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NUR 311: IPC > Week 12 - Topic 2: Pneumonia and Tuberculosis > Flashcards

Week 12 - Topic 2: Pneumonia and Tuberculosis Flashcards

1
Q

What does a chest x-ray show for pneumonia?

A

Infiltrate, consolidation or cavitation that persists for >48h

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2
Q

What are symptoms of pneumonia?

A
  • Rales or bronchial breath sounds (crackles)
  • New onset or worsening cough
  • SOB or incr. in respiratory rate
  • Worsening gas exchange
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3
Q

Why does positive end-expiratory pressure (PEEP) increase in pneumonia?

A

You need more pressure to push the air into your lungs that are now full with fluid –> need for intubation

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4
Q

How is pneumonia classified (3)?

A

1) By region: lobar vs bronchial pneumonia
2) By organism: bacterial, viral or mycoplasma pneumonia
3) Aspiration pneumonia (fluid, fungus found in dust)

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5
Q

You find consolidation in the chest x-ray of a pneumonia patient. What could be filling up the airways/alveoli (4)?

A

1) Pus
2) Fluid
3) Blood
4) Cancer cells

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6
Q

When listening to the lungs of a pneumonia patient, where won’t you hear breathing/airway movement?

A

Where there is consolidation

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7
Q

When looking at the chest x-ray of a pneumonia patient, what might you see?

A
  • Consolidation
  • Nodules
  • Masses
  • Atelectasis (lung collapse)
  • Interstitial opacities (viral cause)
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8
Q

What are common (3) bacterial pathogens for LRTI?

A

1) Strep pneumoniae
2) Haemophilus influenzae type B (Hib)
3) Any bacterial pathogen aspired into the lungs

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9
Q

Who’s at risk for developing strep pneumonia?

A

Elderly > 65 y.o.
Kids <2 y.o.
Smokers
People with heart or lung diseases

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10
Q

Who is at risk for developing an infection from Hib?

A

Unvaccinated children

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11
Q

How can you find out if a patient has TB?

A

You do an acid fast bacillus culture to see if they have Mycobacterium tuberculosis

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12
Q

What must you (the nurse) do when a physician request an acid fast bacilli culture?

A

Put the patient on isolation and airborne precautions

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13
Q

Why MUST TB be reported and treated (4 reasons)?

A
  • High risk of transmission
  • Airborne transmission
  • Lethal
  • Treatment available and effective
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14
Q

What are the symptoms of TB?

A

Fever, weight loss
Cough, night sweats, chills
Sometimes coughing blood (if cavitation in lungs)

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15
Q

True or False: A chest x-ray can specifically show someone has TB.

A

False, unless it shows cavitation

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16
Q

When is cavitation common?

A

In adults with reactivated TB

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17
Q

True or false: Cavitation is uncommon in children with TB.

A

True

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18
Q

True or False: Only pulmonary TB is contagious.

A

True, because that is when the patients are spewing out aerosols/secretions.

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19
Q

What mode of transmission is TB?

A

airborne

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20
Q

True or false: Liver TB is contagious and patient should be placed on airborne precautions.

A

False

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21
Q

When is extra-pulmonary TB contagious?

A

In the OR when you are doing a biopsy and aerosols may be produced

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22
Q

Who is at risk for TB?

A
  • Immigrants from areas of high TB rates
  • Being in close contact with someone of active TB
  • Homeless, IV drug users, HIV (high rates of TB transmission)
  • Kids <5 y.o. with a positive TB test
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23
Q

What vaccine is there against TB? Why is it not very used anymore?

A

BCG (bacille Calmette-Guérin) vaccine

It is not effective in prevention (only offers protection to some people)

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24
Q

True or false: We screen all healthcare workers for TB.

A

False, only those at high risk

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25
Q

Why don’t we really use blood test (IGRA) for TB exposure?

A

It is not very sensitive

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26
Q

How do we test for TB exposure?

A

TST: tuberculin skin test

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27
Q

Can TB exposure testing be used for diagnosis?

A

No, but can be an indicator in children

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28
Q

When can BCG vaccine create a false positive for TST?

A

around 40% of cases if vaccine was done after 12 months-6 years of age (persistent false + after 10 years)

29
Q

How do we diagnose TB?

A
  • Sputum culture (confirmation)
  • Smear microscopy for AFB
  • PCR-NAAT (only presumptive)
30
Q

How do you know if the physician is suspecting TB?

A

They will request 3 AFB sputums:

1) Collect them in the morning when the patient coughs the most
2) Bronchial washings/induced (PT is given a product that makes them cough, sputum collected 1h apart)
3) Gastric aspirates (usually children who cough+swallow a lot)

31
Q

How many people develop latent TB?

