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A client admitted to the medical nursing unit has classic symptoms of tuberculosis (TB) and tests positive on the purified protein derivative (PPD) skin test. Several months later, the nurse who cared for the client also tests positive on an annual TB skin test for work. The most likely course of treatment if the chest X-ray (CXR) is negative is to:
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Exposure with a positive TB skin test usually requires six months of prophylactic treatment unless contraindicated. The TB skin test should not be repeated; the results will always be positive. A CXR is usually not required annually in the event that the skin test was positive. TB is a type of pneumonia caused by the acid-fast bacillus, mycobacterium tuberculosis, and is contracted by airborne droplets that enter the lungs and multiply in the pulmonary alveoli. Nursing Assessment: (1) Assessment includes symptom analysis of type and progression of symptoms; color, consistency, and amount of sputum; knowledge of the disease; weight pattern; vital signs; description of any pain; palpable lymph nodes; breath sounds; and activity tolerance. (2) Diagnostic tests:a) CXR (shows dense lesions in the upper lobes, enlarged lymph nodes, and formation of large cavities); b) CBC (presence of leukocytosis); c) Fiberoptic bronchoscopy and bronchial washing (for obtaining culture specimens); d) Tuberculin skin test (positive at 5 to 9 mm for clients with abnormal CXR or HIV; positive at 10 to 15 mm for clients with high-risk factors such as intravenous [IV] drug use; residence in a long-term facility, high-incidence country; positive at 15 mm for all other people); e) Three early-morning sputum collections for acid-fast staining, culture and sensitivity positive for M.tuberculosis. Results can take up to 10 days.Physiological Adaptation
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