What is the nursing role in managing a patient with a positive tuberculin skin test (PPD)?

• A. Determine latent vs active TB; if active, apply airborne precautions and initiate treatment; confirm with chest X-ray and sputum testing; support adherence, monitor drug toxicity, educate on transmission.
• B. A positive PPD always requires airborne precautions indefinitely.
• C. Positive PPD only requires standard precautions and no further testing.
• D. Positive PPD means immediate isolation is not necessary if patient feels well.

Answer: (D)

A positive PPD signals TB infection exposure, but it does not by itself tell you whether the disease is latent or active. The nursing role is to determine the activity status and manage accordingly, with infection control and patient support at the forefront.

First, assess for symptoms of active TB (cough, fever, night sweats, weight loss, hemoptysis) and obtain chest imaging and appropriate microbiology. If active TB is suspected or confirmed, implement airborne precautions (negative-pressure room as available, use of N95 respirators by staff, and patient masking when outside the room) and coordinate rapid diagnostic testing (sputum smear, culture, and possibly molecular tests) to guide treatment. Start standard multi-drug anti-TB therapy and monitor for adverse effects, drug interactions, and adherence, while ensuring reporting to public health authorities and arranging contact tracing as indicated. The nurse also supports the patient through education about transmission risks, the importance of completing therapy, and ways to reduce spread.

If there are no signs of active disease, this is latent TB infection. The patient is not contagious, so airborne precautions are not required beyond standard precautions. A chest X-ray is typically used to rule out active disease, and if active TB is excluded, LTBI treatment or preventive therapy may be offered to prevent progression, with careful monitoring for drug toxicity and adherence. The nurse emphasizes adherence strategies, monitors for hepatotoxicity or other adverse effects, and provides education about reducing risk of transmission should active disease develop later.

In short, the key nursing actions are to differentiate latent from active infection, apply appropriate precautions based on that status, coordinate diagnostics, initiate or support therapy, monitor safety and adherence, and educate the patient and public health partners.