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Test 4 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is Tuberculosis

A
  • Infectious bacterial disease caused by Mycobacterium tuberculosis.
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2
Q

What organ(s) does TB affect

A
  • Primarily affects the lungs but can involve other organs like: kidneys, brain (meninges), bones, adrenal glands, and lymph nodes.
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3
Q

What are 3 factors contributing to Multi-Drug Resistant (MDR) strains of tuberculosis?

A
  • Poor compliance
  • poor adherence to proper follow-up
  • Ineffective RX
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4
Q

How is tuberculosis (TB) spread?

A

AIROBORNE droplets from an infected person BY:

  • Breathing
  • Coughing
  • Sneezing
  • Singing
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5
Q

How long do infectious droplets remain in the air?

A

Minutes to Hrs

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6
Q

Ways TB is NOT through:

List 4

A
  • touch
  • kissing
  • utensils
  • bed linens
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7
Q

What is the growth environment of Mycobacterium tuberculosis and why does it thrive in the lungs?

A
  • thrives in the lung environment due to its aerobic nature
    -requiring oxygen (O2) to survive and multiply.
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8
Q

immunocompetent

A

funcitoning immune

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9
Q

Can most immunocompetent adults clear M. tuberculosis from their system?

A

YES!

  • In healthy individuals with a functioning immune system, the body can mount an effective immune response against M. tuberculosis, leading to the containment or eradication of the bacteria.
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10
Q

What is the INITIAL defense against M.Tuberculosis for immunocompenten individuals?

A

trapping bacteria in MUCUS
-which can then be cleared out, preventing infection.

  • prevents bacteria from reaching lungs
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11
Q

Does having M.Tuberculosis trapped in the mucus make the person infectious?

A

No!
person exposed to TB but NOT INFECTED

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12
Q

What happens to M.Tuberculosis if left over bacteria persist after initial defenses

A

If some bacteria evade initial clearance and persist in the body, the immune system can still contain them but in a non-replicating dormant state- This is known as latent tuberculosis (latent TB).

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13
Q

So, is a patient INFECTED during the Latent TB phase?

A

Yes - patients are infected with M.tuberculosis but will NOT exhibit symptoms and are NOT contagious.

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14
Q

Also, in Latent TB individuals are infected but DO NOT progress to

A

ACTIVE TB/ disease

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15
Q

They are a hallmark of the body’s attempt to contain pathogens that are difficult to eradicate, such as M. tuberculosis.

A

Granulomas

  • organized clusters of immune cells, primarily macrophages, that form in response to chronic inflammation or infection
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16
Q

Granulomas are vital in which phase of TB?

A

Latent TB

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17
Q

granulomas help prevent

A

replication and limit the infection
-often resulting in “healed” lesions.

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18
Q

when granulomas are hardened they are considered

A

healed

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19
Q

What are the TB test results for a patient in the Latent phase?

A
  • Positive for TB
  • But infection will NOT progress to further stages
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20
Q

infection

A

a person is infected

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21
Q

disease

A

signs of ACTIVE infection and associated health issues

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22
Q

In Immunocompromised individuals, what happens to the granulomas?

A

Granulomas may form but are ineffective in halting bacterial replication.

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23
Q

If Granulomas fail to contain bacteria, what happens to the bacteria M.TB?

A
  • Leads to reactivation of bacteria.
  • Bacteria mutates and progresses from Latent TB to Active TB.
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24
Q

When Latent TB transitions to Active TB, symptoms of the disease may arise ___.

