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Difficulty: MediumStandard and Transmission-Based Precautions

A facility policy requires staff to wear an isolation gown, an N95 respirator, a face shield, and clean gloves when providing tracheostomy care for a client on airborne and contact precautions. Which sequence should the practical nurse use to put on these protective items prior to the procedure?

  1. Isolation gown, N95 respirator, face shield, clean glovesAnswer
  2. B
    N95 respirator, isolation gown, clean gloves, face shield
  3. C
    Clean gloves, isolation gown, N95 respirator, face shield
  4. D
    Isolation gown, clean gloves, N95 respirator, face shield

Answer

The correct sequence is to first put on the isolation gown, followed by the N95 respirator, then the face shield, and finally the clean gloves.
According to the Centers for Disease Control and Prevention (CDC) guidelines, the safest sequence for donning full personal protective equipment ensures that the foundational body layers and respiratory protection are secured before applying outer barrier layers. The correct order is always gown first, followed by the mask or respirator, then goggles or face shield, and finally gloves. The gloves must be applied last so they can be pulled up to extend over the isolation gown's wrist cuffs, creating a continuous barrier, and ensuring all straps and ties were handled with bare, clean hands.

Step-by-Step Solution

1
Put on the isolation gown and tie it securely at the neck and waist.
The nurse's clothing and exposed torso/arms are covered and protected.
The gown forms the foundational layer of protection and must be secured first with ungloved hands.
2
Don the N95 respirator, securing the elastic bands and fitting the flexible nose piece.
The respiratory tract is sealed against airborne pathogens.
Respiratory protection is critical and must be carefully adjusted to the face without interference from face shields or gloves.
3
Place the face shield over the face and eyes, adjusting the band over the head.
The eyes and mucous membranes are protected from potential splashes during tracheostomy care.
The shield is worn over the respirator as a secondary barrier for the face and eyes.
4
Put on the clean gloves, ensuring they extend over the wrist cuffs of the isolation gown.
The hands are protected and a complete continuous barrier is formed between the gown and the hands.
Gloves are always donned last so they can cover the gown cuffs, leaving no skin exposed, and ensuring that earlier equipment adjustments were made with clean, ungloved hands.

Key Concept

Proper Donning Sequence for Personal Protective Equipment (PPE)
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Topics

Standard and Transmission-Based Precautions

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