This past week while treating a patient on my pediatric rotation, I may have been exposed to TB. If it is TB, it is an atypical presentation. The child had a tumor over his mastoid that seemed to meet the criteria and I administered the PPD. There was no coughing or anything that would propel droplets. He was playing in the playroom and played with other kids.
Since we were still in the diagnostic phase and the only place that TB was mentioned in the chart was for administration of the PPD, only universal precautions were being observed. It was only tonite when I was working on the pathophys paperwork for my careplans that I realized that there is a good chance this little guy has active TB. The chart just said "mass", r/o abcess.
How will I know if he tested positive? Does this mean everyone who had contact with him will have PPDs?
Our jobs as nurses really does put us at risk. Sometimes I think we believe that if we do everything just right, we'll always be protected and nothing will happen. The truth is, we have a lot of sick people out there and it's not until after they are diagnosed with an infectious disease that we pull out the isolation setups. By then, it's a little late for us. This would never sway me from nursing. It's just a thought.
Feb 12, '05
I'd contact your peds clinical instructor ASAP (yes, even over the weekend). He/she should direct you to employee health at that hospital.
At my hospital it's rare to see a TB case (not a big immigration area), but protocols call for droplet precautions including masks as soon as TB is suspected, not confirmed.
Hope things work out. <hugs>
Feb 13, '05
TB that is not [I]pulmonary[U] is not contagious. Like anything else that has drainage, it would be important to use "Universal Precautions" [or whatever their calling it currently]. Gloves and hand washing.
The site of infection for Pulmonary TB is the alveoli--if it's not small enough to get into the alveoli, don't worry about it. TB often gets to other areas of the body in children--it starts out in the lungs, and moves blood borne to where ever you subsequently find it.
This is a good opportunity for you instructor to review TB/transmission etc., with your class. One source for good info is the American Lung Association.
Feb 13, '05
Oh thank God you posted this! I just got off a special rotation in the ED where I helped care for a patient with r/o TB and HIV. I trust the masks and the rooms, but regardless, I am still scared. He was icky...kept pulling his lines out, blood all over the floor. I asked the nurse to spray me down with dispatch...Getting in the shower in a second. These shoes now have no other use than nursing. Ew! We finally got an order for restraints, were getting ready to put them on (dreading that...non-english speaking guy), when the charge came in and told us the room was finally clean. So, I feel you in the sense of wondering.
Like someone else said, contact your instructor. I would go get a PPD anyways. Go to an urgent care place. -Andrea
Feb 13, '05
I have been exposed to TB many times and thank God remain mantoux negative.
Keep in mind a PPD is not a conclusive test for TB. If positive, the patient has or had TB in their lifetime. They would need a chest x-ray and/or sputums to rule out active TB.
I am not sure how long it takes to convert from negative to positive. Meaning you are exposed, contract the disease - I'm not sure a week is long enough for you to develop antibodies which would change the PPD from negative to positive.
If there is an exposure, the hospital is obligated to test you beyond the annual testing. In your case, they'd also have to test everyone exposed including all the rest of the patients.
Feb 13, '05
Relax... TB is not very contagious. Yes, we use respirators when caring for pts suspected of TB, but it really is an opportunistic infection. I went to school for half a semester with a girl with active TB who subsequently died(poor thing didn't know she had it). I didn't contract it. My PPD's are always a little funny, but never truly positive since.
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