Fundamentals of Nursing Q 349
A client requires protective isolation. Which client can be safely paired with this client in a client-care assignment? One:
A. Admitted with unstable diabetes mellitus.
B. Who underwent surgical repair of a perforated bowel.
C. With a stage 3 sacral pressure ulcer.
D. Admitted with a urinary tract infection.
Correct Answer: A. Admitted with unstable diabetes mellitus.
The client with unstable diabetes mellitus can safely be paired in a client-care assignment because the client is free from infection. Protective Isolation aims to protect an immunocompromised patient who is at high risk of acquiring micro-organisms from either the environment or from other patients, staff, or visitors.
Option B: Perforation of the bowel exposes the client to infection requiring antibiotic therapy during the postoperative period. Therefore, this client should not be paired with a client in protective isolation. Patients should remain in isolation whilst they remain symptomatic; a risk assessment should be undertaken to ascertain if and when isolation precautions can be relaxed.
Option C: A client in protective isolation should not be paired with a client who has an open wound, such as a stage 3 pressure ulcer. Patient’s requiring protective isolation should be nursed in a single room. Where possible this room should have an ante-room, positive pressure ventilation and Hepa filtered air. The room should have an en-suite and hand washing facilities and the doors(s) should be kept closed at all times.
Option D: A client in protective isolation should not be paired with a client who has a urinary tract infection. Many infections acquired by immunocompromised patients are endogenous infections (An infection caused by an infectious agent that is already present in the body but has previously been inapparent or dormant), however, the transmission of infection from other patients, staff, or the environment can be a risk and therefore extra precautions are required.