NR-293: WEEK ONE-SEVEN NOTES FUNDAMENTALS- SKILLS | 2026 UPDATE

WEEK ONE-SEVEN NOTES FUNDAMENTALS- SKILLS



WEEK ONE NOTES:
While your quiz will mainly cover chapters 27 and 29, you are still expected to review chapters 15, 16,
17, 18, 19 and 20

Chapters 27, 29

Chapter 27:

Environmental Safety

 Transmission of Pathogens
o Airborne, Contact, Droplet, Protective

Assessment

 Risk for falls
o Mobility
o Use of assisted devices
o Visual disturbances
 Glasses
 Contacts
o Drugs or alcohol
o Clutter on floors
 Risk for medical errors
o Medication administration
 AMOUNT (DOSE), TIME,ROUTE,MEDICATION,PATIENT
 Mathematical error
o Wrong patient, check name and DOB
 Ask them to clarify name
 ID CHECKS
o Allergies
o Diagnosis
o Extremities/body parts
o Communication errors
 Accurate information on the patient
o Documentation errors
 Nurses note

Acute and Restorative Care

 Fall Prevention
o Remove clutter and cords on ground
o Side rails, 2-3 up, all up considered RESTRAINED

, o Bed alarms
o Good lighting
o Non-slip socks
o Wristbands
o Bed locked, lowest position, side rails up
o Call light within reach
 Restraints
o All 4 siderails up considered RESTRAINTS
o Mittens, wrist restraints
o Side tables
o Medications= chemical restraint
o NEED ORDER FOR RESTRAINTS
 Side Rails
o Make sure side rails are and bed locked
o ALL 4 SIDE RAILS UP = RESTRAINED
o 2-3 side rails up

Chapter 29:

Chain of Infection

The most effective basic technique in preventing and controlling the transmission of infection is hand
hygiene

1. Infectious agent or the germ
2. A reservoir
3. A portal of exit
4. A mode of transmission
5. Portal of entry
6. A susceptible host

Healthcare Associated Infections (HAI)

 Iatrogenic infection- caused by heath care worker of stay in hospital
 Types of HAI’s
o Pneumonia, TB, MRSA (COMPLETED ANTIBIOTIC REGIMEN—EDUCATION), CDIFF, UTI,
wound ulcers (NUTRITION AND TURNING PT AND SKIN CARE ), hepatitis, sepsis, COVID
o Catheter associated urinary tract infection (CAUTI)
• Unsterile insertion of urinary catheter
• Improper positioning of the drainage tubing
• Open drainage system
• Catheter and tube becoming disconnected
• Drainage bag port touching contaminated surface
• Improper specimen collection technique
• Obstructing or interfering with urinary drainage
• Urine in catheter or drainage tube being allowed to reenter bladder (reflux)

, • Repeated catheter irrigations
• Improper perineal hygiene
o Surgical and traumatic Wounds
• Improper skin preparation before surgery (e.g., shaving versus clipping hair;
not performing a preoperative bath or shower)
• Failure to clean skin surface properly
• Failure to use aseptic technique during operative procedures and dressing
changes
• Use of contaminated antiseptic solutions
o Respiratory tract
• Contaminated respiratory therapy equipment
• Failure to use aseptic technique while suctioning airway
• Improper disposal of secretions
o Bloodstream
• Contamination of intravenous (IV) fluids by tubing
• Insertion of drug additives to IV fluid
• Addition of connecting tube or stopcocks to IV system
• Improper care of needle insertion site
• Contaminated needles or catheters
• Failure to change IV access at first sign of infection or at recommended
intervals
• Improper technique during administration of multiple blood products
• Improper care of peritoneal or hemodialysis shunts
• Improperly accessing an IV port

Laboratory Data

Isolation and Isolation Precautions

o Tier one- Use with all patients regardless of diagnosis
o Tier two- Transmission based precautions
 Types of isolation
 Airborne
o Droplets smaller than 5 um
o MEASLES, chickenpox, TB, COVID
o N95 respirator
o Private room, negative pressure airflow of at least 6-12
exchanges (HEPA FILTER)
o mask
 Contact
o MRSA, CDIFF, herpes simplex, wounds, Hepatitis B and
Hepatitis C (bloodborne), Hepatitis A (fecal or oral), VRE
o Private room or cohort patients
o Gloves
o Gowns

, o Mask/goggles depending on wound
 Droplet
o Droplets larger than 5 um
o Mask
o Being within 3 feet of the patient
o Private room or cohort patients
o Ex. Influenza, Adenovirus, group A streptococcus, pertussis,
rubella, mumps, PNA
 Protective
o Stem cell transplants, immunocompromised
o Private room, positive airflow (HEPA FILTRATION for incoming
air)
o Mask
o Gown
o Gloves

Surgical Asepsis

 Definition
o Surgical asepsis or sterile technique prevents contamination of an open wound, serves
to isolate an operative or procedural area from an unsterile environment, and maintains
a sterile field for surgery or procedural intervention. Surgical asepsis includes procedures
used to eliminate all microorganisms, including pathogens and spores, from an object or
area
 Principles of Surgical Asepsis
o A sterile object remains sterile only when touched by another sterile object. This
principle guides a nurse in placement of sterile objects and how to handle them.
 Sterile touching sterile remains sterile
 Sterile touching clean becomes contaminated
 Sterile touching contaminated becomes contaminated
 Sterile state is questionable (e.g., when you find a tear or break in the covering
of a sterile object).
o Only sterile objects may be placed on a sterile field.
o A sterile object or field out of the range of vision or an object held below a person’s
waist is contaminated.
 Nurses never turn their back on a sterile field or tray or leave it unattended.
o A sterile object or field becomes contaminated by prolonged exposure to air
 Do not talk, laugh, sneeze, or cough over a sterile field or when gathering and
using sterile equipment. When opening sterile packages, hold the item or
piece of equipment as close as possible to the sterile field without touching
the sterile surface.
o When a sterile surface comes in contact with a wet, contaminated surface, the sterile
object or field becomes contaminated by capillary action