Question

Anne Chovy, a 57 year-old female, comes to the office with c/o of blood-tinged sputum; she reports having a productive cough for “about a month”.  Upon further questioning, Anne mentions that she has been having “really bad night sweats but thought it was probably due to menopause”.  She tells you she has lost 15 pounds since her annual check-up, which was 6 months ago.  She lives in a rural home with her spouse and is the volunteer coordinator at the county homeless shelter.  She is given a PPD test and the result is positive.  

PMH:  optic neuritis

1. List the manifestations that helped you make Anne’s diagnosis.   

2. What additional tests may be done next to diagnose/confirm her diagnosis?

3. Anne is hospitalized and placed on special precautions to prevent the spread of illness to others.  What type of precautions do you think will be initiated?

4. Anne is started on 4 different medications:  Isoniazid, Rifampin, pyrazinamide & ethambutol.  Anne asked why she is taking so many medications.  What is the nurse’s best response?

5. What labs will be assessed before initiating drug therapy?  Any special exams?  What labs do you anticipate will be monitored during therapy?  How will you monitor for therapeutic response?

6. Anne is discharged home with prescriptions for a isoniazid/rifampin combo drug and instructions to take pyridoxine (vitamin B6) daily.  Her husband, Bon Chovy, is prescribed isoniazid.  Why is Anne being told to take vitamin B6? Why is her husband Bon also prescribed medication?  What patient teaching will you provide to Anne and Bon?  (Be thorough!)

Answer 1

diagnosis of patient is  pulmonary tuberculosis , the manifestations that help to make the diagnosis are ;

productive cough ( for 1 month ) , bllod tinged sputum , night sweating , remarkable weight loss , positive PPD test.

diagnostic test for pulmonary tuberculosis are ;

tuberculin skin test ( mantoux test / PPD test) , chest x ray ( reveais lesion in the upper lob) , acid - fast bacillus smear ( contain mycobacteria ) , sputum culture .

precausion to prevent the spread of infection to others ;

separation of patient from others by isolation , preferably in negative pressure room , follow personal hygienic measures like mouth care , covering of mouth & nose while coughing and sneezing proper disposal of tissues , hand washing , follow correct treatment regimen .

high prevalence of drug resistance in tuberculosis is the indication to begin TB treatment with 4 or more medications.

before starting treatment patient should have following test like acid fast smear ,mycobacterial cultures ,DST to rifampicin and isoniacid , liver enzyme , creatinine , potassium , HIV rapid test , CD4 count if HIV positive , pregnancy test for women , chest x ray , ecg etc.

during drud therapy monitor liver enyme s , BUN , uric acid ,sputum culture  

vitamine B6 supplementation during TB treatment is necessary to prevent peripheral neuropathy caused by isoniazid or other TB medications.

isoniazid used as a prophylatic or preventive measures for people who are at risk.it involves daily doses for 6 - 12month. liver enzyme ,BUN and creatinine level monitored monthly.

patint teaching includes ;

take medication correctly

take medication 1 hr before meal or empty stomach

avoid food contain tyramine and histamine ( tuna ,red wine ,soy sauce etc )

monitor temperature and breathing report if alteration occure

use eye glass instead of contact lens due to possible colour change of lens with rrifampin therapy it also cause orange discolouration of body fluids

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