A home care nurse is making a follow-up visit with a client who has COPD and is using a compressed oxygen system in his home.
Which of the following actions should the nurse take?

Explanation: MRSA is a type of bacteria that is resistant to many antibiotics and can cause serious infections in various parts of the body. The nurse should wear a gown when assisting the client with personal hygiene to prevent contact transmission of MRSA to other clients or staff members. The nurse should also wear gloves and a mask and perform hand hygiene before and after contact with the client or their environment. The nurse should remove personal protective equipment before leaving the client's room and dispose of it properly to avoid contamination of other areas or surfaces. Negative air pressure is not required for MRSA isolation because it is not an airborne infection. The client's visitors should not be restricted, but they should be educated on the proper use of personal protective equipment and hand hygiene when visiting the client.

The correct answer is Choice B.

Choice A rationale: Maintaining bed elevation at 20 degrees is not recommended. The recommended bed elevation for patients receiving enteral tube feedings is at least 30 to 45 degrees.This is to prevent aspiration of the feeding solution into the lungs.

Choice B rationale: Flushing the tubing with 30 mL of water every 4 hours is a recommended practice.This helps to maintain the patency of the feeding tube and prevent clogging.

Choice C rationale: Checking for gastric residual every 12 hours is not sufficient.For patients receiving continuous tube feedings, gastric residual volume (GRV) should be monitored every 4 hours.This helps to assess tolerance to the feeding and prevent complications such as aspiration.

Choice D rationale: Placing enough formula in the container to last 18 hours is not recommended.For an open system, the formula should be replaced every 4 hours to prevent bacterial growth.