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Difficulty: HardStandard and Transmission-Based Precautions

An oncology client with severe neutropenia is placed on protective environment precautions. The client subsequently develops a heavily draining abdominal wound that cultures positive for Pseudomonas aeruginosa, prompting the addition of contact precautions. When planning care for this client, which action by the practical nurse is correct?

  1. Performing meticulous hand hygiene and donning a clean gown and gloves immediately prior to entering the room.Answer
  2. B
    Placing the client in a negative-pressure isolation room to prevent the wound pathogens from circulating into the hallway.
  3. C
    Removing the contaminated gown and gloves in the hallway after exiting the room to avoid shedding pathogens near the client.
  4. D
    Wearing a fit-tested N95 respirator during all interactions to provide maximum respiratory protection for the immunocompromised client.

Answer

The correct action is to perform meticulous hand hygiene and don a clean gown and gloves immediately prior to entering the room.
The correct answer accurately synthesizes the requirements for both precaution types. By performing meticulous hand hygiene and wearing a clean gown and gloves upon entry, the nurse establishes a barrier that protects the highly vulnerable neutropenic client from opportunistic external pathogens. Simultaneously, these exact same barriers fulfill the requirements for contact precautions, ensuring the nurse does not carry Pseudomonas aeruginosa out of the room on their uniform or hands.

Step-by-Step Solution

1
Analyze the client's dual isolation requirements.
The client requires protective environment precautions for neutropenia (protecting the client from the environment) and contact precautions for the infected wound (protecting the environment and nurse from the client).
Understanding the distinct goals of each precaution type is necessary to synthesize a safe care plan.
2
Evaluate the environmental needs (room pressure).
Protective environments require positive-pressure airflow (HEPA filtered air flowing out of the room).
Negative pressure would draw contaminated hospital air into the room, endangering the immunocompromised client.
3
Determine the correct PPE selection and sequence.
Contact precautions mandate a gown and gloves upon room entry. Protective precautions also benefit from clean barrier nursing to prevent the transfer of opportunistic pathogens.
Simultaneous compliance requires donning the barriers prior to entry and doffing them inside the room prior to exit to contain the contact pathogen.

Key Concept

Synthesizing simultaneous protective environment and contact precaution protocols
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Topics

Standard and Transmission-Based Precautions

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