Tuberculosis

Question 1

What is the infectious agent of TB?

Answer 1

Mycobacterium tuberculosis

Question 2

What is the incubation period of TB?

Answer 2

2-10 weeks

Question 3

What is the number one killer among all infectious diseases?

Answer 3

TB

Question 4

It is when you already have the TB infection in our bodies, but still inactive state

Answer 4

Latent TB

Question 5

What is the mode of transmission of TB?

Answer 5

• Inhalation
• direct or indirect
• contact

Question 6

True or False. TB is highly communicable during its active phase

Answer 6

True

Question 7

Why are patients who have undergone organ transplant immunocompromised?

Answer 7

the kidney or heart is not part of the body so it will be attacked by the antibodies & WBCs that will reject the organ. so inorder for the body not to reject it, they will give immunosuppressant drugs. this will not attack the organ transplanted but will decrease the immune system and weakens it. Example: steroids

Question 8

How can cancer lead to TB?

Answer 8

anti cancer drugs will cause the bone marrow to be destroyed, this will lead to decreased WBC making you prone from acquiring the TB virus

Question 9

What is the effect of being immunocompromised relating to TB?

Answer 9

When a patient who is 10 years old is infected with TB, WBCs and immune system is strong enough to cover the bacteria making it inactive. As you grow old, and you will be having organ transplant, you will be taking immunosuppressant like your steroids/prednisone that is going to make your immune system weak. the engulf of the microbacilli will get out of the bacilli and will be activated and seen in the body.

Question 10

What are some health teaching to patients taking steroid?

Answer 10

• take it in full stomach since it is a GI irritant
• since patient is going to take it for 1 year, this is going to decrease the immune system therefore being prone to infection
• avoid going to crowded places like your malls, supermarkets, or parties
• do not get exposed to people who have upper respiratory infection
• avoid eating raw foods such as green salads or sashimi due to many worm or insects that may infect the patient
  *make sure to eat well cooked foods
  *eat low sodium diet and lower caloric intake such as no canned goods, cured meat, milk and milk products since steroids increases reabsorption of sodium and where sodium is, water follows. it can also increase weight
  *give low caloric diet such as oatmeal, low fat cottage cheese, egg, and cooked vegetables to avoid getting fat
  *Lessen pastries, bread, anything sweet, collard greens, and carbohydrate to avoid blood glucose elevation
• inform patient that it causes osteoporosis so their bones might be weaked and fragile that is prone to having fracture

Question 11

What is the pathogenesis of TB?

Answer 11

Once inhaled, bacteria travels to lung alveoli which are also transported to the lymph system, bloodstream, to other parts of the body where the body responds by an inflammatory reaction against the infection being established.
Phagocytes engulfs these bacteria and TB specific lymphocytes destroy the bacilli and the normal tissue which results in the accumulation of exudates in the alveoli causing bronchopneumonia. Granulomas which are new tissue masses of live and dead bacilli are surrounded by macrophages which form a protective wall that are then transformed to a fibrous tissue mass in the central portion of which is called the Ghon tubercle. The material (bacteria and macrophages) becomes necrotic forming a cheesy mass that may become calcified and form a collagenous scar. the bacteria becomes dormant and no further progression of active disease. When there is reinfection and inadequate immune system, this will activate the dormant bacteria. ghon tubercle will ulcerate and release the cheesy material into the bronchi where it can become airborne resulting to further spread of the disease.

Question 12

What are the signs and symptoms of TB?

Answer 12

1. progressive fatigue
2. malaise
3. anorexia
4. weight loss
5. chronic cough (productive)
6. night sweats
7. hemoptysis
8. pleuritic chest pain
9. low grade temp (late afternoon)

Question 13

why is there progressive fatigue to a pt with TB?

Answer 13

it is due to less oxygen. tb affects the alveoli therefore the affects the quality of blood and has less oxygen

Question 14

why is there hemoptysis in patients with TB?

Answer 14

blood vessels around the alveoli can rupture due to increased pressure which leads to coughing of blood

Question 15

what is the reason why there is low grade temperature of patients with TB in the late afternoon?

Answer 15

patient’s energy is decreased in the afternoon therefore infection can be higher compared in the early morning of the day. this infection is manifested by the high temperature due to the decrease in the production of cortisol by the adrenal cortex which is responsible for hindering inflammation and vascular permeability. since cortisol natural production is during the morning which is 6-8am.

Question 16

What do you call the skin test done to TB patients?

Answer 16

Tuberculin Skin Test or Mantoux Test

Question 17

How do you perform the TBT test?

Answer 17

• Administered via intradermal injection
• Hold the needle & syringe almost parallel to the patient’s skin, keeping the skin slightly taut when the needle is inserted
• Insert the needle with the bevel side up
• Inject 0.1mL PPD intradermally
• Should produce wheal of 6-10mm
• Find and measure induration
  o 0 to 4mm not significant
  o >5mm significant to people at risk
  ≥15mm up to 7 days after placement, the result can be considered positive
  o Does not necessarily mean that active disease is present in the body
  Non-significant skin test means the person’s immune system did not react to the test and least like to TB infection/disease

Question 18

Two types of blood tests to patient with TB

Answer 18

QuantiFeron-TB Gold Plus and T-SPOT

Question 19

Diagnostic test preferred for patients who has BCG vaccine and patients who will not return for 2nd appointment to TST

Answer 19

QuantiFeron-TB Gold Plus and T-SPOT

Question 20

Frequency of Sputum Collection for Patients with Suspected TB Disease

Answer 20

• Three negative sputum smears
• At least 8 hours apart
• At least one collected during early morning
• Patients with negative sputum smear results may be released from AII in 2 days
• Sample sputum is 5ml

Question 21

TB bacteria developed a resistance to the first line drugs such as Isoniazid and Rifampicin. Also called “superbug”

Answer 21

MDR-TB

Question 22

Recommended strategy for TB control. They get free anti TB drugs for low socioeconomic people

Answer 22

Directly Observed Therapy Short Course (DOTS)

Question 23

Asking a relative or a health worker to directly observe the patient taking the anti TB medicines daily

Answer 23

DOTS

Question 24

How can a patient develop resistance to medications?

