All members of a newly arrived immigrant family from a ...

[vicotolentino]

All members of a newly arrived immigrant family from a third-world country have received positive tuberculosis skin test results. The family consists of parents, a 2-year-old, and a 7-year-old.
 
  Which therapy regimen does the family practice nurse coordinate for this family?
  A.
  A course of intravenous pyrazinamide (PZA) given once a month in the clinic
  B.
  Directly observed therapy with isoniazid (INH) and rifampin (Rifadin) for 9 months
  C.
  Isoniazid and rifampin once a week for 6 months, given by the nurse in the clinic
  D.
  Isoniazid daily for 9 months, followed by rifampin once a week for 3 months

Question 2

A mother brings her newly adopted non-English-speaking 8-year-old daughter to the clinic for follow-up after a complete physical and immunizations before starting school. The child's tuberculin skin test results in redness and induration of 12 mm.
 
  Which response by the nurse is best?
  A.
  Ask the mother what country the child was adopted from.
  B.
  Give the child a mask to wear while in the clinic.
  C.
  Instruct the mother on directly observed TB therapy.
  D.
  Tell the mother the result does not show tuberculosis.

[kardosa007]

Answer to Question 1

ANS: B
Because the duration of therapy for TB is so long, noncompliance is an issue that must be addressed by the nurse. Directly observed therapy (DOT) helps with compliance, which reduces relapses, treatment failure, and drug resistance, especially in children and adolescents. Because all members of the family must take the medication, and because they are immigrants who may have limited English proficiency, limited health literacy, and perhaps values and beliefs that contradict Western medical care, directly observed therapy is vital to ensure cure and to prevent spread of the disease. Drugs used include isoniazid and rifampin for 9 months. Pyrazinamide can be added, decreasing the treatment time to 6 months.

Answer to Question 2

ANS: D
An induration of 10 mm or more is a positive result in children under 4 years of age, so this result is not diagnostic for TB in an 8-year-old child. Knowing what country the child was from originally might provide useful information because if the child received bacille Calmette-Guerin vaccine for TB (common in some foreign countries) the skin test results will be inaccurate. However, the nurse would need to know which countries use the vaccine in order for this information to be useful. Because the result is not positive for TB, the child does not need to wear a mask, nor does the mother need instruction on directly observed therapy.