TB Flashcards by Tatiana ose

An airborne, infectious disease (usually of the lungs) caused by Mycobacterium tuberculosis is defined as:

How well did you know this?

Not at all

Perfectly

What are some predisposing factors of TB:

Poor economic conditions, inadequate health care, malnutrition, overcrowding, substandard housing, immunocompromised (DM, ESRD, HIV, AIDS), health care workers

How well did you know this?

Not at all

Perfectly

What type of bacterium is TB:

Mycobacterium TB is gram + aerobic, rod shaped acid fast bacillus

How well did you know this?

Not at all

Perfectly

Why is TB not highly infectious:

requires close, frequent, repeated exposures (w/in 6 inches of the persons mouth) via airborne droplets

How well did you know this?

Not at all

Perfectly

Can you catch TB by touching items from a TB pt:

No, TB cannot be spread by hands or objects

How well did you know this?

Not at all

Perfectly

Can you kill TB with disinfectants:

How well did you know this?

Not at all

Perfectly

WHat is TB sensitive to:

sensitive to heat and UV light

How well did you know this?

Not at all

Perfectly

What is the amount of micron particles of TB filtered by the nose:

10 micron-particles

How well did you know this?

Not at all

Perfectly

What is the amount of micron particles of TB cleared by the mucociliary clearance system:

5-10 micron particles

How well did you know this?

Not at all

Perfectly

What is the amount of micron particles of TB inhaled by the alveoli:

1-5 micron particles

How well did you know this?

Not at all

Perfectly

What is the amount of droplet nuclei released when a TB pt coughs:

3000 droplet nuclei

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after exposure/inhalation of infected aerosol via droplet nuclei:

Tubercle bacilli invasion in the apices of the lungs or near the pleurae of the lower lobes

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after the tubercle bacilli invades the apices of the lungs or the lower lobes of the lungs:

Inflammation of the alveoli where the bacilli replicates slowly spreading via lymphatic system and macrophages begin to ingest organisms

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after inflammation of the alveoli d/t bacilli replicating slowly while spreading via the lymphatic system:

Cellular immunity limits further multiplication/spread of infection

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after cellular immunity limits further spread of infection:

Tissue granuloma occurs to contain the bacteria in order to prevent further replication and the tissue transforms to a fibrous tissue mass

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after granuloma and fibrous tissue mass:

Necrotic generation occurs

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after necrotic generation:

Ghon tubercle (calcified lesions) form scars that may heal after a period of time

How well did you know this?

Not at all

Perfectly

In the pathophysiology of TB, what occurs after Ghon tubercle:

Tubercle bacilli immunity develops 2-6 wks after infection and is maintained in the body as long as living bacilli remain in the body

How well did you know this?

Not at all

Perfectly

TB infection in a person who does not have the active TB disease is not considered a case of TB and is defined as:

Latent TB infection (LTBI)

How well did you know this?

Not at all

Perfectly

How is LTBI reactivated:

compromised/inadequate immune system response/reinfection/activation of dormant bacteria will cause the Ghon tubercle to ulcerate the cheesy material into the bronchi

How well did you know this?

Not at all

Perfectly

Where else in the body can be infected with TB:

CNS (meninges), GI tract/larynx, lymph nodes, skin, skeletal system, GU system, adrenal glands

How well did you know this?

Not at all

Perfectly

What class is: No TB exposure

How well did you know this?

Not at all

Perfectly

What class is: TB exposure, no evidence infection

How well did you know this?

Not at all

Perfectly

What class is: TB clinically active

How well did you know this?

Not at all

Perfectly

What class is: TB, not clinically active (hx of TB)

What class is: TB suspect (dx is pending)

What are the initial S/S of active TB:

fatigue, malaise, weight-loss (unexplained anorexia), low-grade fevers, night sweats, cough that becomes more frequent that may produce mucoid or purulent sputum; pleuritic pain, flu-like symptoms

Is dyspnea and hemoptysis common in TB:

No. Dyspnea is unusual, but may occur. Hemoptysis occurs in advance cases of TB.

