Reference no: EM133870739
Scenario
You are a public health nurse working at a county immunization and tuberculosis (TB) clinic. B.A. is a 51-year-old woman who wants to obtain a food handler's license and is required to show proof of a negative tuberculosis skin test (TST) result before being hired. She came to your clinic 2 days ago for the first step of the TST. She has returned to have you evaluate her reaction.
B.A. is a natural-born American and has no risk factors for TB infection by the CDC guidelines. She has a 6-year history of type 2 diabetes mellitus that is well controlled with metformin (Glucophage). She admits that her mother had TB when she was a child but says she herself has never tested positive before. She is angry at the thought that she might have TB and says, "I feel just fine, and I don't think anything else is necessary."
The provider orders a chest x-ray examination and informs B.A. that the image is clear, showing no signs of active TB infection. He tells her that she has class 2 TB, or a latent TB infection (LTBI), and that he will report her condition to the local public health department.
The provider decides to place B.A. on a 12-dose, once-weekly regimen of isoniazid and rifampin as directly observed therapy (DOT).
B.A. is hired under the condition that she complies with LTBI therapy and will immediately report any signs and symptoms of active disease to the clinic. She reports weekly for her medications and finishes her 12 weeks of therapy without experiencing any significant effects.
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.
4. List 5 populations at high risk for developing active disease.
5. Describe the 2 methods of TB screening
6. How do you determine whether a TST result is positive or negative?
7. Interpret B.A.'s TST.
8. What other information do you need to obtain from B.A.?
9. You inform B.A. of the test result. She asks you what the result means. How will you respond?
10. What is a LTBI?
11. What parameters are used to decide whether a person is treated for LTBI?
12. Is B.A. a candidate for LTBI treatment? State your rationale.
13. How will you describe LTBI and DOT to B.A?
14. What other information does B.A. need to receive before leaving the clinic?
15. The medications used to treat LTBI have different side effects.