A

months or years later

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25
Q

Individuals at risk for TB

A
  • Poor/underserved, homeless
  • Immigrants, elderly
  • IV drug users, alcoholics
  • Immunocompromised individuals (HIV, chemotherapy).
  • Children under 5 years old.
  • Workers in high-risk institutions (prisons, hospitals, shelters).
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26
Q

Clinical Manifestations for Latent TB

KNOW

A
  • No symptoms
  • Does not feel sick

(cannot spread TB)

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27
Q

DX results for Latent TB

A
  • (+) TB skin test
  • (-) sputum smear
  • normal chest x-ray
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28
Q

Active TB/TB disease

Early S/S

A
  • Persistent dry cough leads to productive
    -lasts >3 weeks
  • chest pain (pleuritic)
  • low-grade fever
  • fatigue
  • anorexia
  • no appetite/weight loss
  • night sweats, chills
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29
Q

Active TB/TB disease

Late S/S

A
  • hemoptysis: coughing up of blood or blood-stained sputum
  • dyspnea: SOB
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30
Q

If patients show Active TB S/S, what question should be asked?

A

Have they traveled recently to:
india (#1), china, indonesia, phillippines, S. Africa

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31
Q

What are the 3 complications associated with TB?

A
  1. Cavitations
  2. Miliary TB
  3. TB Meningitis
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32
Q

What are Cavitations

A

Destruction of healthy lung tissue, forming “caves.”

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33
Q

What is Miliary TB?

A
  • Type of meningitis
  • spread of TB bacteria throughout the body (in blood), resulting in small lesions (millet seeds) in multiple organs, often leading to systemic symptoms.
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34
Q

Miliary TB:

Acutely ill S/S

A
  • Fever
  • dyspnea
  • cyanosis
  • organ enlargement,
  • cognitive changes
  • systemic symptoms

(depends on where TB is located)

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35
Q

Miliary TB:

Progression of illness S/S

A
  • Weight loss
  • fever
  • GI issues
  • hepatomegaly
  • splenomegaly
  • renal changes
  • cognitive changes
  • severe cough
  • dyspnea
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36
Q

What is TB Meningitis

A

specific form of meningitis resulting from TB infection to the meninges (protective covering of the brain) and spinal cord.

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37
Q

S/S of TB Meningitis

know

A
  • Fever
  • persistent HA
  • altered mental status
  • stiff neck
  • dislike bright lights **
  • loss of appetite
  • vomiting
  • seizures
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38
Q

Most important S/S of TB Meningitis

A
  • spread to Meninges leads to seizures - most important **
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39
Q

Complications arrising from TB Meningitis

A
  • long term paralysis
  • hearing loss
  • blindness
  • brain injury
  • epilepsy:*unprovoked seizures due to abnormal electricalf activity in the brain
  • hydrocephalus: accumulation of cerebrospinal fluid in the ventricles of the brain*
  • death
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40
Q

5 DX studies for TB

A
  1. Tuberculin Skin Test
  2. Blood Tests
  3. Chest X-rays
  4. CT scans
  5. Sputum Smears and Cultures
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41
Q

Another name used for Tuberculin SKin Test

A

Mantoux Test

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42
Q

Which of the DX test is the STANDARD for tesing

A

Tuberculin Skin Test (Mantoux Test)

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43
Q

What is injected into patient when performing Tuberculin Skin Test (Mantoux Test)

A

0.1 mL of PPD= component of M. Tuberculosis

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44
Q

Is PPD a live bacteria?

A

NO! NOT A LIVE BACTERIA

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45
Q

What will the skin appear if patient tests positive for Tuberculin Skin Test (Mantoux Test)

A

Hardening, or induration, of skin at the injection site.

  • redness is not enought to read results
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46
Q

How long after a Tuberculin Skin Test (Mantoux Test) does it take to show positive if pt infected with TB?

A

Will show positive 2-12 weeks AFTER a patient becomes infected with TB.

  • can not read results before 2 weeks!!!
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47
Q

If a patient has had a previous POSITIVE skin test, what happens in future TB tests?

A

Will test positive for life.

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48
Q

Why will an infected TB patient test positive for the rest of their lives when taking a TB skin test?

A

Body will always continue to make antibodies agains TB

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49
Q

When should TB skin test be administered when it comes to LIVE immunizations?

A
  • SAME DAY as LIVE virus vaccines
    or
  • 4-6 weeks AFTER administration of live-virus vaccine
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50
Q

What vaccines contain a LIVE-VIRUS?

