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Provide education about swine flu infection and how and where viral transmission occurs. Disseminate information on the appropriate PPE (Personal Protective Equipment), such as gowns, gloves, eye protection and fit-tested disposable N95 respirator or better. (Note: persons who have certain chronic pulmonary conditions, such as asthma, emphysema, or restrictive airway disease may require alternate respirators.) Present education to workers on hand washing, appropriate respirator use, gloves and triaging patients who come into the clinic or hospital setting coughing or febrile. Educate patients and families to: (1) Stay home if symptomatic but seek medical help if very high fever (greater than 101 with Tylenol or other appropriate fever-reducing medications), uncontrollable diarrhea, shortness of breath/difficulty breathing. Also, if parents are unwilling or unable to follow simple directions at home then they should seek medical care. (2) Cover mouth/nose if coughing or sneezing, and (3) Identify their primary care provider, hospital, and health insurance or local public health system. accordance with state and federal OSHA guidelines, including timely notice of exposure and access to anti-viral medications, when medically indicated/recommended. Assess all patients for signs and symptoms of abrupt onset of fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis; because the typical incubation period for influenza is one to four days, a patient admitted for an accident or other illness may develop symptoms after hospitalization. Patients and visitors with the above symptoms should immediately be isolated as if they had H1N1 flu until H1N1 can be ruled out. RNs caring for adult patients will observe for primary influenza viral pneumonia, exacerbation of underlying medical conditions (e.g., pulmonary or cardiac disease), secondary bacterial pneumonia, sinusitis, and otitis media; and for co- infections with other viral or bacterial pathogens. Provide care for each individual patient as needed. All patients and families need teaching and reassurance. Restorative Care - Acute and Long Term Care direct care rns in acute care and long term care facilities have a pivotal role in the early detection of signs and symptoms of the disease, the implementation of scientific-based intervention, and the evaluation of the patient's response to the treatment prescribed, including patient advocacy intervention when in the independent professional judgment of the RN the treatment regimen is not in the best interest of the patient. Infection prevention and control play a vital role in our patients' safety and well being. This is even more crucial in our hospitals where our patients may already be compromised due to illness, injury or disease and are at very high risk of life-threatening infections. In general, the Center for Disease Control (CDC) recommends that RN Role in Infection Control for Patients RN Role in Restorative Care - Acute and Long Term Care early detection and intervention. Continuous environmental surveillance and monitoring. Minimizes and seeks to eliminate patients' risk of preventable complications. Reduces susceptibility and exposure to risk factors. Modifies, removes, or treats problems to prevent serious or long term effects. Alleviates the effects of disease and injury by providing competent care that is safe, therapeutic and effective. RN Role in Acute Care insist that your hospital immediately implement—at a minimum—state and federal, OSHA, HHS/Public Health Department and CDC guidelines on disaster preparedness and response, including facility-based policies on disaster preparedness and response. Insist that your facility, at a minimum, provide protection for health care personnel by providing personal protective equipment (PPE) in accordance with state and federal OSHA, HHS/Public Health Department and CDC guidelines. Enforce acute care hospitals' requirement to immediately staff up. There shall be no violation of safe-staffing ratios or any state work rules and no retaliation for sick-calls or care of a family member suffering from swine flu. Insist that medical facilities monitor and track all caregiver and patient unprotected exposures to H1N1 patients and/or patients with flu-like symptoms and provide treatment and follow-up in 32 N AT I O N A L N U R S E nurses consider the possibility of H1N1 influenza virus infections in patients presenting with febrile respiratory illness. A combination of infection control strategies is recommended to decrease transmission of influenza in healthcare settings. These include: Placing any patient with confirmed H1N1 or flu-like symptoms in a private, negative-air-pressure isolation room when possible and having health care personnel observe contact and droplet isolation precautions, plus eye protection. All healthcare personnel who enter the rooms of patients in isolation with confirmed, suspected, or probable novel H1N1 influenza should wear a fit-tested disposable N95 respirator or better. Respiratory protection should be donned when entering a patient's room. Personal protective equipment must be disposed of after each use. Applying current knowledge and demonstrating competency in infection prevention and control procedures. Understanding and implementing Primary, Secondary, and Tertiary prevention measures in all practice settings. Performing ongoing assessments and science-based interventions to eliminate the risk of nosocomial infection and the spread of multi-drug-resistant organisms. Observing and monitoring compliance with infection surveillance standards and protocols. Maintaining professional vigilance and self-awareness to promote a safe and therapeutic environment of care. Providing appropriate education to co-workers, visitors, patients, friends, and families regarding hygiene and infection prevention and control measures. Engaging in case finding of possible undiagnosed patients with influenza. Advocating for laboratory confirmation of diagnosis because the symptoms may or may not be influenza, H1N1 or other form. Observe visitors, physicians, and others for respiratory symptoms. These people will be restricted from visiting patients and encouraged to stay at home until recovered. RN Role in Clinical Facility-Based Enforcement of Patient Health and Safety Regulations collectively and professionally hold employers accountable W W W. N A T I O N A L N U R S E S U N I T E D . O R G JANUARY | FEBRUARY 2010