After 2 months of tuberculosis (TB) treatment with isoniazid ...

[mcmcdaniel]

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?
 
  a. Teach about treatment for drug-resistant TB treatment.
  b. Ask the patient whether medications have been taken as directed.
  c. Schedule the patient for directly observed therapy three times weekly.
  d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

Question 2

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?
 
  a. Arrange for a friend to administer the medication on schedule.
  b. Give the patient written instructions about how to take the medications.
  c. Teach the patient about the high risk for infecting others unless treatment is followed.
  d. Arrange for a daily noon meal at a community center where the drug will be administered.

[aburgess]

Answer to Question 1

ANS: B
The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed.

Answer to Question 2

ANS: D
Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients but are not likely to be as helpful for this patient.