ATI: Chapter 23 - Tuberculosis Flashcards
_______ is an infectious disease caused by Mycobacterium tuberculosis.
Tuberculosis (TB)
TB is transmitted through ________ (airborne route)
aerosolization
Once inside the lung, the body encases the TB bacillus with _______ and other cells. This can appear as a ______ on a chest x ray.
collagen
Chon tubercle
Only a small percentage of people infected with TB actually develop an _____ form of the infection.
active
The TB bacillus can lie _____ for many years before producing the disease.
dormant
TB primarily affects the lungs but can spread to any _______ in the blood.
organ
The risk of transmission decreases after ___ to _____ weeks of antituberculin therapy.
2 to 3 weeks
Client who live in ______ areas for tuberculosis should be screened on a yearly basis.
high risk
Family members of clients who have _______ should be screened.
tuberculosis
Early detection and treatment are vital. TB has a _____ onset, and the client might not be aware until the symptoms and disease are advanced.
slow
TB diagnosis should be considered of any client who has a persistent cough, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, ______, or chills.
night sweats
Increasing the percentage of clients who ______ treatment for TB should be the goal.
complete
Individuals who have been exposed to TB but have not developed the disease can have ______.
latent TB
Latent TB means that Mycobacterium tuberculosis is in the body, but the body has been able to _____ off the infection. If not treated, it can lie dormant for several ____ and then become active as the individual becomes older or immunocompromised.
fight
years
Frequent and close contact with an ______ TB is a risk factor.
untreated
Lower _____ status and homelessness is a risk factor for TB.
socioeconomic
_______ status (HIV, chemo, kidney disease, diabetes mellitus, Crohn’s disease) is a risk factor for TB.
immunocompromised
Poorly _____, crowded environments (prisons, long-term care facilities) are risk factors for TB.
ventilated
_____ age is a risk factor for TB.
advanced
Recent travel _____ of the US to areas where TB is endemic is a risk factor.
outside
______ (especially from Mexico, Philippines, Vietnam, China, Japan, and Eastern Mediterranean countries) is a risk factor for TB.
immigration
_____ use is a risk factor for TB
substance
Health care ______ that involves performance of high risk activities (respiratory treatments, suctioning, coughing procedures) is a risk factor for TB.
occupation
Expected findings with TB include persistent _____ lasting longer than 3 weeks.
cough
Expected findings with TB include _____ sputum, possibly blood-streaked.
purulent
Expected findings with TB include fatigue and _____.
lethargy
Expected findings with TB include weight loss and ______.
anorexia
Expected findings with TB include night seats and a ______ fever in the afternoon.
low-grade fever
Older adult clients often present with ______ symptoms of the disease (altered mentation or unusual behavior, fever, anorexia, weight loss)
atypical
A client will have a positive intradermal TB test within ____ to ____ weeks of exposure to infection.
2 to 10 weeks
______ is a blood test that detects release of interferon-gamma in fresh heparanized whole blood from sensitized people.
QuantiFERON-TB Gold
QuantiFERON-TB Gold will let you now if the infection is _______ or ______.
active or latent
Results are available with _____ from a QuantiFERON-TB Gold.
24 hours
A _______ test for TB should e read in 48 to 72 hours.
Mantoux or PPD
An interdermal injection (Mantoux test) of an ____ of the tubercle bacillus is made.
extract
An induration (palapable, raised, hardened area) of ____ mm or greater in diameter indicates a positive skin test.
10
An induration of ____ mm is considered a positive test for immunocompromised clients.
5
A positive Mantoux test indicates that the client has developed an immune response to _____. It does not confirm that active disease is present. Clients who have been treated for TB can retain a ______ reaction.
TB
positive
Individuals who have latent TB can have a positive Mantoux test and can receive treatment to prevent development of an ____ form of the disease.
active
Clients who have received a Bacillus Calmette-Guerin vaccine withing the past _____ years can have a false-positive Mantoux test. These clients need a chest x ray or ________ test to evaluate the presence of active TB infection.
10
Quantiferon gold
Clients who are immunocompromised (such as those who have HIV) and older adult clients should be tested for TB. Clients starting immunnosuppressive therapy (such as tumor necrosis factor antagonists) should be tested for TB ____ to starting treatment.
prior
Reinforce the importance of returning for a reading of the injection site by a health care personnel within ____ to ____ hours with a Mantoux test.
