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Difficulty: Very hardHandling Hazardous and Infectious Materials

A client who underwent thyroid ablation with a high-dose oral unsealed radioactive iodine (I-131) solution three hours ago experiences sudden, severe nausea. The client vomits a large volume of fluid onto the floor and their hospital gown. As the primary nurse responding to the isolation room, which sequence of actions represents the safest and most appropriate management of this hazardous incident?

  1. Instruct the client to step away from the spill, provide a clean gown for the client to change into, cover the emesis with absorbent chux pads without wiping, and immediately notify the Radiation Safety Officer (RSO).Answer
  2. B
    Don a lead apron and dosimeter badge, use long-handled forceps to carefully retrieve the soiled gown and any solid matter, and place them directly into the room's lead-lined brachytherapy container.
  3. C
    Delegate the initial containment of the spill to environmental services or an unlicensed assistive personnel (UAP) after verifying they are wearing a lead apron, double gloves, and shoe covers.
  4. D
    Don a fluid-resistant gown and respirator, apply a solidifying agent from a chemical spill kit to the fluid, and dispose of the coagulated waste in a yellow trace-hazardous receptacle.

Answer

The most appropriate sequence is to have the client step away and change their gown, cover the emesis with absorbent pads without wiping it up, and immediately notify the Radiation Safety Officer.
The correct action strictly adheres to the principles of radiation safety: time, distance, and shielding. By having the client step away and change, the nurse minimizes the client's ongoing exposure. By simply covering the spill rather than wiping it, the nurse prevents personal exposure and environmental spread. Most importantly, it correctly identifies that a major unsealed I-131 spill requires the specialized intervention of the Radiation Safety Officer (RSO), rather than standard nursing cleanup.

Step-by-Step Solution

1
Protect the client and limit immediate exposure.
The client moves away from the concentrated radiation source (emesis) and removes contaminated clothing.
I-131 is an unsealed radioactive isotope excreted heavily in body fluids (urine, saliva, emesis) shortly after administration. Removing the soiled gown limits the client's continuous skin exposure.
2
Contain the environmental spread without manual cleaning.
Absorbent pads are placed over the spill, but no wiping occurs.
Wiping a radioactive spill spreads the contamination and exposes the nurse's hands to massive doses of radiation. Covering it prevents aerosolization, tracking, and further spread.
3
Notify the Radiation Safety Officer (RSO).
The RSO arrives to oversee and execute the decontamination.
Major unsealed radioactive spills require specialized monitoring equipment (Geiger-Müller counters) and specialized radioactive waste disposal procedures that fall outside the standard scope of a registered nurse or environmental services.

Key Concept

Management of Unsealed Radioactive Material Spills
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Topics

Handling Hazardous and Infectious Materials

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