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Difficulty: HardStandard and Transmission-Based Precautions

A 6-year-old child with a widespread, weeping vesicular rash is admitted to the pediatric unit and diagnosed with active varicella. Which actions and precautions must the practical nurse implement when caring for this client? (Select all that apply.)

  1. Verify that the client is placed in a negative-pressure airflow room with the door kept closed.Answer
  2. Don an N95 respirator, an isolation gown, and clean gloves prior to entering the room.Answer
  3. C
    Place an N95 respirator on the client when transport to another department is necessary.
  4. D
    Doff the N95 respirator inside the client's room immediately after removing the gown and gloves.
  5. Leave dedicated reusable clinical equipment, such as a stethoscope, inside the client's room.Answer
  6. F
    Accept the care assignment if lacking documented varicella immunity, provided full personal protective equipment is worn.

Answer

The practical nurse must verify the use of a negative-pressure room, don an N95 respirator along with a gown and gloves before entry, and dedicate reusable clinical equipment to the client's room.
Active varicella (chickenpox) with uncrusted, weeping lesions necessitates a combination of Airborne and Contact precautions. Airborne precautions require the client to be placed in a negative-pressure airflow room (AIIR) with the door closed to prevent contaminated air from escaping. Healthcare workers must don a fit-tested N95 respirator, alongside Contact precaution PPE (an isolation gown and clean gloves), prior to entering the room. Furthermore, Contact precautions dictate that reusable medical equipment be dedicated exclusively to that specific client and left in the room to prevent the spread of infectious exudate.

Step-by-Step Solution

1
Identify the required isolation precautions based on the clinical presentation.
Active varicella (chickenpox) with weeping lesions requires both Airborne and Contact precautions.
The varicella-zoster virus is highly contagious and transmitted via both aerosolized respiratory droplets and direct physical contact with uncrusted lesions.
2
Determine the necessary environmental controls and personal protective equipment (PPE).
A negative-pressure room is required. Staff must don an N95 respirator, isolation gown, and clean gloves before entry.
These combined measures prevent the inhalation of suspended viral particles and stop physical cross-contamination of healthcare workers' clothing and skin.
3
Evaluate protocols for client transport and the PPE doffing sequence.
The client must wear a standard medical mask during transport. The nurse's N95 respirator must be removed outside the room.
Standard masks on clients provide adequate source control. Removing an N95 inside the contaminated room exposes the nurse to infectious airborne particles.
4
Assess the safety and scope of the clinical assignment.
Staff without documented varicella immunity should not be assigned to this client.
PPE does not entirely eliminate exposure risk; assigning immune personnel is the standard of care for ensuring occupational health and safety.

Key Concept

Airborne and Contact Precautions for Active Varicella
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Topics

Standard and Transmission-Based Precautions

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