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Foundations in Nursing


Chain of infection event


Infectious agent

Mycobacterium tuberculosis


Mrs. Smith

Portal of exit

Respiratory tract

Mode of transmission


Portal of entry

M cell

Susceptible host

Immunocompromised and persons who were infected within past 2 years with M.tuberculosis

Transmission mode:

The M.tuberculosis spreads from person to person through air through infected respiratory aerosol particles. M.tuberculosis came into the air when an already infected person with tuberculosis sneezes, cough, spits or speaks, they propel the bacteria into the air. The infected aerosol droplet is then transmitted into the healthy person when they breathe. In infected person, the size of M.tuberculosis ranges from 0.65 μm (small) – 7.0 μm (large). When a healthy person breath in the infected aerosol particle enters the nasal passage and moves into the tracheobronchal region where it implants in the area of high partial pressure of oxygen such as renal cortex, reticulate endothelial system, lungs etc. as soon as it settles in the organ such as lungs it starts to grow. The small aerosol particle passes the nasopharyngeal region and deposits in the distal airways while the larger particles get trapped into the oropharynx or upper airway and terminal alveoli which settles and multiply in the alveolar macrophages and dendritic cells. As the bacteria multiplies they are carried by alveolar macrophages to the lymph nodes and spreads to the other sites such as spine or kidney which further causes tuberculosis of cervical lymph nodes (Shiloh, 2016).

2. Standard precautions are those precautious measures that are used for all patient care. These measures are based on assessment of risk and make use of personal protective instruments and common sense practices that are used to prevent the spread of infection from one patient to other and protect healthcare providers to reduce the risk of transmission of infectious agent (Centers for disease control and prevention, 2016)

Following are the standard precautions:

  • Maintaining hand hygiene
  • Using PPE i.e. personal protective equipment
  • Maintain respiratory hygiene
  • Ensuring appropriate patient placement
  • Proper handling, cleaning, and disinfecting patient care instruments and devices
  • Cleaning and disinfecting environment appropriately
  • Following safe injection processes
  • Handling of laundry carefully
  • Ensuring safety of health care workers

For Mrs. Smith’s care with rationale, the two standard precautions that should be taken are:

  1. Primary environmental control measures: Primary environmental control measures will help in controlling the source of infection. This could be done by using exhaust ventilation such as ventilation, booths, and hoods.
  2. Maintaining respiratory hygiene: Respiratory protection control is the most important standard precaution measure that should be taken to prevent the spread of tuberculosis. For this patients should take measures regarding respiratory hygiene and the significance of cough etiquettes.

3. Transmission based precautions are for the individuals with suspected or documented infection with infectious agent for which additional precautious measures are required beyond standard protection to prevent the transmission of pathogen. Generally, there are three kind of transmission based precautions on the basis of route of transmission of pathogen that are contact precautions, droplet precautions, and airborne precautions (ScienceDirect, 2012)

In Mrs. Smith’s case, the two transmission based precautions that should be taken are:

  1. Airborne precautions: Tuberculosis airborne precautions should be taken for the patients who has signs for of tuberculosis or is suspected to have tuberculosis. This can be initiated by keeping the infected patient in an airborne infection isolation room away from other patients in which the environmental factors are controlled in a way so as to minimise the transmission of infection.
  2. Respiratory protection controls: Respiratory protection control is another important factor which will lead to minimise the risk of exposure to infection.

To reduce the risk of exposure to infection, following are protective measure that should be followed:

  • Implementation of respiratory protection program
  • Training HCWs on respiratory protection
  • Educating patients regarding respiratory hygiene and the significance of cough etiquettes.

The effectiveness of such program requires development of standard precautions and should consist information which will provide guidance for the care of respirators (Centers for disease control and prevention, n.d.)

4. The importance of falls prevention strategies using NSQHS standards is that it prevents the falls and minimise the harms from the falls in the patient. It does not intend to direct the physiological or physical harm management but keeps check on addressing the falls and the harm from falls is always a significant issue in Mrs. Smith’s fall risk situation, The impact of falls and the harm from falls is reaching. It provide a valuable set of resources that is used by health services and consider the needs of the patients (Australian commission on Safety and Quality in health care, 2012). It helps in engaging Mrs. Smith into her assessment process for the evaluation of her medical condition and her perception of fall risk will make her more aware of her risks of falling and harms of falling while engaging the patients in her own assessment process and letting her participate in her competence and physical condition, it will also create a personalized prevention program for falls and harms because customized program for fall prevention is much needed for Mrs. Smith as it is clearly shown in her case study that she is susceptible to falls.

Evaluation of intentions of patient and enaging them in the required behavior will also be achieved by this standard. Preparing a plan for prevention of falls and harm will include common interventions, measurement of causes of falls, assessment of risk factors and current and previous medical condition of Mrs, Smith such as her age, anxiety, hypertension, and medical history that includes tuberculosis, Diabetes mellitus type II, and visual imapairement along with the environmental risk factors, obstacles and relevant physiotherapies needed by her which will help in creating personalized plan with better outcomes (Toren & Lipschuetz, 2017).

5. The aim of using falls prevention strategies using NSQHS standards is to reduce the chance of patient falls and to minimise the harm from falls.

For achieving the preventive falls and hams form falls standard there is a criteria, systems and governance for preventing falls and minimizing the harm from falls. Assessing and screening the risks of falls and harms from falling is needed and communicating with caregivers of patients and patients will help in keeping check on identified risks and falls from ris which will help in the development of a strategy for falls prevention and harms.

In case of Mrs. Smith following are the falls prevention strategies that can be implemented during her hospital stay to prevent further falls:

  • Development and implementation of multifactorial falls prevention plan to direct the risk identified during the assessment: Using best practice multifactorial harm minimization and falls prevention strategies and taking actions along with the appropriate and effective monitor in documenting Mrs. Smith’s clinical record on regular basis will help in reducing the chance of the patient falls and to minimise the harm from falls during her hospital stay
  • Development of falls and prevention plan in partnering with carers and Mrs Smith: Developing and ensuring the model of care consistently with carers and patient will help in prevention of falls and falls related harm. The effective model of care will include the medical history of Mrs. Smith, application of falls prevention interventions, diet plan, and optimization of care pathways and communications (Australian commission on Safety and Quality in health care, 2012).

Reference for Foundations in Nursing

Australian commission on Safety and Quality in health care. (2012) National safety and quality health safety standards. Retrieved from: https://www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-Standards-Sept-2012.pdf

Centers for disease control and prevention. ( n.d). Chapter 7: Tuberculosis Infection control. Retrieved from: https://www.cdc.gov/tb/education/corecurr/pdf/chapter7.pdf

Centers for disease control and prevention. (2016). Standard precautions for all patient care. Retrieved from: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html

Government of Western Australia. (2014). Falls prevention model of care. Retrieved from: https://healthywa.wa.gov.au/~/media/Files/Corporate/general%20documents/Health%20Networks/Falls%20prevention/Falls-Prevention-Model-of-Care.pdf

ScienceDirect. (2012). Understanding, controlling, and preventing infectious diseases. Retrieved from: https://www.sciencedirect.com/topics/medicine-and-dentistry/transmission-based-precautions

Shiloh, M. U. (2016). Mechanisms of mycobacterial transmission: how does Mycobacterium tuberculosis enter and escape from human host. Future microbiology, 11(12). 1503-1506.

Toren, O. & Lipschuetz, M. (2017). Falls prevention in hospitals- the need for a new approach an integrative article. Nursing & Care open access Journal, 2(3), 93-96.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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