Care of Patients with Tuberculosis and Influenza

Question 1

Very Highly communicable resp infectious disease
Mycobacterium tuberculosis - bacteria
Transmitted via aerosolization - transmitted via air
5-10% people exposed to bacteria develop active TB most have active immunity that able control it; sometimes not develop active TB and then get secondary TB
5-10% develop progress developing cavitary lesions
90-95% primary lesion walled off and show scar but no active infection but could develop secondary later on
Only when have active TB that can transmit the infection; cavities liquifying and opening up into bronchioles and person can transmit it
Secondary TB
Patho: TB bacilli - gets into lungs and inflammatory process where collagen, fibroblasts, lymphocytes all go to where inflammation is caused by the bacilli and then causes cavities - necrosis - and necrotic tissue turns into granular mass and see on CXR - see necrotic cavity items and indicates active TB

Answer 1

Pulmonary TB

Question 2

airborne route - in acute care setting on airborne precautions

Answer 2

Transmitted via aerosolization - transmitted via air

Question 3

reactivation of the disease in a previously infected person
Been exposed and never probs with disease and then reactivated
More likely in older adults and people who are immunocompromised

Answer 3

Secondary TB

Question 4

Higher risk
Those in constant, frequent contact with an untreated person
Those who have decreased immune function - immunocompromised
People who live in crowded areas
Older homeless people
Abusers of injections drugs or alcohol
Lower socioeconomic grps
Immigrants from countries with a higher incidence of TB - Foreign immigrants: more prevalent other areas of world indivs that immigrate from diff countries higher incidence of it or someone who traveled to one areas higher risk - look at with history

Answer 4

Pulm TB: Risk factors for TB

Question 5

Ex. HIV - very common worldwide but decrease in US except in people immunocomprosed and when HIV came onto scene and more people immunocompromised

Answer 5

Those who have decreased immune function - immunocompromised

Question 6

Ex. Homeless; prisons; living in shelters

Answer 6

People who live in crowded areas

Question 7

Past exposure - someone in life active TB higher risk
Country of origin or travel to countries where incidence of TB is high
Results of previous tests for TB - previous + TB test
Had the BCG vaccine

Answer 7

Pulmonary TB: Assessment history

Question 8

Within last 10 years always test + for TB so those pats will always have + skin test not able go get annual TB test via skin with IGRA or CXR
Contains attenuated tubercle bacilli
Anyone who has received the vaccine within the previous 10 years will have a positive skin test
Should be evaluated with a CXR or the QuantiFERON-TB Gold test

Answer 8

Had the BCG vaccine

Question 9

Progressive fatigue and lethargy - BIG
Nausea and anorexia
Weight loss
Irregular menses
Low-grade fever - sometimes
Night sweats may occur - classic sign
Cough with mucopurulent sputum, may be streaked with blood
Chest tightness, dull aching chest pain may occur with the cough
Dullness with percussion over involved lung fields
Auscultation of lung fields may have bronchial sounds, wheezing or crackles
Very tired, weak, lethargic, not eating well, sweats at night; sputum and productive cough and blood streaks in those; sometimes chest tightness/dull chest pain - will have/can have abn lung sounds - wheezing/coarse crackles - dullness where lesions might be

Answer 9

Pulmonary TB: CM

Question 10

NAA (nucleic acid amplification) test
QuantiFERON-TB Gold (QFT-G)
Sputum culture of M. tuberculosis confirms the diagnosis
Tuberculin (Mantoux) test
Chest x-ray

Answer 10

Pulm TB: Diagnostic assessment

Question 11

Very Rapid test for TB with results available in less than 2 hours - used in areas where have higher incidence of TB - because communicability of it risk for transmitting it to lot other people and getting quicker results better

Answer 11

NAA (nucleic acid amplification) test

Question 12

Blood serum test with results in 24 hours/day
Moved to lot here
Blood draw

Answer 12

QuantiFERON-TB Gold (QFT-G)

Question 13

Requires 1-4 weeks to determine + or – results
Obtained after drugs are started to determine therapy effectiveness
Do when want to confirm the diagnosis
+ QuantiFERON-TB/skin test and if in-pat get serial (3 diff mornings) sputum cultures to test for TB - best if first morning sputum - send down and check for TB - also do after diagnosis for serial sputum cultures and once have 2-3 weeks of treatment and get 3 neg sputum cultures no longer considered contagious

