Tuberculosis and Pneumonia Flashcards
tuberculosis infection
-any infection caused by bacteria mycobacterium
-MTB is aerobic bacillus-rod shaped and needs lots of oxygen to grow and proliferate
tuberculosis
-characterized by granulomas in the lungs- nodular accumulations of inflammatory cells
-transmitted via humans, cattle or birds
-tubercle bacilli are transmitted in airborne droplets expelled by infected people
-slow growing organism
active TB manifestations
-fatigue/lethargy
-weight loss/anorexia
-low grade fever
-productive cough
-anxiety
-night sweats
TB screening and diagnosis
-high risk populations- IGRA
-non high risk- TB skin test
-confirm through a sputum stain and culture and look for the granulomas on chest x-ray
5 drugs to treat TB
-INH
-rifampin
-ethambutol
-pyrazinamide
-streptomycin
anti-tubercular drugs
-treat all infections caused by mycobacterium organism
-2 categories: first and second line
Isoniazid (INH) MOA
disrupts cell wall synthesis essential functions of mycobacteria
INH side effects
-peripheral neuropathy
-hepatotoxicity
-optic neuritis
-hyperglycemia
INH nursing implications
-avoid antacids
-when given with rifampin can increase CNS and hepatotoxicity
-black box warning- related to increased risk of hepatitis: often given with pyridoxine
-given PO
Rifampin MOA
inhibits protein synthesis via attacking the hydrocarbon ring structures
rifampin side effects
-hepatitis
-hematologic disorders
-red-brown discoloration of the urine and other body fluids
rifampin route
PO/IV
ethambutol MOA
diffusing into the mycobacteria and suppresses RNA synthesis, which inhibits protein synthesis
ethambutol side effects
-retrobulbar neuritis
-blindness
ethambutol nursing implications
-given PO- first line bacteriostatic
-usually used in combo with INH and rifampin
-not for children less than 13
pyrazinamide
-given PO
-bacteriostatic or bactericidal depending on drug concentration
-used in combo with other meds
pyrazinamide side effects
-hepatotoxicity
-hyperuricemia
pyrazinamide contraindications
-severe hepatic disease
-acute gout
-not for pregnant women in the US
streptomycin MOA
-aminoglycoside: interfering with normal protein synthesis causing production of faulty proteins within the bacteria
streptomycin side effects
-ototoxic
-nephrotoxic
-blood dyscrasias
-careful with people on anticoagulants: can increase bleeding
streptomycin route
IM injection
what to treat drug resistant TB with
-second line drugs
pneumonia
defined as any type of infection of the lower respiratory system
-causes inflammation of the lung tissues, the alveolar air spaces become filled with purulent, inflammatory cells, and fibrin
-transmission occurs via inhaled infectious droplets
pneumonia risk factors
-age extremes (<5, >70 or 80)
-compromised immunity
-underlying lung disease
-alcoholism
-altered LOC
-impaired swallowing
-nursing home resident
-hospitalization
-influenza
what is hospital acquired pneumonia?
-developed within 48 hours AFTER admission
-has worse outcomes than community acquired
pneumonia patho
-aspiration of oropharyngeal secretions most common route
-inhalation of droplets containing bacteria or other pathogens
-inflammatory reaction is stimulated within the lungs- vasodilation occurs, infection begins to spread into the resp. tract and alveoli
-goblet cells are stimulated and mucus is excreted
-alveoli attempts to open and close against the purulent exudate but many cannot
pneumonia patho (more basic)
-failure of cough reflex, the mucociliary clearance mechanism, and the immune system
-failure of the mucociliary defense mechanism allows exudative fluid and inflammatory cells to invade the alveoli
note: mucociliary clearance mechanism is INEFFECTIVE in smokers
PNA manifestations:
-usually preceded by URI
-proceeds to fever, chills, productive or dry cough, malaise, pleural pain, sometimes dyspnea and hemoptysis
-bacterial-productive, purulent cough
-viral-nonproductive, scanty cough
-severe: tachypnea, signs of resp distress/failure
PNA clinical diagnosis
-s/s on assessment
-pulmonary consolidations: dullness to percussion, crackles, increased tactile fremitus, egophony
-diagnostic tests: chest xray, CBC, + sputum for c&s
bacterial pneumonia
-gram positive: staph aureus (most common for HAP) and streptococcus pneumoniae (most common for CAP)
-gram negative: pseudomonas auruginosa, aceinetobacter, klebsiella pneumoniae
aspiration pneumonia
-aspirated material from GI tract
-can be silent of abrupt
-dysphagia evaluation is crucial
who is at risk for aspiration pneumonia?
-NG tube
-decreased LOC
-decreased gag reflex
-decreased gastric emptying
viral pneumonia
-influenza is major risk factor
-virus alters the pulmonary immune defense and makes the lungs vulnerable to an additional bacterial infection
s/s of viral pneumonia
-fever
-chills
-dyspnea on exertion
-cough
atypical pneumonias
-pneumocystis carini pneumonia
-mycoplasma
-legionella
-aspergillus
do you treat viral or bacterial pneumonia with antibiotics?
bacterial
pneumonia prevention
-2 vaccines
1.)PCV13-prevents pneumococcal pneumonia caused by 13 strains of strep
2.)PPSV23-prevents against an additional 23 types of PNA
what precautions are used for TB?
airborne
