Question

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?

a. Ask the patient whether medications have been taken as directed.
b. Discuss the need to use some different medications to treat the TB.
c. Schedule the patient for directly observed therapy three times weekly.
d. Educate about using a 2-drug regimen for the last 4 months of treatment.

Answer 1

The nurse should first ask the patient whether medications have been taken as directed to address potential issues with adherence. Nonadherence is a critical factor in failed TB treatment and the emergence of antibiotic resistance. If adherence is not the concern, directly observed therapy may be considered next.

Step-by-step explanation:

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, and the patient still presenting positive sputum smears for acid-fast bacilli (AFB), the nurse should take several steps. The initial action should be to ask the patient whether medications have been taken as directed. This action checks for patient adherence, which is critical for successful treatment and for preventing the emergence of drug-resistant TB strains. Nonadherence to TB medications is a known cause of treatment failure and contributes to antibiotic resistance.

If nonadherence is not the issue, the next step might involve discussing alternative treatment options, which could include directly observed therapy (DOT), particularly if there is a suspicion of poor adherence. DOT involves a healthcare provider observing the patient take their medication, ensuring each dose is taken as prescribed. The main goals are to ensure successful treatment and to prevent the development of multidrug-resistant TB.