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You are a public health nurse working at a county immunization and tuberculosis (TB) clinic. B.A. is a 61-year-old woman who wishes to obtain a food handler’s license and is required to show proof of a negative Mantoux (purified protein derivative [PPD]) test before being hired. She came to your clinic 2 days ago to obtain a PPD test for TB. She has returned to have you evaluate her reaction.

 

1. What is TB, and what microorganism causes it?

2. What is the route of transmission for TB?

3. The Centers for Disease Control and Prevention (CDC) recommends screening people at high risk for TB. List five populations at high risk for developing active disease.

4. Describe the two methods for TB screening.

5. How do you determine whether a Mantoux test is positive or negative?

 

 

B.A. consumes 3 to 4 ounces of alcohol (ETOH) 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 this is necessary.”

 

6. What additional information would you want to obtain from B.A. before interpreting her skin test result as positive or negative?

7. Determine whether B.A.’s skin test is positive or negative.

8. B.A. asks you what a positive PPD result means. How will you respond?

9. What steps will need to be done to determine whether B.A. has an active TB infection?

 

 

The HCP orders a chest x-ray (CXR) and informs B.A. that her CXR is clear (shows no signs of TB). The HCP tells her that she has a 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 gets TB.

10. What is a latent TB infection (LTBI)?

11. What parameters are used to determine whether treatment should be initiated for LTBI?

12. According to the most current CDC guidelines, what constitutes usual preventive therapy

for LTBI?

 

13. Different medications are associated with different side effects. Identify the test used to

monitor each possible side effect listed as follows:                                                                                                                                                                                                                                                                                                                                                                                     

Side Effects Tests

_____ A. Peripheral neuropathy                                 

_____ B. Clinical hepatitis

_____ C. Fever and bleeding problems

_____ D. Nephrotoxicity/renal failure

_____ E. Hyperuricemia

_____ F. Optic neuritis

_____ G. Hearing neuritis

1. Audiogram

2. CBC (WBC and platelets)

3.Cr/BUN, Cr Cl (creatinine clearance)

4. AST/ALT

5. Physical exam and monofilament testing

6. Red-green discrimination and visual acuity

7. Uric acid

14. Non-adherence to drug therapy is a major problem that leads to treatment failure, drug

resistance, and continued spread of TB. The CDC recommends two methods to ensure compliance with medication for all patients who have drug-resistant TB and for those who take medication two or three times every week. Identify one of those methods.

15. What information should B.A. receive before leaving the clinic?

B.A. is hired under the condition that she must immediately report any signs and symptoms of active disease to the county health department or her physician and have a yearly CXR.

SCIENCE
HEALTH SCIENCE
NURSING
NURSING NUR2222

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