A nurse is assessing patients in an emergency department. Which patient requires airborne precautions in addition to standard precautions?

Suspected pulmonary tuberculosis requires airborne precautions due to potential transmission via airborne droplet nuclei (

Core Nursing Explanation Key Concept Analysis: This question tests your knowledge of Transmission-Based Precautions (TBP), specifically identifying which diseases require Airborne Precautions. Standard Precautions are used for all patients. TBP (Airborne, Droplet, Contact) are added based on the specific pathogen's mode of transmission. Airborne precautions are for diseases spread via airborne droplet nuclei (tiny particles < 5 microns) that can remain suspended in the air and travel long distances.

Answer Rationale: Key Point! Pulmonary tuberculosis (TB) is a classic example requiring airborne precautions. The bacterium Mycobacterium tuberculosis is transmitted via airborne droplet nuclei when an infected person coughs, sneezes, or speaks. These particles are so small they can be inhaled deep into the alveoli. Therefore, a patient with suspected pulmonary TB must be placed on airborne precautions immediately, even before confirmation, to prevent transmission. This includes a negative pressure isolation room and N95 respirator (or higher) for healthcare personnel.

Distractor Analysis:
• Watch out for confusion! Option ① (MRSA wound infection) and Option ④ (VRE UTI) require Contact Precautions. These multidrug-resistant organisms (MDROs) are primarily spread through direct contact with the patient or contaminated surfaces/equipment.
• Option ② (Clostridium difficile-associated diarrhea) also requires Contact Precautions, but with a critical addition: soap and water for hand hygiene instead of alcohol-based hand rub, as C. diff spores are not killed by alcohol.

Related Concepts: The three categories of Transmission-Based Precautions are defined by how the pathogen travels: Airborne (small particles, long-distance), Droplet (larger particles, short-range, e.g., influenza, pertussis), and Contact (direct/indirect touch). Some diseases may require a combination (e.g., Contact + Airborne for varicella).

Nursing Clinical Practice Guide Clinical Scenario: You are the triage nurse in the ED. A 45-year-old patient presents with a persistent cough for 8 weeks, night sweats, weight loss, and fatigue. A chest X-ray shows upper lobe infiltrates. The physician suspects pulmonary TB and orders sputum for AFB (Acid-Fast Bacilli) smear and culture.

Nursing Intervention Strategy:
1. Immediate Action: Place the patient in a negative pressure airborne infection isolation room (AIIR) immediately upon suspicion. Do not wait for test results. If an AIIR is not available, place a surgical mask on the patient and move them to a private room with the door closed, then arrange transfer to a facility with an AIIR.
2. Personal Protective Equipment (PPE): Anyone entering the room must wear a fit-tested N95 respirator (or PAPR - Powered Air-Purifying Respirator). Don and doff the respirator outside the room.
3. Patient Transport: Limit transport. If essential, the patient must wear a surgical mask during transport.
4. Patient Education: Educate the patient on "cough etiquette" – covering mouth/nose with a tissue when coughing, proper disposal, and hand hygiene.

Patient Safety and Precautions: Ensure the negative pressure room is monitored and functioning correctly. The door must remain closed. Visitors must be instructed on proper PPE use. For patients with suspected Watch out for confusion! viral hemorrhagic fevers (e.g., Ebola), a combination of Contact, Droplet, and Airborne Precautions may be implemented per CDC guidance.
Nursing Procedure & Medication Flow Airborne Precautions Setup & Monitoring:
1. Verify room is a certified negative pressure AIIR (pressure monitor should show negative reading).
2. Post "Airborne Precautions" signage outside the door.
3. Keep a supply of N95 respirators outside the room.
4. Ensure dedicated patient care equipment is in the room (stethoscope, BP cuff) or that equipment is disinfected before use on another patient.
5. For medication administration, prepare medications outside the room, don PPE, enter, administer, exit, then doff PPE and perform hand hygiene.
A Word from Your Senior Nurse "Infection control is a non-negotiable pillar of nursing. Knowing your precautions isn't just for the test—it protects you, your colleagues, other vulnerable patients, and the community. When you see 'suspected TB' or 'measles,' your brain should immediately sound the 'Airborne Precautions' alarm. In the real world, you might be the first to recognize the need for isolation. That vigilance saves lives."