A nurse is assessing a client who is at 28 weeks of gestation and has a Clostridium difficile infection.

The nurse should initiate which of the following types of isolation precautions for the client?

Choice A rationale:
A previous delivery at 37 weeks gestation is considered full term, not a risk factor for preterm delivery.
Choice B rationale:
A previous cervical cerclage indicates a history of cervical insufficiency, which is a risk factor for preterm delivery.
Choice C rationale:
A previous reactive non-stress test is a positive sign of fetal well-being, not a risk factor for preterm delivery.
Choice D rationale:
A previous delivery of a newborn weighing 2.5 kg (5.5 Ib) is within the normal range, not a risk factor for preterm delivery.

Choice A rationale:
Yellow exudate will form at the surgical site in 24 hours, which is a normal part of the healing process.
Choice B rationale:
A dark red appearance of the penis could indicate a complication such as infection or necrosis, which would require medical attention.
Choice C rationale:
The Plastibell is not removed manually; it falls off naturally within 5 to 8 days.
Choice D rationale:
A snug diaper could cause pressure and discomfort on the surgical site; it’s recommended to fasten the diaper loosely.

The Plastibell circumcision technique is one of the most common methods of newborn circumcision. It involves placing a plastic ring under the foreskin and tying a suture around it to cut off blood flow. The foreskin then falls off naturally with the ring in seven to 10 days.

The correct answer is A. The nurse should include that “yellow exudate will form at the surgical site in 24 hours” as part of the teaching to the parents. This is because the yellow exudate is a normal sign of healing and should not be confused with infection.

The other options are incorrect because:

b. The parents should notify the provider if the end of the baby’s penis appears black, not dark red. This could indicate that the ring is too tight and is cutting off blood supply to the glans.
c. The Plastibell will not be removed 4 hours after the procedure. It will stay on the penis until the foreskin falls off naturally in seven to 10 days.
d. The newborn’s diaper should be loose, not snug. This is to prevent the ring from being dislodged or rubbing against the diaper.