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Zorluk: Çok zorStandard and Transmission-Based Precautions

An oncology nurse is caring for a 55-year-old client who underwent a hematopoietic stem cell transplant two weeks ago. During the morning assessment, the nurse discovers a weeping, clustered vesicular rash strictly following the T10 dermatome on the client's right side. Based on these clinical findings, which infection control and care actions are required? Select all that apply.

  1. Coordinate a transfer to an isolation room equipped with negative-pressure directional airflow.Cevap
  2. Assign a dedicated stethoscope, sphygmomanometer, and thermometer for exclusive use in this client's care area.Cevap
  3. Secure a standard surgical mask over the client's nose and mouth if leaving the clinical unit for imaging.Cevap
  4. D
    Implement standard and contact isolation measures exclusively, given the rash is confined to one specific nerve pathway.
  5. E
    Fit the client with an N95 particulate respirator prior to any transport through hospital corridors.
  6. F
    Instruct the unlicensed assistive personnel (UAP) to apply the prescribed topical antiviral ointment to the affected dermatome after bathing.

Cevap

The required actions are transferring the client to a negative-pressure room, assigning dedicated medical equipment, and placing a surgical mask on the client during transport.
The correct interventions reflect strict adherence to Airborne and Contact Precautions. Severely immunocompromised clients with localized herpes zoster must be treated as having disseminated disease, necessitating a negative-pressure room. Dedicated equipment prevents contact transmission from weeping lesions, and placing a surgical mask on the client during transport provides necessary source control.

Adım Adım Çözüm

1
Analyze the client's systemic immune status.
The client is two weeks post-hematopoietic stem cell transplant, making them severely immunocompromised.
Immune status dictates the severity and potential spread of viral infections.
2
Evaluate the clinical presentation.
The client has a weeping, clustered vesicular rash localized to the right T10 dermatome, indicating herpes zoster (shingles).
Identifying the pathogen and its presentation determines the necessary isolation precautions.
3
Determine the appropriate transmission-based precautions.
Airborne and Contact Precautions are required.
Although the rash is currently localized, the client's severely immunocompromised state creates a high risk for disseminated disease. The CDC mandates both Airborne and Contact Precautions for immunocompromised clients with localized zoster.
4
Select interventions that align with Airborne and Contact Precautions.
The client needs a negative-pressure room (Airborne), dedicated equipment (Contact), and must wear a surgical mask if transported (Airborne source control).
These specific actions break the chain of infection for pathogens transmitted via aerosols and direct contact.

Anahtar Kavram

In severely immunocompromised clients, localized herpes zoster requires both Airborne and Contact Precautions due to the high risk of dissemination. Furthermore, clients on airborne precautions wear standard surgical masks for transport, not N95 respirators.
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