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Med Surge 4th exam > TB > Flashcards

TB Flashcards

1
Q

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

A

TB

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2
Q

What are some predisposing factors of TB:

A

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

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3
Q

What type of bacterium is TB:

A

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

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4
Q

Why is TB not highly infectious:

A

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

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5
Q

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

A

No, TB cannot be spread by hands or objects

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6
Q

Can you kill TB with disinfectants:

A

No

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7
Q

WHat is TB sensitive to:

A

sensitive to heat and UV light

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8
Q

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

A

10 micron-particles

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9
Q

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

A

5-10 micron particles

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10
Q

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

A

1-5 micron particles

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11
Q

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

A

3000 droplet nuclei

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

Cellular immunity limits further multiplication/spread of infection

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15
Q

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

A

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

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16
Q

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

A

Necrotic generation occurs

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

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

A

Latent TB infection (LTBI)

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20
Q

How is LTBI reactivated:

A

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

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21
Q

Where else in the body can be infected with TB:

A

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

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22
Q

What class is: No TB exposure

A

0

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23
Q

What class is: TB exposure, no evidence infection

A

1

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24
Q

What class is: TB clinically active

A

3

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25
Q

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

A

4

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26
Q

What class is: TB suspect (dx is pending)

A

5

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27
Q

What are the initial S/S of active TB:

A

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

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28
Q

Is dyspnea and hemoptysis common in TB:

A

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

29
Q

What is the objective data for TB:

A

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

30
Q

What are the elderly atypical S/S of TB:

A

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

31
Q

What are the dx for TB:

A

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

32
Q

What is the protocol for AFB

A

3 consecutive sputum specimens collected on different days

33
Q

When do you see mycobacterium on a sputum culture:

A

6-88 wks for mycobacterium to grow

34
Q

What is a QFT (quantiFERON-TB):

A

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

35
Q

What will a TB CXR present:

A

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

36
Q

Can a TB CXR confirm TB:

A

No

37
Q

What is a TST test:

A

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

38
Q

What is a positive TST result:

A

a width >10 mm is positive

39
Q

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

A

5 mm or greater

40
Q

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:

A

10 mm or greater

41
Q

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

A

15 mm or greater

42
Q

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

A

False-negative

43
Q

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

A

false-positive

44
Q

What is the BCG vaccine:

A

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

45
Q

What is the preventative therapy for LTBI pts:

A

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

46
Q

For active TB, why are four drugs given:

A

Increases therapeutic effectiveness and decreases drug resistance

47
Q

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

A

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

48
Q

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

A

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

49
Q

When are treated TB pts considered to be noninfectious:

A

2-3 wks of continued medicated therapy

50
Q

What are the risk factors of first line TB therapy:

A

drug toxicity; drug resistance

51
Q

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

A

primary resistance

52
Q

Drug resistance that develops during TB therapy is termed:

A

secondary resistance

53
Q

Why is B6 (pyridoxine) given along with INH:

A

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

54
Q

What is DOT and why is it used:

A

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

55
Q

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

A

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

56
Q

Where are TB pts placed in the hospital:

A

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

57
Q

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

A

Regular mask

58
Q

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

A

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

59
Q

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:

A

domestic goal

60
Q

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:

A

Global goal

61
Q

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

A

Military TB

62
Q

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

A

Pleural TB causing pleural effusion or less common empyema

63
Q

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:

A

TB PNA

64
Q

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

A

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

65
Q

What is the major side effect of rifampin:

A

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

66
Q

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

A

Ocular toxicity (decreased red/green discrimination)

67
Q

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

A

hepatitis

68
Q

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

A

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

69
Q

What class is LTBI, no disease:

A

2

Med Surge 4th exam (8 decks)

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