The nurse is caring for a client who is receiving parenteral nutrition through a central venous catheter. Which action should the nurse plan to implement to decrease the risk of infection in this client?

1. A

   Track the client's oral temperature

2. B

   Administer antibiotics intravenously

3. C

   Evaluate the differential of the leukocytes

4. D

   Use sterile technique for dressing changes

Appeared in: DHS 2018 shift 1st

Explanation

• The question asks for a nursing action to prevent or decrease the risk of infection.
• Using sterile technique during dressing changes is a direct, primary preventive measure that creates a barrier against pathogens at the catheter insertion site.
• Parenteral nutrition solutions are high in dextrose, making them an ideal medium for bacterial and fungal growth, thus elevating the risk of Central Line-Associated Bloodstream Infections (CLABSI).
• Adherence to aseptic technique is a cornerstone of all CLABSI prevention bundles and a critical nursing responsibility.

Why Other Options Were Wrong

• Option A: Tracking temperature is a monitoring or assessment action, not a preventive one. It helps detect an infection after it has already started.
• Option B: Prophylactic (preventive) administration of antibiotics is not a standard of care for all CVCs because it can lead to the development of antibiotic-resistant bacteria.
• Option C: Evaluating the leukocyte (white blood cell) differential is a diagnostic measure. It helps confirm if an infection is present and may suggest the type (bacterial vs. viral), but it does not prevent the infection.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Infection control and prevention for central venous catheters to guide bedside assessment, documentation, and the next nursing action.
• CLABSIs are a significant cause of healthcare-associated infections, leading to increased patient morbidity, mortality, length of stay, and healthcare costs.
• Nurses are at the forefront of preventing CLABSIs. Meticulous and consistent application of infection control bundles, including sterile dressing changes, is a critical patient safety competency.
• What if? If the patient suddenly develops a fever, chills, and hypotension, the priority shifts from prevention to intervention. The nurse's immediate actions would be to notify the provider, anticipate orders for blood cultures (drawn from both the CVC and a peripheral site), and prepare to administer IV fluids and antibiotics for suspected sepsis.

How to Approach the Question

• First, identify the key goal of the question: to find an action that will 'decrease the risk of infection'. This points to a preventive measure.
• Next, analyze each option to determine its primary purpose: prevention, monitoring, diagnosis, or treatment.
• Evaluate Option A (Track temperature): This is monitoring for signs of infection.
• Evaluate Option B (Administer antibiotics): This is typically a treatment, not a routine preventive measure.
• Evaluate Option C (Evaluate leukocytes): This is a diagnostic test.
• Evaluate Option D (Use sterile technique): This is a direct action to prevent pathogens from entering the CVC site.

Concept Tested & Keywords

• Concept Tested: Infection control and prevention for central venous catheters.
• Stem keywords: parenteral nutrition, central venous catheter, decrease the risk of infection
• Lead-in keywords: action, plan to implement
• Clinical cues: Client receiving parenteral nutrition, which increases infection risk due to high glucose content.

Question ID

Qz53ENKDcTdG1OeUz-DoX4

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 107-109

E6 Pharmacology Nursing Lilley 11e Part 3 p. 234-236