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Difficulty: MediumStandard and Transmission-Based Precautions

An interdisciplinary healthcare team is coordinating care for a newly admitted client presenting with generalized, weeping vesicular lesions diagnosed as disseminated herpes zoster. When establishing the infection control and safety protocols for this client, which of the following actions are appropriate? Select all that apply.

  1. Assign the client to a private room equipped with negative-pressure airflow.Answer
  2. B
    Instruct healthcare personnel to wear a standard surgical mask prior to entering the client's room.
  3. Wear a clean, disposable gown and non-sterile gloves when providing direct physical care.Answer
  4. D
    Delegate the continuous evaluation of the client's skin integrity to the unlicensed assistive personnel (UAP).
  5. Ensure the door to the client's room remains securely closed at all times.Answer
  6. F
    Place an N95 particulate respirator on the client whenever transport outside the isolation room is required.

Answer

The appropriate actions are assigning the client to a negative-pressure room, wearing a gown and gloves for direct care, and keeping the room door closed.
Disseminated herpes zoster presents a high risk of transmission through both aerosolized particles and direct contact with weeping lesions. Therefore, the client requires strict airborne and contact precautions. This includes placement in a negative-pressure Airborne Infection Isolation Room (AIIR) with the door kept closed to contain the virus. Furthermore, healthcare personnel must wear clean gowns and gloves to prevent contact transmission during direct physical care.

Step-by-Step Solution

1
Identify the transmission-based precautions required for the client's specific diagnosis.
Disseminated herpes zoster requires both airborne and contact precautions.
The virus can spread through aerosolized droplets from the respiratory tract or generalized lesions, as well as through direct physical contact with vesicular fluid.
2
Determine the environmental requirements for airborne precautions.
The client must be placed in a negative-pressure Airborne Infection Isolation Room (AIIR) with the door closed.
Negative pressure and a closed door prevent the virus from escaping into adjoining hospital corridors.
3
Select the appropriate personal protective equipment (PPE) for healthcare staff and the client.
Staff must wear an N95 respirator, gown, and gloves. If the client leaves the room, the client wears a standard surgical mask.
An N95 protects staff from inhalation, while gowns/gloves prevent physical contamination. A standard mask on the client serves as adequate source control without compromising their respiration.
4
Evaluate the proposed delegation tasks against the RN scope of practice.
Assessment and evaluation cannot be delegated to a UAP.
The UAP can assist with basic hygiene, but clinical evaluation of skin integrity requires RN judgment.

Key Concept

Disseminated Herpes Zoster requires both Airborne and Contact Precautions, necessitating specific environmental controls (negative pressure), appropriate PPE (N95, gown, gloves), and strict adherence to RN delegation principles.
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Topics

Standard and Transmission-Based Precautions

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