You are the nurse caring for a 64-year-old male client who is postoperative day four on the medical-surgical unit after having an emergency right colectomy due to cancer. The client is NPO with a nasogastric (NG) tube to low intermittent suction. The client has a history of smoking and no other health problems.
Vital signs:
- Temperature: 99.2° F
- Heart rate: 91 beats/min
- Respirations: 20 breaths/minute
- O2 saturation: 93% on 2L oxygen via nasal cannula
- Blood pressure: 110/68 mm Hg
- Pain: “6/10”
Focused assessment findings:
- Alert and oriented to person, place, and time
- Moves all four extremities, refuses to ambulate
- Apical pulse is regular at 91 beats/minute
- Lungs clear to auscultation, diminished bilaterally
- Bowel sounds hypoactive, abdomen soft, tender in all four quadrants
- Midline abdominal incision well approximated with staples intact, no erythema, Penrose drain intact with scant serous drainage
- Right lower quadrant Jackson-Pratt drain with sutures intact, no erythema, 30 mL of serosanguineous drainage
Student Name: __________________________
Date: ______________________
Client Gender: ____________ Client Age: ________
Client Diagnosis: __________________________________________________________________________________________________
| Assessment data for Nursing Diagnosis | Nursing Diagnosis (3) | Expected Outcomes with Indicators
(1 per Nursing Diagnosis) |
Nursing Interventions
(2 per Expected Outcome) |
Evidence-based Rationale for each Nursing Intervention (Cited/referenced) | Evaluation
(How do you know it worked?) |
Respond to this critical thinking question:
Describe evidence-based precautions to prevent this client from obtaining a nosocomial infection. Provide supporting rationales.
Support your response with evidence from credible sources.
Nosocomial infections are infections that are acquired during hospitalization or in a healthcare setting. They can cause significant morbidity and mortality, particularly in vulnerable populations such as postoperative patients. To prevent this client from obtaining a nosocomial infection, evidence-based precautions should be implemented.
- Hand hygiene: Hand hygiene is the most important measure to prevent nosocomial infections. Healthcare workers should perform hand hygiene before and after every patient contact, as well as after any contact with the environment surrounding the patient. Hand hygiene can be accomplished using soap and water or an alcohol-based hand rub. (Centers for Disease Control and Prevention [CDC], 2021)
- Appropriate use of personal protective equipment (PPE): Healthcare workers should use appropriate PPE when caring for patients with known or suspected infectious diseases. PPE includes gloves, gowns, masks, and eye protection. Healthcare workers should don PPE before entering the patient’s room and remove it before leaving. (CDC, 2021)
- Environmental cleaning: Environmental cleaning is essential to prevent the spread of nosocomial infections. Surfaces should be cleaned and disinfected regularly, particularly high-touch surfaces such as bed rails, doorknobs, and light switches. (CDC, 2021)
- Implementation of transmission-based precautions: Transmission-based precautions are additional precautions that are implemented based on the mode of transmission of the infectious agent. For example, patients with airborne infections such as tuberculosis should be placed in negative-pressure rooms with appropriate PPE. (CDC, 2021)
- Minimizing invasive procedures: Invasive procedures such as the insertion of catheters and intravenous lines increase the risk of nosocomial infections. Healthcare workers should minimize the use of invasive procedures and remove them as soon as they are no longer necessary. (Institute for Healthcare Improvement [IHI], 2020)
These evidence-based precautions are supported by the CDC and IHI and have been shown to be effective in preventing nosocomial infections. By implementing these precautions, the risk of a nosocomial infection can be significantly reduced, particularly in vulnerable populations such as postoperative patients.
References:
Centers for Disease Control and Prevention. (2021). Hand hygiene in healthcare settings. Retrieved from https://www.cdc.gov/handhygiene/index.html
Centers for Disease Control and Prevention. (2021). Standard precautions. Retrieved from https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
Institute for Healthcare Improvement. (2020). How-to guide: Prevent harm from high-alert medications. Retrieved from http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx