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NCLEX Review > Tuberculosis > Flashcards

Tuberculosis Flashcards

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1
Q

a contagious bacterial infection caused by mycobacterium tuberculosis

A

Tuberculosis

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2
Q

Tuberculosis mainly affects the ____________ but it can also

A

upper lungs; spread to the lymphatic system, the brain, the joints, the liver, the spine, and kidney

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3
Q

Mycobacterium Tuberculosis - what do you know?

A

It’s acid-fast (it stains bright red with the acid-fast staining smear)
It’s an AEROBIC bacteria (so it LOVES oxygen and must have it to grow):
Which is why TB most commonly affects the UPPER part of the lungs because there is a higher oxygen concentration in the apex of the lungs rather than the base

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4
Q

How is Tuberculosis spread? What should someone wear at all times? Is the bacteria large or small?

A

Through the air.
(airborne precautions….wear a respirator at all times when providing patient care and special ventilation/negative pressure air room must be used for the patient with an ACTIVE TB infection). The bacteria is very small, so it can suspend itself in the air….it’s different than droplet type of infections:
If a person with an ACTIVE infection of TB talks, coughs, sneezes, laughs, yells (all these actions create droplets that harbor the bacteria) this can be inhaled by others.
Must be in contact with the person for a period of time to catch tuberculosis, which is why people who live in close quarters or spend a lot of time together are at risk. Another risk factor is having a weaken immune system (ex: HIV)

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5
Q

Risk factors for Tuberculosis

T
B
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S
K
A

Tight living quarters: long-term health care facilities, homeless shelters, prisons etc.

Below or at the poverty line (poor…homeless)

Refugees (high incidence of TB in their home country)

Immune system issues: HIV

Substance abusers (IV drugs, ETOH)

Kids less than the age of 4-5….weak immune systems

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6
Q

Questions to ask patients coming in with respiratory issues upon admission

A

Have you travelled outside of the country or lived outside of the country for a long period of time? If so, where and how long?

Where do you live? LTC (long term care facility), homeless, prison etc.

Use drugs? If so, what type?

If foreign born, ask is they have ever received the BCG (bacillus Calmette-Guerin) vaccine. This is a vaccination administered in some countries to prevent TB in children. If the patient has received this vaccine, they will have a positive TB skin test result (avoid a PPD skin test because it will give a false positive….needs a blood test instead) and a chest x-ray.

Are you having the following signs and symptoms: night sweats, cough for 3 weeks or more, blood in sputum, chest pain, weight loss and loss of appetite etc.?
Ever have a tuberculin skin test? If so, what where the results?

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7
Q

Latent vs Active TB - what is the difference?

A

Not everyone who actually inhales mycobacterium tuberculosis will develop a full case of active TB.

Most of the time when a person inhales the bacteria the immune system detects it, and it becomes encapsulated (so the immune system keeps it under control). Therefore, most people will never develop the active disease unless those encapsulated bacteria become active again.

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8
Q

everyone who is infected with mycobacterium tuberculosis will develop an active tuberculosis infection. TRUE OR FALSE

A

FALSE

*Not everyone who is infected with mycobacterium tuberculosis will develop an active tuberculosis infection

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9
Q

Latent tuberculosis infection (LTBI): the mycobacterium tuberculosis bacteria is lying_______________ and being controlled by the immune system….it’s ______________

A

dormant; encapsulated

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10
Q

Are people with active TB contagious?

A

Absolutely. The immune system can’t deal with it and it is flourishing

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11
Q

Do people with latent TB have signs & symptoms ?

Are they contagious ?

A

the person is: NOT contagious and does NOT have signs and symptoms, will have a normal chest x-ray, and negative sputum test

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12
Q

What is the only sign the person with latent TB will have ?

Do they still need treatment ?

A

Only sign the person will have is a positive TB skin test or blood test. This means that the immune system has responded to the bacteria.

Still need treatment? YES! This will help prevent an ACTIVE TB infection in the future. According to the CDC, 5-10% of patients who do NOT receive treatment for latent TB will develop active TB at some point.

