Question

The public health nurse working at a county immunization and tuberculosis clinic sees a 61 year old woman who wishes to obtain a food handlers license and is required to show proof of a negative Mantoux (PPD) test for being hired. She came to the clinic two days ago to obtain a PPD test for TB. She has returned for the nurse to evaluate her reaction. 1. There are two methods of screening for tuberculosis. Describe the two methods and discuss when one method would be used instead of another. When taking a history the nurse learns that the woman consumes 3 to 4 ounces of alcohol per day and has smoked 1.5 packs of cigarettes per day for 40 years. She is a natural 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 herself has never tested positive. She says, “I feel just fine and I don't think all of this is necessary.” 2. How do you determine whether a Mantoux test is positive or negative? 3. What additional information would the nurse wants to obtain from the client before interpreting her TB skin test as positive or negative? 4. Based on the client’s history determine whether her skin test is positive or negative. 5. The client asks what a positive PPD result means. How should the nurse respond? 6. What steps will need to be done next to determine whether the client has an active TB infection? The provider orders a chest x-ray and informs the client that her chest x-ray is clear and shows no signs of TB. He tells her that she has latent TB infection and that he will report her condition to the local public health department. The health department will monitor her over time and initiate treatment if she converts to active TB. 7. What is latent TB infection (LTBI)? 8. What parameters are used to determine whether treatment should be initiated for LTB I? 9. What is the priority nursing diagnosis for this client at this time and why is this a priority? 10. According to the most current CDC guidelines, what constitutes usual preventative therapy for LTBI?

Answer 1

Question 1:

1. Two meters of screening tuberculosis are

Tuberculin skin test

Sputum culture

Sputum culture is highly indicates the tuberculosis. But tuberculin skin test is not a absolute for detecting tuberculosis.

Question 2:

Mantoux test negative : less than 5mm

High risk: 5- 10mm

Positive : more than 15mm

Question 3:

Additional information:

Associated HIV infection

Post organ transplant

.skin infection

Diabetes.

Because these infections produce false mantoux test.

Question 4:

Based on client history indicates positive for mantoux test.

Question 5:

PPD results indicates positive for mantoux test, that indicates patient is prone to get tuberculosis.

Question 6:

If mantoux test is positive next advice the patient to under go

Sputum culture

Chest x ray

Question 7:

Latent TB infections is a person infected with tuberculosis but does not have active signs and symptoms of TB.

Question 8:

Latent tuberculosis infections will have less bacteria so initiation of treatment choice that tablet INH is necessary.

Question 9:

1. Ineffective airway clearance related to infectious process in lungs.

2. Acute pain related to inflammatory process.

Question 10:

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention