A nurse in a pediatric clinic is reviewing the laboratory results of a school-age child. Which of the following findings indicates the child may have a potential bacterial infection?

Rationale:

• "We should expect the swelling and tingling to worsen before it gets better." This statement needs reinforcement because worsening swelling and tingling can indicate early signs of compartment syndrome. These symptoms are not normal and should prompt immediate medical attention.

• "It is important that our child avoids placing anything inside the cast." This statement reflects understanding because inserting objects inside the cast can break the skin and introduce bacteria, leading to infection. It may also damage the padding and compromise skin protection.
• "We should prop the casted arm on pillows for the next 24 hours." Elevating the limb helps reduce swelling and pain by improving venous return. Keeping the casted arm elevated is a standard part of cast care teaching after an injury.
• "We should notify the provider if the cast becomes loose over time." A loose cast may no longer immobilize the fracture effectively and can allow excessive movement. It may also rub the skin, increasing the risk of irritation or breakdown.
• "We need to be very careful about how we handle the cast for the first 2 days while it dries." This shows understanding because a plaster cast takes 24 to 48 hours to fully dry. Improper handling can cause pressure indentations, leading to skin damage and poor cast integrity.

Rationale:

A. Change gloves after contact with infectious material: Gloves must be changed after contact with infectious material to prevent cross-contamination. C. difficile spores can survive on surfaces and be transferred if gloves are not properly changed between tasks or patients.

B. Wear an N95 respirator when providing care: An N95 respirator is not required for C. difficile, as it is transmitted via the fecal-oral route through spores, not by airborne particles. Standard and contact precautions not airborne are appropriate for this infection.

C. Wear a gown when providing care: Wearing a gown is essential when caring for a client with C. difficile, as the spores can contaminate clothing and surfaces. Contact precautions require both gloves and gowns for direct care.

D. Remove the thermometer from client's room for use on another client: Equipment used for a client with C. difficile should remain dedicated to that client to prevent environmental contamination. Sharing items between patients increases the risk of spreading spores.

E. Wash hands with an alcohol-based cleaner: Alcohol-based hand sanitizers are ineffective against C. difficile spores. Hands should be washed with soap and water, which is the only effective method for removing these resilient organisms.