The nurse is admitting a client who presents with a 3-week history of a persistent cough, hemoptysis, night sweats, and unintentional weight loss. The healthcare provider suspects active pulmonary tuberculosis (TB). Which of the following interventions should the nurse include in the plan of care? Select all that apply.
- Initiate airborne precautions and place the client in a negative-pressure room.Answer
- Don a fit-tested N95 respirator prior to entering the client's room.Answer
- CPlace a fit-tested N95 respirator on the client during transport for a chest x-ray.
- DKeep the door to the client's room open slightly to facilitate close observation.
- Ensure the client wears a standard surgical mask when transported outside the room.Answer
- FDelegate the initial auscultation of the client's lung sounds to the unlicensed assistive personnel (UAP).
Answer
The correct interventions are initiating airborne precautions in a negative-pressure room, donning an N95 respirator before entering, and placing a standard surgical mask on the client during transport.
Clients with suspected active pulmonary tuberculosis require airborne precautions. This includes placement in a negative-pressure airborne infection isolation room (AIIR) to prevent contaminated air from escaping into the hallway. Healthcare personnel must wear a fit-tested N95 respirator or a higher level of respiratory protection before entering the room. If the client must leave the room for essential procedures, they should wear a standard surgical mask to contain respiratory secretions and prevent the expulsion of infectious droplet nuclei.
Step-by-Step Solution
Key Concept
Airborne Precautions for Pulmonary Tuberculosis