Answer 13

Sputum culture of M. tuberculosis confirms the diagnosis

Question 14

PPD given intradermally in forearm (0.1 ml)
Screening tool - very pop, cheap, easy; typ HCPs have done
48-72 hours check to see if any rxn

Answer 14

Tuberculin (Mantoux) test

Question 15

Detect active TB or old, healed lesions

Answer 15

Chest x-ray

Question 16

Area of induration (localized swelling with hardness of soft tissue), not just redness, measuring 10 mm or greater in diameter 48 to 72 hours after injection indicates exposure to and possible infection with TB
Looking for induration - have to redness of tissue, hardness, AND swelling; some people react to injection but it has to be indurated and swelling and hardness of tissue - measure at 48 hour and 72 hour marks - want 10 mm in diameter and considered +
If immunocompromised/had HIV - 5 mm be + decreased immunity body not react as severe as someone with full functioning immune sys
Positive reaction does not mean that active disease is present but indicates exposure to TB or the presence of inactive (dormant) disease. - get CXR to further clarify and confirm have active
Reduced skin reaction or a negative skin test does not rule out TB disease or infection in the (very) old or anyone who is severely immunocompromised. - everything else points to it and have - skin test do further testing

Answer 16

Pulm TB: PPD Skin Test

Question 17

Best Treatment for pulm TB is give drugs
Combination drug therapy is most effective method of treatment and preventing transmission
All these drugs can affect liver function
Nausea is very common
Good thing for pats now; combined into one pill; less amount pills have take
Typical drug treatment is 6-12 months
Not taking the drugs as prescribed could lead to an infection that is drug resistant
Multidrug-resistant TB (MDR TB) strains are emerging
Discharge Education
Hospitalized patients

Answer 17

Pulm TB: Interventions

Question 18

Avoid all alcohol
Report any dark urine or yellow changes in skin color
All affect liver func - no alcohol drinking during treatment of TB, report dark urine, skin changes, sclera changes - indicates liver func decrease; liver enzymes checked periodically

Answer 18

All these drugs can affect liver function

Question 19

Take medications at night so nausea not as prominent; also give anti-nausea
Imp adhere to drug regiment can detere people from staying on meds and actively help them prevent this

Answer 19

Nausea is very common

Question 20

Imp to take all drugs and stick to it for full course of treatment; so not as many drug resistant strains of TB because not finishing course of treatment; makes more diff to treat it

Answer 20

Not taking the drugs as prescribed could lead to an infection that is drug resistant

Question 21

Resistant to first-line and second-line therapy
Drug therapy more limited
Absolute adherence to therapy is critical for survival and cure of the disease

Answer 21

Multidrug-resistant TB (MDR TB) strains are emerging

Question 22

Super imp
Teach a lot about infection prevention - in infectious period of time avoid crowds of people and wear a mask; everyone in household tested and evaluated
Cover the mouth and nose with a tissue when coughing or sneezing and place tissues in plastic bags because not want bacteria get out to anyone else; handwash
Wear a mask when in contact with crowds until the drugs suppress the infection
All members of the household need to undergo TB testing
Sputum specimens are usually obtained every 2-4 weeks once drug therapy is initiated

Answer 22

Discharge Education

Question 23

After 3 consecutive sputum cultures are negative, the patient is no longer infectious - same thing in hospital; take out isolation and airbone precautions

Answer 23

Sputum specimens are usually obtained every 2-4 weeks once drug therapy is initiated

Question 24

Airborne precautions
Other appropriate precautions as needed

Answer 24

Hospitalized patients

Question 25

Use of personal respirator for all caregivers and visitors - N95 mask/PAPR
Negative flow isolation room - any air out room filtered through certain number exchanges before leaves so protecting people
If leaves room - wear mask to protect others

Answer 25

Airborne precautions

Question 26

Follow the exact drug regimen - stay on exactly what prescribed for them
Continue prescribed drugs for 6 months or longer as prescribed; sometimes 12
Some cases Directly observed therapy (DOT) - health care professional watches the patient swallow the drugs, may be indicated in some situations; health clinic and have HCP watch take med every single day because so communicable if question if pat stay compliant on meds - sometimes is required; sometimes go to skilled facilities so get drugs (if cannot get them tho heath depts will provide the drugs necessary - make sure saying on correct regiment)
Proper nutrition and rest
Patient to receive follow-up care for at least 1 year during and after active treatment even if stop meds at 6 months

