NCLEX RN Practice Question # 401

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TUBERCULOSIS

1. 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.

1. 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.

1. Assessment
2. Mother

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

2. Neonate

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

1. Interventions
2. 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.

2. 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.