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Difficulty: HardStandard and Transmission-Based Precautions

A nurse is developing a plan of care for a client admitted with active pulmonary tuberculosis and a large, uncontained abdominal wound infected with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following infection control interventions should the nurse include in the plan of care? Select all that apply.

  1. Place the client in a private room equipped with monitored negative air pressure.Answer
  2. Don a fit-tested N95 respirator, a disposable gown, and clean gloves before entering the room.Answer
  3. C
    Place an N95 respirator on the client during transport to other departments.
  4. D
    Remove all personal protective equipment (PPE), including the N95 respirator, inside the room prior to exiting.
  5. Utilize dedicated, single-use medical equipment for the client's vital sign assessments.Answer
  6. F
    Delegate the initial instruction of visitors regarding necessary isolation protocols to the unlicensed assistive personnel (UAP).

Answer

The nurse should place the client in a negative-pressure room, wear an N95 respirator along with a gown and gloves before entering, and use dedicated medical equipment.
The client requires a combination of Airborne and Contact Precautions. Airborne Precautions necessitate placement in a negative-pressure room and the use of an N95 respirator by healthcare personnel. The addition of Contact Precautions for the uncontained MRSA wound requires the concurrent use of a gown, clean gloves, and dedicated, single-use medical equipment to prevent cross-contamination.

Step-by-Step Solution

1
Analyze the client's specific diagnoses to determine the required transmission-based precautions.
Active pulmonary tuberculosis requires Airborne Precautions. The uncontained MRSA wound requires Contact Precautions.
Accurately identifying the modes of disease transmission is the essential first step in selecting appropriate infection control interventions.
2
Evaluate room assignment requirements based on the identified precautions.
Airborne Precautions strictly dictate placement in a negative-pressure Airborne Infection Isolation Room (AIIR).
Negative pressure continuously pulls air into the room and safely exhausts it, preventing airborne droplet nuclei from escaping into the facility hallway.
3
Determine the necessary personal protective equipment (PPE) for healthcare workers entering the environment.
The nurse must wear an N95 respirator (for Airborne Precautions) as well as a disposable gown and clean gloves (for Contact Precautions) prior to entering the room.
Simultaneously combining these PPE elements protects the nurse from both respiratory inhalation of tuberculosis and direct contact with MRSA exudate.
4
Assess the appropriateness of the remaining interventions regarding transport, doffing sequences, and delegation rules.
Client transport requires a standard surgical mask, not an N95. The nurse's N95 must be removed entirely outside the room. Initial teaching cannot be delegated to a UAP.
Adhering to these established clinical guidelines prevents pathogen transmission and ensures that nursing care remains within the legal scope of practice.

Key Concept

Clients with multiple transmissible infections require the simultaneous implementation of all applicable transmission-based precautions. Airborne Precautions mandate a negative-pressure room and an N95 respirator for staff, while Contact Precautions require a gown, gloves, and dedicated equipment.
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Topics

Standard and Transmission-Based Precautions

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