Week 6: Tuberculosis Flashcards
What Is It?
an infectious disease caused by Mycobacterium tuberculosis
- primarily affects the lungs
- life threatening
- classified as latent, primary, primary progressive, and drug-resistant
How is TB Transmitted?
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
What does TB affect?
-primarily affects the lungs but can spread to any organ in the blood
Diagnosis
diagnosis of TB infection is made by laboratory testing, a skin test, and a chest x-ray
Laboratory Testing
-Sputum test for culture and acid-fast staining
Chest-x ray
-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
Skin Test
-positive purified protein derivative (PPD) screen skin test, also called Mantoux test
Blood Testing
-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
Goals for Treatment
-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
Four-drug Combination for TB
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol
Complications
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
Clinical Manifestations
- unexplained weight loss
- night sweats
- fever
- chills
- rusty-colored sputum
- pleuritic chest pain from coughing
Nursing Assessments
Assess:
- oxygen saturation
- temperature
- sputum
- breath sounds (wheezing from irritated airways; rales and rhonchi from fluid/exudate)
Nursing Actions
- humidified oxygen
- institute airborne isolation
- administer antibiotics as ordered
- ensure adequate nutrition
Client Education
- skin/blood testing for individuals living with or exposed to infected person
- importance of completing all medication
- assess support systems
Safety Alert
- 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
Risk Factors
- 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
Nursing Diangoses
- ineffective airway clearance
- alteration in gas exchange r/t necrosis of lung tissue
- ineffective coping r/t isolation and long-term therapy
Why is there rusty colored sputum?
as a result of the destruction of the lung tissue during granuloma formation
