A nurse is preparing discharge teaching for a client who has Crohn's disease and a new ileostomy. Which of the following community resources should the nurse include in the teaching?

• Infection: Poor glycemic control, indicated by an elevated hemoglobin A1c of 9.5%, leads to impaired immune function, delayed wound healing, and increased risk of postoperative infections. Chronic hyperglycemia promotes bacterial growth, reduces leukocyte function, and compromises vascular integrity, further predisposing the client to infections.
• Deep vein thrombosis (DVT): Postoperative immobility, increased coagulation, and endothelial injury increase DVT risk. However, BUN of 15 mg/dL is within the normal range and does not indicate dehydration or hemoconcentration, which would contribute to thrombus formation.
• Hypovolemia: Reduced blood volume typically presents with signs such as hypotension, tachycardia, and elevated BUN/creatinine ratio. Preoperative hypertension does not indicate hypovolemia and is more commonly associated with chronic vascular resistance rather than acute fluid loss.
• BUN of 15 mg/dL: A BUN level within the normal range does not suggest an increased risk for DVT or fluid imbalance. It primarily reflects renal function and hydration status, neither of which are significantly altered in this case.
• Preoperative hypertension: While chronic hypertension is a cardiovascular risk factor, it does not indicate hypovolemia, which would present with dehydration-related signs such as orthostatic hypotension, tachycardia, and decreased urine output.
• Hemoglobin A1c: A value of 9.5% indicates poor long-term glycemic control, which impairs immune function and slows wound healing. Elevated glucose levels reduce neutrophil function, impair macrophage activity, and increase oxidative stress, all of which contribute to a heightened infection risk.

A. Wears an N95 mask when providing wound care: MRSA is transmitted via direct contact rather than airborne particles, so an N95 mask is unnecessary unless the client has a secondary airborne infection like tuberculosis. Standard contact precautions, including gloves and gowns, are sufficient to prevent transmission.

B. Wears clean gloves when caring for the client: MRSA requires contact precautions, which include wearing gloves when touching the client or contaminated surfaces. Gloves help prevent the spread of bacteria, particularly from wound drainage, body fluids, or contaminated equipment.

C. Remains 3 feet away from the client: MRSA does not require droplet precautions, which would necessitate maintaining a distance of 3 feet. Instead, direct skin-to-skin contact or contact with contaminated surfaces is the primary mode of transmission, requiring gloves and gowns rather than distance.

D. Disposes of isolation gown outside of the client's room: Isolation gowns should be removed inside the client’s room to prevent cross-contamination. Removing the gown before exiting the room reduces the risk of spreading MRSA to other areas and healthcare personnel.