Know

A
  • varicella-chkn pox
  • MMR
  • Rota Virus
  • small pox
  • yellow fever
  • ORAL Pollio
  • BCG: Bacillus-Calmette-Guerin Vaccine
  • NASAL Flu (has to be nasal)
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51
Q

Is COVID a live-virus

A

NOPE

52
Q

is an IM flu vaccine live-virus?

A

NOPE- only nasal flu is live

53
Q

Is PPD a live-virus

A

NOPE

54
Q

BCG recipients is NOT a direct contraindication to TB skin test but may result in

A

FALSE-POSITIVE test

55
Q

Can Pregnant patients have the TB skin test (with PPD)?

A

YEs- safe to administer

56
Q

Live-virus vaccines NOT safe for

A

pregnant patients

57
Q

Why is an adverse reaction to the TB skin test a contraindication for future tests?

A
  • body may react inappropriately to the test substance (tuberculin)
  • Administering another skin test in the future could trigger a stronger or dangerous immune response
58
Q

How would an immunocompromised state possibly affect TB skin test

A
  • Immunocompromised patients are unablel to produce enought antibodies
  • will give FALSE NEGATIVE result
  • Anything greater than or equal to 5 = positive test
59
Q

Steps when administering TB skin test

A
  • 0.1mL of PPD solution (bevel up)
  • 6-10mm in diameter bleb (will absorb quickly)
  • brief delay b4 withdrawing needle
  • standard precautions when administering (gloves)
60
Q

What should you NOT THROW AWAY during a TB skin test?

A

VIAL!!! - do not throw away until you have documented

61
Q

Things to know about TB PPD VIAL?

A
  • dark brown in color- light sensitive
  • do NOT draw before hand
  • once opened good for 30 days or expiration date- whichever comes FIRST
62
Q

TB skin test should be read within

A

48-72 hrs after injection

63
Q

how to measure induration (hardening or raised)

A
  • Always touch induration
  • measure widest diameter
  • measure transversely
  • record in millimeters (mm)
64
Q

TB skin test:

Skin that is red and inflammed, should it be included in the measuring of induration?

A

No. only induration (raised/hardening) of skin is measured.

65
Q

if induration present pt will be monitored for how long

A

Continue to monitor for up to 1 week -if needed

66
Q

in a healthy person with normal immune system, an induration of 15mm is considered

A

a POSITIVE SKIN TEST.
* a positive reactino is a response by the immune system.

67
Q

If test is not read between 48-72 hrs what needs to be done?

A

retake test

68
Q

Who can read a TB test?

A

anyone who is trained

69
Q

Interpretation of results:

≥ 5mm = Positive Test for:

A
  • HIV Infected Individuals
  • Immunocompromised (Organ Transplant, Cancer, Chemo, Etc.)
  • Pts taking >15 mg/day of PREDNISONE for 1 month or longer
  • Pts taking TNF-alpha antagonist
70
Q

Interpretation of results:

  • ≥10mm = Positive Test for:
A
  • Drug users
  • Healthcare workers
  • Children and Adolescents
71
Q

Interpretation of results:

  • ≥15mm = Positive Test for:
A
  • Persons with NO known risk for TB
  • healthy immune patients
72
Q

Interpretation of results:

No induration:

A
  • Does not guarantee that pt may not have TB
  • MANY factors can play a role
73
Q

When is ‘TWO-STEP testing’ performed for TB test?

A
  • if suspicion of a possible negative test or to ensure TB dx is not missed
  • perfoming 2 skin tests: 1-3 weeks apart.
  • Both test HAVE to be NEGATIVE in order to be considered NEGATIVE.
74
Q

2 Types of Blood Test for TB

A
  • IGRA: interferon-gamma release assay
  • Quantiferon-TB “Gold Test”
75
Q

Blood test readings

A
  • Negative results = not infected
  • positive results = infected
76
Q

Why is a further evaluation required for a positive BLOOD test?

