A licensed practical nurse (LPN) is assigned to care for a client recently admitted from a long-term care facility. The client has an unstageable sacral pressure injury, a documented history of methicillin-resistant Staphylococcus aureus (MRSA), and has just developed profuse, watery diarrhea. A stool specimen is pending for Clostridioides difficile. Which actions should the LPN implement? Select all that apply.
- Don a fluid-resistant isolation gown and clean gloves before crossing the threshold into the room.Answer
- BWash hands meticulously with an alcohol-based hand rub for at least 20 seconds after providing client care.
- Ensure a dedicated disposable thermometer and blood pressure cuff are kept exclusively inside the client's room.Answer
- DRemove the isolation gown and gloves in the hallway immediately after exiting the client's room.
- EPerform the initial comprehensive skin assessment of the unstageable sacral wound to establish a baseline.
- Maintain the client in a private room equipped with a dedicated toilet or bedside commode.Answer
Answer
The correct actions include donning an isolation gown and clean gloves before entering the room, ensuring dedicated disposable equipment is kept inside the room, and maintaining the client in a private room with a dedicated toilet.
The client's presentation of a multidrug-resistant organism (MRSA) and suspected C. difficile requires strict Contact and Enteric Precautions. The nurse must don a gown and gloves before entering the environment to prevent uniform contamination. To contain the pathogens, the client must be isolated in a private room with a dedicated toilet, and all assessment equipment (like stethoscopes and blood pressure cuffs) must remain in the room exclusively for that client's use.
Step-by-Step Solution
Key Concept
Integration of Enteric Contact Precautions, PPE protocols, and LPN scope of practice