TB Flashcards
What is TB caused by?
Mycobacterium tuberculosis
Tb- airborne or droplet?
airborne :survive for minutes to hours
which is more common- active or latent TB?
latent
-5-10% of those with latent develop active tb
Pathophysiology of latent TB
- ->Bacillus enters lungs –> Bronchi or Alveoli
- ->Exudative response–> Pneumonitis
- ->Body develops immunity walling off with granuloma –> growth stops
-Cell-Mediated immunity (antibodies) develops _______ weeks after initial infection
Why do I care?
2-12 weeks
-will test positive for TB at this point
how do you get active TB?
become immunocompormised and breakdown of granuloma containing TB
Who is at risk of getting TB?
- People repeatedly exposed with person with Active TB/ Untreated
- Reduced immune response
- Anyone living in a crowded area
- Homeless Population
- IV drug users
- Alcoholics
- Foreign immigrants
- Low socioeconomic groups
(marginalized people)
When interview patient collect information regarding:
-Recent exposure?
-Previous test results/ Vaccination
-if vaccinated then can not have Mantoux PPD
test
-Travel/Country of origin
If you are vaccinated for TB you cannot have what TB test?
Mantoux PPD
sign and sxs of TB?
- Fatigue
- Productive Cough : blood tinged sputum
- Weight Loss/decreased appetite
- Night Sweats
- Low Grade Fever
- Adventitious Breath sounds maybe:
- Bronchial Breath Sounds
- Crackles
- Wheezing
- Whispered Pectoriloquy: person whispers and you hear increased sounds when auscultating
Psychosocial assessment for TB considerations?
- Isolation
- Support
- Ability to cope
- Ability to adhere to regimen*
- Current living situation/ local resources available
Diagnosis of TB: 2 types of screening tests
1.TB skin test (Mantoux) -Inject 0.1 mL of purified protein Derivative into forearm (intradermal)
-cannot have if vaccinated for TB
2. Blood Tests:
:QuantiFERON-TB Gold In-Tube
:T-SPOT TB test (Mission) - can differentiate b/w antibodies from exposure vs. vaccinated
2 ways to get definitive diagnosis of TB?
- Chest x ray
- Sputum Cultures
what is X-pert MTB/RIF?
Blood test. The test simultaneously detects Mycobacterium tuberculosis complex (MTBC) and resistance to rifampin (RIF) in less than 2 hours.
How to read a PPD- what does a positive result mean?
-A positive result means the person has been exposed to TB and has developed an immune response
> 15 mm
general public without risk factors (= robust immune system) is + if result is >15
> 10mm
Residents of long term care facilities, IV drug abusers, Medically Underserved Populations, Healthcare Workers are + is result >10mm
> 5mm
HIV+ or recent close contact with Active TB (=weakened immune system) is + if result >5mm
the greater the induration means….
the more robust the immune response
ppd stand for? what is it?
purified protein derivative (not a true antigen)
- causes antibodies to come to surface to try and wall off the invader
- indicator that someone has had cell mediated response and now has antibodies
3 sputum tests for TB?
- Nucleic acid amplification (NAAT)
- Results in 2 hours
- Less accurate then culture
- Sputum AFB Smear
- Only id’s presence of mycobacteria (not specifically TB) - Sputum culture
- Confirms diagnosis of TB
- Takes about 4 weeks
- Also used to confirm negative status after treatment: -requires 3 consecutive negative tests to come off of isolation
3 sputum tests for TB?
- Nucleic acid amplification (NAAT)
- Results in 2 hours
- Less accurate then culture
- Sputum AFB Smear
- Only id’s presence of mycobacteria (not specifically TB)
- Sputum culture - Confirms diagnosis of TB
- Takes about 4 weeks
- Also used to confirm negative status after treatment:
- requires 3 consecutive negative tests to come off of isolation
- Only id’s presence of mycobacteria (not specifically TB)
What is NAAT test?
how long for results? accuracy?
Nucleic acid amplification (NAAT)
- Results in 2 hours - Less accurate then culture
What does Sputum AFB Smear test for?
Only id’s presence of mycobacteria (not specifically TB)
*notify health department in + AFB
What is sputum culture for TB? How long does it take? what do we use it for?
- Confirms diagnosis of TB
- Takes about 4 weeks
- Also used to confirm negative status after treatment: -requires 3 consecutive negative tests to come off of isolation
Nursing intervention for the old TB
- Facilitate Adequate breathing/ oxygenation
- Hydration
- Deep Breath and Cough (Every 2 hours)
- Incentive Spirometer (10X/hour)
- Manage Anxiety
- Nutritional consult
- Fatigue
- Case Management
- Reduce Alcohol Intake (Eliminate)- interaction with TB drugs
- Infection prevention
what substance must ya avoid if ya takin dem TB medz?
ETOH- you’ll have to get drunk in a few months, sorry
–> interact with TB meds
2 phases of medication treatment for TB?
-Initial Phase
Isoniazid, Rifampin & Pyrazinamide (2 months)
-Continuous
-Isoniazid & Rifampin (Up to 6-12 months)
What is DOT?
Directly Observed Therapy
= go to health department to take pills
How do we treat TB?
combination drug therapy!
Infection prevention for TB?
- Airborne Precautions in acute care setting Negative Pressure Room
- Disposable Respirators (N95) or Powered Air Purifying Respirator
- Negative Pressure Room
- Patient
- Mask in public
- People living with person should be tested
- Sputum Specimens every 2-4 weeks
- Three Consecutive Negative Sputum Cultures 2 weeks apart = non-infectious
how do we know when someone is no longer infectious after active TB?
- Sputum Specimens every 2-4 weeks
- Three Consecutive Negative Sputum Cultures 2 weeks apart = non-infectious
