Bethany is a 20-year-old nursing student. Although she has practiced the intramuscular injection technique in the nursing laboratory, she is nervous about giving her first intramuscular injection to a “real” client

QUESTION

Bethany is a 20-year-old nursing student. Although she has practiced the intramuscular injection technique in the nursing laboratory, she is nervous about giving her first intramuscular injection to a “real” client.

Case Study Bethany has reviewed the procedure and the selected intramuscular site landmark technique. She follows all the proper steps, including donning gloves. The syringe was equipped with a safety device to cover the needle after injection, but after giving the injection, before the instructor can stop her, Bethany attempts to recap the needle and sticks herself with the needle through her glove. She is embarrassed to say anything in front of the client so she removes her gloves and washes her hands. Once outside the client’s room, Bethany shows the nursing instructor her finger. There is blood visible on her finger where she stuck herself. Questions

1. What should Bethany do first?

2. Discuss the appropriate interventions that the clinical agency should initiate following Bethany’s needle stick injury.

3. What is the recommended drug therapy based on the level of risk of HIV exposure?

4. Which form(s) of hepatitis is Bethany most at risk for contracting? Discuss her level of risk of the form(s) of hepatitis you identified, as well as the risk of infection with HIV resulting from this needle stick.

5. Can the client’s blood be tested for communicable diseases if the client does not give consent?

6. What will be the recommendations for Bethany’s follow-up antibody testing?

7. HIV test results are reported as positive, negative, or indeterminate. What does each result mean?

8. What is an incident (occurrence or variance) report, and why should Bethany and her nursing instructor complete one?

9. Discuss how Bethany could have prevented this needle stick injury.

10. Bethany’s nursing instructor decides to share information with the nursing students about OSHA’s Needlestick Safety and Prevention Act. Explain OSHA’s role and the safety and prevention act.

11. Discuss who is most likely responsible for the expense of Bethany’s care immediately following the needle stick and any follow-up care. What risks are presented if the expense is prohibitive?

12. Identify three potential nursing diagnoses appropriate for Bethany

ANSWER

The first thing Bethany should do is immediately inform her nursing instructor about the needle stick injury. It is crucial to report any occupational exposure promptly to ensure appropriate follow-up care and minimize the risk of infection or other complications.

The clinical agency should initiate several interventions following Bethany’s needle stick injury

Prompt evaluation of the injury site and determination of the depth of the needle stick.
Documentation of the incident, including details such as the date, time, location, and circumstances surrounding the needle stick.
Assessment of the client’s medical history and infectious disease status, if available, to determine the potential risk of transmission.
Collection of blood samples from both Bethany and the client, with their consent, for testing to assess the presence of communicable diseases.
Immediate medical evaluation and counseling for Bethany, addressing her emotional well-being and concerns about potential infection.
Referral to appropriate healthcare professionals, such as infectious disease specialists or occupational health services, for further assessment and follow-up.
Reinforcement of education and training for healthcare workers regarding proper handling of sharps, adherence to safety protocols, and prevention of needlestick injuries.

Based on the level of risk of HIV exposure, the recommended drug therapy for Bethany would typically involve post-exposure prophylaxis (PEP).

 PEP consists of antiretroviral medications administered to reduce the risk of HIV infection following a potential exposure. The specific regimen and duration of PEP depend on various factors, including the HIV status of the source patient and the time elapsed since the exposure. It is crucial for Bethany to consult with healthcare professionals experienced in managing occupational exposures, such as infectious disease specialists or occupational health services, to determine the most appropriate drug therapy in her specific case.

Bethany is most at risk for contracting Hepatitis B (HBV) and Hepatitis C (HCV) due to the needle stick injury. 

The risk of infection with these forms of hepatitis is higher than that of HIV through percutaneous exposures. HBV is highly infectious, and the risk of transmission following a needle stick injury involving an HBV-positive source is estimated to be around 6-30%. The risk of HCV transmission is approximately 1.8%. In contrast, the risk of HIV transmission through a needle stick injury is relatively low, estimated at about 0.3% (Coppola et al., 2016).

Generally, testing a client’s blood for communicable diseases requires their consent. 

However, in some situations, such as occupational exposures involving healthcare workers, legal and ethical considerations may come into play. Laws and regulations regarding consent for testing may vary depending on the jurisdiction and specific circumstances. In the case of a needle stick injury, it is important to follow established protocols and consult with appropriate healthcare authorities to determine the appropriate course of action regarding testing the client’s blood.

The recommendations for Bethany’s follow-up antibody testing will depend on various factors, including the specific protocols and guidelines in place at her clinical agency and the advice of healthcare professionals managing her case.

Typically, follow-up testing involves repeated blood samples taken at designated intervals to assess the presence of communicable diseases. These intervals may vary depending on the specific disease and testing methods used (Gupta et al., 2014). It is crucial for Bethany to follow the guidance provided by healthcare professionals and adhere to the recommended testing schedule.

HIV test results are reported as positive, negative, or indeterminate. Each result carries a specific meaning
Positive: A positive HIV test result indicates the presence of HIV antibodies or antigens in the individual’s blood, confirming an HIV infection. Further confirmatory testing may be necessary to establish the diagnosis conclusively.
Negative: A negative HIV test result indicates the absence of detectable HIV antibodies or antigens in the individual’s blood at the time of testing. However, a negative result does not rule out the possibility of recent exposure to HIV, and repeat testing may be necessary to confirm the negative status.
Indeterminate: An indeterminate HIV test result means that the test did not provide a clear positive or negative result. Further testing and evaluation are usually required to determine the individual’s HIV status conclusively.

