Medical-Surgical I (NBNN 1243)
Question 1
Infection control involves preventing the spread of microorganisms between patients or from staff to patients, and vice versa. Infections can be transmitted through various modes such as direct contact, indirect contact, inhalation, injection, fomite, ingestion, and more. Therefore, healthcare providers, including hospital staff, must control infections. This is necessary because many infections spread in conditions where people are vulnerable. Care providers need to be aware of potential infection transfer and act promptly. According to the Essex Health Protection Team (2013), different microorganisms require various means of transmission, often involving hands. Hands can carry microorganisms found in body secretions and excretions. If not properly decontaminated, they can transmit infections. For instance, gram-positive Enterococcus can cause foot ulcers’ infection.
Microorganisms’ impact varies among individuals due to factors like immune status, health, medical condition, age (young and old being more vulnerable), and hygiene. Hospital settings with confined spaces and various patients can lead to increased vulnerability. The presence of contaminated waste, combined with patients’ vulnerability, results in frequent infections. Hospital care providers must establish standard infection control procedures. Not only can care providers get infected, but they can also spread infections to other patients, staff, and the public, particularly family members and household contacts. Following infection control procedures is crucial to protect those outside the hospital.
The National Audit Office (2000) reported that around 9 percent of hospital patients acquire infections, leading to deaths each year. These hospital-acquired infections are often challenging to treat and costly for the government. Infection control in hospitals aims to maintain a safe environment, reducing disease transmission risk.
Question 2
Mr. Ali has a right foot ulcer requiring regular nursing care. Daily foot inspections will be performed, looking for bumps, bruises, blisters, cracks, or sores. Even tiny cracks can worsen infection. Any patches of thin or shiny skin signal poor blood flow, indicating infection. Gentle washing with mild soap and lukewarm water will help remove dead skin. Drying the foot, including between toes, is important. Wound dressing with antimicrobial agents will follow. For foot ulcers with dying tissue, hydrogels or collagen dressings are effective. Matching the dressing’s absorbency with wound drainage is crucial.
Mr. Ali’s shoes will also be inspected for fit, foreign objects, and wear patterns. Clinical Assessment involves assessing ulcer etiology, local/systemic infection presence/severity, extent/depth, and peripheral vascular status. Skin assessment of both feet is vital. Joint/gait assessments help understand dysfunction leading to ulceration. A non-removable total contact cast will redistribute pressure and promote healing.
Question 3
The first nursing care plan is Impaired Skin Integrity. This problem indicates damaged or ineffective skin repair. Assessing specific pressure ulcer risk factors is crucial, even for existing ulcers. Factors like age, skin condition, nutritional status, chronic diseases, radiation therapy history, fecal/urinary incontinence, mobility, and pain are considered. Ulcer size, edges, undermining, and near tissue condition are evaluated. The pressure ulcer scale for healing tool gauges ulcer healing. Topical vasodilators improve skin circulation. Hydrocolloid dressings prevent shear and friction. Vitamin-enriched emollients moisturize the skin.
The second nursing care plan is infection risk. Nutritional status, unexplained sepsis, urinary/fecal incontinence, ulcer tissue color/drainage/odor, temperature, and white blood cell count are assessed. Maintaining perineal hygiene, administering prescribed antibiotics, and providing local wound care are essential steps for preventing and treating infections.
