A charge nurse is evaluating the implementation of infection control measures by unit nurses when caring for clients who have Clostridium difficile. The charge nurse should intervene for which of the following actions by a unit nurse?

The correct answer is: d.

Choice A reason: An allergy to penicillin requiring an alternative antibiotic to be prescribed is a common and expected variation in care. Allergies are patient-specific factors that must be accommodated within the care pathway. The need for an alternative antibiotic does not typically constitute a variance that requires reporting, as adjustments for allergies are part of personalized care planning.

Choice B reason: Initiating antibiotic therapy 2 hours after implementation of the care pathway may not require a variance report if it falls within the acceptable time frame for antibiotic administration. The timing of antibiotic therapy can be critical, but slight deviations are often accounted for within the care pathway guidelines. However, if the care pathway specifies a narrower time frame for initiation, then this could be a reportable variance.

Choice C reason: Changing the route of antibiotic therapy from IV to PO (oral) is a clinical decision that may be based on the patient's condition, progress, and ability to tolerate oral medications. This switch is a part of antimicrobial stewardship and is often encouraged when clinically appropriate to reduce IV line use and potential complications. It is a standard practice and does not typically require a variance report unless the change contradicts a specific protocol in the care pathway.

Choice D reason: Obtaining a blood culture after the initiation of antibiotic therapy is a significant variance from the standard care pathway. Blood cultures should be obtained before starting antibiotics to accurately identify the causative organisms and their antibiotic sensitivities. Starting antibiotics before obtaining blood cultures can reduce the likelihood of growing the bacteria in the culture, potentially leading to misdiagnosis and inappropriate treatment. This is a deviation from the standard of care that requires a variance report.

Choice A reason: This is the correct choice because a social worker can help the parent with financial assistance, insurance coverage, or other resources to obtain the nebulizer and the medication for the child. A social worker can also provide emotional support and education to the parent and the child about asthma management.

Choice B reason: This is not the correct choice because a pharmacist can only provide information about the medication, such as the dosage, side effects, and interactions. A pharmacist cannot help the parent with the cost of the nebulizer or the medication.

Choice C reason: This is not the correct choice because child protective services is not a referral that the nurse should recommend in this situation. The parent is not neglecting or abusing the child, but rather expressing a concern about the affordability of the nebulizer. Reporting the parent to child protective services could cause more harm than good to the parent-child relationship and the child's well-being.

Choice D reason: This is not the correct choice because a respiratory therapist can only provide technical assistance and education on how to use the nebulizer and the medication. A respiratory therapist cannot help the parent with the cost of the nebulizer or the medication.