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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse is supervising an unlicensed assistive personnel (UAP) who is preparing to bathe and provide oral care for a client. The client is currently on contact precautions for a multidrug-resistant organism (MDRO) wound infection. Upon assessment, the nurse notes the client has a new tracheostomy and is frequently coughing up copious amounts of thin respiratory secretions. Which instruction regarding personal protective equipment (PPE) should the nurse provide to the UAP before they enter the room?

  1. A
    Wear a gown and gloves, as the client is only on contact precautions.
  2. Don a clean gown, gloves, a surgical mask, and eye protection before initiating care.Answer
  3. C
    Apply an N95 respirator, a gown, and gloves due to the frequent coughing.
  4. D
    Use gloves and a face shield, but a gown is only required if you touch the infected wound.

Answer

The nurse should instruct the UAP to don a clean gown, gloves, a surgical mask, and eye protection before initiating care.
Standard precautions mandate that healthcare workers wear a mask and eye protection whenever there is a risk of splashes or sprays of blood, body fluids, or secretions. Because the client has a tracheostomy and is coughing up copious secretions, the UAP is at high risk for droplet exposure during bathing and oral care. Additionally, the client is on contact precautions, which specifically require a gown and gloves for any direct client care or contact with the client's environment. Combining these requirements ensures comprehensive protection.

Step-by-Step Solution

1
Identify the baseline transmission-based precautions required for the client's specific diagnosis.
The client has an MDRO infection requiring contact precautions.
Contact precautions mandate the use of a gown and gloves upon entry into the room for any direct client care or interaction with the client's environment.
2
Assess the specific nursing task and client presentation for additional exposure risks.
The UAP will be performing a bath and oral care on a client with a tracheostomy who is coughing up copious secretions.
These factors create a high risk for splashes and sprays of body fluids (respiratory secretions) reaching the healthcare worker's face.
3
Apply standard precautions to the transmission-based baseline.
In addition to the gown and gloves, the UAP must wear a surgical mask and eye protection (goggles or face shield).
Standard precautions dictate that facial protection must be worn whenever a procedure is likely to generate splashes or sprays of blood, body fluids, or secretions, regardless of the isolation status.

Key Concept

Integration of Standard Precautions with Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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