A

to determine if Latent infx or Active dz

77
Q

Blood tests are not usually done bc

A

they are expensive

78
Q

A CXR or CT scans may be done

A
  • AFTER a positive skin test to detect lung abnormalities (infiltrates) in upper lobes of lungs
  • Does not confirm or rule out TB
79
Q

Can CXR define the stage of TB?

A

Helps define if infection is latent or active but NOT DEFINITIVE
* Helps see how much is going on in the lungs
.

80
Q

Which DX test is the MOST CERTAIN to determine stage of TB?

A

SPUTUM CULTURE!!!

know

81
Q

TB Testing: Culture & Sputum:

What does the Sputum SMEAR test for?
(not the same as sputum culture)

A

Acid-Fast-Bacilli (AFB)

  • type of bacteria, including Mycobacterium tuberculosis, that retain a specific stain (acid-fast stain) under a microscope. This property helps identify TB bacteria in diagnostic tests like AFB smears.
82
Q

AFB smear DOES NOT confirm dx of TB, but it does indicate

A

TB disease
* due to some acid-fast-bacilli are not M.tuberculosis
* it’s NOT very sensitive and may not detect the bacteria if they are in low numbers.

83
Q

How many AFB Smear sputum tests are need to be taken to confirm/deny TB?

A

3 consecutive sputum speciments collected on DIFFERENT days.

84
Q

Cultures:

Is a POSITIVE CULTURE indicative of starting or continuing tx?

A

No
(idk why, PP just says this)

85
Q

Cultures:

What does a Positive Culture test for M.Tuberculosis means?

A

confirms the diagnoses of TB disease

86
Q

Culture Tests:

Every sample collected from a patient for TB testing MUST

A

Must undergo a culture test, even if a preliminary test, like an AFB smear, shows no bacteria, or regardless of AFB smear results.

87
Q

Down side of Cultures

A

takes up to 8 weeks

88
Q

Culture:

A Negative CULTURE test means

A
  • patient is negative OR
  • in Latent stage of TB
89
Q

Culture:

A Positive CULTURE test means

A

patient is in ACTIVE stage of TB

90
Q

What is the primary treatment for both latent and active TB?

A

drug Therapy

91
Q

__ & __ is critical for treatment to be successful

A

Promoting and monitoring compliance

92
Q

Hospitalization is reserved for

A

severly ill patients.

93
Q

Main class of medications used to treat TB

A

Anti-Tuberculin - Antibiotics

94
Q

Many of these Anti-tuberculin (Antbx) drugs can cause

A
  • hepatotoxic: liver damage caused by toxic substances
  • hepatitis: inflammation of liver

-need to monitor liver

95
Q

What test are needed for baseline of Liver function

A

AST/ALT
(requirs ongoing monitoring)

96
Q

S/S of hepatic involvement

A
  • Nausea or vomiting
  • loss of appetite
  • jaundice
  • dark urine
  • fever: lasting three or more days and has no obvious cause
97
Q

Which stage of TB requires MULTIPLE MEDS used in combination

A
  • Active TB
98
Q

Two types of Anti-Tuberculin Drugs

A
  • First line drugs: need to know 4
  • second line drugs: do not need to know
99
Q

Combination of meds regimen usually lasts

A

26-39 weeks
(initial phase (plus B6) + continuation phases).

100
Q

4 main drugs used for Active TB/Disease

A

R.I.P.E MEDS

  • Isoniazid (INH)
  • Rifampin
  • Pyrazinamide
  • ethambutol
101
Q

What can happen with pt’s who are Non-adherence

List 3

A
  • drug-resistant strains of M.TB.
  • danger to public
  • increases risk for reactivation of TB.
102
Q

TB treatment:

What is Directly Observed Therapy (DOT)

A

ensures patients swallow their anti-tuberculosis medication.

103
Q

Directly Observed Therapy is used for what patients

A

Used for ALL TB patients but required for pts who are high-risk for non adherence

104
Q

Medication that causes peripheral neuropathy

A

Isoniazid ‘INH’

105
Q

Isoniazid (INH) is often used for what TB stage?