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13
Q

ACTIVE or LATENT TB

the immune system isn’t able to contain the bacteria so it takes over (ex: weaken immune system due to HIV).

A

ACTIVE TB

Most cases of active TB are due to a latent case that turns into an active case

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14
Q

Is the person with active TB contagious? Do they have signs/symptoms?
What about their chest x-ray? Their sputum culture? Their PPD or blood test?

A

Therefore, the person is: CONTAGIOUS AND HAS SIGNS/SYMPTOMS, positive PPD or blood test, will have an ABNORMAL chest x-ray and positive sputum culture.
The bacteria can now spread via the lymphatic system throughout the body and affect other areas of the body like the brain, spine, joints etc.

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15
Q

signs & symptoms; symptoms of active tuberculosis

A 
Cough that lasts three weeks or more
coughing up blood
fever
night sweats
fatigue
unintentional weight loss
chills
loss of appetite
chest pain, or pain with breathing or coughing
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16
Q

remember most TB patients are asymptomatic until they reach the _______ stage

A

active

17
Q

Testing for Tuberculosis - which test is this ?

this is where purified protein derivative (hence where PPD comes from with the name) is injected with a tuberculin needle on the inner part of the forearm…

A

PPD tuberculin skin test (also called Mantoux Test, TST, TB skin test)

It is read in 48-72 hours…..(the patient must come back to have the test read and if the patient does NOT return within 72 hours the test will have to be repeated)
A positive result doesn’t necessarily mean the patient has an active infection of TB. It just means they have been exposed to it.
Does it tell the difference between a latent vs active infection? NO! The person will need a chest x-ray and sputum culture to confirm.

18
Q

Does the PPD test tell the difference between active and latent TB infection ?

A

NO! The person will need a chest x-ray and sputum culture to confirm.

A positive result doesn’t necessarily mean the patient has an active infection of TB. It just means they have been exposed to it.

19
Q

____________ is a hard or swollen area that is raised on the skin.

A

Induration

20
Q

What are we assessing for when reading the PPD test ?

What is the criteria for positive results ?

A

Induration of the injection site. Induration is a hard or swollen area that is raised on the skin. This will be measured in millimeters (mm). Redness is not measured…the induration is measured (for exams remember the criteria for positive results)

15 millimeters (mm) or more: Positive in all persons (doesn’t matter if the person does not have any risk factors)

10 mm or more: positive if the person is an immigrant, IV drug user, working or living in tight living quarters, child less than 4

5 mm or more: positive if person have HIV, in contact with someone with TB, organ transplant patient, or immunosuppressed

21
Q

What TB test is this ?

Two types currently on the market: QuantiFERON-TB Gold (QFT) and T-Spot

This test will check for the immune system’s reaction to mycobacterium tuberculosis.

A

BLOOD TEST: Interferon-Gamma Release Assays (IGRA Test):

Benefits: just one visit (doesn’t have to come back for results to be read and results are not affected by people who have had the BCG vaccine)

Downsides: It doesn’t differentiate between latent vs active…again the person will need a sputum culture and chest x-ray to confirm.

22
Q

What TB test is this ?
the patient provides the specimen through coughing it up or a bronchoscopy to collect the ______ The ________ is stained with a special dye and given an acid wash. If mycobacterium tuberculosis is present it will stain a bright red color.

What should the nurse remember about getting these tests ?

A

SPUTUM

“acid-fast bacilli” Smear

NURSE: collect three different sputum specimens on 3 different days
It’s best to collect them in the morning before breakfast (most collection of secretions from overnight)

23
Q

assesses for abnormal infiltrate in the lungs.

Which TB test is this ?

A

Chest X-ray

24
Q

NURSING INTERVENTIONS FOR ACTIVE TB PATIENTS

A

Initiate airborne precautions:

Negative pressure room (door closed at all times)

Must wear a respirator when providing care (fitted yearly for this mask)

Strict hand hygiene

How about if the patient has to leave the room for testing? Many procedures can be performed by the bedside, but if the patient must leave the room they will need to wear a surgical mask.

