AsepsisMedical asepsis1. Includes all practices intended to confine a specific microorganism to a specific area2. Limits the number, growth, and transmission of microorganisms3. Objects referred to as clean or dirty soiled, contaminated!Surgical asepsis1. "terile techni#ue2. $ractices that %eep an area or object free of all microorganisms3. $ractices that destroy all microorganisms and spores&. 'sed for all procedures in(ol(ing sterile areas of the body$rinciples of Aseptic )echni#ueOnly sterile items are used within sterile field.1. "terile objects become unsterile when touched by unsterile objects.2. "terile items that are out of (ision or below the waist le(el of the nurse are considered unsterile.3. "terile objects can become unsterile by prolong e*posure to airborne microorganisms.&. +luids flow in the direction of gra(ity.,. -oisture that passes through a sterile object draws microorganism from unsterile surfaces abo(e or below to the surface by capillary reaction... )he edges of a sterile field are considered unsterile./. )he s%in cannot be sterili0ed and is unsterile.1. 2onscientiousness, alertness and honesty are essential #ualities in maintaining surgical asepsisInfectionSigns of Localized Infection Locali0ed swelling Locali0ed redness $ain or tenderness with palpation or mo(ement $alpable heat in the infected area Loss of function of the body part affected, depending on the site and e*tent of in(ol(ementSigns of Systemic Infection +e(er Increased pulse and respiratory rate if the fe(er high -alaise and loss of energy Anore*ia and, in some situations, nausea and (omiting 3nlargement and tenderness of lymph nodes that drain the area of infectionFactors Influencing Microorganisms Capability to Produce Infection 4umber of microorganisms present 5irulence and potency of the microorganisms pathogenicity! Ability to enter the body "usceptibility of the host Ability to li(e in the host6s bodyAnatomic and Physiologic Barriers efend Against Infection Intact s%in and mucous membranes -oist mucous membranes and cilia of the nasal passages Al(eolar macrophages )ears 7igh acidity of the stomach 8esident flora of the large intestine $eristalsis Low p7 of the (agina 'rine flow through the urethra!A!A iagnosis 8is% for Infection "tate in which an indi(idual is at increased ris% for being in(aded by pathogenic microorganisms 8is%s factors Inade#uate primary defenses Inade#uate secondary defensesRelated Diagnoses $otential 2omplication of Infection9 +e(er Imbalanced 4utrition9 Less than :ody 8e#uirement Acute $ain Impaired "ocial Interaction or "ocial Isolation An*ietyInter"entions to #educe #is$ for Infection $roper hand hygiene techni#ues 3n(ironmental controls "terile techni#ue when warranted Identification and management of clients at ris%2hain of Infection1. )he chain of infection refers to those elements that must be present to cause an infection from a microorganism2. :asic to the principle of infection is to interrupt this chain so that an infection from a microorganism does not occur in client3. Infectious agent; microorganisms capable of causing infections are referred to as an infectious agent or pathogen&. Modes of transmission9 the microorganism must ha(e a means of transmission to get from one location to another, called direct and indirect,. Susceptible host describes a host human or animal! not possessing enough resistance against a particular pathogen to pre(ent disease or infection from occurring when e*posed to the pathogen; in humans this may occur if the person6s resistance is low because of poor nutrition, lac% of e*ercise of a coe*isting illness that wea%ens the host... Portal of entry9 the means of a pathogen entering a host9 the means of entry can be the same as one that is the portal of e*it gastrointestinal, respiratory, genitourinary tract!./. Reservoir9 the en(ironment in which the microorganism li(es to ensure sur(i(al; it can be a person, animal, arthropod, plant, oil or a combination of these things; reser(oirs that support organism that are pathogenic to humans are inanimate objects food and water, and other humans.1. Portal of exit9 the means in which the pathogen escapes from the reser(oir and can cause disease; there is usually a common escape route for each type of microorganism; on humans, common escape routes are the gastrointestinal, respiratory and the genitourinary tract.:rea%ing the 2hain of Infection%tiologic agent 2orrectly cleaning, disinfecting or sterili0ing articles before use 3ducating clients and support persons about appropriate methods to clean, disinfect, and sterili0e article#eser"oir &source' 2hanging dressings and bandages when soiled or wet Appropriate s%in and oral hygiene ris%A e*posure high blood (olume and source with a high 7I5 titer!, three drug treatment is recommended +or @increased ris%A e*posure high blood (olume or source with high 7I5 titer!, three>drug treatment is recommended +or @low ris%A e*posure neither high blood (olume nor source with a high 7I5 titer!, two>drug treatment is considered 725 and AL) at baseline and & to . months after e*posureAssisting patient 'bed$ chair$ (heelchair)I. $urpose1. )o strengthen the patient gradually.2. )o pro(ide a change in position. In wheelchair to ta%e her around for a change!II. 3#uipment 2hair or wheelchair $atient6s robe and slippers $illows :lan%et, sheet or draw sheetIII. $rocedure1. "ee that the chair or wheelchair is in good condition.2. $lace the chair con(eniently at night angles to the bedGbac% of chair parallel to the foot of the bed and facing the head of bed.3. $lace pillow on the seat of the chair. If using wheelchair, line it with a blan%et or sheet and arrange pillows on the seat and against the bac%. $ut the foot rest up and loc% the wheels.