TOPIC 3 - pneumonia and TB Flashcards
pathophysiology of pneumonia
Inflammation, characterized by an increase in blood flow and vascular permeability, activates neutrophils to engulf and kill the offending organisms.
As a result, the inflammatory process attracts more neutrophils, edema of the airways occurs, and fluid leaks from the capillaries and tissues into alveoli.
manifestations of pnuemonia
cough, fever, chills, dyspnea, tachypnea, pleuritic chest pain, sputum (green, yellow, rust color)
diaphoresis, anorexia, fatigue, myalgia, headache
auscultate - fine or coarse crackles / consolidation - bronchial, egophony breath sounds
palpations - increased fremitus, dullness during percussion
older adult symptoms of pneumonia
confusion or stupor related to hypoxia
hypothermia (rather than fever)
symptoms of acute exacerbation
increased resp rate, use of accessory muscles, decreasing LOC, restless
complications of pneumonia
atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, meningitis, acute resp failure, sepsis, lung abscess, emphysema
diagnosis related to pneumonia
impaired gas exchange
ineffective breathing pattern
acute pain
activity intolerance
interventions for acute exacerbation
oxygen therapy
prompt initiation of antibiotics
hydration
nutritional support
breathing exercise
early ambulation
therapeutic positioning
pain management
adjunctive therapy for pneumonia
cough suppressants,
mucolytics,
bronchodilators,
corticosteroids
tuberculosis
gram positive, acid fast bacillus that is spread via airborne droplets
microorganisms lodge in lungs = pneumonitis
multi-drug resistant Tb vs extensively drug resistant
multi-drug = resistance to 2 of the most potent first line anti-TB drugs (isoniazid and rifampin)
extensively drug resistant = resistant to any fluoroquinolone plus any injectable antibiotic
symptoms of TB
Initial dry cough that becomes productive that frequently becomes productive with mucoid or mucopurulent sputum.
Fatigue
Malaise
Anorexia
weight loss
low-grade fever
night sweats
can also present acutely as -
High fever
Chills, generalized flulike symptoms
Pleuritic pain
Productive cough
Crackles and/or adventitious breath sounds
risk factors for TB
Homeless
Residents of inner-city neighborhoods
Foreign-born persons
Living or working in institutions (includes health care workers)
IV injecting drug users
Poverty, poor access to health care
Social and occupational history to determine risk factors for transmission of TB
TB infections outside the lungs
TB in the spine can lead to destruction of intervertebral disc
CNS Tb can cause severe bacterial meningitis
Abdominal TB can lead to peritonitis
diagnostic studies for TB
bacteriologic studies - consecutive sputum samples obtained on 3 different days, examined for AFB, results can take up to 8 weeks
if patient has productive cough - early morning is the ideal time to collect sputum specimens
manifestations of TB
fatigue, weight loss, lethargy, anorexia, low grade fever in afternoon, cough with purulent sputum, night sweats and anxiety, dyspnea, chest pain, and hemoptysis
TB skin test
also know as the matoux test
uses PPD injected ID
assess for induration in 48-72 hours
presence of induration at injection site indicates development of antibodies secondary to exposure to TB
TB skin test results
positive if greater than 15 mm induration in low risk individuals
positive if greater than 5 mm in immunocompromised patients
5 or more mm is positive for
HIV infected
close contact with infected person
person who have abnormal xrays
persons who inject drugs
10 mm or more is considered positive for
foreign born
HIV negative but who inject drugs
low income medically underserved
residents of long term care
person with medical conditions
children younger than 4 without other risks
staff of long term care
IGRA tests
detects t cells in response to myobacterium tb
includes quantiferon-TB and T-spotTB
rapid results
more expensive
chest x ray test
cannot make diagnosis soley on x ray
may appear normal in a patient with TB
upper lobe infiltrates, cavity infiltrates, lymph involvement and pleural pericardial effusion suggest TB
nursing diagnosis related to TB
ineffective breathing pattern (related to decrease lung capacity)
ineffective airway clearance (related to increased secretions)
risk for infection (related to cough and sputum)
noncompliance and ineffective health management (related to lack of knowledge or motivation)
first line drugs
ethambutol
isoniazid
pyrazinamide
rifamycin
rifampin
rifapentine
streptomycin
ethambutol
Adverse effects: headache, malaise, dizziness, confusion, optic neuritis, N &V, diarrhea, anorexia
isoniazid
Most widely used anti-tubercular
Contraindicated in hepatic dysfunction
Adverse effects: hepatotoxicity, peripheral neuropathy, visual disturbances, hyperglycemia
pyrazinamide
Adverse effects: hepatoxicity, N &V, diarrhea, anorexia, dysuria, itching, photosensitivity, anemia
rifamycin
Most used to treat mycobacterium avium complex disorders
Can turn body fluids red-orange-brown
rifampin
Broad spectrum bacteriocidal drug
Adverse effects: GI upset, skin eruptions, hepatitis, thrombocytopenia, discoloration of sweat ,tears,urine (Usually orangish-red color)
rifapentine
Derivative of rifampin with longer action
streptomycin
Aminoglycoside
Available for injection only
treatment for patients with PPD, ghons complex, and sputum
adults - isoniazid for 6 months
children - INH or other antibiotic for 9 months
HIV and INH for 12 months
treatment for active disease and sputum culture
multidrug therapy for 12-18 months
(isoniazid, rifampin, pyrazinamide, ethanbutol, stremptomycin)
may return to community when sputum is negative
multidrug resistant tuberculosis
develops when therapy is terminated early
bacteria become resistant to usual regimen
therapeutic regimen adjusted based on C&S
very expensive
vaccine for TB
bacile-calmette-guerin vaccine to prevent TB
given to infants in parts of the world where there is high prevalence of TB
not recommended in US because of low risk
BCG vaccine can result in false positive TST
how long will a patient stay infectious
2 weeks after starting treatment is sputum is positive
implementation of care for TB
airborne isolation - single occupancy room with 6 to 12 airflow exchanges/hour, HEPA masks
receive medical workup and appropriate drug therapy
if in ambulatory care - go home even if cultures are positive, monthly sputum culture