25
Q

Active TB infection education: most patients are treated ______________ because of the duration of how long they must take medications (6 months to a year)

Do they have to be isolated ? When can they be removed from isolation?

A

outpatient

Yes; they have to be isolated.

Isolation at home: can’t go to work, run errands, school etc. until no longer contagious (can go to medical appointments only….must wear surgical mask). To be removed from isolation they will need to be on medications for about 3 weeks, have 3 negative acid-fast sputum cultures, improvement of signs and symptoms, and be taking medications exactly as ordered (TB can become drug resistant)

No visitors, stay in separate rooms from other family member (stay away from young kids), keep windows and doors closed

Coughing, sneezing? Do this in a tissue and dispose immediately by flushing or put it an air tight bag and dispose

26
Q

How long will a patient with TB be on medications ?

A

They will be on medication treatment for several months…6 months to a year (depending on if they have LTBI or active TB)…..must be compliant (this is very hard for patients due to the amount of time they must take the medication and the frequency)

27
Q

Pertaining to tuberculosis medication compliance, what is DOT?

A

DOT (directly observed therapy): CDC recommends this to be used with ALL patient with TB because it is difficult to determine who will and won’t take their medication correctly.

This ensures the patient takes the correct medication at the right time and continues therapy. A trained individual (public health nurse or trained DOT worker) actually observes the patient swallowing the medication.
It helps decrease the patient from being noncompliant, monitors the patient for signs and symptoms related to the medications, and helps prevent resistant cases of TB.
Family members are NOT candidates for DOT.

28
Q

For TB, most common drug regime used includes four drugs: what are they ?

Mnemonic “PERI”: This word means “around or surrounds”. Normally, our body would surround this bacteria and ____________ it, but it has failed to do this. Therefore, these medications must do it!

A

encapsulate

Pyrazinamide
Ethambutul
Rifampin
Isoniazid

29
Q

What does Pyrazinamide do ?

What side effect should we look out for ?
Should we take it with food?
What should we monitor?

A

bactericidal effect (kills the bacteria)

watch in patients who are diabetic or have kidney problems, gout (increases uric acid which can lead to a gout attack)
Monitor uric acid level, liver and kidney function…can cause liver problems. Look for jaundice and adequate urinary output
GI problems common…take with food

30
Q

What does Ethambutul do ?

What can it inflame and what should we monitor for?
What other side effect can it cause ?

A

stop RNA synthesis and is bacteriostatic (stops the bacteria from reproducing)

Can inflame optic nerve (monitor for blurred or color changes in vision): needs to get eye checked regularly….always ask patient about vision…notify MD if this occurs
Peripheral neuropathy (damage to peripheral nerves): report numbness or burning in the hands or feet….notify MD if this occurs
31
Q

What does Rifampin do ?

What should we educate patient to look out for ?

A

Rifampin: kills the bacteria by stopping RNA-polymerase

Educate about turning body fluids orange and can stain soft contact lenses…so wear hard contact lenses instead
makes birth control less effective (use back up method), sunburn easily, no alcohol (this drug can cause liver problems: watch for jaundice, issues bleeding etc.)

32
Q

What does Isoniazid do ?

What vitamin levels does it decrease?
What should we monitor for?

A

kills the bacteria and stops it growth

decrease Vitamin B6 levels: monitor for tingling in extremities, tried, irritable, depressed (peripheral neuropathy)…need supplementation
monitor liver function and tell patient to monitor for liver problems as well
neurotoxicity: mental status

33
Q

What does Streptomycin do

What should we watch out for ?

A

still used for TB, but not as the first line usually

Stops protein synthesis and kills the bacteria…..watch for hearing changes (ringing in the ears…can be ototoxicity (eight cranial nerve)

34
Q

Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear?

A

No special PPE is needed

Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.

35
Q

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm the diagnosis ?

A

Sputum culture

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