# A 10-year-old child has been diagnosed with active pulmonary tuberculosis and will be starting anti-tuberculosis therapy. Which nursing intervention is most important during the initial phase of treatment?

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> subject: Adult Health

## 문제

A 10-year-old child has been diagnosed with active pulmonary tuberculosis and will be starting anti-tuberculosis therapy. Which nursing intervention is most important during the initial phase of treatment?

## 보기

1. Encourage the child to participate in group activities with other hospitalized children
2. Implement airborne precautions and ensure proper isolation procedures **✔ 정답**
3. Provide high-calorie snacks between meals to promote weight gain
4. Schedule frequent rest periods to conserve the child's energy

**정답: 2**

## 해설

Airborne precautions are the priority to prevent transmission of active pulmonary TB. Other interventions are supportive but secondary to infection control.

## 심화 해설

Understanding the Priority: Infection Control in Active Pulmonary Tuberculosis

For a 10-year-old child newly diagnosed with active pulmonary tuberculosis (TB), the most critical nursing intervention during the initial phase of treatment is to implement airborne precautions and ensure proper isolation procedures. This is not merely a routine task but a fundamental safety priority grounded in the mechanism of TB transmission. Mycobacterium tuberculosis is spread through the air via tiny droplet nuclei, which are particles small enough to remain suspended for extended periods and travel through ventilation systems. When a person with active pulmonary TB coughs, sneezes, or sings, they expel these infectious particles, and others can become infected by inhaling them [1]. This mode of transmission makes TB a classic airborne disease, requiring a specific set of controls that differ from those used for droplet or contact-spread pathogens.

The rationale for prioritizing airborne precautions immediately upon diagnosis, even before anti-tuberculosis therapy begins to reduce infectiousness, is to break the chain of infection at its most vulnerable point. The initial phase of treatment is when the child is most likely to be contagious. A negative pressure isolation room, where air is drawn into the room and exhausted directly outside or through a high-efficiency particulate air (HEPA) filter, prevents contaminated air from escaping into the hallway and other patient-care areas. The use of fit-tested N95 respirators by all healthcare workers and visitors entering the room is equally essential; standard surgical masks do not provide adequate protection against airborne droplet nuclei. This practice is a cornerstone of standard and transmission-based precautions, and compliance with these measures is crucial for preventing nosocomial transmission in the hospital setting [1,2]. Studies assessing healthcare worker behavior highlight that consistent and correct use of respiratory protective equipment is a key factor in self-protection and patient safety, a principle that becomes an absolute requirement when managing a known airborne infection [2].

While the other options represent important aspects of holistic nursing care for a child with TB, they are secondary to the immediate safety need of infection control. Encouraging participation in group activities (option 1) is contraindicated during the infectious phase, as it would expose other hospitalized children and staff to a significant risk of acquiring TB. This intervention must be delayed until the child is deemed non-infectious, typically after several weeks of effective therapy and three consecutive negative sputum acid-fast bacillus (AFB) smears. Providing high-calorie snacks (option 3) and scheduling frequent rest periods (option 4) are valuable supportive measures to address the malnutrition and fatigue often associated with TB. However, these address the individual child's physiological needs and do not mitigate the immediate public health threat posed by an untreated, active airborne pathogen. The safety of other patients, visitors, and the healthcare team must always take precedence, making the establishment of effective airborne isolation the non-negotiable first step in the care plan. This principle is especially critical in vulnerable populations, such as hospitalized children, who may be at higher risk for progression from infection to active disease [3,4].References (research sources)

- [1]Knowledge and Compliance With Standard Precautions Among Nurses.Research articleGhabayen F, ALBashtawy M, Abdelkader RH, Jarrah S, Eshah N, Abdalrahim A, Saifan A, Alkhawaldeh A, Rayan A, Ayed A, Al-Amer R, Mohammad KI, Al-Dwaikat T, Omari OA, ALBashtawy S, ALBashtawy B, Dameery KA. (2023) · DOI: 10.1177/23779608231189966

- [2]Understanding routine (non-outbreak) respiratory protective equipment behaviour of hospital workers in different clinical settings - lessons for the future post-COVID-19.Research articleBarratt R, Gilbert GL. (2023) · DOI: 10.1016/j.jhin.2023.04.003

## 임상 시나리오

Airborne Precautions Implementation for Active Pulmonary TB

Upon suspicion or confirmation of active pulmonary TB, immediately place the patient in a **negative pressure isolation room** (Airborne Infection Isolation Room, AIIR) with the door kept closed. Verify negative pressure daily using smoke tubes or visual indicators.

All healthcare workers and visitors must wear a fit-tested **N95 respirator** before entering the room. Surgical masks are not sufficient for airborne pathogens. The patient should wear a surgical mask if transport outside the room is essential.

Instruct the child on cough etiquette: cover the mouth and nose with a tissue when coughing or sneezing, dispose of tissues in a designated no-touch receptacle, and perform hand hygiene immediately afterward. For young children, model and assist with these behaviors.

Airborne precautions remain in place until the patient meets clinical criteria for deisolation: typically three consecutive negative acid-fast bacilli (AFB) sputum smears collected at least 8 hours apart, clinical improvement, and at least 2 weeks of effective anti-tuberculosis therapy. Coordinate with infection control and the local health department for clearance.

Educate the family about the rationale for isolation to reduce anxiety and promote adherence. Emphasize that restrictions are temporary and protect both the child and others. Provide age-appropriate activities that can be done alone in the room, such as art supplies, books, or tablet-based games.

## 핵심 개념

- **Airborne precautions** — Infection control measures for pathogens transmitted via tiny droplet nuclei that remain suspended in the air, requiring a negative pressure isolation room and N95 respirator.
- **Droplet nuclei** — Microscopic particles (1-5 microns) produced when a person with active TB coughs or sneezes; they can remain airborne for hours and travel through ventilation systems.
- **Negative pressure room** — An isolation room where air pressure is lower than the corridor, causing air to flow into the room and be exhausted outside or through a HEPA filter to prevent contamination.
- **Active pulmonary tuberculosis** — A contagious form of TB where Mycobacterium tuberculosis bacteria are actively multiplying in the lungs, causing symptoms and transmissible through the airborne route.
- **N95 respirator** — A tight-fitting mask that filters out at least 95% of airborne particles, required for healthcare workers entering the room of a patient on airborne precautions.

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