A nurse is caring for an adult client.

Exhibits

The nurse should determine the assessment findings are consistent with which of the following disease processes?

For each assessment finding, click to specify if the assessment finding is consistent with laryngotracheobronchitis (LTB), epiglottitis, or foreign body aspiration. Each finding may support more than 1 disease process.

A. The number of medication errors committed by another nurse. Quality improvement focuses on systemic issues rather than individual performance. Addressing medication errors should involve evaluating factors such as workflow inefficiencies, high workloads, or unclear protocols rather than singling out a specific nurse. Identifying system-wide improvements enhances patient safety more effectively.
B. Systems that make it difficult for the nurses to do their job. Quality improvement initiatives aim to identify and correct systemic barriers that hinder nursing efficiency and patient care. Issues such as inadequate staffing, poor communication, or outdated technology can lead to errors and inefficiencies. Addressing these barriers can improve workflow, reduce mistakes, and enhance patient outcomes.
C. Collective bargaining activity at a nearby hospital. Discussions about union activities or labor disputes are not directly related to quality improvement. While working conditions can impact patient care, this topic is more relevant to human resources or labor relations than a quality improvement committee focused on systemic patient safety issues.
D. How unhappy the nurses are with their current pay. While job satisfaction is important, a quality improvement committee focuses on patient safety, workflow efficiency, and care outcomes. Salary concerns are best addressed through administration or labor negotiations rather than a committee designed to implement clinical and operational improvements.

• Clostridium difficile infection is likely because the client has pneumonia and is receiving ceftriaxone, an antibiotic known to disrupt gut flora and cause opportunistic infections like C. difficile. The presence of frequent, liquid, foul-smelling stools further supports this diagnosis.
• Myocardial infarction is unlikely because while the client has chest pain, it is pleuritic and related to inspiration rather than the typical crushing, non-pleuritic chest pain seen in an MI. There is no mention of radiating pain, diaphoresis, or hemodynamic instability.
• Pulmonary edema is unlikely since it typically presents with dyspnea, crackles throughout the lung fields, pink frothy sputum, and signs of fluid overload such as peripheral edema and weight gain. The client’s symptoms do not align with this condition.
• Pulmonary embolism is also unlikely, as it presents with sudden-onset dyspnea, pleuritic chest pain, tachycardia, and often calf swelling or a history of deep vein thrombosis. The client lacks the risk factors and clinical signs of PE.
• Placing the client on contact precautions is necessary because C. difficile is highly contagious and spreads through the fecal-oral route. Gloves and gowns should be used to prevent transmission.
• Obtaining a stool culture is necessary to confirm the presence of C. difficile toxins in the stool, which is essential for accurate diagnosis and treatment.
• Requesting a prescription for an anticoagulant is not necessary because the client does not show any signs of thromboembolic disease such as deep vein thrombosis or pulmonary embolism. Anticoagulation could increase the risk of bleeding in the gastrointestinal tract, which would worsen the diarrhea.
• Requesting a prescription for a diuretic is not needed because the client is more likely to be dehydrated due to diarrhea. Diuretics would exacerbate fluid loss and electrolyte imbalances.
• Restricting fluids is not appropriate because dehydration is a major concern with C. difficile infection. Instead, fluid intake should be encouraged to prevent complications from excessive fluid loss.
• Level of consciousness should be monitored because severe dehydration and electrolyte imbalances can lead to confusion, weakness, and altered mental status. While altered mental status can occur with severe dehydration or sepsis, it is not the primary concern at this stage.
• Potassium level should be monitored because diarrhea can cause significant potassium loss, leading to hypokalemia, which can result in muscle weakness, cardiac arrhythmias, and fatigue.
• Urine output is not the most specific parameter for monitoring C. difficile infection. While dehydration is a concern, tracking electrolyte levels and neurological status is more critical.
• Calf swelling is not relevant since the client does not have signs or risk factors for deep vein thrombosis or pulmonary embolism.
• Weight: C. difficile infection can cause significant fluid loss due to persistent diarrhea, leading to dehydration and weight loss. Tracking daily weight helps assess hydration status and the effectiveness of fluid replacement therapy.