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Nursing 271 > Med-Surg: Chapter 24: Tuberculosis > Flashcards

Med-Surg: Chapter 24: Tuberculosis Flashcards

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1
Q

What is Tuberculosis (TB)

A

life-threatening respiratory infection caused by the organism Mycobacterium tuberculosis

  • can affect any body system if not treated promptly
  • highly contagious
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2
Q

Who is at risk?

A
  • populations living outside the U.S.
  • low socioeconomic groups
  • homeless
  • incarcerated populations
  • persons infected with HIV or who have AIDS
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3
Q

How is TB transmitted?

A

aerosolized droplets inhaled from the coughing or sneezing of an infected individual

  • droplets of M. tuberculosis are tiny and can remain suspended in the air for several hours
  • those whose sputum is infected with active TB are most likely to transmit the infection
  • droplets dry quickly and can remain suspended in the air for hours
  • if not isolated immediately, TB can spread
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4
Q

Tuberculosis Classifications

A
  • Latent Tuberculosis Infection (LTBI)
  • Primary Tuberculosis Infection (PTBI)
  • Primary Progressive TB Infection (PPRBI)
  • Drug-resistant M. tuberculosis (MDR TB)
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5
Q

Latent Tuberculosis Infection (LTBI)

A
  • classic sign: calcified granuloma evident on chest x-
  • the inactive bacilli remain dormant within the healed granuloma (bacteria lie dormant within calcified granuloma that can be see on chest x-ray)
  • have no symptoms, usually asymptomatic
  • not contagious
  • as long as immune system remains intact, the bacilli remain in the healed tissue of the granuloma for the individuals lifetime and do not progress to TB infection
  • disease reactivated if immune system becomes compromised; HIV infection, long-term diabetes, chronic renal disease, long-term steroid administration, sepsis, malnutrition
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6
Q

Primary Tuberculosis Infection (PTBI)

A

granuloma formation is initiated but is unable to progress to calcification leading to PTBI

  • individuals with a weakened immune response are unable to control the multiplication of Mycobacterium
  • asymptomatic
  • confirmed by positive sputum cultures and positive skin test
  • not infectious
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7
Q

Primary Progressive TB Infection (PPTBI)

A

aka symptomatic TB infection

  • nonspecific symptoms: fatigue, weight loss, and night sweats
  • cough with rusty-colored or blood streaked sputum
  • as disease progresses, dyspnea, orthopnea (SOB when lying flat), and rales evident
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8
Q

Drug-resistant Mycobacterium Tuberculosis (MDR TB)

A

can be mono-drug or poly-drug resistant (one or more of the first-line medications used for treatment of TB are not effective)

  • caused by primary or secondary means
  • Primary resistance: caused by person-to-person transmission
  • Secondary (acquired): develops during treatment and results from an ineffective treatment regimen or incomplete treatment regimen
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9
Q

How is Diagnosing Done?

A
  • laboratory testing
  • skin test
  • chest x-ray
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10
Q

Diagnosing: Laboratory Testing

A

-Sputum test for culture and acid-fast staining

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11
Q

Diagnosing: Chest x-ray

A

suspicious cavitating lesions (resulting from pathologic processes leading to necrosis and formation of a “gas-filled” space within the lung tissue) are seen on chest x-rays

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12
Q

Diagnosing: Skin Test

A

Mantoux Test

  • positive purified protein derivative (PPD)
  • standard method
  • injection of 01. mL of PPD intradermally into forearm; within 48 to 72 hours after injection, administration site should be observed for a reaction
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13
Q

Goals of Treatment of TB

A
  • cure the patient

- minimize the transmission of M. tuberculosis to other persons

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14
Q

Treatment: Medications

A 
four-drug combination: Antibiotics 
-isoniazid (INH)
-rifampin (RIF)
-ethambutol (EMB)
-pyrazinamide (PZA)
>treatment should continue for 9 to 12 months
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15
Q

The person with TB should be placed on what, when admitted to the hospital?