48 to 72 hours
A _____ can be prescribed to detect active lesions in the lungs.
chest x ray
A positive _____ test suggests an active infection.
acid-fast
The diagnosis is confirmed by a positive culture for ________.
mycobacterium tuberculosis
Obtain _____ early morning sputum samples for an acid fast bacilli smear and culture.
3
Wear personal protective equipment when _______ an acid-fact specimen.
obtaining
Samples for acid-fast bacilli smear and culture should also be obtained in a _______ airflow room
negative
Administer heated and ____ oxygen therapy as prescribed to TB patients.
humidified
Prevent infection transmission of TB by wearing a _____ or powered air purifying respirator when caring for clients who are hospitalized.
N95 HEPA filter
Place the client in a _______ room and implement airborne precautions for clients who are hospitalized with TB.
negative airflow
Use _____ protection when the risk of hand or clothing contamination exists for TB.
barrier
Have the client wear a ______ if transportation to another department is necessary. The client should be transported using the shortest and least busy route.
surgical mask
Teach the client to cough and _______ sputum into tissues that are disposed of by the client into the provided plastic bags or no touch receptacles.
expectorate
Administer prescribed _____ to TB patients.
meds
Promote adequate nutrition. Encourage foods that are rich in protein, iron, and vitamins _____ and ____.
B and C
Encourage fluids intake and a ________ diet to adequate caloric intake.
well balanced
Provide ______ support to TB patients.
emotional
Due to the resistance that is developing against antituberculin meds, ______ therapy of two or more medications at a time is recommended.
combination
Because antituberculin meds must be taken for ____ to ____ months, medication noncompliance is a significant contributing factor in the development of resistant strains of TB.
6 to 12 months
The current four medication regimen includes:
isoniazid
rifampin
pyrazinamide
ethambutol
Instruct the client with TB to ______ a series of prescribed mediation.
complete
_______, commonly referred to as INH, is a bactericidal and inhibits growth of myocbacteria by preventing synthesis of mycolic acid in the cell wall.
isoniazid
_____ should be taken on an empty stomach.
isoniazid
Monitor for ________ (jaundice, anorexia, malaise, fatigue, and nausea) and neurotoxcity (such as tingling of the hands and feet) with isoniazids.
hepatoxicity
Vitamin ____ (pyridoxine) is used to prvent neurotoxciity from isoniazid.
B6
Liver function testing should be completed prior to an monthly after starting _______.
INH
Advise the client not to drink _____ while taking isoniazid because it can increase the risk for hepatotoxcity.
alcohol
Advise the client to report any manifestations of _____ while taking isoniazids.
hepatotoxicity
______ commonly referred to as RIF, is a bacteriostatic and bactericidal antibiotic that inhibits DNA-dependent RNA polymerase activity in susceptible cells.
Rifampin
With Rifampin observe for _______.
hepatotoxicity
While taking ______ liver function testing should be completed prior to and at least monthly after starting.
Rifampin
Inform the client that _____ and other secretions will be orange when taking Rifampin
urine
Advise the client to immediately report ______ of the skin, pain or swelling of joints, loss of appetite, or malaise while taking Rifampin.
yellowing
Inform the client that ______ medication can interfere with the efficacy of oral contraceptive.
Rifampin
______, commonly referred to as PZA, is a bacteriostatic and bactericidal. Its exact mechanism of action is unknown.
Pyazinamide
With Pyrazinamide observe for _______.
hepatotoxicity
Assess for history of _____, as Pyrazinamide will cause an adverse effect of nongouty polyarthalgias.
gout
Liver enzymes should be completed baseline and every ____ weeks after starting PZA when taking Pyrazinamide.
2 weeks
Instruct the client to drink a glass of water with each dose and increase fluids during the ______ to help prevent gout and kidney problems w/ pyrazinamide.
day
Advise the client to immediately report yellowing of the skin, pain or swelling of joints, loss of appetite, or ______ with pyazinamide.
malaise
Advise the client to avoid using ____ while taking pyrazinamide.
alcohol
_______ commonly referred to as EMB, is a bacteriostatic and works by suppressing RNA synthesis, subsequently inhibiting protein synthesis.
Ethambutol
Obtain baseline visual ________, and complete monthly after starting treatment when taking ethambutol.
acuity tests
Determine the color _______ ability when taking ethambutol.
discrimination
Pyrazinamide not be given to children younger than ______ years of age.
