TUBERCULOSIS handout Flashcards
What is TB primarily caused by
Mycobacterium tuberculosis ( gram positive aerobic bacilli)
How is TB transmitted
By airborne droplet infection
What is primary TB
Granuloma tissue erodes bronchus or blood vessel spreading throughout the lungs, organs.
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.
What is chronic TB
Infected person spreads disease continually by droplet infection into environment
What is extrapulmonary TB
Spreads thru blood and lymph system to other organs, more prevalent in persons with HIV
What are signs and symptoms of miliary TB
Fever,chills, fatigue,malaise, anemia, thrombocytopenia
What are signs and symptoms of genitourinary TB
Dysuria, hematuria, pyuria, flank pain
What are signs and symptoms of tuberculosis meningitis
Confusion, listless, irritability,fever, anorexia, vomiting which leads to increased ICP leading to decreased LOC
Where does blood come from
Bone marrow
What are the manifestations of primary or reactivation TB
Fatigue, anorexia, weight loss, low grade fever and night sweats, cough ( hemoptysis may occur)
What are gerontological considerations of TB
Elderly population may not have fever, look for altered mental status, unusual behavior, UTIs, hemoptysis, pleuritic chest pain
How is TB detected
Detected by injection of 0.1 ml of purified protein derivative PPD of tuberculin which produces a local inflammatory response
What are prophylactic mess given for TB
6-12 month treatment of isoniazid (INH)
What are adverse effects of priftin
Body secretions turn orange red
Toxic to kidneys
Thrombocytopenia
What are adverse effects of ethambutol
Optic neuritis- can cause irreversible blindness
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
What are adverse effects of INH
Peripheral neuritis
What is given to treat peripheral neuritis caused by INH
Vitamin B6 (pyridoxine)
What are adverse effects of rifampin
Turns body secretions orange
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.
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)
What are adverse and toxic effects of anti tubercular meds
Hepatoxicity; avoid alcohol and toxic drugs
Nephrotoxicity
When is a tuberculosis patient considered noninfectious
After 2-3 weeks of continuous therapy
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
- Tuberculosis empyema ( pus in pleural space, needs a chest tube to drain out pus)
- bronchopleural fistula
- 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
