Week 2 - TB

Question 1

what is TB (tubercolosis)

Answer 1

• an infectious disease caused by mycobacterium tubercolosis

Question 2

what does TB usually effect? what else might it effect (5)?

Answer 2

• the lungs

- may also effect the kidneys, brain, spine, joint, and liver

Question 3

how is TB spread

Answer 3

• thru airborne drops
• coughing
• sneezing
• speaking

Question 4

what are airborne precautions that must be used for a pt with TB (4)

Answer 4

• isolation until not infectious
• wear a high efficiency particulate (hepa) mask by all who enter the room
• must be in a negative pressure room
• room w regular air exchanges

Question 5

what are risk factors for TB (6)

Answer 5

• low socioeconomic factors
• tight living quarters
• smokers
• pollution exposure
• alcohol and subtance abuse
• immunosuppresion (ex. HIV)

Question 6

what are symptoms of TB (9)

Answer 6

• frequent, productive cough
• chest pain
• fever
• chills
• night sweats
• mucous
• malaise
• anorexia
• weight loss

dyspnea unsual

Question 7

what are some complications of TB (5)

Answer 7

• miliary TB
• pleural effusion
• empyema
• TB pneumonia
• other organ involvement

Question 8

what is miliary TB

Answer 8

• form of TB that results from lrg numbers of organisms invading the blood stream and spreading to all body organs

Question 9

what other organs might become involved as a complication of TB (6)

Answer 9

• bone
• joint tissue
• kidneys
• adrenal glands
• lymph nodes
• genital tract

Question 10

what diagnostics can be used to diagnose TB (3)

Answer 10

• tuberculin skin testing
• chest xray
• bacteriological studies (sputum)

Question 11

what is the TB test (mantoux test)

Answer 11

• where purified protein derivative is injected w a TB needle on the inner part of the arm
• then read in 48-72 hrs
• the induration is measured in mm, size determines if the pt has been exposed or not

Question 12

what is the treatment for active TB

Answer 12

• combo drug therapy

Question 13

how long does treatment for TB last

Answer 13

6-9 months and they must be compliant

Question 14

what are the first line drugs for TB (4)

Answer 14

• rifampin (RMP)
• ethambutol (EMB)
• pyrazinamide (PZA)
• isoniazid (INH)
• combo of these)

Question 15

what is the purpose of combo therapy for treatment of TB

Answer 15

• increase effectiveness

- decrease development of resistance strains

Question 16

what are second line drugs for TB? (2)

Answer 16

antibiotics

• levofloxacin
• streptomycin

Question 17

when are second line drugs added to the regimen

Answer 17

• in drug resistant TB

Question 18

why is follow-up care imp for pts on long-term therapy (3)

Answer 18

• monitor effectiveness
• monitor for side effects
• to ensure adherence

Question 19

why is adherence so important in treatment of TB

Answer 19

leads to:

• treatment failures
• emergence of multidrug resistance

Question 20

what is used to ensure adherence during tx of TB

Answer 20

Direct Observation Therapy (DOT

Question 21

what is DOT

Answer 21

• involves observing the ingestion of every dose of medications for TB for the pt’s entire course of treatment

Question 22

what is the major adverse effects of INH, RMP, and PZA? what indication does this have

Answer 22

hepatitis

• baseline liver function tests are done at start of treatment
• and is monitored throughout treatment (esp. if baseline is abnormal)

Question 23

what is a latent TB infection

Answer 23

• this is when an individual is infected w m. tubercolosis but does not become acutely ill
  = not contagious, not S&S

Question 24

does a pt with latent TB require ttreatment?

Answer 24

• yes, otherwise it may become active

Question 25

what is the typical treatment for latent TB

Answer 25

• lesser drug theraoy

- usually INH for 6-9 mo.

Question 26

a pt with HIV and latent TB should take INH for how long?

Answer 26

• 9 mo.

Question 27

what is important to prevent TB

Answer 27

• vaccination

Question 28

what vaccine is used to prevent TB

Answer 28

bacille calmette-guerin (BCG) vaccine

Question 29

how effective is the BCG vaccine

Answer 29

• efficacy is unclear

Question 30

what would indicate that a pt with TB is no longer infectious

Answer 30

3 negative AFB (acid fast bacilli) smears

Question 31

where are pts usually treated

Answer 31

• as outpatient

- in hospital care is rare, but if needed it will be for a shirt period

Question 32

what can be used to reduce airborne TB organisms

Answer 32

• UV light

Question 33

what should a pt with TB be taught (3)

Answer 33

• cover mouth with a paper tissue when sneezing or coughing
• tissue then goes into paper bag and is disposed, burned, or flushed
• careful handwashing techniques after handling sputum & tissues