Answer 26

Teaching for self-management - Pulm TB: Community-Based Care

Question 27

Seen often in acute care
Highly contagious acute viral respiratory infection respiratory - very contagious
5-20% of the population can be infected in a given year
2012-2013: 56,000 deaths due to influenza; highest in long time; running out of ventilators
2017-2018: 80,000 deaths due to influenza (CDC)
Can become a real prob
Epidemics are common
Complications of pneumonia or death can occur

Answer 27

Influenza

Question 28

During 2017-2018 flu season the rate of flu was at or above epidemic levels for 16 consecutive weeks (CDC) happening very frequently

Answer 28

Epidemics are common

Question 29

Especially higher risk in older adults or immunocompromised patients - get very serious for pats very quick

Answer 29

Complications of pneumonia or death can occur

Question 30

Rapid onset
Severe headache
Muscle aches
Fever
Chills
Fatigue - unlike anything else
Weakness
Influenza strain B can also cause nausea, vomiting and diarrhea
Number diff strands: A, B, C
Contagious before symp and up to 5 days and week after
Adults are contagious from 24 hours before manifestations occur and up to 5 days after they begin.

Answer 30

Influenza: CM

Question 31

Prevention is the best
Yearly vaccinations for the prevention of influenza are recommended
Patient Education

Answer 31

Influenza: Prevention

Question 32

Especially for those at risk
The vaccine is changed every year on the basis of prediction which specific viral strains are most likely to pose a problem during the influenza season - 3-4 antigens from prediction of 3-4 viral strains expected to have; changes every year; why sometimes very effective and sometimes not effective
May lessen severity of the flu; may still get the flu/cold
Usually contain three or four antigens for the three or four most expected viral strains
Can be taken IM or a live attenuated intranasal spray

Answer 32

Yearly vaccinations for the prevention of influenza are recommended

Question 33

Older than 50 years
Chronic illness
Living in institutions
Caring for another with chronic illnesses
Health care personnel providing direct patient care
Recommended for everyone - many hospitalized not fit this criteria so get yearly vaccine

Answer 33

Especially for those at risk

Question 34

Since the intranasal spray is live it is only recommended for young, healthy individuals
CDC recommends IM - move more away from intranasal spray

Answer 34

Can be taken IM or a live attenuated intranasal spray

Question 35

Talk to pats about
Hand hygiene
Staying home from work, school, or places where people gather - have flu; away from people 5-7 days
Covering the mouth and nose with a tissue when sneezing or coughing - cough into arms or sleeves
Disposing properly of used tissues immediately in a safe manner
Avoiding close contact with other people
Coughing or sneezing into sleeve rather than hand

Answer 35

Patient Education

Question 36

Especially after nose blowing, sneezing, coughing, rubbing the eyes, or touching the face.
Good talk to them about this

Answer 36

Hand hygiene

Question 37

Especially if not able to wash hands immediately
Droplets on hands can contaminate surfaces very easily

Answer 37

Coughing or sneezing into sleeve rather than hand

Question 38

Know have the flu
Do have active flu do prevention type things as well
Some antiviral agents may be effective for prevention and treatment of some types of influenza. - not used a lot
Drugs that shorten the duration of influenza A and influenza B are zanamivir (Relenza) and oseltamivir (Tamiflu) - not eliminate but shortens duration; those at risk for resp comps prescribed this
Rest for several days - very imp; fatigue severe
Increase fluid intake unless contraindicated - HF where not want give fluids; easily dehydrated with fever and not eating and nauseated so want increase fluid
Saline gargles may ease sore throat pain. - OTC stuff for this
Antihistamines may reduce the rhinorrhea - nasal symp
Droplet precautions if hospitalized - surgical mask within 3 feet; private room; give IV fluids until start decrease in symp

Answer 38

Influenza: Treatment and interventions

Question 39

Prevent viral spread in the respiratory tract by inhibiting a viral enzyme that allows the virus to penetrate respiratory cells
Prevents further spread
Taken 1-2 days of onset of symp to be effective
Not high risk comps may not prescribe
Must be taken within 24 to 48 hours after the onset of manifestations.

Answer 39

Drugs that shorten the duration of influenza A and influenza B are zanamivir (Relenza) and oseltamivir (Tamiflu) - not eliminate but shortens duration; those at risk for resp comps prescribed this