Pneumonia Q 17

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A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions?

  

     A. Admit him to the hospital in respiratory isolation.

     B. Prescribe isoniazid and tell him to go home and rest.

     C. Give a tuberculin test and tell him to come back in 48 hours and have it read.

     D. Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home.

    

    

Correct Answer: A. Admit him to the hospital in respiratory isolation.

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The client is showing s/s of active TB and because of a productive cough is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they’re negative, he would be considered non-contagious and may be sent home, although he’ll continue to take the antitubercular drugs for 9 to 12 months.

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Option B: He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. It is usually given with vitamin B6, pyridoxine (to prevent nerve damage). Isoniazid is recommended for Mantoux or quantiferon positive individuals and should be continued for 6 or 9 months.

Option C: Note that a Mantoux test indicates exposure or latent tuberculosis. However, this test lacks specificity, and patients would require subsequent visits for interpreting the results as well as chest x-ray for confirmation. Although relatively sensitive, the Mantoux reaction is not very specific and may give false positive reactions in individuals who have been exposed to the BCG-vaccine.

Option D: Treatment of confirmed TB requires a combination of drugs. Combination therapy is always indicated, and monotherapy should never be used for tuberculosis. Isoniazid and Rifampicin follow a 4-drug regimen (usually including Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for 2 months or six months. Vitamin B6 is always given with Isoniazid to prevent neural damage (neuropathies).

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