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Difficulty: HardStandard and Transmission-Based Precautions

A newly admitted client who is receiving immunosuppressive therapy for a renal transplant develops fluid-filled blisters across multiple dermatomes on the chest, back, and face. The healthcare provider suspects disseminated herpes zoster. Which infection control protocols should the nurse initiate for this client? Select all that apply.

  1. Assign the client to a private isolation room with negative air pressure.Answer
  2. Don a fit-tested N95 respirator, disposable gown, and clean gloves before entering the client's room.Answer
  3. C
    Instruct the client to wear an N95 respirator if transport outside the room to radiology is required.
  4. D
    Remove the N95 respirator inside the client's room immediately after completing care.
  5. E
    Delegate the application of soothing topical ointments over the uncrusted vesicles to the unlicensed assistive personnel (UAP).
  6. Dedicate reusable medical equipment, such as a stethoscope and blood pressure cuff, exclusively for this client's use.Answer

Answer

The correct interventions are assigning the client to a negative-pressure isolation room, donning an N95 respirator with a gown and gloves, and dedicating reusable equipment exclusively to the client.
Disseminated herpes zoster in an immunocompromised client requires both Airborne and Contact precautions until all lesions have crusted over. This mandates a negative-pressure isolation room, an N95 respirator, a gown, gloves, and dedicated medical equipment to prevent the spread of the varicella-zoster virus.

Step-by-Step Solution

1
Analyze the clinical presentation.
The client is immunosuppressed and has widespread vesicular lesions across multiple dermatomes, indicating disseminated herpes zoster.
Identifying the specific condition and client immune status is required to determine the necessary transmission-based precautions.
2
Determine the appropriate isolation categories.
Disseminated herpes zoster in an immunocompromised client necessitates both Airborne and Contact precautions.
While localized shingles in an immunocompetent adult may only require Standard or Contact precautions, the disseminated form spreads via airborne particles and direct contact with fluid from uncrusted lesions.
3
Select interventions that comply with Airborne precautions.
The nurse must use a negative-pressure room and wear an N95 respirator. The N95 must be removed outside the room. If transport is needed, the client wears a standard surgical mask.
These measures prevent the inhalation and spread of suspended infectious droplet nuclei.
4
Select interventions that comply with Contact precautions.
The nurse must wear a gown and gloves during care and dedicate reusable medical equipment to the client's room.
These measures prevent the spread of the pathogen via direct contact with the client or their contaminated environment.
5
Evaluate delegation safety.
Wound care and topical medication administration for open lesions cannot be delegated to a UAP.
Applying medicated ointments to active infectious lesions involves nursing assessment and falls outside the UAP scope of practice.

Key Concept

Transmission-Based Precautions for Disseminated Herpes Zoster
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Topics

Standard and Transmission-Based Precautions

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