A

airborne isolation precautions
-immediate isolation of the patient with suspected or confirmed TB infection in a private room with negative airflow capabilities is a priority

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16
Q

Airborne Precautions

A
  • use of a N95 mask respirator for healthcare personnel (requires fit-testing)
  • snug-fitting surgical mask for visitors
  • patient’s movement and transportation to other departments should be limited to essential needs only
  • if leaving the negative-pressure room, patient must wear a surgical mask
17
Q

Complications of TB

A

> extensive respiratory tissue destruction by M. tuberculosis can lead to:

  • Respiratory failure
  • Bronchopleural fistula formation (abnormal pathway or sinus tract that develops between the bronchus and pleural space)
  • Pleural effusions (collections of fluid in pleural space)

> untreated active TB can spread to parts of the body outside the respiratory system via the bloodstream and lymph circulation
-extrapulmonary TB can present as meningitis, lymphadenopathy, bone disease, and liver and kidney failure

18
Q

Clinical Manifestations of TB

A

-unexplained weight loss
-night sweats
-fever
-chills
(seen as a result of the inflammatory response to Mycobacterium)
-Rusty-colored sputum (result of destruction of lung tissue during granuloma formation)
-Collection of WBCs presents in an attempt to wall off infection, resulting in production of sputum
-Pleuritic chest pain r/t chronic coughing

19
Q

Nursing Assessments

A

> Oxygen Saturation
-decreased O2 Sat occurs with destruction of lung tissue, lessening the available surface area for air exchange

> Temperature
-fever is a result from inflammatory process

> Sputum
-blood-tinged or rusty-colored sputum is present as a result of the destruction of lung parenchyma tissue

> Breath Sounds
-wheezing from irritated airways; rales/rhonchi from fluid/exudates

20
Q

When dealing with the medications modifications may be necessary in what special circumtances?

A
  • HIV +
  • pregnancy
  • drug resistance
  • in children
21
Q

Nursing Actions

A

> Humidified O2
-helps ensure adequate oxygen delivery to the tissues and maintains integrity of the mucous membranes

> Institute airborne isolation
-TB is extremely contagious; care must be taken to avoid transmission to other individuals, especially ones with increased risk for infection

> Administer antibiotics as ordered
-antibiotics are the definitive treatment for TB and are essential in controlling the spread of the disease

> Adequate Nutrition
-adequate caloric intake to maintain optimal body weight for recovery (symptom of TB report of weight loss)

22
Q

Teachings

A

> Stress importance of skin/blood testing for individuals living with or exposed to the infected person

  • helps monitor the spread of TB and ensures prompt treatment if necessary
  • TB is a reportable disease and is tracked by local, state, and federal health authorities; healthcare providers are obligated to notify local health departments of an identified TB infection so that an investigation of contacts can be initiated and any positive TB infections can be identified and treated

> Complete all medications
-incomplete treatment or interruptions can cause the emergence of drug-resistant forms of the bacterium

> Assess patient support systems and community resources that will ensure successful adherence to the treatment plan after discharge

23
Q

Evaluating Care Outcomes

A

successful treatment of TB requires early detection and a comprehensive, interprofessional structure that addresses the clinical, psychosocial, environmental, and financial issues
-b/c of long-treatment period, patients need to be encouraged to follow the prescribed plan of care after discharge

> resolving TB:

  • ability of the patient to gain and maintain a stable body weight
  • improved skin turgor and muscle tone
  • absence of cough and sputum production
  • even and unlabored breathing
  • cessation of fevers and night sweats
24
Q

Medication: Isoniazid
others: Pyrazinamide, Ethambutol

A

antimycobacterial (selective anti-tuberculosis)

  • highly specific for mycobacteria
  • inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall
  • for active and latent TB
  • orally or IM
  • when given IM, warm to room temperature to ensure that solution is free of crystals, and inject deeply into large muscle
  • for active TB, direct observation therapy to ensure adherence

> can cause Peripheral Neuropathy: numbness, burning, and pain resulting from deficiency of pyridoxine, vitamin B6

  • administer 50 to 200 mg vitamin B6 daily
  • prophylactic use of pyridoxine at 25 to 50 mg/day can decrease risk of acquiring peripheral neuropathy
  • if peripheral neuropathy develops, can be reversed by administering pyridoxine
  • notify provider if manifestations occur

> can cause Hepatotoxicity: anorexia, malaise, fatigue, nausea, and yellowish discoloration of skin and eyes

  • monitor liver function tests
  • elevated liver function tests can result in the need to d/c the medication
  • avoid alcohol
  • contact provider if manifestations occur

> can cause Hyperglycemia and decreased glucose control (in patients with diabetes mellitus)

  • monitor blood glucose
  • clients with diabetes might require additional antidiabetic medication

