TB Flashcards
what are the three causative agent of pulmonary tb?
mycobacterium tuberculae
mycobacterium africanum
mycobacterium bovis
what do the three causative agent do in the lungs?
they attack the lung tissue
what lung tissue do the causative agents attack specifically?
lung parenchyma
what organs do the causative agent attack other than the lungs?
heart, liver, throat
mode of transmission of tb
airborne
droplet
milk as a vehicle
how milk posturized?
pasteurization of milk, designed to destroy the pathogen COXIELLA BURNETTI, is accomplished by a time/temp. integrated process.
63 degrees Celsius for 30 minutes
71.7 or 72 for 15 minutes
incubation period for TB
2-10 weeks
enumerate the cardinal signs of TB
cough
night sweat
weight loss
anorexia
loss of appetite
hemoptysis
low grade fever
what. are the two direct sputum smear microscopy of tb?
conventional strategy (spot)
spot-spot
in conventional spot, when do the patient return?
early morning the next day
how many specimen in spot-spot?
3
what are the 3 specimen in spot-spot?
one spot
2nd spot
3rd spot
one spot
right there and then
2nd spot
after 1 hour
3rd spot
the next day early in the morning
nursing consideration for direct spot smear microscopy
no mouthwash, plain water only
what are the 3 diagnostic test for tb
direct spit smear microscopy
sputum analysis
tuberculin skin test or mantoux test
in sputum analysis, what indicates 2 positive specimen?
positive tb
in sputum analysis, what indicates 1 positve and 1 negative specimen?
needs chest xray
what procedure determines the extent of the lesion?
chest xray
other term for tuberculin skin test
purified protein derivative or mantoux test
what is tuberculin test?
to test susceptibility exposure and immunity of tuberculosis
how to determine if it is positive of tuberculin test?
wheal formation or induration
size of wheal formation?
10mm
route of tuberculin skin test?
intradermal
how many ml do they inject in tuberculin skin test? what site?
0.1 ppd injected to left forearm
how many days do they wait for the result of tuberculin test?
2-3 days or 48-72 hours
classification based on history of previous TB treatment
new
relapse
treatment after failure
treatment after lost of follow up (talf)
previously treatment outcome unknown (ptou)
other
discuss NEW
- newly diagnosed patient
- positive sputum smear
- someboday who have taken anti-TB dugs for less than a month
discuss RELAPSE
might have been cured but diagnosed to have
tB again
discuss treatment after failure
finished treatment regimen but
Still have TB ; never cured
discuss TALF
started tx however never follow-up for
2 months
discuss PTOU
claimed that pt has undergone TB tx however there’s ‘ no treatment record or document no evidence
discuss OTHER
pt who does not fit to any category
what are the recommended category of treatment regimen?
c1,c2,c3,c4
C1
+ sputum mear
-newly diagnosed pt
-extensive Parenchymal lesion
- seriously ill
c2
- relapse
-treatment after failure
-TALF, PTOU - other
C3
- newly diagnosed
- (+)sputum smear
- slightly / minimal lesion
C4
-chronic PTB
-still w/ TB after supervised treatment
-chronic PTB
- Helpless/ hopeless
drugs for C1
2 months HRZE
4 months HR
drugs for C2
2 months HRZES
5 months HRE
drugs for C3
2 months HRZ
4 months HR
drugs for C4
none
intensive phase
2 months
maintenance phase
4 months except C2
maintenance phase of C2
5 months
First line drugs of TB
Rifampicin
(H) Isoniazid
(Z) pyrazinamide
Ethambutol
Streptomycin
SE of rifampicin
red orange urine, tears, sweats
SE of isoniazid
peripheral neuritis/neuropathy (tingling and numbness of the extremities)
SE of pyrazinamide
hyperurecemia
nephrotoxicity
hepatotoxicity
management for hyperurecemia
no purine rich food such as organ meats
what labs do nurses monitor for pt taking pyrazinamide with a side effect of nephrotoxicity?
BUN and Creatinine
normal BUN and creatinine?
BUN - 10-20mg/dl
Creatinine - 0.4-1.2
what labs do nurses monitor for pt taking pyrazinamide with a side effect of hepatotoxicity?
AST and ALT
SE of ethambutol
optic neuritis
damage eyes
loss of vision (transient or temporary)
difficulty discriminating yellowish-green
what specific part of the eyes do ethambutol affects?
optic disc
nursing consideration for loss of vision
snellen chart
nursing consideration for difficulty discriminating yellow-green color
Ishihara diagram
what cranial nerve do streptomycin affects?
8th cranial nerve ( acoustic nerve)
SE of streptomycin
tinitus
vertigo
loss of balance
ototoxicity
second line of drugs of tb
amikacin
kanamycin
capreomycin
classification of second line drugs
amino glycosides
route of second line drugs
IV or IM
SE of second line drugs
ototoxicity
hepatotoxicity
nephrotoxicity
Other second line drugs
Ciprofloxacin
moxifloxacin
levofloxacin
classification of other second line drugs
fluoroquinolones
route of other second line drugs
per orem
SE of other second line drugs
headache
N/V
No LIVE VAXX for?
immunocompromised patients
Prevention/ vaccine for TB
Content:
Given when:
Dosage:
# if doses:
route:
old sched:
new sched:
SE:
Content: LIVE ATTENUATED BACTERIA
Given when: AT BIRTH
Dosage: 0.05 ML
# if doses: 1
route: INTRADERMAL
old sched: AT BIRTH
new sched: AT BIRTH
SE: PERMANENT SCAR, LOCAL SORENESS, FEVER
nursing consideration for local soreness
apply warm compress
do not massage the scar
nursing considerations for fever
give antipyretics
continue breastfeeding
Absolute considerations for LIVE ATTENUATED BACTERIA
cough, hiv, aids, immunocompromised
contraindications for any vaxx
chemotherapy
glucocorticoids therapy ( sone)
for fever more than 38.5
vaccine reconstitution
BCG
BCG:
Diluent:
Syringe:
Discharge:
Diluent: sterile water: 2-3 ml
Syringe: 5cc
Discharge: after 4 hrs
