A charge nurse is teaching a newly licensed nurse about the administration of total parenteral nutrition. Which of the following statements should the charge nurse include?

Rationale:

A. Wear a gown while providing personal hygiene: Contact precautions are required for clients with Clostridium difficile to prevent transmission via contaminated surfaces or direct contact. Wearing a gown during personal care protects the nurse’s clothing and skin from spores.

B. Place the client in a room with negative airflow: Negative airflow rooms are required for airborne infections such as tuberculosis or measles. C. difficile is spread via the fecal–oral route and does not require airborne isolation measures.

C. Apply a mask when providing care: Masks are necessary for droplet or airborne pathogens, but C. difficile spores are transmitted through direct or indirect contact, not respiratory droplets, so masks are not routinely required unless there is another indication.

D. Wipe the stethoscope with alcohol after leaving the client's room: C. difficile spores are resistant to alcohol-based disinfectants. Cleaning equipment requires soap and water or a sporicidal disinfectant to effectively remove spores and prevent spread.

Rationale for Correct Choices:

• Intravenous antibiotic: The client is exhibiting signs of postpartum endometritis, including fever, tachycardia, a boggy and tender uterus, and foul-smelling lochia. IV antibiotics are the standard treatment to rapidly address bacterial infection and prevent systemic complications.
• Increase in daily fluid intake: Adequate hydration supports the client’s recovery by improving perfusion to the uterus, aiding in the clearance of infection, and preventing dehydration, especially if the client is febrile or breastfeeding.

Rationale for Incorrect Choices:

• Intrauterine tamponade balloon: This intervention is used primarily for severe postpartum hemorrhage, which is not evident in this client. Vital signs and lochia amount do not indicate ongoing hemorrhage.
• Kleihauer-Betke test: This test identifies fetal-maternal hemorrhage, which is not relevant to postpartum infection management. The client’s presentation suggests infection rather than blood loss.
• Tocolytic medication: Tocolytics are used to suppress preterm labor, which is not a concern for a postpartum client. The client’s symptoms are consistent with infection rather than uterine contractions needing suppression.