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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse is preparing a client with active pulmonary tuberculosis and a heavily draining, uncontained methicillin-resistant *Staphylococcus aureus* (MRSA) wound on the right lower extremity for an essential transport to the radiology department. Which action by the nurse represents the most appropriate management of transmission-based precautions?

  1. A
    Place an N95 respirator mask on the client, wrap the leg in a sterile drape, and wear a gown and gloves while transporting the client through the hospital corridors.
  2. B
    Instruct an unlicensed assistive personnel (UAP) to assess the amount of wound drainage, apply a fresh surgical mask to the client, and immediately transport the client to the department.
  3. Apply a clean, intact dressing over the draining wound, place a standard surgical mask on the client's face, and notify the radiology department of the required isolation protocols.Answer
  4. D
    Ensure the client's wound is exposed for the radiology technician to visualize, don an N95 respirator, and apply clean gloves before pushing the client's wheelchair.

Answer

Apply a clean, intact dressing over the draining wound, place a standard surgical mask on the client's face, and notify the radiology department of the required isolation protocols.
When a client requiring both airborne and contact precautions must leave their negative-pressure room, the primary nursing goal is to contain the pathogens at the source. This is effectively achieved by covering the infected wound with a clean, dry dressing and having the client wear a standard surgical mask to trap expelled respiratory droplets. The receiving department must always be notified in advance so they can prepare the appropriate environment and don necessary personal protective equipment.

Step-by-Step Solution

1
Identify the transmission-based precautions required for the client's diagnoses.
The client requires Airborne Precautions for active pulmonary tuberculosis and Contact Precautions for the draining MRSA wound.
Different pathogens require specific containment strategies to prevent transmission to healthcare workers, other clients, and the environment.
2
Determine the protocol for transporting a client on Airborne Precautions.
The client must wear a standard surgical mask over their nose and mouth to trap expelled droplet nuclei at the source.
Clients do not wear N95 respirators; the standard surgical mask is sufficient to contain their secretions during essential transport.
3
Determine the protocol for transporting a client on Contact Precautions.
The infected area (the heavily draining wound) must be completely covered and contained with a clean, dry dressing.
Containing the wound prevents the shedding of MRSA bacteria onto the wheelchair, stretcher, or hospital corridors.
4
Formulate a safe transport plan that includes interdepartmental communication.
The nurse contains both sources of infection, ensures the transport staff does not wear contaminated PPE in the hallways, and alerts the radiology department.
Clear communication ensures the receiving department has appropriate PPE ready and can manage the room's ventilation and cleaning protocols after the procedure.

Key Concept

Management of concurrent Airborne and Contact precautions during client transport
Estimated Time:1m 30s
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Topics

Standard and Transmission-Based Precautions

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