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NURS 313R > Exam 2: Pulmonary TB > Flashcards

Exam 2: Pulmonary TB Flashcards

1
Q

Pulmonary Tuberculosis

A

Infectious disease cause by mycobacterium tuberculosis.

Usually involves lungs but can infect any part of the body.

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2
Q

Factors of resurgence of TB

A

High rates of TB among HIV patients

Emergency of MDR strain of M. Tuberculosis.

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3
Q

What is the leading cause of death from infection in the world?

A

TB

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4
Q

Risk Factors for TB

A
  • 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
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5
Q

Why are patients taking prednisone at an increased risk for TB?

A

Prednisone treats inflammation -> lowers resistance -> lowers WBC

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6
Q

Why do patients who have had transplants at an increased risk for TB?

A

D/t lifelong immunosuppressant therapy

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7
Q

TB occurs commonly in

A

Poverty
Minorities
Undeserved

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8
Q

Types of TB Drug Resistance

A

Primary Drug Resistance
Secondary Drug Resistance
Multiple Drug Resistance

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9
Q

Drug resistance results from

A

Incorrect prescribing
Lack of PH care management
Patient non-adherence

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10
Q

How is TB spread?

A

Via airborne droplets. Can also be spread vi lymph and blood.
Can be suspended in the air for minutes to hours.

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11
Q

Factors influencing the likelihood of transmission

A

of organisms expelled in air
Concentration of organisms
Length of exposure
Immune system of exposed person

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12
Q

Pathophysiology of TB

A
  1. Patient inhales m. Tuberculosis bacilli
  2. Infection of the tracheobroncheal tree
  3. Multiply in the alveoli
  4. Transport to other body parts via lymph/blood
  5. Inflammatory Process
  6. Neutrophils/macrophage engulf bacteria
  7. Accumulation of exudate in the lung/lobe
  8. Granulomas formation
  9. Transformation to a fibrous mass (Ghon tuberculi)
  10. Formation of a cheesy mass and cavitation of lobe tissue necrosis
  11. Calcification and form collagen scar
  12. Bacteria becomes dormant/no progression of the disease
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13
Q

Ghon Focus

A

Neutrophil and macrophage try to contain local bacteria

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14
Q

Granuloma

A

Defense mechanism -> walls off infection and prevents further spreading.
Secondary to exudate accumulation.

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15
Q

Ghon tuberculi

A

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

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16
Q

Primary infection

A

Bacteria is inhaled and initiates inflammatory reaction

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17
Q

Latent TB Infection

A

Occurs in person who does not have active TB.
Cannot transmit to others
Treatment is important d/t being able to develop active disease.

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18
Q

Active TB Disease

A

immune response not adequate and bacteria replicates

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19
Q

Primary TB: develops w/i

A

first 2 years of infection

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20
Q

Postprimary TB or “reactivation”: disease occurring

A

2+ years after initial infection

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21
Q

Latent TB Infection: Clinical Manifestations

A

Positive skin test but is asymptomatic

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22
Q

Pulmonary TB: Clinical Manifestations

A 
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.)
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23
Q

Acute Symptoms of TB

A 
Generalized flu symp. 
High fever
Chills
Pleuritic pain
Productive cough
24
Q

TB findings upon auscultation

A

Normal

Or reveal crackles, ronchi, bronchial breath sounds

25
Q

Extra pulmonary TB

A

Depends on organs it affects

E.g. renal TB → dysuria and hematuria

26
Q

Appropriately treated TB

A

Heals w/o complications

Scar and residual cavitation w/i lung

27
Q

Military TB

A

Widespread of bacteria via bloodstream to distant organs

Fatal if left untreated

28
Q

Pleural TB

A

From primary disease or reactivation
Pleural effusion d/t bacteria in pleural space
Causes inflammatory response → exudate of protein rich fluid

29
Q

Acute TB Complications

A

d/t large amounts of tubercle bacilli discharged from granulomas into lung/lymph

30
Q

TB: Diagnostic Studies

A

TB Skin Test
AFB Smear
CXR
Sputum Culture/Sensitivity

31
Q

TB Skin Test

A

..

32
Q

CXR

A

Can’t make dx off CXR

Upper lobe filtrates, cavitary infiltrates, lymph node involvement

33
Q

Sputum Culture

A

Dx of TB requires demonstration by tb bacilli

Stained sputum smears for AFB: 3 consecutive samples must be collected on different days

34
Q

Management of TB

A
  • treated primarily with chemo therapeutic agent for 6-12 mons (short / term chemo therapy)
  • use of multiple drug therapy
35
Q

Patients with a positive TB sputum smear are considered

A

Infectious for first 2 weeks after starting treatment.

36
Q

Drug Therapy: Main Treatment for TB

A

Two phases: initial and continuation

RIPE: Rifampin, INH, Pyrazinamide, ethambutol

37
Q

Treatment for drug resistant TB

A

Sensitivity testing

38
Q

MDR-TB therapy includes

A

Fluoroquinolones, injectable antibiotics

39
Q

Directly Observed Therapy

A

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)

40
Q

Latent TB Infection Drug Therapy

A

Drug therapy helps prevent active TB
Usually only one drug
9 months daily INH

41
Q

BCG Vaccine

A

Live strain of mycobacterium bovis
Given in high prevalence areas
If meet criteria
E.g. health care workers who are constantly exposed too

42
Q

Assessment of TB

A

Previous hx TB, chronic illnesses, immunosuppressants

Social and occupational hx → determine risk factors

43
Q

Health Promotion for TB

A
  • 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
44
Q

TB Intervention Goals:

A

Promote airway clearance d/t sputum.
Promote activity and adequate nutrition.
Advocate adherence to treatment regimen.

45
Q

TB Interventions for Promoting airway clearance d/t sputum

A
  • Patient position, cough and deep breathing
  • Postural Drainage
  • Suctioning
  • Medications: expectorant
  • Hydration (liquifies secretions)
  • Humidify air (loosens secretions)
46
Q

Advocate adherence to treatment regiment to

A

Limit multiple drug resistance.

47
Q

Promote activity and adequate nutrition because

A

Malnutrition is a risk factor for TB

48
Q

If a patient is strongly suspected for TB, they

A
  1. 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)
  2. Will receive medical workup
  3. Will receive appropriate drug therapy
49
Q

Ambulatory and Home Care of TB

A

Monthly sputum cultures obtained until 2 consecutive specimens are negative → not infectious
Encourage to quit smoking

50
Q

Monitoring and Managing Potential Complications of TB includes

A

Malnutrition
Side Effects of Medication Therapy: INH and rifampin
Multiple Drug Resistance
Spread of TB infection

51
Q

INH: Nursing Implications

A
  • 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
52
Q

Adverse Effects: INH

A
  • Can cause liver damage.
  • Asymptomatic elevation of ALT, AST (liver enzymes)
  • hepatitis
53
Q

Adverse Effects: Rifampin

A
  • Hepatitis
  • Thrombocytopenia
  • Orange discoloration of bodily fluid (sputum, urine, sweat and tears.)
  • Can cause liver damage (can lead to increased bleeding time)
54
Q

Adverse Effects: PZA

A
  • Hepatitis
  • Arthralgias: Pain in joint
  • Hyperuricemia: Excessive amount of uric acid in blood
55
Q

Adverse Effects: Ethambutol

A

Ocular Toxicity (decreased red-green color discrimination)

56
Q

Ethambutol: Nursing Implications

A

Monitor visual acuity and color discrimination regularly

NURS 313R (18 decks)

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