Tuberculosis (TB) Flashcards
What is tuberculosis?
A bacterial infection which primarily affects the lung parenchyma
What other parts of the body can TB be transmitted to?
Meninges
Kidneys
Bones
Lymph nodes
How is TB transmitted?
Respiratory droplets through sneezing or coughing by an infected person.
Patho for TB
- Inhaled bacilli implanted in bronchioles and alveoli
- Inflammation occurs to counteract infection. Lesions called tubercle form and are surrounded by lymphocytes
- Lesions undergo necrosis characterized by cheesy consistency in center which may become liquid and cause cavities
- when lesions heal, tubercle bacilli remain in lung in walled off, dormant state
- May be reactivated if organisms rapidly multiply and body defenses lowered. Called reactivation TB or adult type progressive TB
- Ghon Tubercle ulcerates releasing the cheesy material into bronchi.
- Bacteria becomes airborne leading to further spread of the disease.
What are some risk factors for TB?
- Close contact with someone who has active TB
- Immigrants from other counties where TB not controlled
- Medically undeserved
- Immuocompromised
- Substance abuse
- Preexisting conditions
- Long term care and congregate living situations
- Living in overcrowded, substandard housing
- Healthcare workers
How do you prevent TB?
- TB skin tests to persons with s/s or lab suggestive of TB
- TB skin tests to people with recent contact w/ TB pts
- TB skin test for people at high risk for TB
- TB skin test for people w/ abnormal CXR
What if patient has TB?
- Dispose of sputum correctly
- Reduce spread by teaching pt to wear a mask, cover mouth when coughing
- Evaluate persons w/ positive TB skin test who don’t have active disease
- Medication. Must complete entire course of meds
- Recognize, prevent and manage noncompliant behavior in persons being treated
How do you protect health care workers from TB?
Pts in private rooms w/ door closed or negative pressure room
Pt wear mask when transported
Healthcare worker wear mask and gloves when caring for pt w/ TB
yearly skin tests
How many sputum samples need to be negative to not be considered infective?
Three negative sputums (3 wks to get results)
Some clinical manifestations for TB?
Fatigue, malaise, anorexia, weight loss, chronic cough that lasts more than three wks, night sweats, hemoptysis, low grade fever sputum greenish yellow. In geriatrics a LOC change
Classes of TB
Class 1 - exposure, no infection Class 2 - + skin test, no active disease Class 3 - active disease Class 4 - inactive disease Class 5 - suspected disease
What is essential to cure and prevent the spread of TB?
Compliance
What are some recommended treatment for new cases? What medication regimen?
Isoniazid (INH) Rifampin (RIF) Pyrazinamide (PZA) Ethambutol (EMB) Streptomycin
How long does the pt usually have to take the meds?
six months to a year
What can INH be used for?
a preventive for pts at risk - family members of client w/ active TB - or clients w/ positive skin test but no active disease. Usually take med for six to twelve months
What are some combination meds?
Combination INH and RIF (Rifamate)
Combination INH, and RIF and PZA (Rifater)
What is PRimary drug resistance?
Resistance to med in people w/ no previous treatment
What is secondary drug resistance?
Resistance to one or more drug in pts undergoing therapy
What is multi drug resistance?
Resistance to INH and RIF - often occurs b/c pts don’t complete treatment
About twenty percent of pts noncompliant
Also common in HIV pts/homeless/institutionalized
What is Extreme drug resistant - XDR
Usually originated from foreign country
Dousn’t respond to regular meds may try second line drugs
May need surgery
What vaccine is used in many countries but not in the US?
Bacille Calmette-Guerin (BCG)
What are some nursing interventions for TB?
- Teach s/s, what disease does, how it’s spread
- Monitor for TB in Jail
- How to dispose of tissue, how to cough, hand hygiene
- adequate treatment - take all meds
- promote airway
- promote thinning of secretions
- small frequent meals, high protein, calories, vitamin c
- Bed rest until stable
- test family, teach family
Nursing Diagnoses for TB
ineffective breathing pattern RT infected alveoli
Ineffective airway clearance RT copious secretions
Activity intolerance RT fatigue, fever, altered nutritional status
