Immunology Flashcards
What does m. TB Organism affect
Primarily the lungs in the upper airway where oxygen content is the highest
Also - the brain intestines peritoneum kidneys joints and liver
What can happen in the active phase of Tb
Necrosis and cavitation in the lesions which can lead for rupture and the spread of necrotic tissue
What are the clinical manifestations of TB
May be asymptomatic I the primary infection
Fatigue
Lethargy
Anorexia
Weight loss
Low grade fever
Chills
Night sweats
Persistent cough and production of mucous and mucopurulent sputum which is occasionally streaked with blood
Chest tightness And a dull aching chest pain may accompany the cough
Presence of what on an X-ray suggests TB
Multinodular infiltrates with calcification in the upper lobe
On X-ray what would indicate active disease TB
Caseation and inflammation
Describe advanced TB
Dullness with percussion over involved parenchymal areas
Bronchial breath sounds
Ronchi and crackles
Partial obstruction of the bronchus caused by endobronchial disease or compression by lymph nodes may produce localized wheezing and dyspnea
QuantiFERON TB GOLD test - what is it and what is it for
Blood analysis test by an enzyme linked immunosorbent assay
A sensitive and rapid test that assists in diagnosis
TB SPUTUM cultures - what are they looking for
M. Tuberculosis confirms the diagnosis
After medications are started sputum samples are obtained again to determine the effectiveness of therapy
Most are negative after 3 months of therapy
Tuberculin skin test - what does it mean when the skin shows a positive reaction ?
Does not mean that the disease is active
Indicates previous exposure to TB or the presence of a dormant disease
Once the test is positive it will be positive in any future tests
What happens after a positive skin test
CXR
To rule out active TB Or to detect old healed lesions
Isolation precautions for TB
Airborne isolation
Negative pressure room
Door must be tightly closed to remain negative pressure
Nurse requires N95 mask
Hand washing
If client needs to leave the room pt needs a mask
When no longer infectious precautions are done
How long does it take for the transmission risk to reduce in TB
2-3 weeks of therapy
What happens if clients are not compliant with TB MEDS
Mutations in the tubercle bacilli resulting in resistant strains MDR -TB
What happens to those who have been close to TB PTS
TST
And chest X-ray
Steps of TB progression
- Droplets enter lungs tubercle lesion is formed
- Defence system makes a scar of lesion
- If encapsulation does not occur, bacteria may enter the lymph system, travel to the nodes and cause an inflammatory response
- granulomatous inflammation - Primary lesions form - may become dormant and become reactivated and become a secondary infection when reexposed to the bacteria
Individuals who have received what vaccine are at risk for TB
Bacilli calmette guerin will have a positive test result and should receive an X-ray as the vaccine has attenuated tubercle bacilli
TST Induration of 5 >5mm considered positive in
HIV Infected persons
Recent contact of a person with TB disease
Persons with fibrotic changes on CXR consistent with prior TB
Clients with organ transplants
Persons immunosuppressed for other reasons
Indication 10 or >10mm considered positive in
Recent immigrants from high prevalent countries
Injection drug users
Residents and employees in high risk settings
Labs
Persons with clinical conditions that place them at high risk
Children under four
Infants children and adolescents exposed to adults in high risk categories
Induration of 15 or >15 mm positive in
Any person including persons with no known risk factors for TB
What foods are recommended for TB PTS
Foods high in iron protein and vitamin c
Who is respiratory Isolation not necessary for
Family members because they have already been exposed
What should TB PTS avoid
Exposure to silicone because this can further lung damage
What are the names of the fist line medications for TB
Isoniazid Rifampin Ethambutol Pyrazinamine Rifabutin Rifapentine
What are the second line medications for TB
Capreomycin sulfate Antibiotics - aminoglycosides - fluroquinolones (not for children) Bactericidal
Ethionamide
Aminosalicylic acid
Cycloserine
Streptomycin
What can many TB medications cause
Hepatotoxicy Nephrotoxicity Neurotoxic Optic neuritis Ototoxic
What is a pulmonary embolism
Occurs when a thrombus forms - commonly in a deep vein
Detaches travels to the right side of the heart and then lodges in the pulmonary Artery
Assessment findings of a pulmonary embolism
Apprehension and restlessness Blood tinged sputum Chest pain Cough Crackles and wheezes on auscultation Cyanosis Distended neck veins Dyspnea accompanied by anginal and pleuritic pain - exacerbated by inspiration Feeling of impending doom Hypotension Petechia over abdomen and axilla Shallow respirations Tachycardia and tachypena
What do you do if you suspect a pulmonary embolism
Notify the response team
Reassure the client and elevate the HOB
Prepare to administer oxygen
Obtain vital signs and check lung sounds
Prepare to obtain arterial blood gas
Prepare for the administration of heparin therapy or other therapies
Document
What is TB caused by ?
Myobacterium tuberculosis - aerobic organism
What is systemic lupus erythematosus
Chronic
Progressive
Systemic inflammatory disease
Major organs and systemic systems to fail
What happens with SLE
Connective tissue and fibrin deposits collect in blood vessels on collagen fibres and on organs
Deposits lead to necrosis and inflammation in the blood vessels lymph nodes GI tract and pleura
No cure but remissions for those who manage well
SLE ASSESSMENT
Assess for precipitating factors Butterfly rash Dry scaly raised rash on the face or upper body Fever Weakness malaise and fatigue Anorexia Weight loss Photosensitivity Joint pain Erythema of the palms Anemia Positive ANA test and LE prep Elevated ESR rate and C reactive protein
