tuberculosis

A client admitted to the medical surgical unit with possible pulmonary tuberculosis asks the nurse why sputum specimens are needed if the skin test and chest x-ray indicate tuberculosis. The best response by the nurse would be:

"The sputum collection has nothing to do with the diagnosis of TB." CORRECT: "Definitive diagnosis of the infection can only be made by the presence of the organism in sputum." "The sputum helps to determine the presence of secondary infection." Rationale: While a screening test may yield a false positive or false negative, and a chest x-ray can indicate possible symptoms of tuberculosis, only the sputum specimen with the tuberculosis organism can definitively diagnose TB. The purpose of sputum collection is for diagnosis, not for determining disease progression.

The nurse, teaching a client taking prophylactic daily Isoniazid (INH) following tuberculin test conversion, should include which of the following in the instructions?

"This drug turns your urine red-orange. This is harmless." "Do not use aspirin while taking this drug because abnormal bleeding may occur." CORRECT:"Report numbness and tingling of your extremities to your health care provider." "You will need to have periodic eye examinations during treatment." Rationale: When teaching a client who is taking INH, the nurse needs to include information on adverse effects such as numbness and tingling of extremities, and the importance of reporting this information to the health care provider. The remaining statements reflect adverse responses to other drugs used in treatment of tuberculosis

A client with a positive tuberculosis skin test asks the nurse, "What needs to be done in order to determine if I really do have TB?" The nurse's best response is:

A skin test only. CORRECT: A sputum culture and chest x-ray. A chest x-ray. A series of recurrently positive skin tests. A chest x-ray is usually done first because a clear chest x-ray eliminates the diagnosis of TB. If any symptoms of TB are visible on the chest x-ray, a sputum specimen is collected and examined for the presence of the bacilli. There are no serial skin tests. A skin test is for screening purposes, not diagnosis.

The nurse evaluating a tuberculin test result 72 hours after it was administered notes an area of induration 9 mm in diameter. What additional information would indicate to the nurse that this is a positive result? The client:

A.Was born in Southeast Asia. B. Uses injected drugs. C. Has HIV disease. (correct) D.Resides in a long-term care facility. Rationale: A 9 mm induration is a positive result in a client with HIV disease. Induration of 10-15 mm would be considered positive in the other instances.

tuberculosis

An infectious disease caused by mycobacterium tuberculosis which affects the lungs but can also spread to other parts of the body.

Which of the following is highest priority when teaching a client about antituberculosis medications?

Avoid exposure to crowds. Get adequate rest when taking the medications. Eat a well-balanced diet. CORRECT: Take all the medications as prescribed. Rationale: Taking all medications as prescribed is a priority for a client on antituberculosis medications. If clients fail to finish a medication regimen, they may remain infectious to the community at large. Eating right, getting sleep, and avoiding crowds are good advice from the nurse, but they are not the priority.

A client's skin test for tuberculosis is positive. Which of the following is the most appropriate nursing action?

CORRECT: Notify the health care provider. Immediately begin antituberculosis medications. Place the client in a negative air-flow room. Isolate the client immediately. Rationale: A client does not necessarily have tuberculosis based on a positive skin test for tuberculosis. The client has been exposed to the disease, and other tests such as a chest x-ray and sputum culture should be expected to confirm a positive diagnosis of tuberculosis. Isolation, negative air-flow, and medications are not indicated prior to a definitive diagnosis.

The nurse who is working in a clinic would suspect that which of the following people is most likely to contract tuberculosis?

Tobacco farmer CORRECT: Homeless person Day care worker Homemaker Rationale: Crowded conditions common in shelters contribute to the spread of tuberculosis, putting the homeless person at higher risk for developing TB. Farmers, homemakers, and day care workers are at no particular risk.

Which statement by a 17-year-old client indicates the need for additional counseling from the nurse regarding the use of medications for tuberculosis treatment? (Select all that apply.)

YES: "I can return to school after I have been on the medicine for 2 days." NO: "I know this should be reported to the health department." YES: "I will need to take the medications for 4 months." YES:"I should take the Isoniazid when I eat." NO:"Everyone in my home will need to be tested." I soniazid should be taken 1 hour before or 2 hours after meals. The medicine is given for 6-12 months. Individuals cannot return to school until they are symptom-free and have been taking the medication. The statements regarding testing of others in the home and reporting to the health department are correct.

tb precautions

airborne precautions TB masks, respirator, pt will be on respiratory isolation. Negative pressure room, vacuum in the room, keeps the bacteria in the room. Ultraviolet light can destroy airborne bacteria

active tb symptoms

chronic cough, fatigue, chest pain, high fever, night sweats, chills, sputum coughed from the lower respiratory tract may contain blood, malaise, loss of appetite, unexplained weight loss

What information would you want to obtain from b.a. before interpreting skin tests results as positive or negative?

exposure to tb, positive test before, vaccinated with bcg before

latent tb

have a TB infection but bacteria remain in inactive state causing no symptoms; also called inactive TB or TB infection but isn't contagious; 90% of people will never develop active TB

population at risk for tuberculosis

immunocompromised (hiv) young children, drug users, low weight,

tb pathophysiology

mycobaterium pneuonia --> aspirated -> moves to alveoli --> phagocytes try to remove --> inflamm occurs and secretions produced --> can move through the blood and to other organs --> can become dormant (encapsulated or in a tubercle)

positive tb test

swelling (induration) at the site of injection is more than 5 mm in diameter 48 to 72 hours after injection indicates exposure . also hardness

tb screening

tuberculin skin test/Mantoux test/PPD. Intradermal injection of purified protein derivative. Check site in 48-72 hrs, CMI, positive indicates exposure NOT an active infection