Nursing Prioritization Delegation Assignment Q 49
During the shift of a triage nurse in the Emergency Department (ED), the following clients arrive. Which client needs the most rapid response to protect other clients in the ED from infection?
A. A 72-year-old who must undergo tuberculosis (TB) testing after being exposed to TB during a recent international airplane flight.
B. A 58-year-old who has a history of a methicillin-resistant Staphylococcus aureus (MRSA) abdominal wound infection.
C. A 7-year-old who has a new pruritic rash and a possible chickenpox infection.
D. A 4-year-old who has paroxysmal coughing and whose sibling has pertussis.
Correct Answer: C. A 7-year-old who has a new pruritic rash and a possible chickenpox infection
Varicella or chickenpox is spread by airborne means and could be quickly transmitted to other clients in the ED. The child with a rash should be immediately isolated from the other clients through placement in a negative-pressure room.
Option A: The client who has been exposed to TB does not set other clients at risk for infection because there are no symptoms of active TB. In the past few decades, there has been a concerted global effort to eradicate TB. These efforts had yielded some positive dividends especially since 2000 when the World Health Organization (WHO, 2017) estimated that the global incidence rate for tuberculosis has fallen by 1.5% every year.
Option B: Prevention and control of MRSA infections include necessary infection-control steps like strict hand hygiene and adequate contact precautions. Contact precautions include the use of gowns, gloves, and possibly masks during clinical encounters with patients with MRSA infection. Infection control also may include keeping patients in isolated rooms or the same rooms of other patients who have an MRSA infection.
Option D: Droplet precautions should be instituted for the clients with possible pertussis, but this can be achieved after isolating the child with possible chickenpox. Strict isolation is important while the patient remains infectious. Pertussis is contagious throughout the catarrhal phase and for 3 weeks after the onset of the paroxysmal phase.