An incident (occurrence or variance) report is a formal document used to record and document any unusual or unexpected incidents, events, or accidents that occur within a healthcare setting.

Bethany and her nursing instructor should complete an incident report to ensure that the needle stick injury is properly documented and addressed. The reasons for completing an incident report include:
Documentation: An incident report serves as an official record of the needle stick injury, providing detailed information about the event for administrative and legal purposes.
Investigation and Analysis: Incident reports facilitate investigations into the circumstances surrounding the needle stick, helping to identify contributing factors and potential areas for improvement in safety protocols.
Preventive Measures: Incident reports support the implementation of preventive measures and corrective actions to minimize the risk of similar incidents in the future.
Quality Improvement: By collecting data from incident reports, healthcare facilities can identify patterns or trends, allowing for quality improvement initiatives to enhance patient and healthcare worker safety.

Bethany could have prevented this needle stick injury by taking several precautions:
Following proper needle safety protocols

This includes not attempting to recap the needle after use, as recapping increases the risk of accidental needle stick injuries.
Focusing and maintaining concentration: Bethany should have been mindful of her actions and focused on the task at hand, especially during critical moments such as handling sharps.
Seeking assistance and guidance: If Bethany felt uncertain or uncomfortable during the procedure, she should have sought assistance from her nursing instructor or a more experienced healthcare professional.
Using safety devices and equipment: Bethany should have utilized the safety device on the syringe to cover the needle after injection. Safety devices, such as retractable needles, can help minimize the risk of accidental injuries.
Practicing good hand hygiene: Bethany should have practiced proper hand hygiene before and after the procedure, reducing the risk of contamination.

OSHA (Occupational Safety and Health Administration) plays a crucial role in ensuring workplace safety, including healthcare settings.

The Needlestick Safety and Prevention Act is a federal law passed in 2000 that amends the OSHA Act to address the specific issue of needlestick injuries and bloodborne pathogen exposures among healthcare workers. OSHA’s role is to enforce and regulate workplace safety standards and provide guidelines for preventing occupational hazards.

The Needlestick Safety and Prevention Act emphasizes the following key points

 Use of safer medical devices: The act requires healthcare facilities to implement safer medical devices, such as needleless systems or sharps with engineered safety features, to minimize the risk of needlestick injuries.

 Comprehensive exposure control plans: Healthcare facilities are required to develop and implement comprehensive exposure control plans, which include assessing and minimizing the risk of occupational exposure to bloodborne pathogens.

 Training and education: The act mandates training and education programs for healthcare workers, focusing on safe practices, proper handling of sharps, and prevention of needlestick injuries.

 Recordkeeping and reporting: Healthcare facilities are required to maintain records of needlestick injuries and exposure incidents. These records are crucial for tracking and analyzing trends, identifying areas for improvement, and facilitating appropriate follow-up actions.

The responsibility for the expense of Bethany’s care immediately following the needle stick and any follow-up care may depend on various factors, including the policies of the clinical agency, the jurisdiction’s regulations, and any applicable insurance coverage.

In many cases, the clinical agency or the educational institution may bear the initial costs associated with occupational injuries and provide insurance coverage for students ([Solved] Bethany Is a 20-year-old Nursing Student. Although She Has. . . | Course Hero, 2020). However, if the expense is prohibitive or falls outside the coverage, Bethany may face financial challenges in accessing necessary care.

The risks presented if the expense is prohibitive include:

 Delayed or inadequate medical care: Bethany may be unable to receive prompt and appropriate medical care if the expense is prohibitive, which can compromise her health and increase the risk of complications or infection.

Emotional and psychological stress: The financial burden associated with medical expenses can cause significant stress, anxiety, and emotional strain for Bethany, potentially affecting her overall well-being and recovery.

 Potential long-term consequences: If Bethany is unable to receive necessary follow-up care and monitoring, it may lead to undetected complications, delayed treatment, or missed opportunities for early intervention.

In such situations, it is essential for Bethany to seek guidance and support from her educational institution, healthcare professionals, and relevant resources to explore available options for financial assistance and ensure she receives the care she needs.

Potential nursing diagnoses appropriate for Bethany include:
Risk for Infection: This nursing diagnosis reflects the potential vulnerability for acquiring communicable diseases as a result of the needle stick injury. Nursing interventions may focus on monitoring for signs of infection, providing education on infection prevention measures, and ensuring appropriate follow-up care.
Anxiety: Bethany may experience anxiety related to the needle stick injury, fear of potential infection, and uncertainty about the consequences. Nursing interventions can include providing emotional support, facilitating coping strategies, and offering education to alleviate anxiety.
Deficient Knowledge: Bethany may have a deficit in knowledge regarding needle safety, infection prevention, and appropriate procedures. This nursing diagnosis highlights the need for education and training to enhance Bethany’s understanding and skills related to safe injection practices, occupational health, and self-care following a needle stick injury.

References

Coppola, N., De Pascalis, S., Onorato, L., Calò, F., & Sagnelli, E. (2016). Hepatitis B virus and hepatitis C virus infection in healthcare workers. World Journal of Hepatology, 8(5), 273. https://doi.org/10.4254/wjh.v8.i5.273 

Gupta, E., Bajpai, M., & Choudhary, A. (2014). Hepatitis C virus: Screening, diagnosis, and interpretation of laboratory assays. Asian Journal of Transfusion Science, 8(1), 19. https://doi.org/10.4103/0973-6247.126683 

[Solved] Bethany is a 20-year-old nursing student. Although she has. . . | Course Hero. (2020, December 2). https://www.coursehero.com/tutors-problems/Nursing/27544813-Bethany-is-a-20-year-old-nursing-student-Although-she-has-practiced-t/