A 31-year-old caucasian male presented

TUBERCULOSIS CASE STUDY

A 31-year-old caucasian male presented to the Emergency Department (ED) after experiencing gross hemoptysis. He had a 2 month history of productive cough, a 25 pound weight loss, night sweats, and fatigue. A CXR revealed bilateral infiltrates. The initial sputum specimen was obtained & sent for culture, and sensitivity. The patient has a history of heavy alcohol and drug use. He is HIV negative, Hepatitis B and C positive, has a long history of cigarette use, and a chronic smoker’s cough. The patient resides with his wife and three children (ages 9, 7&2yrs) 1) When the patient is admitted to the hospital, should he be placed on precautions? A. No, TB has not been confirmed yet. B. No, he should be admitted to a private room because he probably has lung cancer and isolation would be too distressing. C. No, he can be admitted into a shared room. D. Yes, he should be placed in an isolation room. 2- If the patient has active Tuberculosis what will the sputum culture report reveal? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3- If the culture confirms the diagnosis of TB will the patient be admitted to the hospital? Why? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 4- If the patient is admitted to the hospital, what type of isolation precautions will he be placed on? A. Airborne precautions B. Reverse isolation C. Neutropenic precautions D. Droplet precautions 5- Explain & describe all airborne precaution protocols implemented for this patient. _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 6- Regarding respiratory isolation precautions, what should the patient be educated on? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 7- What are additional tests used to screen for Tuberculosis? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8- With the patient’s sputum culture positive for M. tuberculosis he was immediately started on a standard four drug regimen. What classification of drugs are used to treat tuberculosis? ________________________________________________________________________ 9- Explain why medications used to treat TB are always used in combination? _______________________________________________________________________ _______________________________________________________________________ 10- Which of the following drugs are used to treat active TB? (Select all that apply) A. Cefazolin B. Ethambutol C. Isoniazid (INH) D. Rifampin E. Streptomycin F. Pyrazinamide 11- How long may this patient remain on medication to treat his tuberculosis infection? (Select all that apply) A. 3-6 months B. 6-9 months C. 6-12 months D. Up to 2 years E. Up to 3 years 12- What are some of this patient’s risk factors that put him at risk for pulmonary tuberculosis? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 13- Teach your patient about the side-effects associated with the following medications: 1)Rifampin- ___________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2) Isoniazid- ____________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 14- What is the criteria for this patient’s discharge from the hospital? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 15- Prior to discharge, what is important patient education to provide to this patient? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

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