A

95% of people

32
Q

How many people will develop reactivated TB?

A

5% of people with latent TB

33
Q

Who can develop extra-pulmonary TB?

A

Those who have reactivated TB

34
Q

What is a latent TB infection?

A

Presence of M tuberculosis (tubercle bacilli) without:

  • Signs and sx
  • Culture is negative
35
Q

How does one with latent TB reduce the risk of getting it reactivated?

A

By getting treatment

36
Q

What is common between latent and active TB?

A

They give positive skin tests

37
Q

True or False: Latent TB is a reportable disease.

A

False, but active TB is

38
Q

True or False: A pt with latent TB does not need to be put in isolation/additional precautions.

A

True

39
Q

How long is active vs. latent TB treament?

A

Active: 6+ months
Latent: 4-6 months (no obligation to get treated)

40
Q

What is DOT?

A

Direct observation therapy

Nurse must observe patients take their obligatory TB treatment (usually for non-compliant patients)

41
Q

Who is at risk of developing reactivated TB (after previously having latent TB)?

A
  • HIV
  • Untreated TB + fibrotic lesions
  • Children < 5
  • Substance abusers
  • Receiving TNF-a antagonists for treatment of rheumatoid arthritis or Crohn’s disease
42
Q

When is TST done?

A

Pre-exposure to TB

43
Q

How is TST done?

A

Administer 0.1 mL of tuberculin intradermal and read 48-72h later

Must be done in two steps (1-4 weeks apart) to eliminate false +

44
Q

What makes a negative TST?

A

<10 mm induration

45
Q

What makes a positive TST?

A

> = 10 mm induration

46
Q

True or False: You do not do a second TST on those who were tested + the first time.

A

True, to avoid getting an even worse reaction the 2nd time

47
Q

Who is given a 2 step TST?

A
  • HCW
  • Prison workers
  • Residents of nursing homes
  • People who have travelled to TB endemic countries for a long time
48
Q

What does the contagiousness of TB depend on?

A

1) the level of bacilli in the sputum (can be AFB - or AFB 3+)
2) If the pt had sx

An asymptomatic pt with AFB 3+ is less contagious than a symptomatic pt with AFB 2+

49
Q

True or False: You can get TB from simply sharing the same airspace as a TB person.

A

Yes, because it is airborne

50
Q

When is TST post-exposure done?

A

Once, at least 8 weeks post exposition

51
Q

A person has done a TST with a result of 0-4 mm. When would we give him treatmen?

A

If he is under 5 y.o. and was in contact with an infected person
(Give treatment until we do another TST test 8 weeks after exposure)

52
Q

What is the best protection against TB?

A

Early diagnosis and treatment

53
Q

Where must you place in a TB PT in a hospital?

A

Negative-pressure room under airborne precautions

54
Q

What must the HCW do before entering the TB PT’s room?

A

Need a fit check for the N95 respirator

55
Q

What is atypical/walking pneumonia?

A

Mild version of typical pneumonia (moderate to no sputum, absence of leukocytosis)

56
Q

How does atypical pneumonia progress?

A

Starts as mild URTI and develops into dry cough and dyspnea

57
Q

What bacteria cause atypical pneumonia?

A

Bacteria that does not gram stain:

  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Chlamydia psittaci
  • Legionella spp**
58
Q

What viruses cause atypical pneumonia?

A

Influenza
RSV
Parainfluenza

59
Q

What fungus (2) cause atypical pneumonia?

A

Histoplasma

Pneumocystis

60
Q

Which microorganism generally causes atypical pneumonia?

A

Viruses

61
Q

What type of pneumonia is especially spread through contaminated water?

A

Legionella pneumophila that causes Legionnaire’s disease/Legionellosis

62
Q

What is the mode of transmission of legionella infection?

A

Droplet

63
Q

How do you diagnose Legionnaire’s diseae (3)?

A

1) Urine antigen test
2) Sputum culture
3) Blood serology (increase in IgG)

64
Q

What is pneumocystis pneumonia (PCP)?

A

Fungi pneumonia that greatly affects HIV or immunosuppressed patients

65
Q

What is characteristic of PCP?

A

Presence of cysts from the fungi

66
Q

What is aspergillosis?

A

Infection of the lungs caused by aspergillus (a mold)

67
Q

Who is at risk of aspergillosis?

A

Immunocompromised people (oncology especially)

68
Q

How do we diagnose aspergillosis?

A

Serology test that looks for galactomannan, a component of the cell wall of Aspergillus

NUR 311: IPC (17 decks)

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