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Difficulty: Very hardStandard and Transmission-Based Precautions

A nursing care team is coordinating the admission of a client who has confirmed active pulmonary tuberculosis and concurrently tests positive for norovirus gastroenteritis. Which of the following actions should the nurse include in the client's plan of care? Select all that apply.

  1. Instruct all staff to perform hand hygiene using soap and water rather than an alcohol-based hand rub upon exiting the client's room.Answer
  2. B
    Place the client in a negative-pressure Airborne Infection Isolation Room (AIIR) with a roommate who is also currently being treated for active pulmonary tuberculosis.
  3. Apply a standard surgical mask to the client and cover them with a clean sheet prior to transport for a medically necessary imaging study.Answer
  4. D
    Delegate the evaluation of the client's perianal skin integrity to the unlicensed assistive personnel (UAP) during routine incontinent care.
  5. Don a fit-tested N95 respirator, a disposable isolation gown, and clean gloves before crossing the threshold into the client's room.Answer
  6. F
    Remove the N95 respirator inside the client's room immediately after doffing the isolation gown and gloves.

Answer

The correct actions are: instructing staff to use soap and water for hand hygiene, applying a surgical mask and clean sheet to the client for transport, and donning an N95 respirator, gown, and gloves before entering the room.
The client requires both Airborne Precautions (for active pulmonary TB) and Contact-Enteric Precautions (for norovirus). Entering the room requires an N95 respirator for airborne protection, plus a gown and gloves for contact isolation. During necessary transport, placing a surgical mask on the client contains airborne respiratory secretions, while wrapping them in a clean sheet prevents environmental contamination from contact pathogens. Finally, because norovirus is a non-enveloped virus resistant to alcohol, all staff must wash their hands with soap and water upon exiting the room.

Step-by-Step Solution

1
Identify the required isolation categories based on the client's dual diagnoses.
Active pulmonary tuberculosis requires Airborne Precautions. Norovirus gastroenteritis requires Contact-Enteric Precautions.
Establishing the correct precaution tiers is the foundational step for planning safe and effective infection control.
2
Determine the necessary personal protective equipment (PPE) and doffing sequences for staff.
Staff must wear an N95 respirator, gown, and gloves before entry. The N95 must be removed outside the room.
Combined precautions require PPE that protects against both aerosolized particles and direct environmental contact. Removing the respirator outside prevents airborne exposure.
3
Evaluate transport, delegation, and hand hygiene protocols for these combined precautions.
The client wears a surgical mask and clean sheet during transport; the RN assesses skin (no delegation); hands must be washed with soap and water.
Norovirus resists alcohol, transport must contain both airborne and contact pathogen types, and clinical assessment is strictly within the RN's scope of practice.

Key Concept

Integration of Airborne and Contact-Enteric Precautions
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Topics

Standard and Transmission-Based Precautions

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