1 8/08 Lincoln Memorial University Caylor School of Nursing Nursing 115 Fall 2008 UNIT V LESSON PLAN: Protection DATES & TIMES: See Class Schedule OBJECTIVES: Upon completion of this unit, the student will be able to demonstrate in the clinical/campus laboratory setting, in individual and group conferences and on written materials, the ability to: 1. Differentiate between medical and surgical asepsis. 2. Identify the body's normal defenses against infection. 3. Differentiate the symptoms of localized and systemic infections. 4. Describe the characteristics of each link of the infection chain. 5. Identify patients most at risk for acquiring an infection. 6. Explain conditions that precipitate the onset of nosocomial infections. 7. Describe nursing interventions designed to break each link in the infection chain. 8. Utilize the nursing process to develop a plan of care for a patient at risk for developing an infection. 9. Describe the guidelines for surgical asepsis. 10. Utilize therapeutic communication techniques in meeting the needs of patients having protection needs. 11. Describe psychosocial considerations for a patient with protection needs. 12. Identify the physiologic action, use, side effects and nursing implications of the drugs used in pharmacological management of protection needs. 13. Apply the nursing process as it relates to medical asepsis. 14. Identify the factors that contribute to pressure ulcer formation. 15. Recognize and utilize nursing interventions to prevent and treat pressure ulcers. 16. Discuss appropriate nursing care for a patient receiving heat and/or cold therapy. 17. Describe the factors affecting skin integrity. 18. Discuss the proper selection and use of the various wound dressings. TOPICAL OUTLINE I. Asepsis and Infection Control A. Assessment of stimuli and behavior related to infection 1. Medical asepsis 2. Surgical asepsis 3. Body’s defenses against infection 4. Chain of infection 5. Course of infection 6. Assessment of wound site 7. Assessment of laboratory data B. Nursing diagnoses related to infectious processes C. Expected outcomes related to infectious processes2 8/08 D. Implementation of nursing care for the patient experiencing an infectious process 1. Asepsis a. Medical b. Surgical 2. Types of bacteria a. Resident b. Transient 3. Cleansing agents a. Soaps/detergents b. Antibacterial/Antimicrobial 4. Sterilization/Disinfection 5. Personal Protective Equipment (PPE) 6. CDC guidelines 7. Prevention of nosocomial infections a. Types of resistant organisms b. Protection of patient 8. Nursing care of patient with nosocomial infection 9. Teaching related to infection control E. Evaluation of interventions for adaptive responses F. Documentation II. Pharmacological Management A. Antibiotics 1. Cephalosporins 2. Fluoroquinolones 3. Macrolides 4. Penicillins 5. Sulfonamides 6. Tetracyclines B. Antivirals C. Antifungals D. Anti-infectives III. Skin Integrity and Wound Care A. Integumentary system 1. Structure of skin 2. Functions of skin 3. Factors affecting skin integrity 4. Wound classification B. Assessment of stimuli and behavior related to skin alterations 1. Phases of wound healing 2. Factors affecting wound healing 3. Wound complications a. Infection b. Hemorrhage c. Dehiscence d. Evisceration e. Fistula formation3 8/08 4. Factors in pressure ulcer development a. Pressure b. Friction c. Shear 5. Risks for pressure ulcer development a. Immobility b. Nutrition/hydration c. Moisture d. Mental status e. Age 6. Staging of pressure ulcers 7. Wound/pressure ulcer assessment 8. Types of wound drains B. Nursing diagnoses related to skin alterations C. Expected outcomes related to skin alterations D. Implementation of nursing care for the patient experiencing skin alterations 1. Prediction of pressure ulcers (risk assessment scales) 2. Prevention of pressure ulcers 3. Wound dressings a. Selection b. Application c. Removal 4. Additional techniques a. Vacuum Assisted Closure (VAC)) b. Pouching c. Growth factors d. Oxygen therapy e. Surgery f. Heat and cold therapy 5. Care of sutures/staples 6. Patient education E. Evaluation of interventions for adaptive responses F. Documentation REQUIRED READINGS: Fischbach, F., & Dunning, M. (2006). Nurses’ quick reference to common laboratory and diagnostic tests. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 208-215, 289-290, 494-495, & 573-588. Karch, A. (2008). 2008 Lippincott’s nursing drug guide. Philadelphia: Lippincott Williams & Wilkins. TBA. (Readings applicable to the drug categories in II listed above.) Taylor, C., Lillis, C. & LeMone, P., & Lynn, P. (2008). Fundamentals of nursing: The art and science of nursing care. (6th ed.). Philadelphia: Lippincott Williams & Wilkins. chap. 27 & 38.4 8/08 Taylor,C.,Lillis, C. & LeMone, P., & Lynn, P. (2008). Study guide to accompany fundamentals of nursing: The art and science of nursing care. (6th ed.). Philadelphia: Lippincott Williams & Wilkins. Readings to coincide with above chapters. CLINICAL SKILLS: 1. Utilize principles of medical asepsis in the provision of patient care. 2. Utilize principles of surgical asepsis in the provision of patient care. 3. Demonstrate proper handwashing technique. 4. Assess assigned patients for data pertaining to their basic need for protection. 5. Demonstrate proper application of heat and cold therapies. 6. Demonstrate safe, effective administration of medications utilized to treat infections. 7. Perform suture/staple removal. HANDOUTS: 1. Medications utilized to treat infections (including antibiotics, antifungals, antivirals, and anti-infectives.) 2. Wound dressing handout (See list of products attached.) (Complete handout to be forthcoming.)5 8/08 Class Examples Indications for Use MOA Mechanism of Action Common Side Effects Nursing Implications Cephalosporins 1st Generation: cefazolin (Ancef) cepalexin (Keflex) 2nd cefaclor (Ceclor) 3rd:ceftriaxone-(Rocephin) Antibiotic Treatment of various infections such as OM, pneumonia, UTIs. Periop prophylaxis. Bactericidal Inhibits synthesis of bacterial cell