A

Latent TB- used by itself.

106
Q

Causes of Isoniazid

Remember INH

A

‘INH’:

I- interferes with B6 absorption (Low B6=peripheral neuropathy
N- neuropathy
H-hepatotoxicity - jaundice (yellow skin/sclera, dark urine, fatigue, elevated AST/ALT)

107
Q

Patients on ISONIAZID should avoid

A

alcohol- any amount!!!

  • if option says ‘reduced alcohol’- DONT CHOOSE IT!!
108
Q

With Rifampin remember “RED” because

A

Body fluids turn red/orange: tears, urine, sweat

THis is NORMAL

109
Q

Pt education when taking Rifampin

A
  • wear glasses (avoid contacts)
  • use backup non-hormonal birth control- oral contraceptives wont work
  • monitor for jaundice
110
Q

How to take Rifampin

A
  • take on empty stomach- 1 hr before meals (least effective with food)
  • Can make some meds less effective: BB, digoxin, verapamil, anticoags - dont need to know drugs)
111
Q

Patient education for Pyrazinamide (PZA)

A
  • Sun sensitivity
  • jaundice
  • dark urine
  • bleeding
  • difficult urinating (potential liver damage)
  • No ALCOHOL
112
Q

For Ethambutol Pt education

A

Think ‘EYE’

  • Risk of vision changes (blurry or color changes)- need to report!!!
  • routine eye exams recommended.
113
Q

Drug of choice for Latent TB infection

A

Isoniazid (INH)
* due to its effectiveness and inexpensiveness

114
Q

What does Isoniazid (INH) cause?

A

Liver damag- so NO ALCOHOL

115
Q

Pts on Isoniazid (INH) usualy take it how long?

A

1x daily for 6-9 months
(9months= optimal esp for children)

116
Q

When will Isoniazid (INH) need to be monitored by medical personel?

A

when dosage is increased

117
Q

Combination therapy primarily used for

A

resistant strains or toxicity cases
(ie: isoniazid and rifampin)

118
Q

What is the treatment duration for Multi-Drug Resistant (MDR) TB?

A

ADDITION 20-30 months of antbx INJECTIONS

119
Q

How long after starting TB therapy are most patients no longer infectious?

A
  • After 2-3 weeks of therapy
120
Q

Why is follow-up with smears, cultures, and chest X-rays essential in TB treatment?

A
  • to confirm recovery
  • Tests will be done throughout the course of drug therapy.
121
Q

Hospitalized clients:
Treatement of Active TB dz will include

A
  • Negative pressure room.
  • Airborne Isolation
  • Nurse precautions: N95 mask (particulate mask), wash hands before and after caring for patient.
  • Patient outside room: pt wears a mask (standard precautions), no mask for healthcare workers needed if pt has a mask.
  • Drug Therapy: started ASAP
  • CXR, Sputum & Cultures
122
Q

TB client Education:

A
  • Teach infection control measures: wear masks (1st three weeks), hand-washing, proper disposal of tissues- paper bag or toilet.
  • At home: well ventilated, sleep alone, outdoors as much as possible, limit areas of dense population
  • Ensure strict adherence to medication regimens: Teach side effects and ways to minimize.
  • Reassure patients that after 2-3 weeks of treatment, they are no longer contagious.
  • adequate nutrition
  • No strict isolation for family members living with infected pt = already exposed.
  • No new family or friends can visit until sputum cultures are negative.
123
Q

Know for test:

do Latent TB pts need PPE when transported?

A

No- they are not infectious

124
Q

If pt comes to ER with coughing up blood what should you ask the question immediately?

A

have they traveled recently?

125
Q

Questions with Patient and Vitals:

1st thing to do if TB suspected
2nd thing to do
3rd thing to do
4th thing to do

A

1st: airborne isolation
1nd: O2
3rd: blood cultures BEFORE starting meds
4th: Meds

Test 4 (8 decks)

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