&. )a%e the patient6s pulse,. Assist the patient to a sitting position on bed, i.e., put one arm under the head and shoulders and the other arm under her %nees and pi(ot her to a sitting position with the legs hanging o(er the side of the bed... =atch the patient for a minute to defect any change in his color, pulse and respiratory rate./. $ut on patient6s robe and slippers. $lace the foot stool under the patient6s feet.1. "tand directly in front of the patient and with a hand under each a*illa, assist him to stand, step down and turn around, with his bac% to the chair. Let patient fle* his %nees and lower body to seat him to the chair. Anchor chair with foot or ha(e someone hold iton. Or let patient place his arm o(er your shoulders while you put your arm around his waist. )urn patient around with his bac% to thechair and seat him gently!. 7elp him get comfortable in the chair.H. Adjust the pillows and wrap blan%et o(er patient6s lap. If in a wheelchair adjust the foot rests.1F. Obser(e fre#uently for changes in color and pulse rate, di00iness or sign of fatigue.11. )o put him bac% to bed, assist to stand, help to turn and stand on stool and bac% to bed. "upport patient while he sits on the side of bed. 8emo(e robe and slippers. $i(ot to a sitting position in bed, supporting her head and shoulders with one arm and her %nees with the other arm, and lower slowly to bed in lying position.12. carrying capacity of blood with minimal e*pansion of blood.2. Leu%ocyte>poor pac%ed 8:2s, indicated for patients who ha(e e*perience pre(ious febrile no hemolytic reactions.3. $latelets, either 7LA human leu%ocyte antigen! matched or unmatched.&. Cranulocytesbasophils, eosinophils, and neutrophils !,. +resh fro0en plasma, containing all coagulation factors, including factors 5 and 5III the labile factors!... "ingle donor plasma, containing all stable coagulation factors but reduced le(els of factors 5 and 5III; the preferred product for re(ersal of 2oumadin>induced anticoagulation./. Albumin, a plasma protein.1. 2ryoprecipitate, a plasma deri(ati(e rich in factor 5III, fibrinogen, factor JIII, and fibronectin.H. +actor IJ concentrate, a concentrated form of factor IJ prepared by pooling, fractionating, and free0e>drying large (olumes of plasma.1F. +actor 5III concentrate, a concentrated form of factor IJ prepared by pooling, fractionating, and free0e>drying large (olumesof plasma.11. $rothrombin comple*, containing prothrombin and factors 5II, IJ, J, and some factor JI. Ad(antages of blood component therapy1. A(oids the ris% of sensiti0ing the patients to other blood components.2. $ro(ides optimal therapeutic benefit while reducing ris% of (olume o(erload.3. Increases a(ailability of needed blood products to larger population.$rinciples of blood transfusion therapy1. =hole blood transfusion Cenerally indicated only for patients who need both increased o*ygen>carrying capacity and restoration of blood (olume when there is no time to prepare or obtain the specific blood components needed.2. $ac%ed 8:2s "hould be transfused o(er 2 to 3 hours; if patient cannot tolerate (olume o(er a ma*imum of & hours, it may be necessary for the blood ban% to di(ide a unit into smaller (olumes, pro(iding proper refrigeration of remaining blood until needed. One unit of pac%ed red cells should raise hemoglobin appro*imately 1I, hemactocrit 3I.3. $latelets Administer as rapidly as tolerated usually & units e(ery 3F to .F minutes!. 3ach unit of platelets should raise the recipient6s platelet count by .FFF to 1F,FFFDmm39 howe(er, poor incremental increases occur with alloimmuni0ation from pre(ious transfusions, bleeding, fe(er, infection, autoimmune destruction, and hypertension.&. Cranulocytes -ay be beneficial in selected population of infected, se(erely granulocytopenic patients less than ,FFDmm3! not responding to antibiotic therapy and who are e*pected to e*perienced prolonged suppressed granulocyte production.,. $lasma :ecause plasma carries a ris% of hepatitis e#ual to that of whole blood, if only (olume e*pansion is re#uired, other colloids e.g., albumin! or electrolyte solutions e.g., 8inger6s lactate! are preferred. +resh fro0en plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing... Albumin Indicated to e*pand to blood (olume of patients in hypo(olemic shoc% and to ele(ate le(el of circulating albumin in patients with hypoalbuminemia. )he large protein molecule is a major contributor to plasma oncotic pressure./. 2ryoprecipitate Indicated for treatment of hemophilia A, 5on =illebrand6s disease, disseminated intra(ascular coagulation treated product decreases the ris% of hepatitis and 7I5 transmission.1F. $rothrombin comple*>Indicated in congenital or ac#uired deficiencies of these factors.Objecti(es1. )o increase circulating blood (olume after surgery, trauma, or hemorrhage2. )o increase the number of 8:2s and to maintain hemoglobin le(els in clients with se(ere anemia3. )o pro(ide selected cellular components as replacements therapy e.g. clotting factors, platelets, albumin!4ursing Inter(entions1. 5erify doctor6s order. Inform the client and e*plain the purpose of the procedure.2. 2hec% for cross matching and typing. )o ensure compatibility3. Obtain and record baseline (ital signs&. $ractice strict Asepsis,. At least 2 licensed nurse chec% the label of the blood transfusion hec0 the follo(ing: "erial number :lood component :lood type 8h factor 3*piration date "creening test 5carried diseases and therefore, safe from transfusion.2. =arm blood at room temperature before transfusion to pre(ent chills.3. Identify client properly. )wo 4urses chec% the client6s identification.&. 'se needle gauge 11 to 1H. )his allows easy flow of blood.,. 'se :) set with special micron mesh filter. )o pre(ent administration of blood clots and particles... "tart infusion slowly at 1F gttsDmin. 8emain at bedside for 1, to 3F minutes. Ad(erse reaction usually occurs during the first 1, to 2F minutes./. -onitor (ital signs. Altered (ital signs indicate ad(erse reaction.1.