Case Study for TB You are an

Case Study for TB You are an 11-7 nurse on a busy Med-Surg unit located in Anywhere USA. You receive the report for your shift and begin rounds. Your first client is a 23-year-old male, Eric, with a medical diagnosis of drug resistant TB. Eric had TB as a child but did not complete his medication regimen. He now has a recurrence of TB, and it is drug resistant. What kind of isolation is necessary for TB? Why? Describe how the room should be set up. Ideally patients with TB should be accommodated in negative pressure rooms or Type 5 (respiratory isolation) rooms that are equipped with environmental controls to reduce the risk of transmission of airborne diseases. If this is not possible then the patient should be placed in a single room with a suite from which the air does not circulate to other areas. What type of equipment will you need to wear in order to enter the room? How is TB diagnosed? Tuberculin skin test: Tuberculin – a TB antigen is injected to determine the extent of immune response. CT scan: CT scan of chest helps confirm pulmonary TB. Sputum culture test: Sputum is cultured for the presence of bacteria with a special stain. Usually after skin test. Pleural fluid analysis: Pleural fluid analysis is a group of tests used to diagnose the cause of Pleural TB. Usually after imaging tests. Interferon gamma release assay (IGRA): Blood test to confirm or rule out latent or active tuberculosis. You don the appropriate attire and enter the room. Eric is lying in bed and his mother is in the room. His mother tells you that Eric has been chilling and wants you to take Eric’s temperature. His mother also shows you her right forearm. Her forearm has a red swollen area at least 12mm in diameter. She says this is where she had her TB test done and the area itches. She wants to know if there is any medicine, she can put on the area to stop the itching. She also tells you that she needs to go home soon to take care of her other children. She says that her other children are young and cannot stay alone. Her babysitter will need to leave within 30 minutes, and she needs to be at home. She would like to stay with Eric since he has been feeling so ill this evening. What are the implications of the area on the mother’s forearm? How are the other members of the household affected? The mother is positive for the skin test Does the nurse have a responsibility concerning the mother? Why or why not? 6. What agency is responsible for managing TB cases? How is this care delivered? Eric is currently receiving isoniazid, rifampin, pyrazinamide and streptomycin (IV) for his TB. He is receiving IV fluids NS at 75cc/hr. He is on a soft diet. He has scattered rales bilaterally. He in on O2 at 3L/NP. O2 SAT 91%. Abdomen is soft and nondistended. Bowel sounds are active – last BM is the day before. Vital signs: T 102 P100 R 26 BP 126/76 7. What are the implications of these medications? 8. What parts of the assessment should the nurse focus on? What client teaching should the nurse provide for Eric and his family? One week later Eric is ready to be discharged. His O2 sats are staying around 95 and his temperature has not risen above 99.6F in 24 hours. His lungs are clear. He will be discharged on the same medications. He will receive IV streptomycin at home. Eric has received anti TB drugs for about 2 weeks. His mother had her TB test read as positive. Her chest x-ray was negative. How long will Eric continue on medications? How will his home care be managed? 11. Will Eric be quarantined and if so for how long? 12. What kind of treatment will Eric’s mother receive? Will his mother require quarantine? Why or why not? How is TB spread? 15. What is the difference between active TB and latent TB? What factors have contributed to drug resistant TB?

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