A nurse is admitting a client who has pertussis. Which of the following types of transmission-based precautions should the nurse initiate?

A. Excessive thirst and urination:
Excessive thirst and urination are symptoms typically associated with hyperglycemia, where there is a high level of glucose in the blood, often related to diabetes. When TPN is stopped suddenly, the concern is more about hypoglycemia due to the abrupt lack of glucose infusion, not hyperglycemia.

B. Shakiness and diaphoresis:
When TPN is suddenly interrupted, the continuous supply of glucose that the patient relies on is abruptly halted. This can lead to a rapid drop in blood sugar levels, causing hypoglycemia. Symptoms of hypoglycemia include shakiness, diaphoresis (sweating), confusion, and even loss of consciousness if not promptly addressed. Monitoring for shakiness and diaphoresis is crucial in this scenario to prevent severe hypoglycemia.

C. Hypertension and crackles:
These symptoms are typically indicative of fluid overload or heart failure. While TPN can contribute to fluid overload if not managed properly, the immediate concern with the cessation of TPN is the lack of glucose and potential hypoglycemia, not fluid overload.

D. Fever and chills:
Fever and chills are generally signs of an infection, such as sepsis. While infections can be a complication of TPN due to the intravenous route of administration, they are not directly related to the sudden stopping of TPN. The primary concern when TPN stops unexpectedly is the risk of hypoglycemia due to the cessation of glucose infusion.

A. Turn the client on his side before starting oral care: This is the correct action. Turning the client on their side helps prevent aspiration of oral secretions or fluids during oral care, especially for an immobile client who may have difficulty swallowing or managing oral secretions effectively. Positioning the client on their side also facilitates better access to the oral cavity for oral care procedures.

B. Use the thumb and index finger to keep the client's mouth open: Using the thumb and index finger to keep the client's mouth open may cause discomfort or injury to the client. Instead, it's essential to encourage the client to open their mouth gently or use an appropriate oral device to keep the mouth open during oral care.

C. Apply petroleum jelly to the client's lips after oral care: Applying petroleum jelly to the client's lips after oral care can help keep the lips moisturized and prevent dryness. However, it is not the most immediate action necessary for oral care. Ensuring proper positioning and cleaning of the oral cavity take precedence during oral care for an immobile client.

D. Use a stiff toothbrush to clean the client's teeth: Using a stiff toothbrush can cause damage to the client's oral tissues, especially if the client has impaired oral hygiene or compromised oral health. It's essential to use a soft-bristled toothbrush or sponge swabs for oral care to prevent injury or trauma to the oral mucosa, especially in clients who are immobile.