The pathophysiology of active Pulmonary Tuberculosis

January 21 in a Northeastern inner city Pulmonary Tuberculosis.  The police bring a 40-year-old male, Tommy B, to the emergency room for possible frostbite to his toes bilaterally.  He was found living below a bring in a cardboard box in a homeless area with many other individuals.  He is 5 ft.  10 in tall and weighs 145 lbs.  He reports fatigue, weight loss of 20 pounds over the last month despite no change in his usual nutrition, loss of appetite, chills, and night sweats.  The nurse immediately places him in isolation in a negative airflow room.




1.  Determine from the current clinical data why the nurse placed the client in a negative airflow isolation room.

a.  In addition to the frostbite, considering the client’s lifestyle and clinical data, for what major health problem is he most at risk and why?


b.  What clinical and lifestyle data will assist you on your decision?


c.  What other populations are also at risk for his major health problem and why?


1100 Tommy is admitted to a negative flow isolation room on a medical surgical unit for treatment of frostbite and to rule out active pulmonary tuberculosis (TB)


1.  Relate Tommy’s current manifestations to the pathophysiology of active pulmonary TB.


2.  What additional screening methods, laboratory and diagnostic tests would the nurse expect to be ordered for this client?  Describe each test and what constitutes significant findings.


3.  Discuss the pharmacology and surgical interventions to prevent and treat TB.


4.  Describe prophylactic treatment for newly diagnosed clients and with noncompliant clients.


5.  Apply the principle related to the spread of droplet nuclei to develop nursing

interventions to prevent the spread of infection during Tommy’s hospitalization, and when he is dislodged.



Tommy is discharged seven days after readmission.  He was diagnosed with active pulmonary TB.  Discharge instructions related to his TB are written as follows:  home health nurse to administer INH, Rifampin, and Pyrazinamide twice weekly for the next two months.  Chest x-ray and sputum specimens monthly for the next three months, avoid crowds and close physical contact, use respiratory precautions for the next two weeks.


1.  Plan the discharge for Tommy using each of the following focus areas:  referral, client teaching, prevention of infection, and monitoring of drug toxicity and side effects


2.  Prioritize a list of Nursing Diagnoses with three nursing interventions for each


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