NCLEX RN Practice Question # 408

tuberculosis

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TUBERCULOSIS

Description

  • Highly communicable disease caused by Mycobacterium tuberculosis
  • Transmitted by the airborne route
  • Multidrug-resistant strains of tuberculosis can result from improper compliance, noncompliance with treatment programs, or development of mutations in tubercle bacillus.

Transmission

  • Transplacental transmission is rare.
  • Transmission can occur during birth through aspiration of infected amniotic fluid.
  • The newborn can become infected from contact with infected individuals.

 Risk to mother:

Active disease during pregnancy has been associated with an increase in hypertensive disorders of pregnancy.

Diagnosis:

If a chest radiograph is required for the mother, it is done only after 20 weeks of gestation, and a lead shield for the abdomen is required. Tuberculin skin testing is safe during pregnancy; however the health care provider may want to delay testing until after delivery.

Assessment

Mother

  • Possibly asymptomatic
  • Fever and chills
  • Night sweats
  • Weight loss
  • Fatigue
  • Cough with hemoptysis or green or yellow sputum
  • Dyspnea
  • Pleural pain

 Neonate

  • Fever
  • Lethargy
  • Poor feeding
  • Failure to thrive
  • Respiratory distress
  • Hepatosplenomegaly
  • Meningitis
  • Disease may spread to all major organs

 Interventions

Pregnant client

  • Administration of isoniazid (INH), pyrazinamide, and rifampin (Rifadin) daily for 9months (as prescribed); ethambutol (Myambutol) is added if medication resistance is likely.
  • Pyridoxine (vitamin B6) should be administered with INHto the pregnant client to prevent fetal neurotoxicity caused by the INH.
  • Promote breast-feeding only if the client is noninfectious.

Newborn

  • Management focuses on preventing disease and treating early infection.
  • Skin testing is performed on the infant at birth, and the infant may be placed on INH therapy; the skin test is repeated in 3 to 4 months, and INH may be stopped if the skin test results remain negative.
  • If the skin test result is positive, the infant should receive INH for at least 6 months (as prescribed).
  • If the mother’s sputum is free of organisms, the infant does not need to be isolated from the mother while in the hospital.

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