Phlebotomist – Prioritizes patient’s blood draw
(5) Pharmacy – alerts pharmacist to prioritize patient’s antibiotics
•Who responds when a code Sepsis is called in the ED?
Advanced age, antibiotics, SNF, GI surgery or GI manipulation, PPI
•What are risk factors for developing C. diff?
In Plan of Care, During shift end report to charge, During RN to CNA Huddle, During RN to RN bedside report, In report to therapies, to patient and patient’s family
•When does communication of risk for falling occurs?
Intermittent Catheterization
•What you do when:
- If problem persists, perform bladder ultrasound to verify bladder volume
-Perform intermittent catheterization every 6-8 hours x 2:
•If bladder volume by ultrasound is equal or greater than 800 mL or
•If patient reports discomfort and urgency to void regardless of bladder volume; whichever comes first.
NWH Maintenance Standards: Flushing
What is 10 mL NS after each use and QD
And/or 20 mL NS after blood draw and/or
Heparin Lock Flush 5mL of 10units/mL after each use and QD For a Non-valved central line?
Or-
What is 10 mL NS after each use and QD and/or 20 mL NS after blood draw for a valved central line or Heparin Allergy?
Turning, offloading, moisture management, nutrition, pressure reduction surfaces
•What are measures to prevent pressure injury?
The amount of fluid give initially for a code Sepsis
•What is 30 ml/kg of crystalloid?
Shift assessment, I & O, ADLs, Nurses notes
•Where are loose stools are documented?
1. Bed locked and in lowest position
2. Clear path to the bathroom
3. Purposeful rounding- assessing for pain, toileting need, position, and possessions within reach
4. Call light and phone within reach
5. Encourage patients/family to call for assistance when needed
•What are Standard Fall Prevention Interventions for all patients?
Kinking in Foley tubing, non-dependent loop, no cath secure, drainage bag on floor, multiple swipes with one wipe for Foley care, Foley catheter in greater than 24 hours
•What are risk actors for developing a CAUTI?
The amount of time I should “scrub the hub” of a needleless connector with an alcohol pad prior to accessing.
•What is 15 seconds and allow to dry?
Shallow ulcer involving the epidermis and dermis but not underlying subcutaneous tissue, caused by pressure
•What is a Stage 2 pressure injury?
Step 1: of sepsis bundle
What is:
1) Notify provider if suspicion of infection or sepsis
•2) Send 2 sets of blood culture
•3) Send lactic acid level
•4) Start antibiotics
•5) Start IV crystalloids
C. Diff is considered as Hospital acquired infection
•What happens when a diagnosis of C. diff made after 48 hours of hospitalization?
Assessment, Vital signs, Patient Location, Notify LIP, Huddle, Morse Falls Scale, PSN
•What is post falls management?
Antihistamines
Antihypertensives
Anticholinergics
Antidepressants
Antiparkinsonian agents
Muscle Relaxants
Opioid analgesics
•What are common medications associated with urinary retention?
The most common source of central venous catheter colonization when catheters are in place for less than 10 days.
•What are organisms on the skin?
The length of time it takes for a pressure ulcer to develop under a bony prominence
•What is from 1 hour to 4-6 hours
Normal range 0.5-2.2 mmol/L
•What is a Lactate level (venous plasma)?