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Unit V Promoting Health in Patients With Oxygenation Disorders
Making Connections
l Ensure that the patient and family understand the importance of completing all medications. Treatment for those who have become infected is nec- essary to prevent the spread of the disease and prevent complications that can occur from nontreatment. Incom- plete treatment or interruptions in treatment can cause the emergence of drug-resistant forms of the bacterium. Directly observed therapy (DOT) may be necessary to ensure adherence. l Assess the patient’s support systems and community resources that will ensure successful adherence to the treatment plan after discharge. Early involvement of family, the medical team, and case management will provide the best support for the patient to comply with the established long-term treatment plan. Evaluating Care Outcomes The successful treatment of the patient with TB requires early detection and a comprehensive, interprofessional structure that addresses the clinical, psychosocial, envi- ronmental, and financial issues. Because of the long treat- ment period, patients need to be encouraged to follow the prescribed plan of care after discharge into the commu- nity (see Transitional Care). Indicators of resolving TB infection are the ability of the patient to gain and main- tain a stable body weight, improved skin turgor and mus- cle tone, absence of cough and sputum production, even and unlabored breathing, and the cessation of fevers and night sweats.
CASE STUDY: WRAP-UP Mr. Harold Markham is admitted to the medical unit with the diagnosis of TB. He remains in a private negative airflow room on strict isolation and airborne precautions. He is started on the four-drug combination therapy recommended for treat- ment of TB. He will stay on this drug therapy for 9 to 12 months. It is suspected that he was exposed to TB at the HIV clinic where he volunteers. Centers for Disease Control and Prevention personnel are alerted and sent to screen patients and staff at the clinic. Case Study Questions 1. Which statement is correct related to isolation and airborne precautions for Mr. Markham? A. Mr. Markham should wear a mask at all times. B. Staff entering the room should wear a surgical mask. C. Visitors entering the room should wear an N95 mask respirator. D. Staff entering the room should wear an N95 mask respirator. 2. The nurse should question which order concerning Mr. Markham’s care? A. Humidified oxygen via nasal cannula B. NPO C. Vital signs with oxygen saturation every 4 hours D. Activity as tolerated 3. Mr. Markham’s TB can be characterized as which type of infection? A. An LTBI B. A PTBI C. A symptomatic, noncontagious TB infection D. A symptomatic TB infection 4. Which statement demonstrates adequate teaching has been done? A. “Wow! I’m going to be on these drugs for a long time!” B. “I can stop taking the drugs when I feel better.” C. “My family doesn’t need to wear a mask when they come to visit.” D. “I’m looking forward to going down to the cafeteria to get something to eat.” 5. What symptoms indicate a resolving TB infection? (Select all that apply.) A. Decreased sputum production B. Productive cough C. Stable body weight D. Fevers only at night E. Cessation of night sweats Making Connections to Clinical Judgment 1. Recognizing Cues: What reported symptoms are of particular importance for this patient? 2. Analyzing Cues: What additional data can be gathered to support the disorder?
Transitional Care Tuberculosis
Once the patient with tuberculosis (TB) has been stabilized and has started therapy, treatment can continue at home. National TB treatment guidelines strongly recommend using directly observed therapy (DOT) when treating persons with active TB disease. Directly observed therapy is in place when a trained healthcare worker, home healthcare nurse, aide, or designated and trained individual provides the pre- scribed TB medications and watches the patient swal- low every dose. Family members are typically excluded from this role. A recent study indicates that the use of mobile applications for “video” DOT is showing prom- ise. The patient remains on home isolation, receiving periodic sputum cultures to determine the effective- ness of treatment. The need for home isolation may last up to 6 weeks depending on the patient’s response to therapy.
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