Stage 1 — Recognize cues. Review the 0700 handoff. Highlight… | MyMerci
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Standard/Transmission-Based Precautions/Surgical Asepsis

Stage 1 — Recognize cues. Review the 0700 handoff. Highlight the findings that require the nurse's immediate follow-up.

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0700 handoff. Mr. R, a 38-year-old man who moved from the Philippines 14 months ago, was admitted six hours ago to a general medical room for presumed community-acquired pneumonia. He reports a three-week productive cough with intermittent blood-streaked sputum, a 12-pound weight loss over six weeks, drenching night sweats, and fatigue. During the morning interview he adds that a coworker has pulmonary TB, diagnosed last month. Overnight, ceftriaxone and azithromycin were started and blood cultures were collected; his wife and two children visited. He shares the room and bathroom with Mr. S, age 72, a roommate on chemotherapy. At 0630: temperature 38.1 C (100.6 F), heart rate 102 beats/min, respirations 22 breaths/min, BP 118/72, and SpO2 93 percent on 2 L/min; these values are unchanged from admission. His WBC count of 12.4 x 10^9/L is noted. The 0500 chest radiograph, read at 0640, shows a right-upper-lobe cavity with surrounding infiltrate. No airborne order is active, and staff wore surgical masks overnight.
0700 handoff. Mr. R, a 38-year-old man who moved from the Philippines 14 months ago, was admitted six hours ago to a general medical room for presumed community-acquired pneumonia. He reports a three-week productive cough with intermittent blood-streaked sputum, a 12-pound weight loss over six weeks, drenching night sweats, and fatigue. During the morning interview he adds that a coworker has pulmonary TB, diagnosed last month. Overnight, ceftriaxone and azithromycin were started and blood cultures were collected; his wife and two children visited. He shares the room and bathroom with Mr. S, age 72, a roommate on chemotherapy. At 0630: temperature 38.1 C (100.6 F), heart rate 102 beats/min, respirations 22 breaths/min, BP 118/72, and SpO2 93 percent on 2 L/min; these values are unchanged from admission. His WBC count of 12.4 x 10^9/L is noted. The 0500 chest radiograph, read at 0640, shows a right-upper-lobe cavity with surrounding infiltrate. No airborne order is active, and staff wore surgical masks overnight.
Explanation
The findings that change the plan are the recent contact with a coworker who has TB, the cavitary right-upper-lobe lesion, a roommate who is immunocompromised by chemotherapy, and staff who used surgical masks rather than respirators. Together they make pulmonary TB a working concern that needs airborne controls and an exposure assessment now. The fever, tachycardia, tachypnea, oxygen need, and leukocytosis overlap with bacterial pneumonia, are unchanged since admission, and are already being treated, so they do not by themselves change the isolation decision.
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