Oxygenation: TB

Question 1

TB

Answer 1

• chronic, recurrent, infectious disease
• mycobacterium tuberculosis
• major public health concern early 20th century
• remains prevalent worldwide
• rare in US except in high-risk populations

Question 2

TB aka..

Answer 2

white man’s plague

Question 3

How to get TB…

Answer 3

• TB bacilli enter the lungs via droplet
• engulfed by macrophages, replicate within 2-3 weeks
• 95% of the time, macrophages isolate the bacteria, form tubercle
• TB bacteria remain dormant, TB test positive, not contagious - latent TB - patient has immunity to TB

Question 4

If tubercle ruptures…

Answer 4

bacilli will spread to upper lobes of lungs - active disease - pulmonary TB

• can spread to brain, bones, urinary tract
• may rupture decades later

Question 5

Risk Factors for TB

Answer 5

• HIV/AIDs
• Altered immune system
• Homelessness
• Alcohol abuse
• Foreign born
• Racial/ethnic minorities

Question 6

Prevention of TB

Answer 6

• screen high risk people with PPD
• Prophylactic treatment of latent disease
• compliance with treatment
• hospitalized patient in negative airflow room with “Airborne Precautions” sign on door
• Staff wear fitted N-95 mask/particulate mask (95%)

Question 7

Induration

Answer 7

swelling, bump on skin

Question 8

Clinical Manifestations

Answer 8

• Fatigue
• Weight loss
• Decreased appetite
• Low grade fever
• Night sweats
• Cough - dry first, then productive and/or bloody
• pneumothorax

Question 9

Diagnostic Tests

Answer 9

• Positive PPD test?
• Sputum smear for acid-fast bacilli
• Sputum culture
• CXR
• HIV test

Question 10

Therapy to prevent active disease

Answer 10

• postive PPD, negative CXR
• household exposure to TB

***single drug treatment: INH for 6-9 months

Question 11

If INH contraindicated…

Answer 11

BCG vaccine, will likely always have positive PPD

Question 12

Treatment of active TB

Answer 12

• need more than one drug or bacilli will mutate to drug resistant bacteria
• 6 months or more med treatment are needed if bacilli protected in tubercle
• newly diagnosed: 4 meds x 2 months

***INH, rifgampin, pyrazinamide, ethambutol x 2 months

***INH and rifampin x 4-8 months

Question 13

Most common meds

Answer 13

Rifampin and INH (Isoniazid)

-really strong meds, can cause Hepatits

Question 14

Rifampin

Answer 14

• causes body fluids to turn red-orange
• No ASA
• May cause hepatitis
• Monitor CBC, LFTs, renal labs for toxicity
• skipped dose may lead to fever, flu-like symptoms

Question 15

INH

Answer 15

Isoniazid

• need pyridoxine (vit B6) concurrently to avoid peripheral neuropathy
• Avoid alcohol
• Observe for: anemia, brusing, jaundice, peripheral neuropathy
• may cause hepatitis

Question 16

Pyrazinamide

Answer 16

• take with food
• no alcohol
• monitor LFTs and uric acid
• report gout or liver symptoms

Question 17

Ethambutol

Answer 17

• baseline visual exam
• may affect visual acuity and color discrimination
• monitor vision daily
• monitor LFTs and renal function

Question 18

Nursing Care for TB

Answer 18

• H&P
• negative airflow room-isolation until sputum smears negative x3
• mask on patient for transporting
• patient education - disease process, adherence to medication regime, prevention of spread, nutrition
• fluids - 2-3L/day

Question 19

How can the patient newly diagnosed with TB prevent the spread of infection after going home?

Answer 19

• cough into napkin, closed bag
• sleep in own room
• mask
• stay away from others

Question 20

TB is not spread by…

Answer 20

inanimate objects, airborne only (droplets)

Question 21

What education does the patient need?

Answer 21

• compliance with meds

- side effects of meds

Question 22

Mother of a newborn baby?

Answer 22

• no contact until no longer infectious
• pump and others give baby milk (not spread through breast milk)
• neonate: INH for 3-6 months