Tuberculosis Exam 2 Flashcards
What is tuberculosis?
Infectious disease caused by Mycobacterium tuberculosis
Lungs most commonly infected
Primary cause of death worldwide
Leading cause of death in patients with HIV/AIDs
Greater than 2 billion people infected worldwide
What are the risk factors for TB?
Homeless
Residents of inner-city neighborhoods
Foreign-born persons
Living or working in institutions (includes health care workers)
IV injecting drug users
Poverty, poor access to health care
Immunosuppression
Asian descent
Multidrug-Resistant Tuberculosis (MDR-TB)
Occurs when a strain develops resistance to two of the most potent first-line anti-TB drugs (Isoniazid, Rifampin)
Extensively drug-resistant TB (XDR-TB) resistant to any fluoroquinolone plus any injectable antibiotic
Several causes for resistance occur
Etiology and Pathophysiology
Spread via airborne droplets
Can be suspended in air for minutes to hours
Transmission requires close, frequent, or prolonged exposure.
NOT spread by touching, sharing food utensils, kissing, or other physical contact
Once inhaled, particles lodge in bronchiole and alveolus.
Aerophilic (oxygen-loving) – causes affinity for lungs
Infection can spread via lymphatics and grow in other organs as well:
Kidneys
Bones
Brain
Adrenal glands
Latent TB infection (LTBI)
Infected but no active disease
Clinical Manifestations
LTBI – asymptomatic
Pulmonary TB
Takes 2-3 weeks to develop symptoms.
Initial dry cough that becomes productive
Constitutional symptoms (fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats) Fever in the afternoon & evening due to lower cortisol secretion
Dyspnea and hemoptysis late symptoms
Can also present more acutely
High fever
Chills, generalized flulike symptoms
Pleuritic pain
Productive cough
Adventitious breath sounds
Extrapulmonary TB manifestations dependent on organs infected
Complications
Pleural TB
Pleural effusion-
- Bacteria in pleural space cause inflammation.
- Pleural exudates of protein-rich fluid
Empyema
- Large numbers of tubercular organisms in pleural space
- TB pneumonia
- Large amounts of bacilli discharged from granulomas into lung or lymph nodes
- Manifests as bacterial pneumonia
Other organ development
Spinal destruction
Bacterial meningitis
Peritonitis
Diagnostic Studies
Tuberculin skin test (TST)
AKA: Mantoux test
Uses purified protein derivative (PPD) injected intradermally
Assess for induration in 48 – 72 hours
Presence of induration (not redness) at injection site indicates development of antibodies secondary to exposure to TB.
Positive if ≥15 mm induration in low-risk individuals
Response ↓ in immune-compromised patients
Reactions ≥5 mm considered positive
Other diagnostic studies
Interferon-γ release assays (IGRAs) ..blood test
Chest x-ray
Bacteriologic studies:
Required for diagnosis
Sputum samples obtained (usually) on 2-3 consecutive days
Stained sputum smears examined for
acid-fast bacilli
Culture results can take up to 8 weeks.
Can also examine samples from other suspected TB sites
Collaborative Care
Hospitalization not necessary for most patients
Infectious for first 2 weeks after starting treatment if sputum +/No longer considered contagious after 2 weeks of TX and – sputum
Drug therapy used to prevent or treat active disease
Need to monitor compliance
Drug Therapy
Active disease
Treatment is aggressive.
Two phases of treatment
Initial (8 weeks)
Continuation (18 weeks)
Four-drug regimen
INH- Isoniazid- Monitor Liver function
Rifampin (Rifadin)-Tears, urine, ect can turn orange
Pyrazinamide (PZA)
Ethambutol
Directly observed therapy (DOT)
Noncompliance is major factor in multidrug resistance and treatment failures.
Requires watching patient swallow drugs
Preferred strategy to ensure adherence
May be administered by public health nurses at clinic site
Drug Therapy Latent TB
Usually treated with INH for 6 to
9 months/Rifampin if resistant to INH
HIV patients should take INH for
9 months.
Alternative 3-month regimen of INH and rifapentine OR 4 months of rifampin
Vaccine for TB
Bacille Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of the world.
In United States, not recommended except for very select individuals
Can result in positive PPD reaction
Nursing Assessment
History
Physical symptoms
Productive cough
Night sweats
Afternoon temperature elevation
Weight loss
Pleuritic chest pain
Crackles over apices of lungs
Sputum collection
Nursing Diagnosis
Ineffective breathing pattern
Ineffective airway clearance
Noncompliance
Ineffective self-health management
Goals of TX
Comply with therapeutic regimen.
Have no recurrence of disease.
Have normal pulmonary function.
Take appropriate measures to prevent spread of disease.
