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Unit V Promoting Health in Patients With Oxygenation Disorders
Table 24.10 Classification of Tuberculin Skin Test Reactions
5 mm or Greater
10 mm or Greater
15 mm or Greater
An induration of 10 mm or greater is considered positive in: l Recent immigrants from high-prevalence countries l IV drug abusers l Residents and employees of high-risk settings l Mycobacteriology laboratory personnel l Persons with clinical conditions that place them at high risk l Children younger than 4 years l Infants, children, and adolescents exposed to adults in high-risk categories
An induration of 15 mm or greater is considered positive in any person, includ- ing persons with no known risk factors for TB.
An induration of 5 mm or greater is con- sidered positive in: l HIV-infected persons l A person having recent contact with a person with TB l Persons with fibrotic changes on chest radiography consistent with prior TB l Persons who are immunosuppressed, including those with organ transplants
TB, Tuberculosis. Adapted from Centers for Disease Control and Prevention. (2016). Tuberculosis (TB) fact sheet. http://www.cdc.gov/tb/publications/ factsheets/testing/skintesting.htm
Extrapulmonary TB can present as meningitis, lymphade- nopathy, bone disease, and liver and kidney failure.
other persons. A basic four-drug combination is recom- mended for the treatment of TB and should continue for 9 to 12 months. The basic recommended treatment for TB is broadly applicable, but modifications may be necessary in special circumstances, such as HIV+, pregnancy, drug resistance, and children (Table 24.11).
Connection Check 24.4 The nurse understands that the priority intervention with the patient with TB is which of the following? A. Antibiotic administration B. Initiation of isolation C. TB test D. Chest x-ray
Safety Alert
Immediate isolation of the patient with suspected or confirmed TB infection in a
private room with negative airflow capabilities is a priority. Negative airflow occurs when air moves into the contami- nated area or into the patient’s room from bordering areas. The institution of airborne precautions , the use of an N95 mask respirator for healthcare personnel entering the patient’s room (requires fit-testing), and a snug-fitting surgical mask for visitors are essential interventions. The patient’s movement and transportation to other depart- ments should be limited to essential needs only. Patients who must leave the negative-pressure room should also wear a surgical mask. Complications Extensive respiratory tissue destruction by M. tuberculosis can lead to respiratory failure, bronchopleural fistula for- mation (an abnormal pathway or sinus tract that develops between the bronchus and pleural space), and pleural effu- sions (collections of fluid in the pleural space). Untreated active TB can spread to parts of the body outside the respi- ratory system via the bloodstream and lymph circulation.
Nursing Management Assessment and Analysis
Unexplained weight loss, night sweats, fever, and chills are seen as a result of the inflammatory response, specifically the body’s attempt to interact with the Mycobacterium . The Mycobacterium itself may also release fever-causing signals. Rusty-colored sputum occurs as a result of the destruction of lung tissue during granuloma formation. Tissue fragil- ity and microbleeds result. The collection of WBCs pre- sents in an attempt to wall off the infection, resulting in the production of sputum. Pleuritic chest pain is a result of chronic coughing. Nursing Diagnoses/Problem List l Ineffective airway clearance l Alteration in gas exchange related to necrosis of lung tissue
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