A nurse is caring for a 2-year-old child who has Clostridium difficile. Which of the following actions should the nurse take?

Rationale:

A. "You should have a sputum examination every 4 weeks.": Monthly sputum samples are necessary to monitor treatment effectiveness and determine when the client is no longer infectious. Clients typically need three consecutive negative sputum cultures to be considered non-contagious.

B. "You should obtain a chest x-ray every 3 months.": Chest x-rays are not routinely used for frequent follow-up during treatment. They may be used at diagnosis or treatment completion, but monthly sputum cultures are more reliable for monitoring active infection.

C. "You should schedule a tuberculin skin test every 6 months.": A tuberculin skin test is not useful for clients with active TB or for monitoring treatment response. Once a person has tested positive, repeat testing is not recommended due to persistent reactivity.

D. "You should stop taking your antituberculin medication after 2 weeks.": TB treatment requires a prolonged course typically 6 to 12 months. Stopping medication after 2 weeks increases the risk of treatment failure, relapse, and drug resistance, even if symptoms improve.

Rationale:

• Write the full date on the client's whiteboard: Writing the date helps reinforce orientation to time, which the client is lacking. Visual cues are essential for reorienting clients with delirium. This simple step can reduce confusion and distress.

• Acknowledge the client's feelings: Acknowledging the client’s fear builds trust and therapeutic rapport. It reduces agitation and reassures the client when they experience hallucinations. Validation helps calm the client without reinforcing delusions.

• Request that the client's family bring the client's eyeglasses from home: Requesting the glasses improves the client’s ability to recognize surroundings. Visual impairment worsens confusion in older adults. Familiar visual aids reduce cognitive strain.

• Request that the client have the same caregivers with every shift: Consistent caregivers help the client form familiar relationships. Continuity reduces confusion, especially in clients with dementia or delirium. Routine and predictability lower anxiety.

• Reorient the client often: Frequent reorientation is key in delirium management. It helps the client regain understanding of time, place, and situation. Repetition promotes memory and reduces disorganized thoughts.

• Ask the client's partner to stay with the client as much as possible: The partner provides emotional comfort and familiarity. Their presence helps maintain the client’s orientation and decreases agitation. Family members often support communication and reorientation.

• Provide the client with information about what to expect during their care: Detailed information may overwhelm or confuse a delirious client. Cognitive overload can worsen disorientation. Simpler, brief explanations are more effective.

• Maintain a well-lit environment: Bright lighting may worsen hallucinations or cause overstimulation. Soft, ambient lighting is better suited for reducing visual misperceptions. Delirious patients benefit from calm, low-stimulation environments.