Session 1 — Microorganisms, Infection & Asepsis

Key Terms and Concepts

• Microorganism: A microscopic organism found in people, animals, food, water, soil, air, and on objects.

• Non-pathogen: A microorganism that normally does not cause disease.

• Pathogen: A microorganism capable of causing disease.

• Infection: Entry and multiplication of a pathogen in a host, producing tissue response and clinical signs/symptoms.

• Communicable disease: An infection that can be transmitted from one person to another.

• Colonization: A pathogen is present on/in the body without causing harm or symptoms.

• Carrier: A person or animal who has a pathogen and can transmit it without showing symptoms.

Additional info: The presence of a pathogen alone does not guarantee infection; infection requires a susceptible host and appropriate conditions.

Microbial Needs and Flora

• Microbes require a reservoir, water, nourishment, suitable temperature and pH, and appropriate oxygen levels.

• Resident flora: Live and multiply on the body; harder to remove; can cause infection in vulnerable clients.

• Transient flora: Acquired by contact; attach loosely; removed by correct hand hygiene.

Multidrug-Resistant Organisms (MDROs)

• Resist several antibiotics (e.g., MRSA, VRE).

• Contributing factors: unnecessary antibiotic use, incomplete therapy.

The Chain of Infection

Six links must be present for infection to spread. Breaking any link interrupts transmission.

Defenses, Infections, and Health Care-Associated Infections (HAIs)

• Normal defenses: Intact skin/mucous membranes, secretions, normal flora, immune responses.

• Increased susceptibility: Extremes of age, poor nutrition, chronic illness, breaks in skin, immunosuppression.

• HAI: Infection acquired during care; common sites include urinary, respiratory, GI, skin, wound, IV.

• Infection findings: Local (redness, swelling, pain), systemic (fever, malaise, altered labs).

Medical vs. Surgical Asepsis

• Medical asepsis (clean technique): Reduces number/spread of microorganisms; hand hygiene, clean gloves, routine cleaning.

• Surgical asepsis (sterile technique): Maintains area free from all microorganisms; used for surgery/invasive procedures.

Cleaning, Disinfection, Sterilization, Antisepsis

Routine Practices and Hand Hygiene

• Hand hygiene at key moments: before contact, before aseptic procedure, after body fluid exposure, after contact.

• Methods: alcohol-based hand rub, soap and water, antiseptic hand wash/rub, surgical hand antisepsis.

• Gloves do not replace hand hygiene; perform before and after glove use.

Personal Protective Equipment (PPE) and Additional Precautions

• Gloves: Protect hands from exposure.

• Gown: Protects skin/clothing.

• Mask: Protects nose/mouth from droplets.

• Eye/face protection: For splashes/sprays.

• Fit-tested respirator: For airborne hazards.

Session 2 — Assessment, Diagnosis & Care Planning

Assessment Fundamentals

• Subjective data: What the client says (e.g., "I have pain in my chest.").

• Objective data: What the nurse observes or measures (e.g., BP 162/90 mmHg).

• Sources: primary (client), secondary (family, team), tertiary (literature).

• Methods: interview, observation, physical exam, diagnostics.

Interview, Health History, and Cultural Safety

• Phases: orientation (introduce, confirm identity), working (collect history), termination (summarize, next steps).

• Use open/closed questions, clarify, avoid assumptions, use interpreters as needed.

• Consider culture, values, beliefs, language, and preferences.

From Data to Nursing Judgment

• Recognize cues, validate, compare, cluster, interpret, document, and report.

• Medical diagnosis: Identifies disease (e.g., pneumonia).

• Nursing diagnosis: Client's response (e.g., activity intolerance).

• Collaborative problem: Complication managed with the team.

Nursing Diagnosis and Planning

• Types: actual, risk, health promotion, wellness.

• Planning: prioritize, set goals/outcomes, choose interventions, plan for ongoing/discharge needs.

• Goals: specific, measurable, time-limited, realistic, client-centred.

ADPIE — The Nursing Process

Steps and Application

• Assessment: Collect and interpret data.

• Diagnosis: Identify client responses/problems.

• Planning: Set goals, choose interventions.

• Implementation: Carry out interventions safely.

• Evaluation: Compare response to outcomes, revise as needed.

ADPIE is cyclical and applies to all areas of care, including infection control, safety, mobility, and hygiene.

Critical Thinking in Nursing Practice

Role in Nursing

• Recognize relevant findings, validate data, compare with baseline, cluster cues, interpret patterns.

• Weigh risks/benefits, individualize care, adapt to client needs.

