TUBERCULOSIS handout Flashcards by Alisha Reynolds

What is TB primarily caused by

Mycobacterium tuberculosis ( gram positive aerobic bacilli)

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How is TB transmitted

By airborne droplet infection

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What is primary TB

Granuloma tissue erodes bronchus or blood vessel spreading throughout the lungs, organs.

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What is reactivation TB

Previously healed lesion ruptures when the immune system is suppressed due to age, disease,immunosuppression. ( patients on corticosteroid therapy, transplant, neutropenia, dialysis, diabetes, lupus patients.

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What is chronic TB

Infected person spreads disease continually by droplet infection into environment

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What is extrapulmonary TB

Spreads thru blood and lymph system to other organs, more prevalent in persons with HIV

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What are signs and symptoms of miliary TB

Fever,chills, fatigue,malaise, anemia, thrombocytopenia

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What are signs and symptoms of genitourinary TB

Dysuria, hematuria, pyuria, flank pain

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What are signs and symptoms of tuberculosis meningitis

Confusion, listless, irritability,fever, anorexia, vomiting which leads to increased ICP leading to decreased LOC

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Where does blood come from

Bone marrow

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What are the manifestations of primary or reactivation TB

Fatigue, anorexia, weight loss, low grade fever and night sweats, cough ( hemoptysis may occur)

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What are gerontological considerations of TB

Elderly population may not have fever, look for altered mental status, unusual behavior, UTIs, hemoptysis, pleuritic chest pain

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How is TB detected

Detected by injection of 0.1 ml of purified protein derivative PPD of tuberculin which produces a local inflammatory response

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What are prophylactic mess given for TB

6-12 month treatment of isoniazid (INH)

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What are adverse effects of priftin

Body secretions turn orange red
Toxic to kidneys
Thrombocytopenia

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What are adverse effects of ethambutol

Optic neuritis- can cause irreversible blindness

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What are adverse effects of streptomycin

High toxicity
Used for multi resistant
Ototoxicity - can lead to deafness
Drink 2-3 L of water per day

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What are adverse effects of INH

Peripheral neuritis

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What is given to treat peripheral neuritis caused by INH

Vitamin B6 (pyridoxine)

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What are adverse effects of rifampin

Turns body secretions orange

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What is TB

It is a CHRONIC recurring infectious disease that usually affects the lungs, but may affect any organ due to the bacteria spreading thru the bloodstream affecting organs such as the kidneys and joints.

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What is initial treatment for the active phase of TB

8 week daily treatment with 4 first line medications INH, rifampin ( Rifadin), pyrazinamide (PZA), and ethambutol ( myambutol)

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What are adverse and toxic effects of anti tubercular meds

Hepatoxicity; avoid alcohol and toxic drugs

Nephrotoxicity

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When is a tuberculosis patient considered noninfectious

After 2-3 weeks of continuous therapy

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What is ongoing nursing management for TB

Monitor sputum Q3 months | Monitor BUN and creatinine

What should be avoided while on INH therapy

Tyramine containing foods: can cause palpitations, hypertensive crisis Avoid histamine: sauerkraut, foods with yeast: can cause hypotension,palpitations, sweating, flushing, diarrhea.

What's a sign of liver failure

Jaundice

Who does TB mainly affect

Foreign born residents, HIV infected, disadvantaged populations

What is the pathophysiology of TB

Bacilli enters upper airway via droplet, Implants in the alveolus or bronchioles, local inflammation occurs and develops into granuloma which becomes a fibrous tissue mass (ghon tubercle)

Where are complications of TB

1. Tuberculosis empyema ( pus in pleural space, needs a chest tube to drain out pus) 2. bronchopleural fistula 3. Pneumothorax

What size needle is used for PPD tests

26 or 27 gauge needle

What is the 2 step method of TB testing

If the first test illicits negative response, second PPD given a week later, if negative, person is free of infection or Anergic ( non responsive to common antigens) RECOMMENDED FOR HEALTHCARE WORKERS AND RESIDENTS

How is TB diagnosed

Sputum culture Chest x Ray Quantiferon TB GOLD ( detects interferon-gamma; results in less than24 hours)

What is prophylactic treatment to prevent active TB

6-12 months of INH ( isoniazid)

What type of vaccine do foreign born persons recieve to prevent TB

Bacilli calmette-guerin ( BCG) vaccine | Persons will have positive skin and chest x rays

What labs should be monitored while on anti TB therapy

Baseline testing and monitoring of LFT's, BUN, Cr,

What should be assesed before and during ethambutol therapy

Vision examination before ethambutol

What should be assessed and reassessed during streptomycin therapy

Audio metric testing | Ototoxicity occurs with amino glycosides such as streptomycin

What is a critical lab that must be assessed and reassessed while on INH therapy

LFT!

What are signs and symptoms of peripheral neuritis

Burning sensation | Tingling, numbness, paresthesia

What are foods to avoid while on INH therapy

Tyramine and histamine

What are foods that contain Tyramine

Red wine Soy sauce Aged meats

Consuming Tyramine while on INH therapy will cause what symptoms

Palpitations Flushing Hypertension

What type of foods contain histamine

Tuna Sauerkraut Yeast

If a person consumes histamine while on INH therapy; what type of symptoms will be displayed

Hypotension Palpitations Sweating, flushing, diarrhea

What type of supplement should a person take while on INH therapy

Take supplemental pyroxidine vit B6.... It helps decrease the side effects of peripheral neuritis

What is considered the initial phase of TB Treatment

The 8 week daily regime with four first line meds

What is the continuous phase of anti TB therapy

4 -7 months; typically 4 of INH and rifampin

What are side effects of anti TB meds

Hepatotoxicity | Nephrotoxicity

What is the course of action for a person non compliant with TB therapy

Twice weekly therapy administered under direct supervision of public health personnel

How is the effectiveness of anti TB therapy monitored

By repeat sputum cultures and chest x rays

What are the 3 types of drug resistance

Primary Secondary or acquired Multi drug

What is primary drug resistance

Resistance to one of the 1st line anti TB meds in ppl who have never been treated before

What is secondary or acquired drug resistance

Resistance to one or more anti TB agent while on anti TB therapy

What is multi drug resistance

Resistance to 2 drugs ( INH,rifampin) | This type of resistance usually occurs in HIV infected, homeless and intuitionalized ppl

How can a person promote airway clearance for a person with TB

Hydration Postural drainage O2 Suction if needed

Should you take your anti TB meds with food

TAKE THEM ON A EMPTY STOMACH

How do you prevent the transmission of TB

Cover mouth, throw tissues away, Hand hygiene, Negative pressure room UV light kills the bacteria

What are signs and symptoms of peripheral neuritis

Burning sensation | Tingling, numbness, paresthesia

What are foods to avoid while on INH therapy

Tyramine and histamine

What is a critical lab to monitor for on INH therapy

LFT BUN CR