A nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which of the following items when performing this care?
1. Surgical mask and gloves
2. Particulate respirator, gown, and gloves
3. Particulate respirator and protective eyewear
4. Surgical mask, gown, and protective eyewear
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.
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.