Answer 24

If pt is not going to take it regularly, due to lack of knowledge, and stopped their regular medications or taking it inconsistently

Question 25

What drugs are used when strains resistant to RIF, INH, EMB?

Answer 25

• Fluoroquinolones (Levofloxacin, Moxifloxacin, Gatifloxacin)

Question 26

This drug inhibits formation of cell walls in mycobacteria. It penetrates body cells & mycobacteria, kills actively growing intracellular & extracellular organisms & inhibits the growth of dormant organisms in macrophages & tuberculous lesions

Answer 26

Isoniazid

Question 27

What are some Health Teaching for Isoniazid?

Answer 27

• When a person is diagnosed with TB, family members are usually given prophylactic doses of INH for 6 months to 1 year
• Vitamin B6 (Pyridoxine) is usually given along with the INH to prevent leg numbness & tingling
• INH 25 to 50mg daily to minimize peripheral neuropathy
  o First manifestation of peripheral neuropathy: tingling sensation then numbness
• Avoid foods containing tyramine and histamine such as tuna, aged cheese, red wine, soy sauce, and yeast extracts
  o Causes headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis
• Avoid alcohol
  o High potential for hepatoxic effects

Question 28

• Bactericidal for both intracellular & extracellular tuberculosis organisms
• Kills mycobacteria by inhibiting synthesis of RNA & thereby causing defective, nonfunctional proteins

Answer 28

Rifampin

Question 29

What are the Health Teachings for RIF?

Answer 29

• Causes harmless RED-ORANGE discoloration of body secretions such as:
  o Urine, tears, saliva, sputum, perspiration, feces
• Soft contact lenses may be permanently stained
• Wear eyeglasses during treatment
• Alter the metabolism of other medications
  o beta blockers
  o oral anticoagulants (warfarin, digoxin, quinidine, corticosteroids, oral hypoglycemic agents, oral contraceptives, theophylline, and verapamil)
  o adjust dosages accordingly

Question 30

• Inhibits synthesis of RNA & thus interferes with mycobacterial protein metabolism
• Major adverse effect is Optic Neuritis

Answer 30

Ethambutol

Question 31

Bactericidal against actively growing mycobacteria in macrophages containing TB organisms. Inhibits urate excretion causing hyperuricemia

Answer 31

Pyrazinamide

Question 32

What is the most common adverse effect and severe adverse effect of Pyrazinamide?

Answer 32

GI upset
Hepatotoxicity

Question 33

How do you check if a patient has hyperuricemia?

Answer 33

if the patient has gouty athritis (accumulation of uric acid in the joints away from the heart)

Question 34

How will you know if a patient with TB is considered noninfectious already?

Answer 34

o They have been receiving adequate treatment for 2-3 weeks
o Their symptoms have improved
o Three consecutive negative sputum smears from sputum collected on different days

Question 35

What are the AII Policies and Practices?

Answer 35

• All rooms should be single patient rooms with a private bathroom
• HCWs who enter should wear at least N95 disposable respirators
• Visitors to AII rooms can be offered respiratory protection and should be instructed in respirator use
• Separate patients with suspected or confirmed infectious TB disease from HCWs and other patients
• Schedule patients with suspected or confirmed infectious TB disease for procedures when a minimum number of HCWs and other patients are present
• Provide a surgical or procedure mask for suspected or confirmed infectious TB patients during transport, in waiting areas, and when others are present
• Keep doors closed as much as possible
• Maintain adequate number of AII rooms
• Check room for negative pressure daily when in use

Question 36

What are some of the DOTS activities?

Answer 36

• Member of the family is supervising the patient top take regularly
• Health workers observe TB patients swallow each dose of a powerful combination of anti-TB medicines
• Health workers counsel TB patients about health services
• Health workers monitor the patient’s progress until they are cured

Question 37

Risk Factors for Non-adherence

Answer 37

• Previously failed the last course
• Physically, emotionally, mentally challenges
• Unable to pay for medications
• Abusing substances

Question 38

How can TB spread to other people? (Miliary TB)

Answer 38

1. Results from late reactivation of dormant infection in the lung or elsewhere
2. Origin of bacilli enters the bloodstream either a chronic focus
3. Ulcerated/injured and invades into blood vessel or military tubercles lining the inner surface of thoracic duct
4. Now migrate into the bloodstream to the body, tissues, organs

Question 39

Give one Nursing Care Diagnosis and Care Plan

Answer 39

Ineffective Airway Clearance related to Alveolar Inflammation Secondary to Pulmonary Tuberculosis
1. Apply standard precautions and airborne precautions when entering the patient’s room, use N95 or N100 respirators before entering the room because PTB is a highly contagious disease and it is possible for you to acquire it since it is suspended in the air
2. Auscultate the lungs of the patients. Note if there are rhonchi, wheezes, and notice if there is diminished breath sound
3. Promote adequate fluid intake since it will help to loosen up the mucus secretion and making it thin so that it will be easy for the patient to expectorate it
4. Position the patient to a semi-fowler or High Flower’s position because by gravity, it will help the patient’s lungs to maximize so that the patient will not have difficulty in breathing
5. Instruct the patient to have a small, frequent diet because eating large meals needs a huge amount of energy, and since patient w/TB have limited energy because of fatigue, dyspnea, chest pain, it will be hard for them to digest regular meals that’s why small, frequent meals are advised.