Exam 3: Tuberculosis Flashcards
Tuberculosis
Infectious disease that primarily affects the lung parenchyma
May also be transmitted to: Meninges, kidneys, bones, lymph nodes
Latent TB infection
No symptoms, not contagious
May have a positive TB skin test reaction or positive TB blood test
NORMAL chest x-ray
May develop TB disease if they do not receive treatment for latent TB infection, immunocompromised particularly at risk
Still requires treatment
Active TB infection
Symptomatic, contagious
Positive TB skin test reaction or positive TB blood test
Abnormal chest x-ray
Needs treatment
TB transmission
Droplets from coughs or sneezes by an infected person, airborne precautions
Co-infections with HIV
Untreated latent TB infection and HIV infection increases likelihood to develop TB disease
HIV infection is the strongest known risk factor for progressing to TB disease
Recommendations: Empiric treatment, Direct observational treatment (DOT)
TB assessment
Key symptoms: Hemoptysis, night sweats, weight loss
Older adults: Atypical presentation - altered mentation, unusual behavior, fever, anorexia, weight loss
Mantoux test
Intracutaneous injection with tubercle bacillus extract, purified protein derivative
Test is read 48-72 hours later
Reaction: Induration >15 mm and erythema
QuantiFERON TB Gold
Blood test that detects release of IFN-g in fresh heparinized whole blood from sensitized people
Diagnostic for infection whether active or latent
Results in 24 hours
Can be used for patients who are not likely to come for return visit
Acid-fast bacilli smear and culture
Positive test suggests an active infection
Diagnosis is confirmed by positive culture
Also tests for drug resistance
Chest X-Ray
Lesions may appear anywhere in the lungs and may differ in size, shape, density, and cavitation
Lesions, abnormalities may suggest TB
Cannot be used to definitively diagnose TB
Nursing care of TB patient
Prevent infection transmission: Airborne precautions
Wear N95 mask, patient in negative airflow room
PPE when risk of touching hand or clothing exists
Patient wears surgical mask when leaving room
Expectorate into disposable tissues, collected in specific bag
Treatment of pulmonary TB
Combination therapy
First line:
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Intensive phase: 8 weeks
Continuation phase: 4-7 weeks
“Non-infectious” after 2-3 weeks of treatment
Rifampin
Adverse effects: Hepatitis, fever, n/v, urine and other secretions will be orange
Can interfere with oral contraceptives
Monitor: LFT, hepatotoxicity
Isoniazid
Adverse effects: Hepatotoxicity, neurotoxicity
Monitor: Take on empty stomach, LFT before and monthly, do not drink alcohol, report hepatotoxicity signs, Take Vitamin B6
Pyrazinamide
Adverse effects: Hepatotoxicity, hyperuricemia, gout, arthralgias
Monitor: LFTs, uric acid levels
Education: Increase fluids to prevent gout, avoid alcohol
Ethambutol (EMB)
Adverse effects: Optic neuritis
Monitor: Obtain baseline and monthly visual acuity tests, determine color discrimination ability before and periodically, stop medication if
Education: Report changes in vision immediately
Promote activity and nutrition
Progressive activity schedule, increase activity tolerance and muscle strength
Increase caloric intake, small frequent meals
Encourage foods rich in iron, protein, vitamins C and B
Preventing transmission
TB often treated in the home setting
Airborne precautions not needed in home setting because family members have already been exposed, they should be tested for TB
Sputum samples needed every few weeks to monitor therapy effectiveness
While TB is active, wear a mask outdoors
Patient education
Transmission and infection control measures
Adherence to treatment regimen
Dietary restrictions and potential adverse effects
Continue with follow up care for 1 full year