• Avoid errors: incomplete data, misinterpretation, vague statements, failure to document changes.

Client Safety & Risk Management

Safety Competencies

• Culture of safety, teamwork, communication, risk management, human/environmental factors, adverse event response.

• Types of incidents: harmful, near miss, no-harm.

• Core actions: identify client, make environment safe, medication safety, communicate, follow policy.

Falls, Reporting, and Incident Response

• Use validated fall-risk assessment; communicate mobility status; do not delegate assessment.

• After incident: protect, assess, notify, document, report, learn.

• Analysis tools: Root Cause Analysis (RCA), Failure Mode and Effects Analysis (FMEA).

Restraint-Free Care

• Restraints are last resort; use least restrictive option, document thoroughly, reassess frequently.

• Alternatives: reorientation, comfort, toileting, distraction, family involvement.

Positioning of Patients

Assessment Before Moving

• Check consciousness, strength, balance, pain, lines/tubes, body size, required staff/equipment.

Common Positions and Purposes

Session 3 — Activity, Exercise & Mobility

Key Concepts

• Activity: Body movement in daily life.

• Exercise: Planned activity for fitness/therapy.

• Mobility: Ability to move freely/purposefully.

• Activity tolerance: Amount/type of activity without unsafe response.

• Deconditioning: Decline in function from inactivity.

Types of Exercise

Effects of Immobility by System

Range-of-Motion (ROM) Exercises

• Active ROM: Client moves joint independently.

• Active-assisted ROM: Client moves with help.

• Passive ROM: Nurse/caregiver moves joint; maintains flexibility, not strength.

Body Mechanics and Safe Handling

• Wide base, low center of gravity, bend at hips/knees, keep load close, pivot with feet, use legs, coordinate with count.

• Use friction-reducing devices, avoid manual lifting when unsafe.

Ambulation and Gait Devices

Session 4 — Personal Hygiene & Bed Making

Factors Influencing Hygiene

• Social practices, personal preferences, body image, socioeconomic status, health beliefs/motivation, cultural variables, physical condition.

Safety Guidelines for Hygiene Care

• Assist dependent patients, keep items within reach, use gloves for contact with nonintact skin/fluids, move from clean to dirty, test water temperature, use body mechanics, assess before/after care.

Bath Types

Oral Hygiene and Denture Care

• Daily care prevents disease, supports nutrition and communication.

• Store dentures in labeled cup; loose dentures impair eating.

• For unconscious patients: two caregivers, suction, assess gag reflex, use CHG as per policy.

Hair, Nail, and Foot Care

• Hair: brush, comb, shampoo; consider cultural/religious restrictions.

• Nail/foot care: assess for neuropathy/PVD; provider order may be needed for trimming.

• Diabetic foot care: check feet daily, wash/dry, wear shoes, test water temperature, do not smoke.

Bed Making

Vital Signs Foundations

Core Values and Techniques

• Temperature: 36-38°C; oral 37°C; rectal ~37.5°C; axillary ~36.5°C.

• Pulse: Assess rate, rhythm, strength, equality; adult normal per course table.

• Respirations: 12-20 breaths/min; assess rate, depth, rhythm.

• Blood pressure: Average 120/80 mmHg; course range <135/<85; pulse pressure 30-50 mmHg.

• Oxygen saturation: SpO2 >95%.

• Pain: Subjective; "fifth vital sign."

Measurement Sites and Considerations

• Temperature: oral, rectal, axillary, tympanic; each has specific technique and normal range.

• Pulse: radial, carotid, apical (for accuracy, especially if irregular).

• Respirations: observe without drawing attention.

• Blood pressure: use correct cuff size; improper size skews results.

• Pulse oximetry: noninvasive, not for primary heart-rate assessment.

Final Rapid Review

• Medical vs. surgical asepsis: Clean vs. sterile technique.

• Cleaning vs. disinfection vs. sterilization: Remove soil, eliminate most pathogens, destroy all microbial life.

• Routine vs. additional precautions: Routine for all; additional for specific risks.

• Subjective vs. objective data: Client-reported vs. observed/measured.

• Nursing vs. medical diagnosis: Client response vs. disease identification.

• ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation.

• Active vs. passive ROM: By client vs. for client.

• Walker, cane, crutches: Walker = most stability; cane on strong side; crutch weight through hands.

• Client begins to fall: Widen base, protect head, lower down leg, assess, report.

• Unsafe transfer: Stop, reassess, ask for help, use correct device.

• Complete bed bath: Only for totally dependent patients.

• Redness over bony prominence: Assess and document; do not massage.

Before and After Care Checklist