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Question

Difficulty: MediumStandard and Transmission-Based Precautions

A hospitalized client is placed on transmission-based precautions due to suspected active pulmonary tuberculosis and a concurrent, confirmed Clostridioides difficile infection. Which of the following nursing actions are appropriate? Select all that apply.

  1. Don an N95 respirator, gown, and clean gloves prior to entering the client's room.Answer
  2. Perform hand hygiene using soap and water immediately after removing personal protective equipment.Answer
  3. Provide the client with a standard surgical mask to wear during transport to the radiology department.Answer
  4. D
    Ensure the client is placed in a positive-pressure isolation room with the door kept strictly closed.
  5. E
    Utilize an alcohol-based hand rub after assessing the client's lung sounds over an intact hospital gown.
  6. F
    Delegate the initial education regarding respiratory hygiene and cough etiquette to the unlicensed assistive personnel (UAP).

Answer

The nurse should don an N95 respirator, gown, and gloves before entry; perform hand hygiene with soap and water after removing PPE; and have the client wear a standard surgical mask during transport.
Caring for this client requires a synthesis of multiple precaution protocols. Airborne precautions for pulmonary tuberculosis mandate a fit-tested N95 respirator and a negative-pressure room. Contact precautions for Clostridioides difficile require a gown and gloves for all interactions. Crucially, C. diff spores are highly resistant to alcohol; therefore, hand hygiene must be performed strictly with soap and water to physically wash away the spores. Finally, standard infection control policy dictates that clients on Airborne precautions wear a standard surgical mask when transported outside their room to filter their exhaled breath and protect others.

Step-by-Step Solution

1
Analyze the client's infectious processes to determine the required isolation categories.
Active pulmonary tuberculosis requires Airborne precautions, and Clostridioides difficile requires Contact precautions with special enteric hand hygiene.
Correctly identifying the transmission route is the first step in applying appropriate infection control measures.
2
Determine the necessary personal protective equipment (PPE) and environmental controls for the combined precautions.
An N95 respirator (or PAPR) is required for Airborne precautions, while a gown and gloves are required for Contact precautions. A negative-pressure room is necessary.
Airborne pathogens can travel long distances on air currents, and enteric pathogens are spread through direct and indirect contact.
3
Evaluate the hand hygiene requirements specific to the identified pathogens.
Handwashing with soap and water is mandatory.
Clostridioides difficile is a spore-forming bacterium. Alcohol-based hand rubs lack sporicidal efficacy.
4
Assess appropriate protocols for client transport and nursing delegation.
The client must wear a standard surgical mask outside the room. Initial client education cannot be delegated.
A standard surgical mask catches exhaled respiratory droplets from the client. RNs cannot delegate initial teaching to UAPs.

Key Concept

Applying combined Airborne and Contact Precautions with enteric specific hand hygiene.
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Topics

Standard and Transmission-Based Precautions

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