My best friend has a B.A. already but she would love to be an R.N. She is very smart; received her B.A. with high honors and was on the dean's list all 4 years while at college. But most importantly, she is super caring not only with people, but also with animals, and even insects (literally she would never hurt a bee or a beetle!) She has been volunteering at our Nursing Home where I work. She truly feels for some of our residents who either don't have any relatives or are not visited often. She would talk to them and is sincerely interested in their stories and lives before they entered the facility. I just see her as one of the best nurses out there who would really make a difference! I spoke with her about it and there is just one problem that prevents her from starting working towards an RN degree, and that is she is EXTREMELY allergic to immunizations including TB test and strongly opposes to unnecessary x-ray exposure. She has always had a positive TB test because she is allergic to it. Her chest X-rays are of course crystal clear. She's been told by a doctor that it is an allergic reaction. She also strongly disagrees with the fact that as an R.N. or even to enroll into any nursing program she has to undergo a chest x-ray just because she is allergic to TB test. It doesn't make sense to her why she has to undergo unnecessary radiation exposure (that is cumulative) just to be proving that she doesn't have tuberculosis. I wonder if there are any other methods besides outdated TB test (that often gives false results), and yearly cancer-promoting x-rays?? Is there anything else that she, and anybody in similar situation, can do in order to show that they in fact are healthy and tuberculosis free? Anyways, any suggestions, experiences and insights about this subject would be appreciated! She will be reading your answers; I told her I'm posting a thread about her dilemma. Thank you all and best wishes!
She's allergic to immunizations? Never heard of such a thing. Most places will not hire someone who is not fully immunized. Most nursing schools will not allow entry into their program if you're not fully immunized. Does your friend have a physician's note exempting her from all immunizations due to "allergy"?
Hello Klone, thank you for your answer! She did have all the required immunizations when she was a child. She just had a more than usual reaction to them. She has sensitive skin, fair complexion, blond hair...She just doesn't see the need to go through any additional rounds of shots, and to possibly experience unknown reactions and symptoms since she already has a history of complications after the immunizations administered in her youth. Otherwise, she is healthy.
It doesn't make sense to her why she has to undergo unnecessary radiation exposure (that is cumulative) just to be proving that she doesn't have tuberculosis. I wonder if there are any other methods besides outdated TB test (that often gives false results), and yearly cancer-promoting x-rays??
We can't give medical advice, but personally I wouldn't worry a bit about the stochastic health risk (the probability of cancer induction/genetic effects of ionizing radiation) from one or even several chest x-rays. If your friend has concerns regarding chest x-rays I think that she should talk to her healthcare provider about this.
The effective dose from a chest x-ray is approximately 0.02 mSv (or 20 µSv).
Compare that to the effective dose from a chest CT; 5-8 mSv (or 5.000 - 8.000 µSv) or an abdominal CT which can deliver an effective dose of approximately 10 mSv (or 10.000 µSv).
One airplane flight from New York to Los Angeles delivers an effective dose of ~40 µSv. People can work as flight attendants or pilots despite this.
The maximum yearly dose permitted for US radiation workers is: 50 mSv (or 50.000 µSv).
The approximate yearly dose from natural potassium in the body is 390 µSv (for a 70 kg male). Compare that to the chest x-ray which adds an extra 20 µSv. (Our bodies are naturally radioactive; potassium-40 is the major isotope that produces gamma radiation (as well as beta decay) but there are many more isotopes present in our bodies. As every nurse knows, potassium is critically important for the functioning of the human body. Most of our potassium is in the form of the stable isotopes -39 and
-41 but some of it is unstable/radioactive potassium-40). Anyway, don't worry too much about the gamma rays that we all emit, it's a relatively small part of to the total dose we receive from all the natural background sources outside the body.
