Question

Mr. R is a migrant worker who has been in the United States for 6 months. He has been doing odd jobs, one of which has been cleaning chicken houses. While he is waiting for official citizenship papers, he has been unable to obtain permanent housing. He went to the health department when he could not stop coughing. He has lost 10 pounds in the last month and just does not feel well. (Learning Objectives: 5 and 6)

What additional information would be helpful?

He speaks and understands very little English, and his native language is Spanish. He has been staying in the homeless shelter since his arrival, and he denies any significant health issues.

Is it significant that he has been cleaning chicken houses? Why or why not?

A tuberculin skin test was administered, and 2 days later, there is 14 mm of induration.

How would the nurse interpret his TB skin test?

How will a definitive diagnosis of TB be made?

What are some risk factors for TB?

A diagnosis of tuberculosis is confirmed in Mr. R, and he is prescribed a combination of drugs for at least 6 months. What is the rationale for multiple drugs and the length of treatment?

Answer 1

1. The informations such as the other jobs he is doing,how long he is suffering from cough, any other symptoms such as fever, hemoptysis, substance abuse like smoking, alcoholism, living conditions especially whether he is living in a congested places.

2.it may or may not be significant. Because if it is significant, the cause of tuberculosis is may be due to the exhale of dust, feathers etc.if it is not significant, this job may not be the exact cause.his living condition is also be a risk factor.

3. 14 mm induration is suggesting that the affected person may be positive for tuberculosis.

4. Definitive cause can made by carrying out more diagnostic test such as sputum culture to find out bacteria.

5. Risk factors are.

• Diabetes mellitus
• Infection with HIV virus
• Old case of tuberculosis
• Living in overcrowded conditions
• Indoor air pollution
• Smoking

6. Reason for use of multiple drugs are lesser side effects and the treatment contain multiple drugs to which the bacteria are susceptible. Treatment with a single drug can lead to the development of bacterial population resistant to that drug.

The length of treatment depending upon the condition of patient like cavitary or non cavitary tuberculosis.in cavitary tuberculosis, the physician may prescribe drugs for more than 6 months.