8
Stop pyrazinamide immediately if _____ toxicity occurs.
ocular
Instruct the client to report changes in _____ immediately when taking pyrazinamide.
vision
_______ is an aminoglycoside antibiotic. It potentiates the efficacy of macrophages during phagocytosis.
Streptomycin sulfate
Due to its high level of toxicity, ______ should be used only in clients who have multidrug-resistant TB (MDR-TB).
streptomycin sulfate
Streptomycin can cause ______, so monitor hearing function and toelrance often.
ototoxicity
Report significant changes in ______ output and renal function studies when taking streptomycin sulfate.
urine
Advise the client to drink at least ____ L of fluid daily when taking streptomycin sulfate
2
Advise the client to notify the provider if ____ declines while taking streptomycin sulfate.
hearing
Contact social services if the client will need assistance in obtaining ______ medications.
prescribed
Refer the client to a ______ as needed for follow-up appointments to monitor medication regimen and status of TB.
community clinic
Provide the client and family education b/c TB is often treated in the _____ setting.
home
______ precautions are not needed in the home setting b/c family members have already been exposed.
airbone
Exposed family members should be tested for ____.
TB
Educate the client and family to continue medication therapy for its full duration of ____ to _____ months, even up to 2 years for multi drug-resistant TB. Emphasize that failure to take medications can lead to a resistant strain of TB.
6 to 12
Instruct the client to continue with follow-up care for ____ .
1 full year
Inform the client that sputum samples are needed every __ to ___ weeks to monitor therapy effectiveness. Clients are no longer considered infectious after ____ consecutive negative sputum cultures, and may return to former employment
2 to 4 weeks
3
Encourage proper ______.
hand hygiene
Instruct the client to cover mouth and nose when coughing or ______.
sneezing
Inform the client that ______ tissues should be disposed of in plastic bags.
contaminated
Advise clients who have active TB to wear a ______ when in public places or in contact with crowds.
mask
With Miliary TB The organism invades the bloodstream and can spread to multiple body organs with complications including the following: Headaches, neck stiffness, and ________ (can be life threatening).
drowsiness
With Miliary TB a complication is _______ resulting in dyspnea, swollen neck veins, pleuritic pain, and hypotension due to an accumulation of fluid in pericardial sac that inhibits the heart’s ability to pump effectively.
pericarditis
Treatment is the same for ______ TB as for pulmonary TB.
miliary
A home health nurse is teaching a client who has active tuberculosis. The provider has prescribed the following medication regimen: isoniazid (Nydrazid) 250 mg PO daily, rifampin (Rifadin) 500 mg PO daily, pyrazinamide 750 mg PO daily, and ethambutol (Myambutol) 1 mg PO daily. Which of the following client statements indicate understanding of the teaching? Select all that apply.
A. “I can substitute one medication for another if I run out because they all fight infection.”
B. “I will wash my hands each time I cough.”
C. “I will wear a mask when I am in a public area.”
D. “I am glad I don’t have to have any more sputum specimens.”
E. “I don’t need to worry where I go once I start taking my medications.”
B. “I will wash my hands each time I cough.”
C. “I will wear a mask when I am in a public area.”
A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching?
A. “You will need continue to take the multimedication regimen for 4 months.”
B. “You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication.”
C. “You will need to remain hospitalized for treatment.”
D. “You will need to wear a mask at all times.”
B. “You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication.”
A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multimedication regimen. Which of the following instructions should the nurse give the client related to the medication ethambutol (Myambutol)?
A. “Your urine may turn a dark orange.”
B. “Watch for a change in the sclera of your eyes.”
C. “Watch for any changes in vision.”
D. “Take vitamin B6 daily.”
C. “Watch for any changes in vision.”
A nurse is preparing to administer a new prescription for isoniazid (INH) to a client who has tuberculosis. Which of the following is an appropriate statement by the nurse about this medication?
A. “You may notice yellowing of your skin.”
B. “You may experience pain in your joints.”
C. “You may notice tingling of your hands.”
D. “You may experience a loss of appetite.”
C. “You may notice tingling of your hands.”
A nurse is providing information to a group of clients at a local community center about tuberculosis. Which of the following clinical manifestations should be included in the teaching? Select all that apply. A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum
A. Persistent cough
C. Fatigue
D. Night sweats
E. Purulent sputum
