Nursing Prioritization Delegation Assignment Q 89
The nurse assessed the client and noted shortness of breath and a recent trip to China. The client is strongly suspected of having Severe Acute Respiratory Syndrome (SARS). Which of these prescribed actions will the nurse take first?
A. Place the client on airborne and contact precautions
B. Introduce normal saline at 75 mL/hr
C. Give methylprednisolone (SOLU-Medrol) 1 g intravenously (IV)
D. Take blood, urine, sputum cultures
Correct Answer: A. Place the client on airborne and contact precautions
SARS is considered deadly so the initial action is to protect other clients and healthcare workers by securing the client in isolation. If an airborne-agent isolation (negative-pressure) room is not yet available, droplet precautions should be initiated until the client can be moved to a negative-pressure room.
Option B: Early in the pandemic, a combination of ribavirin and corticosteroids was adopted as the standard treatment in Hong Kong, Canada and elsewhere because of the apparent good results of the first few patients. Subsequent reports showed that ribavirin was associated with a high rate of toxicity and lacked in vitro antiviral effect on SARS-coronavirus (SAR-CoV).
Option C: The timing and dosage regimens of steroids in the treatment of SARS are controversial. Pulse methylprednisolone 250 to 500 mg/day for 3 to 6 days has been reported to have some efficacy in a subset of patients with “critical SARS”, i.e., critically ill SARS patients with deteriorating radiographic consolidation, increasing oxygen requirement with PaO2 <10 kPa or SpO2 <90% on air, and respiratory distress (rate of 30/min).
Option D: Handle these specimens using Universal Precautions, which includes use of gloves, gown, mask, and eye protection. Any procedure with the potential to generate fine-particulate aerosols (e.g., vortexing or sonication of specimens in an open tube) should be performed in a biological safety cabinet (BSC).