Exam 2: Pulmonary TB Flashcards
Pulmonary Tuberculosis
Infectious disease cause by mycobacterium tuberculosis.
Usually involves lungs but can infect any part of the body.
Factors of resurgence of TB
High rates of TB among HIV patients
Emergency of MDR strain of M. Tuberculosis.
What is the leading cause of death from infection in the world?
TB
Risk Factors for TB
- Contact with person w/ active TB
- Immuno-compromised Status/Preexisting Medical Condition
- Inadequate Health Care (d/t lack of screen and health promotion)
- Immigration
- Institution
- Substance Abuse
- Substandard Housing
- High risk jobs
- Overcrowding
Why are patients taking prednisone at an increased risk for TB?
Prednisone treats inflammation -> lowers resistance -> lowers WBC
Why do patients who have had transplants at an increased risk for TB?
D/t lifelong immunosuppressant therapy
TB occurs commonly in
Poverty
Minorities
Undeserved
Types of TB Drug Resistance
Primary Drug Resistance
Secondary Drug Resistance
Multiple Drug Resistance
Drug resistance results from
Incorrect prescribing
Lack of PH care management
Patient non-adherence
How is TB spread?
Via airborne droplets. Can also be spread vi lymph and blood.
Can be suspended in the air for minutes to hours.
Factors influencing the likelihood of transmission
of organisms expelled in air
Concentration of organisms
Length of exposure
Immune system of exposed person
Pathophysiology of TB
- Patient inhales m. Tuberculosis bacilli
- Infection of the tracheobroncheal tree
- Multiply in the alveoli
- Transport to other body parts via lymph/blood
- Inflammatory Process
- Neutrophils/macrophage engulf bacteria
- Accumulation of exudate in the lung/lobe
- Granulomas formation
- Transformation to a fibrous mass (Ghon tuberculi)
- Formation of a cheesy mass and cavitation of lobe tissue necrosis
- Calcification and form collagen scar
- Bacteria becomes dormant/no progression of the disease
Ghon Focus
Neutrophil and macrophage try to contain local bacteria
Granuloma
Defense mechanism -> walls off infection and prevents further spreading.
Secondary to exudate accumulation.
Ghon tuberculi
Starts to harden and adds weight to it
Circulation obliterated by weighing down on capillary blood vessels in lung
Oxygen deprived in tissue in lungs
Primary infection
Bacteria is inhaled and initiates inflammatory reaction
Latent TB Infection
Occurs in person who does not have active TB.
Cannot transmit to others
Treatment is important d/t being able to develop active disease.
Active TB Disease
immune response not adequate and bacteria replicates
Primary TB: develops w/i
first 2 years of infection
Postprimary TB or “reactivation”: disease occurring
2+ years after initial infection
Latent TB Infection: Clinical Manifestations
Positive skin test but is asymptomatic
Pulmonary TB: Clinical Manifestations
Develops 2-3 weeks after infection/reactivation Initial dry cough → productive cough w. mucopurulent sputum Fatigue* Unexplained weight loss* Low grade fever* Night sweats* Dyspnea (late symp.) Hemoptysis (late symp.)
Acute Symptoms of TB
Generalized flu symp. High fever Chills Pleuritic pain Productive cough
TB findings upon auscultation
Normal
Or reveal crackles, ronchi, bronchial breath sounds
Extra pulmonary TB
Depends on organs it affects
E.g. renal TB → dysuria and hematuria
Appropriately treated TB
Heals w/o complications
Scar and residual cavitation w/i lung
Military TB
Widespread of bacteria via bloodstream to distant organs
Fatal if left untreated
Pleural TB
From primary disease or reactivation
Pleural effusion d/t bacteria in pleural space
Causes inflammatory response → exudate of protein rich fluid
Acute TB Complications
d/t large amounts of tubercle bacilli discharged from granulomas into lung/lymph
TB: Diagnostic Studies
TB Skin Test
AFB Smear
CXR
Sputum Culture/Sensitivity
TB Skin Test
..
CXR
Can’t make dx off CXR
Upper lobe filtrates, cavitary infiltrates, lymph node involvement
Sputum Culture
Dx of TB requires demonstration by tb bacilli
Stained sputum smears for AFB: 3 consecutive samples must be collected on different days
Management of TB
- treated primarily with chemo therapeutic agent for 6-12 mons (short / term chemo therapy)
- use of multiple drug therapy
Patients with a positive TB sputum smear are considered
Infectious for first 2 weeks after starting treatment.
Drug Therapy: Main Treatment for TB
Two phases: initial and continuation
RIPE: Rifampin, INH, Pyrazinamide, ethambutol
Treatment for drug resistant TB
Sensitivity testing
MDR-TB therapy includes
Fluoroquinolones, injectable antibiotics
Directly Observed Therapy
Providing drugs to patients and watching them swallow meds.
Ensures adherence.
Fixed dose combo drugs increases adherence (i.e INH + rifampin or INH + rifampin + PZA)
Latent TB Infection Drug Therapy
Drug therapy helps prevent active TB
Usually only one drug
9 months daily INH
BCG Vaccine
Live strain of mycobacterium bovis
Given in high prevalence areas
If meet criteria
E.g. health care workers who are constantly exposed too
Assessment of TB
Previous hx TB, chronic illnesses, immunosuppressants
Social and occupational hx → determine risk factors
Health Promotion for TB
- Dx TB must be reported to PH
- Improve access to health care and education
- Minimize social determinants of TB
- Cover nose and mouth w. tissue when sneezing or coughing
- Hand wash
TB Intervention Goals:
Promote airway clearance d/t sputum.
Promote activity and adequate nutrition.
Advocate adherence to treatment regimen.
TB Interventions for Promoting airway clearance d/t sputum
- Patient position, cough and deep breathing
- Postural Drainage
- Suctioning
- Medications: expectorant
- Hydration (liquifies secretions)
- Humidify air (loosens secretions)
Advocate adherence to treatment regiment to
Limit multiple drug resistance.
Promote activity and adequate nutrition because
Malnutrition is a risk factor for TB
If a patient is strongly suspected for TB, they
- Are placed on airborne isolation
(Negative pressure room → sucks in the air when the door opens and releases air outside to atmosphere and never comes back into room (doesn’t recycle air) + UV rays will kill mycobacteria) - Will receive medical workup
- Will receive appropriate drug therapy
Ambulatory and Home Care of TB
Monthly sputum cultures obtained until 2 consecutive specimens are negative → not infectious
Encourage to quit smoking
Monitoring and Managing Potential Complications of TB includes
Malnutrition
Side Effects of Medication Therapy: INH and rifampin
Multiple Drug Resistance
Spread of TB infection
INH: Nursing Implications
- Take on an empty stomach (1 hour before or 2 hours after meals).
- Extra vitamin B needs to be taken while on this drug.
- Monitor for signs of liver damage
- Avoid Alcohol
Adverse Effects: INH
- Can cause liver damage.
- Asymptomatic elevation of ALT, AST (liver enzymes)
- hepatitis
Adverse Effects: Rifampin
- Hepatitis
- Thrombocytopenia
- Orange discoloration of bodily fluid (sputum, urine, sweat and tears.)
- Can cause liver damage (can lead to increased bleeding time)
Adverse Effects: PZA
- Hepatitis
- Arthralgias: Pain in joint
- Hyperuricemia: Excessive amount of uric acid in blood
Adverse Effects: Ethambutol
Ocular Toxicity (decreased red-green color discrimination)
Ethambutol: Nursing Implications
Monitor visual acuity and color discrimination regularly