It's perfectly safe to go to a concert or football game, despite thousands of people congregating in the same place
OP, I just noticed your post about your friend being from Chernobyl. With her background I can easily understand that radiation exposure is something she's thought a lot about and worries about. I hope she can take some comfort from the fact that a chest x-ray delivers a very low effective dose.
Equally important to nursing, along with compassion, is the ability to take a critical, scientific approach to evaluating information. Some posters have provided some excellent starting points for her own scientific inquiry into the relative risk of Tb tests, CXRs, or any other testing modalities. Your friend could also begin this inquiry with her own healthcare provider, so that she can make an informed decision.
Specializes in Nurse Leader specializing in Labor & Delivery.
Hello Klone, thank you for your answer! She did have all the required immunizations when she was a child. She just had a more than usual reaction to them. She has sensitive skin, fair complexion, blond hair...She just doesn't see the need to go through any additional rounds of shots, and to possibly experience unknown reactions and symptoms since she already has a history of complications after the immunizations administered in her youth. Otherwise, she is healthy.
If she wants to work in healthcare, she needs to realize that she will be required to get an annual influenza vaccine, regular TDap, as well as any others for which she may need boosters.
Unless someone is very practiced in giving the PPD correctly, and then READING it correctly, errors in interpretation are often made.
You are right, READING it correctly is the key. It may well be possible that her results are misread. From your explanations a nurse must be EXTREMELY trained and must have seen all types of allergic reactions to TB test results, but unfortunately most nurses ARE not. Anything that is red and swollen automatically is read as positive, the majority of the times! So, that's why I am saying that TB tests are not accurate and therefore not effective means of testing TB. There gotta be a better way, other than injecting allergens into the skin.
The most common reason for an allergic reaction to a TST is previous exposure to TB. A Quantiferon test or a chest film will be needed for verification, with the former being more costly.
If your friend isn't vaccinated because she is "allergic to vaccines" she is probably going to have a very tough time going to nursing school.
One point regarding the TB issue is that if your friend spent her childhood in the Ukraine (you said she was born there, so unclear), then she would have likely received two doses of the BCG vaccine, for TB. In that case, it would not be surprising for her to test positive with the PPD skin test (vs. an allergic reaction). It is best to be evaluated by an infectious disease physician, who can evaluate her, review her possible BCG vaccination history, history of any possible TB exposure(s) and do additional testing via Quantiferon Gold or a T-Spot blood test. Depending on the results at that point, a chest x-ray may not be necessary (if blood test negative). It should be noted that a PPD should never be done on anyone with a possible history of a positive PPD as it can result in a severe skin reaction up to and including necrosis.
Regarding the vaccination issue, she should probably do some research on the subject on cdc.gov.
One point regarding the TB issue is that if your friend spent her childhood in the Ukraine (you said she was born there, so unclear), then she would have likely received two doses of the BCG vaccine, for TB. In that case, it would not be surprising for her to test positive with the PPD skin test (vs. an allergic reaction). It is best to be evaluated by an infectious disease physician, who can evaluate her, review her possible BCG vaccination history, history of any possible TB exposure(s) and do additional testing via Quantiferon Gold or a T-Spot blood test. Depending on the results at that point, a chest x-ray may not be necessary (if blood test negative). It should be noted that a PPD should never be done on anyone with a possible history of a positive PPD as it can result in a severe skin reaction up to and including necrosis.
Regarding the vaccination issue, she should probably do some research on the subject on cdc.gov.
Most experts seem to agree that prior BCG vaccination (given more than 10 years previously) will not cause a >10-14mm induration in reaction to TST, even in the case of serial testing. But that is a moot point, as additional testing is required to verify anyways.
WE~DO~CARE
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Hello Klone, thank you for your answer! She did have all the required immunizations when she was a child. She just had a more than usual reaction to them. She has sensitive skin, fair complexion, blond hair...She just doesn't see the need to go through any additional rounds of shots, and to possibly experience unknown reactions and symptoms since she already has a history of complications after the immunizations administered in her youth. Otherwise, she is healthy.