> isoniazid contraindicated in patients who have liver disease
use cautiously in older adults, those who have diabetes mellitus or alcohol use disorder
isoniazid, pyrazinamide, ethambutol, are pregnancy risk category C
consider using a second form of birth control (condom) if taking a hormonal contraceptive as various antibiotics decrease their effectiveness
take isoniazid 1 hour before meals or 2 hours after meals with a full glass of water
If GI discomfort, take with meals
avoid foods with high levels of tyramine (aged cheeses, cured meats)

25
Q

Medication: Rifampin

A

Broad-spectrum antimycobacterial (anti-tuberculosis)

  • is a bactericidal as a result of inhibition of protein synthesis
  • effective for gram-positive and gram-negative bacteria
  • given with one other anti-tuberculosis medication to help prevent antibiotic resistance
  • orally or IV

> can cause Discoloration of Body Fluids
-there is an expected orange color of urine, saliva, sweat, and tears

> can cause Hepatotoxicity (jaundice, anorexia, and fatigue)

  • monitor liver function
  • monitor for manifestations of anorexia, fatigue, and malaise; notify provider
  • avoid alcohol

> can cause Mild GI discomfort (anorexia, nausea, abdominal discomfort)

> can cause Pseudomembranous colitis

  • monitor and report fever, diarrhea, abdominal pain, or bloody stool
  • d/c medication if manifestations occur

> contraindicated who have liver dysfunction
pregnancy risk category B
use a non-hormonal form of contraception
increased dosages of HIV medications often necessary
monitor PT and INR
avoid alcohol
monitor liver function
administer oral rifampin 1 hour before or 2 hours after meals with a full glass of water
do not give with food; absorption is decreased if given with food

26
Q

Classification of Tuberculin Skin Test Reactions

A

> 5mm or greater:
an induration of 5 mm or greater is considered (+) in:
-HIV infected persons
-Recent contact with a person with TB
-Fibrotic changes on chest radiography consistent with prior TB
-Those who are immunosuppressed including those with organ transplants

> 10 mm or greater:
an induration of 10 mm or greater is considered (+) in:
-Recent immigrants from high-prevalence countries
-IV drug abusers
-Residents and employees of high-risk settings
-Mycobacteriology laboratory personnel
-Persons with clinical conditions that place them at high risk
-Children younger than 4 years
-Infants, children, and adolescents exposed to adults in high-risk categories

> 15 mm or greater:
an induration of 15 mm or greater is considered (+) in:
-any person, including persons with no known risk factors for TB

27
Q

What happens with a immunocompromised patient?

A

(such as those with HIV)

  • the granulomas do not calcify (non-calcified granuloma)
  • bacteria continue to multiply leading to primary progressive TB infection
28
Q

What do nurses have to get done every year regarding TB?

A
  • TB skin test

- N95 Fit test

29
Q

Mantoux Tuberculin Test

A
  • intradermally into forearm
  • purified protein derivative (PPD)
  • read within 48 to 72 hours; observed for reaction
30
Q

What is the Top Priority for the Nurse When Caring with a Patient with TB?

A

minimizing transmission of TB

-primary or secondary spread of the disease can result in a drug resistant infection

31
Q

What happens if the nurse suspects a possible identification of possible TB?

A

(someone comes in with fever, chills, night sweats)

  • Place in private negative-air pressure room
  • airborne precautions
  • properly fitted N95 mask for healthcare personnel (must be fit tested)
  • patient wears a surgical mask
  • only leave room if necessary
32
Q

Extensive tissue destruction caused by TB infection can lead to what?

A

respiratory failure

33
Q

Untreated active TB can manifest as?

A
  • meningitis
  • lymphadenopathy
  • bone disease
  • liver failure
  • kidney failure
34
Q

What do you want to assess for when caring for a person with TB?

A
  • elevated temperature
  • abnormal breath sounds
  • decreased oxygen saturation
35
Q

What are appropriate Nursing Actions when taking care of a person with TB?

A

> Isolation; airborne precautions
-prevent spread of TB

> Humidified oxygen
-maintain integrity of mucus membranes

> Adequate nutrition
-maintain weight and fuel metabolic demands

> Medication education
-prevent spread and avoid complications like drug resistance

> Support systems
-ensure patient has support to encourage taking entire lengthy treatment of medications

Nursing 271 (208 decks)

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