Tuberculosis Flashcards
two TB-related conditions
1 ) Latent TB infection
2) TB disease
How is TB spread
• Spread via airborne droplets when infected person coughs, speaks, sneezes, sings
• Because they are so small, the particles remain airborne indoors for minutes to hours.
• Factors that influence the likelihood of transmission include
(1) number of organisms expelled into the air
(2) concentration of organisms (small spaces with limited ventilation would mean higher concentration)
(3) length of time of exposure
(4) immune system of the exposed person.
• Organisms are dispersed in a room and then inhaled (rare for infection after brief exposure)
TB once it’s in the lungs
- Inhaled bacilli go to alveoli
- The macrophages swallow the TB bacillus.
- If the amount of TB bacilli is too large, or if the macrophage is not strong enough to resist, the bacilli can reproduce in the macrophage
- Spreads via lymphatic system.
- TB + macrophage build a complex = Ghon focus
- complex in the lung tissue + infected local lymph node = Ghon complex
Symptom Presentation of TB
Initially manifest
•fatigue, malaise (discomfort/unease), anorexia, unexplained weight loss, low-grade fevers, and night sweats.
Clinical manifestations
• early stages are usually free of symptoms
• Cough (hemoptysis is associated with advanced disease, dyspnea is unusual)
• May have chest pain characterized as dull or tight.
Acute symptoms (flulike) High fever, chills, pleuritic pain, productive cough
TB can also be classified according to its 2
(1) presentation
- primary
- latent
- reactivated
(2) symptoms
- pulmonary
- extrapulmonary
4 tests to diagnose TB
tuberculosis skin test (TST), interferon-γ (INF-gamma) release assays, chest x-ray, and bacteriologic studies
4 Complications of TB
• Miliary tuberculosis
• Pleural effusion
- accumulation of fluid in the pleural space
• Empyema
-purulent fluid collection in the pleural space,
Caused y bacteria in pleural space.
•Tuberculosis pneumonia
Other organ involvement
TB Treatment general
Collaborative care
• Hospitalization not necessary for most clients
• Drug therapy is used to prevent and treat active disease
• Monitoring compliance is critical for successful treatment.
• vaccine (Bacille Calmette-Guérin (BCG) vaccine), active only given to high risk people (ie. country/job specific)
Active TB Treatment
- Aggressive treatment is required to combat resistant strains of TB
- 4 drugs are used in the initial 2 month phase (INH, Rifampin, Pyrazinamide and ethambutal (sometimes discontinued
- liver function should be monitored.
- The major adverse effect of isoniazid, rifampin, and pyrazinamide is nonviral hepatitis.
Latent tuberculosis infection Treatment
- Individuals with LTBI have fewer bacteria, treatment is easier and only one drug is needed.
- Treated with INH for 6 – 9 months or rifampin for 4 months
A patient presents with flu-like symptoms including fever, chills, chest pain, and a cough with blood-tinged sputum. Which classifications of tuberculosis would the nurse anticipate?
Class 1 tuberculosis Pulmonary tuberculosis Active tuberculosis disease Latent tuberculosis infection Primary tuberculosis infection
Class 1 tuberculosis
A patient with class 1 tuberculosis would not have any signs of infection, including fever, chills, chest pain, or cough.
Correct
Pulmonary tuberculosis
The respiratory symptoms indicate the disease is pulmonary in nature.
Correct
Active tuberculosis disease
The active symptoms the patient is experiencing indicate that the patient has tuberculosis disease.
Latent tuberculosis infection
A patient with latent tuberculosis would not present with symptoms.
Primary tuberculosis infection
A patient with a primary infection would not have active symptoms because the bacteria are inactive.
Nursing Management:Tuberculosis
-Assessment
Nursing assessment
Assess for productive cough, night sweats, afternoon temperature elevation, weight loss, pleuritic chest pain, crackles over apices of lungs
Nursing Management:Tuberculosis
Nursing diagnoses
Ineffective airway clearance
Risk for infection
Risk for nonadherence or ineffective health management
Nursing Management:Tuberculosis
Planning
Comply with therapeutic regimen
No recurrence of disease
Normal pulmonary function
Take appropriate measures to prevent spread of the disease.
Nursing Management:Tuberculosis
Nursing implementation
Health promotion screening, identify contacts Acute intervention respiratory isolation, 4 drug therapy, medical workup teach client how to cover nose and mouth with tissues and how to dispose soiled tissues, handwashing Ambulatory and home care Ensure adherence Teach symptoms of recurrence
