Tuberculosis

Question 1

Tuberculosis

Answer 1

• an infectious disease caused by the mycobacterium tuberculosis invading the lungs
• transmitted through AIRBORNE routes
• can stay dormant in the body for years until there is a disruption in the immune system

Question 2

Risk factors

Answer 2

1) lower socioeconomic status, homelessness
2) immunosuppression (HIV, chemotherapy)
3) poorly ventilated, crowded environments (prisons, long-term care facilities)
4) advanced age
5) recent travel outside the U.S. to areas where TB is endemic
6) substance use disorder
7) health care occupation that involves performance of high-risk activities (respiratory treatments, suctioning, coughing procedures)

Question 3

Diagnostics

Answer 3

1) Mantoux test–intradermal skin test of a purified protein derivative (PPD)
- a wheal will appear initially
- test should be read in 48-72 hr
- if positive, site will be red and indurated (raised and hardened)
2) QuantiFERON–TB Gold blood test
- detects release of interferon-gamma (IFN-g) in fresh heparinized whole blood from sensitized people
3) chest x-ray
- if client exhibits manifestations of TB or after a positive PPD test
4) sputum smear

Question 4

Tuberculosis Symptoms

Answer 4

1) productive cough
2) poor appetite
3) night sweats
4) weakness
5) fever
6) chest pain
7) dry cough
8) weight loss
9) GI symptoms

Question 5

Nursing Actions for Client who has TB

Answer 5

1) administer O2 therapy as prescribed
2) maintain AIRBORNE isolation techniques
- particulate respirator (HEPA mask, N-95)
- negative airflow
- private room
3) place HEPA mask on client when transporting out of the room
4) assess respiratory status (lung sounds, airway patency, sputum characteristics)
5) obtain specimens. report laboratory/diagnostic findings to provider immediately
6) encourage fluid and proper nutritional intake:
- protein
- iron
- vitamin C

Question 6

Medications for Treatment of TB

Answer 6

1) combination therapy of up to 4 medications at a time is presently recommended due to developing resistance against antituberculin medications
2) these medications may be taken for 6-12 months
- medication noncompliance is a major contributing factor in development of resistant strains of TB
3) current 4-medication regimen includes:
- isoniazid (Nydrazid)
- rifampin (Rifadin)
- pyrazinamide
- ethambutol hydrochloride (Myambutol)

Question 7

Client/Family Education

Answer 7

1) exposed family members should be tested for TB
2) educate client and family to continue medication therapy for full duration of 6-12 months. failure to take medications may lead to a resistant strain of TB.
3) instruct client to continue with follow-up care for 1 year
4) inform client that sputum samples are needed every 2-4 wks to monitor therapy effectiveness. clients are no longer considered infectious after 3 negative sputum cultures
5) encourage proper hand hygiene and covering mouth and nose when coughing or sneezing
6) inform client that contaminated tissues should be disposed of in plastic bags
7) advise clients who have active TB to wear masks when in public places