Online Companion: Fundamentals of Nursing Standards and Practice 2E

Chapter Summary

The nurse has responsibility for providing the client with a safe environment through nursing care that incorporates safety precautions, practices that control infection, and actions that assist the client with personal hygiene. The safety of the client in the environment is influenced by age, lifestyle, sensory and perceptual alterations, mobility and emotional state. The elderly client is at risk to fall; fractures and other serious injuries result from falling. Individuals who operate machinery or who live in high-crime neighborhoods are at risk for injury. Accidents are categorized by three causative factors: client behaviors, therapeutic procedures such as a medication error, or equipment. Infection control practices protect clients and nurses from transmission of microorganisms. The chain of infection describes the interactions among the infectious agent, a susceptible host and the environment. There are four modes of transmission in which the infectious agent enters the susceptible host: contact transmission, airborne transmission, vehicle transmission, and vector-borne transmission. Infection control practices are aimed at breaking the chain of infection by blocking the agent or interrupting the mode of transmission or strengthening the host's immune responses. The body's immune system has general defenses and specific immune defenses to resist the transmission of infectious agents. When the infectious agent invades and damages tissue and infection is present. There are four stages of infection: incubation, prodromal, illness and convalescence. Nosocomial infections are hospital-acquired infections. The most common of this type are urinary tract infections, respiratory infections and skin infections. Nosocomial infections are often from multiple drug-resistant, such a methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). Infection from blood-borne pathogens such as HIV and hepatitis viruses are a major concern in health care facilities.

The client's hygiene is part of client safety and protecting the client's defense mechanisms. The nurse considers the client's social and cultural practices and personal preferences when providing hygiene care. The nursing practice standard on client safety has an outcome " the client will receive care in a safe health care environment and remain free of preventable injuries". The nurse assesses the client and does a physical exam to identify the risk for problems related to safety, infection or hygiene. Risk for Injury, Risk for Infection, and Self-care Deficit are three nursing diagnoses that relate to this assessment. Knowledge Deficit related to health hazards is another nursing diagnosis that is pertinent to this client. Implementation of care includes specialized skills in applying restraints, preventing falls, decreasing radiation exposure, proper handwashing, use of medical and surgical asepsis, isolation precautions, and hygienic care of the client. These skills are described and diagrammed in detail in Chapter 31. The chapter concludes with a case study for Mr. Simon, a client at risk for injury.