What is the objective data for TB:

Physical exam presents crackles over lung apices/maybe dyspnea; tuberculin skin test reaction; cough is initially nonproductive but progresses to be mucopurulent (hemoptysis is associated w/advance cases of TB), CXR presenting pulmonary infiltrate

What are the elderly atypical S/S of TB:

altered mental status, fever, anorexia, weight loss, TST produces no reaction or will have a delayed reaction a week after TST

What are the dx for TB:

TST, XR, AFB smear, sputum culture, quantiFERON-TB (QFT)

What is the protocol for AFB

3 consecutive sputum specimens collected on different days

When do you see mycobacterium on a sputum culture:

6-88 wks for mycobacterium to grow

What is a QFT (quantiFERON-TB):

rapid dx test using blood sample but does not replace routine sputum smears and culture

What will a TB CXR present:

abnormalities seen in the apices of the lungs or superior segments of the lower lungs

Can a TB CXR confirm TB:

What is a TST test:

tuberculin skin test (Mantoux test) uses purified protein derivative (PPD) 0.1 mL injected into the forearm; results read 48-72 hours where the diameter of induration (raised) is measured at its widest

What is a positive TST result:

a width >10 mm is positive

A pt that has either: close contact with TB pt, positive CXR, HIV infected, or organ transplant, immunocompromised will present what measurement for TST:

5 mm or greater

A pt that has either: high risk medical conditions, younger than 4 yo, exposed to TB pts, recent arrival to US, IV drug users, mycobacteriology Lab personnel will present what measurement for TST:

10 mm or greater

A pt that has no risk factors for TB will present what measurement of TST:

15 mm or greater

The person being tested, PPD used, method of administrated, the reading of a TST result will result in type of TST reaction:

False-negative

The person infected with non-TB mycobacteria or had received the BCG vaccine will result in what type of TST reaction:

false-positive

What is the BCG vaccine:

bacillus calmette-guerin vaccine that's given to infants in parts of the world with high prevalence rates of TB; not typically given in the US, can result in a positive TST reaction

What is the preventative therapy for LTBI pts:

Isoniazid (INH) therapy tx daily 6-9 mo; annual CXR; liver is monitored closely for damage d/t INH

For active TB, why are four drugs given:

Increases therapeutic effectiveness and decreases drug resistance

What are the first line of drugs given to active TB pts:

Isoniazid (INH), Rifampin, Ethambutol (M-butol), Pyrazinamide (PZA)

How is the first line of drugs given to TB pts:

Isoniazid, rifampin, ethambutol (M-butol), pyrazinamide (PZA) is given for 8 wks and if TB shows susceptible, then the continuation phase includes INH + rifampin for 4-7 mo

When are treated TB pts considered to be noninfectious:

2-3 wks of continued medicated therapy

What are the risk factors of first line TB therapy:

drug toxicity; drug resistance

Drug resistance d/t no previous Hx of TB and resistant to at least INH and Rifampin is termed:

primary resistance

Drug resistance that develops during TB therapy is termed:

secondary resistance

Why is B6 (pyridoxine) given along with INH:

to prevent INH-associated peripheral neuropathy (numbness in hands and feet)

What is DOT and why is it used:

directly observed therapy is the preferred strategy in adherence b/c you're watching as the pill are being swallowed as non-compliance is the major risk factor of MDR emergence

D/t long periods of anti-tb meds, what are the nsg implementation:

Primary focus is to ensure/encourage adherence to medication regimen; pt monitoring of VS and medication of side effects; maintain isolation until pt is considered noninfectious

Where are TB pts placed in the hospital:

Isolation room w/negative pressure and airflow of 6-12 exchanges per hour

What type of mask does a pt where when out of the room:

Regular mask

What are the health promotion/teachings for the TB pt:

Respiratory Hygiene/cough etiquette; hand hygiene; CXR when there's a positive TST; TB transmission to pt's family/friends; adequate nutrition

The CDC's and the Division of TB Elimination's (DTBE) elimination of TB less than 1 case per million population is defined as a:

domestic goal

THe CDC's and the Division of TB elimination's (DTBE) elimination of TB ny contributing to reductions in TB incidence and mortality by 50% each compared to the 1990 baseline is defined as a:

Global goal

When large numbers of mycobacterium invade the bloodstream and reaches organs simultaneously, it is defined as what type of TB:

Military TB

When mycobacterium invades the pleural space causing inflammation it is defined as what type of TB:

Pleural TB causing pleural effusion or less common empyema

When large amounts of tubercle bacilli are discharged from granulomas into the lung or lymph nodes resulting in PNA, it is defined as what type of TB:

TB PNA

What is the major side effect of INH (isoniazid):

hepatitis; liver should be monitored monthly; EtOH may increase hepatotoxicity

What is the major side effect of rifampin:

Hepatitis, thrombocytopenia (decrease of platelets), orange colored bodily fluids

What is the major side effect of ehtambutol (M-butol):

Ocular toxicity (decreased red/green discrimination)

What is the major side effect of PZA (pyrazinamide):

hepatitis

Why isn't PZA and rifampin given along with INH to LTBI pts:

severe liver damage and deaths d/t combinations of rifampin and pyrazinamide

What class is LTBI, no disease: