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MED SURG > TUBERCULOSIS handout > Flashcards

TUBERCULOSIS handout Flashcards

1
Q

What is TB primarily caused by

A

Mycobacterium tuberculosis ( gram positive aerobic bacilli)

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2
Q

How is TB transmitted

A

By airborne droplet infection

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3
Q

What is primary TB

A

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

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4
Q

What is reactivation TB

A

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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5
Q

What is chronic TB

A

Infected person spreads disease continually by droplet infection into environment

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6
Q

What is extrapulmonary TB

A

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

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7
Q

What are signs and symptoms of miliary TB

A

Fever,chills, fatigue,malaise, anemia, thrombocytopenia

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8
Q

What are signs and symptoms of genitourinary TB

A

Dysuria, hematuria, pyuria, flank pain

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9
Q

What are signs and symptoms of tuberculosis meningitis

A

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

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10
Q

Where does blood come from

A

Bone marrow

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11
Q

What are the manifestations of primary or reactivation TB

A

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

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12
Q

What are gerontological considerations of TB

A

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

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13
Q

How is TB detected

A

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

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14
Q

What are prophylactic mess given for TB

A

6-12 month treatment of isoniazid (INH)

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15
Q

What are adverse effects of priftin

A

Body secretions turn orange red
Toxic to kidneys
Thrombocytopenia

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16
Q

What are adverse effects of ethambutol

A

Optic neuritis- can cause irreversible blindness

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17
Q

What are adverse effects of streptomycin

A

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

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18
Q

What are adverse effects of INH

A

Peripheral neuritis

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19
Q

What is given to treat peripheral neuritis caused by INH

A

Vitamin B6 (pyridoxine)

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20
Q

What are adverse effects of rifampin

A

Turns body secretions orange

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21
Q

What is TB

A

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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22
Q

What is initial treatment for the active phase of TB

A

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

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23
Q

What are adverse and toxic effects of anti tubercular meds

A

Hepatoxicity; avoid alcohol and toxic drugs

Nephrotoxicity

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24
Q

When is a tuberculosis patient considered noninfectious

A

After 2-3 weeks of continuous therapy

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25
Q

What is ongoing nursing management for TB

A

Monitor sputum Q3 months

Monitor BUN and creatinine

26
Q

What should be avoided while on INH therapy

A

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

27
Q

What’s a sign of liver failure

A

Jaundice

28
Q

Who does TB mainly affect

A

Foreign born residents, HIV infected, disadvantaged populations

29
Q

What is the pathophysiology of TB

A

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)

30
Q

Where are complications of TB

A
  1. Tuberculosis empyema ( pus in pleural space, needs a chest tube to drain out pus)
  2. bronchopleural fistula
  3. Pneumothorax
31
Q

What size needle is used for PPD tests

A

26 or 27 gauge needle

32
Q

What is the 2 step method of TB testing

A

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

33
Q

How is TB diagnosed

A

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

34
Q

What is prophylactic treatment to prevent active TB

A

6-12 months of INH ( isoniazid)

35
Q

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

A

Bacilli calmette-guerin ( BCG) vaccine

Persons will have positive skin and chest x rays

36
Q

What labs should be monitored while on anti TB therapy

A

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

37
Q

What should be assesed before and during ethambutol therapy

A

Vision examination before ethambutol

38
Q

What should be assessed and reassessed during streptomycin therapy

A

Audio metric testing

Ototoxicity occurs with amino glycosides such as streptomycin

39
Q

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

A

LFT!

40
Q

What are signs and symptoms of peripheral neuritis

A

Burning sensation

Tingling, numbness, paresthesia

41
Q

What are foods to avoid while on INH therapy

A

Tyramine and histamine

42
Q

What are foods that contain Tyramine

A

Red wine
Soy sauce
Aged meats

43
Q

Consuming Tyramine while on INH therapy will cause what symptoms

A

Palpitations
Flushing
Hypertension

44
Q

What type of foods contain histamine

A

Tuna
Sauerkraut
Yeast

45
Q

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

A

Hypotension
Palpitations
Sweating, flushing, diarrhea

46
Q

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

A

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

47
Q

What is considered the initial phase of TB Treatment

A

The 8 week daily regime with four first line meds

48
Q

What is the continuous phase of anti TB therapy

A

4 -7 months; typically 4 of INH and rifampin

49
Q

What are side effects of anti TB meds

A

Hepatotoxicity

Nephrotoxicity

50
Q

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

A

Twice weekly therapy administered under direct supervision of public health personnel

51
Q

How is the effectiveness of anti TB therapy monitored

A

By repeat sputum cultures and chest x rays

52
Q

What are the 3 types of drug resistance

A

Primary
Secondary or acquired
Multi drug

53
Q

What is primary drug resistance

A

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

54
Q

What is secondary or acquired drug resistance

A

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

55
Q

What is multi drug resistance

A

Resistance to 2 drugs ( INH,rifampin)

This type of resistance usually occurs in HIV infected, homeless and intuitionalized ppl

56
Q

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

A

Hydration
Postural drainage
O2
Suction if needed

57
Q

Should you take your anti TB meds with food

A

TAKE THEM ON A EMPTY STOMACH

58
Q

How do you prevent the transmission of TB

A

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

59
Q

What are signs and symptoms of peripheral neuritis

A

Burning sensation

Tingling, numbness, paresthesia

60
Q

What are foods to avoid while on INH therapy

A

Tyramine and histamine

61
Q

What is a critical lab to monitor for on INH therapy

A

LFT
BUN
CR

MED SURG (15 decks)

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