Week 6: Tuberculosis

Question 1

What Is It?

Answer 1

an infectious disease caused by Mycobacterium tuberculosis

• primarily affects the lungs
• life threatening
• classified as latent, primary, primary progressive, and drug-resistant

Question 2

How is TB Transmitted?

Answer 2

transmitted by aerosolization droplets inhaled from the coughing or sneezing of infected individuals

• (airborne route)
• droplets are tiny and can remain suspended in the air for several hours

Question 3

What does TB affect?

Answer 3

-primarily affects the lungs but can spread to any organ in the blood

Question 4

Diagnosis

Answer 4

diagnosis of TB infection is made by laboratory testing, a skin test, and a chest x-ray

Question 5

Laboratory Testing

Answer 5

-Sputum test for culture and acid-fast staining

Question 6

Chest-x ray

Answer 6

-suspicious cavitating lesions (resulting from pathologic processes leading to necrosis and formation of a “gas-filled” space within the lung tissue) are seen on chest x-rays

Question 7

Skin Test

Answer 7

-positive purified protein derivative (PPD) screen skin test, also called Mantoux test

Question 8

Blood Testing

Answer 8

-2 IRGAs
>QuantiFERON TB Gold In-Tube (QTF-GIT)
>T-SPOT TB test (T-SPOT)
-can determine if an individual has been infected with TB bacteria

Question 9

Goals for Treatment

Answer 9

-cure the patient
-minimize the transmission of M. tuberculosis to other people
> a basic four-drug combination is recommended and should continue for 9-12 months

Question 10

Four-drug Combination for TB

Answer 10

• Isoniazid
• Rifampin
• Pyrazinamide
• Ethambutol

Question 11

Complications

Answer 11

extensive respiratory tissue destruction by M. tuberculosis can lead to:

• respiratory failure
• bronchopleural fistula formation (abnormal pathway or sinus tract that develops between the bronchus and pleural space)
• TB can spread to parts of the body outside the respiratory system via the bloodstream and lymph circulation
• extrapulmonary TB can present as meningitis, lymphadenopathy, bone disease, and liver and kidney failure

Question 12

Clinical Manifestations

Answer 12

• unexplained weight loss
• night sweats
• fever
• chills
• rusty-colored sputum
• pleuritic chest pain from coughing

Question 13

Nursing Assessments

Answer 13

Assess:

• oxygen saturation
• temperature
• sputum
• breath sounds (wheezing from irritated airways; rales and rhonchi from fluid/exudate)

Question 14

Nursing Actions

Answer 14

• humidified oxygen
• institute airborne isolation
• administer antibiotics as ordered
• ensure adequate nutrition

Question 15

Client Education

Answer 15

• skin/blood testing for individuals living with or exposed to infected person
• importance of completing all medication
• assess support systems

Question 16

Safety Alert

Answer 16

• Immediate isolation of the patient with suspected or confirmed TB infection in a private room with negative airflow capabilities is a priority
• airborne precautions
• N95 mask respirator for healthcare personnel
• snug-fitting surgical mask for visitors is essential
• patients movement and transportation should be limited to essential needs only
• patients who must leave the negative pressure room should also wear a surgical mask

Question 17

Risk Factors

Answer 17

• frequent and close contact with an untreated individual
• lower socioeconomic status and homelessness
• immunocompromised status (HIV, chemotherapy, kidney disease, diabetes mellitus, Crohn’s disease)
• poorly ventilated, crowded environments (correctional or long-term care facilities)
• advanced age
• recent travel outside the US to areas where TB is endemic
• Immigration (especially from Mexico, Philippines, Vietnam, China, Japan, and Eastern Mediterranean countries)
• substance use
• health care occupation that involves performance of high-risk activities

Question 18

Nursing Diangoses

Answer 18

• ineffective airway clearance
• alteration in gas exchange r/t necrosis of lung tissue
• ineffective coping r/t isolation and long-term therapy

Question 19

Why is there rusty colored sputum?

Answer 19

as a result of the destruction of the lung tissue during granuloma formation