Kaitlin B. answered • 05/07/23
A new tutor who loves to help others learn.
Hello!
I'l go over the topics in general and I hope this info will help you better understand the concepts for the review.
1) Testing for TB can be done in a variety of different ways, however there is a difference between testing for TB and screening for TB. Something like a QuantiFERON Gold blood test would be a test for tuberculosis whereas the Mantoux skin test is actually a screening tool. This is important to consider when someone is positive for a Mantoux skin test it doesn't automatically mean they have active tuberculosis- further testing is indicated like a blood test or a chest Xray. A negative Mantoux skin test depending on the source you use is less than a 10mm of induration (a hardened raised area) NOT the area of erythema or redness. Greater than 5mm of induration is considered a positive result in immunocompromised people because their body cannot produce the same robust reaction- similar to how sometimes vaccines are less effective for the immunocompromised because their body cannot produce the same antibody response.
2) Important notes to understand regarding tuberculosis drug management are that these drugs are antimycobacterial medications (antibiotics). These drugs are typically taken for 6-12 months and include isoniazid, rifampin, pyrazinamide, and ethambutol or "RIPE" therapy. important things to note include the fact that Rifampin will turn the patients urine to red/orange color. Also most of these drugs (rifampin and pyrazinamide especially) carry the risk of hepatotoxicity/ hepatitis- liver damage. So it will be important for patient's LFT's, bilirubin, etc to be monitored. Ethambutol carries the risk of eye damage so it will be important for the pain to report eye pain, visual changes etc. and follow up with their eye care provider. Sputum cultures will be required throughout therapy to manage progress/ response to drug treatment.
3) Suicide prevention starts with risk identification. To prevent suicide, we must first identify those at risk for suicide- risk factors for suicide include a history of suicide attempts, a family history of suicide attempts or commitments, a PMH history of mental illness, hopelessness or recent severe life stressors such as loss of spouse, job, home etc, comorbid substance use disorders, chronic comorbid health conditions like Traumatic brain injury, chronic pain, trauma etc. Patient's should be asked directly about their suicidal thoughts/ ideations/plans. Components of a suicide assessment include presence of suicidal ideation (active vs. passive), is there a plan in place? is the plan lethal? does the patient have the means accessible? hx of impulsivity? Methods to prevent suicide include implementing a safety plan with the patient that addresses how to respond to suicidal thoughts in the future, restricting access to medications and firearms may be necessary, the patient may need involuntary hospitalization. Suicide prevention in the hospital setting include 1 on 1 monitoring, paper scrubs or no linens, restriction of access to any and all sharp objects ie. pens, pencils, scissors, silverware etc. Medication management will also be paramount.
4) Broca's area of the brain is responsible for movement of the mouth and larynx, making it a key component in the activities of speaking and swallowing. Although not totally isolated or localized it is commonly understood that for most people, the left hemisphere of the brain controls language. We know as nurse the left side of the brain controls the right side of the body. A stroke that affects Broca's area of the brain will likely result in aphasia or difficulty in language and communication. Also, it is likely that this may be a left sided stroke meaning this patient may present with right sided weakness or hemiparesis. Nursing interventions for a stroke patient include aspiration prevention, NPO status (swallow study eval), placing personal objects in the patient's intact field of vision and on the stronger side of the patient, assessing and evaluating for changes in baseline status and functioning to diagnose patient problems that may be related to neurocognitive and musculoskeletal deficits, addressing safety concerns, consulting physical therapy as indicated per patient. In relation to Broca's aphasia the nurse should be sure to allow enough time for the patient to respond, do not speak over or guess the words for the patient, encourage them to speak and be patient with them as they try to find the words they are looking for. It may also be useful to provide alternant means of communication like a communication board may be helpful.
5) Stomatitis is an inflammatory response that occurs along the mucosal membrane of the mouth. It can cause painful lesions like canker sores and reduce a patient's intake. It is common in patients undergoing chemotherapy, as it is a result of the chemotherapeutic agents attacking rapidly replicating cells in the body (like cancer cells) but also the mouth, GI tract, skin, and reproductive organs etc. Pain management for this condition is paramount. It is also important to monitor these sites for signs of bleeding and infection. Pain management can be achieved through special mouthwashes, avoid products that contain alcohol, however. Ice chips if appropriate to the patient situation may be useful. Frequent oral care is paramount, with oral saline rinses every 2 hours or 4-6 times a day. Viscous oral lidocaine may be used for pain management. Monitoring your patient's intake and nutritional status should be implemented.
Please let me know if you found this answer helpful or if you have anything to add in addition. Thank you and good luck! :)
