Question 1710
Question Answered step-by-step TuberculosisScenario You are a public health nurse working at a county immunization and tuberculosis (TB) clinic. B.A. is a 61-year-old woman who wishes to obtain a food handler’s license and is required to show proof of a negative Mantoux (purified protein derivative [PPD]) test before being hired. She came to your clinic 2 days ago to obtain a PPD test for TB. She has returned to have you evaluate her reaction. 1. What is TB, and what microorganism causes it? [ 2. What is the route of transmission for TB? [k] 3. The CDC recommends screening people at high risk for TB and providing guidelines for preventive therapy to those at high risk for developing active disease. List five populations at high risk. 4. What is the preferred method for TB screening? 5. What additional information would you want to obtain from B.A. before interpreting her skin test result as positive or negative? CASE STUDY PROGRESS B.A. consumes 3 to 4 ounces of alcohol (ETOH) per day and has smoked 1.5 packs of cigarettes per day for 40 years. She is a native-born American, has no risk factors according to the CDC guidelines, lives with her daughter, and becomes angry at the suggestion that she might have TB. She admits that her mother had TB when she was a child but says she has never tested positive. She says, “I feel just fine and I don’t think all this is necessary.”6. How do you determine whether the test is positive or negative? 7. You measure and note that the area of erythema measures 30 mm in diameter and the area of induration (hardened tissue) measures 16 mm in diameter. Determine whether B.A.’s skin test is positive or negative. 8. What does a positive PPD result mean? 9. How would you determine whether B.A. has active TB? CASE STUDY PROGRESS The physician orders a chest x-ray (CXR) and informs B.A. that herCXR is clear (shows no signs of TB). However, he must report her to the local public health department because her PPD test measured greater than 15 mm. The department will monitor her over time and initiate treatment if she gets TB.10. According to the CDC, if a person has a positive PPD, what subsequent steps are necessary? 11. According to the American Thoracic Society and CDC (2006) guidelines, what constitutes usual preventive therapy? (NOTE: Be certain to consult the most recent CDC guidelines. Also note that guidelines for diagnosing and treating TB in individuals who are HIV positive are different from those for lower-risk populations.) 12. Different medications are associated with different side effects. Identify the test used to monitor each possible side effect listed below. A.Peripheral neuropathy1.AudiogramB.Hepatitis2.CBC (WBC and platelets)C.Fever and bleeding problems3.Cr/BUN, CrCl (creatinine clearance)D.Nephrotoxicity/renal failure4.Hepatitis C virus (HCV), AST/ALTE.Hyperuricemia5.Physical exam and monofilament testingF.Optic neuritis6.Red-green discrimination and visual acuityG.Hearing neuritis7.Uric acid 13. Nonadherence to drug therapy is a major problem that leads to treatment failure, drug resistance, and continued spread of TB. The CDC recommends 2 methods to ensure compliance with medication for all patients who have drug-resistant TB and those who take medication 2 or 3 times every week. Identify one of those methods. 14. What information should B.A. receive before leaving the clinic? Health Science Science Nursing MEDICAL NURSING Share QuestionEmailCopy link Comments (0)
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