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tuberculosis
pn141 test 2: book- burke: ch 22, pg 544
| Question | Answer |
|---|---|
| DEf of TB | a chronic, recurrent infectious disease that usually affects the lungs, it can also involve other organs |
| cause of TB | mycobacterium tuberculosis |
| where in the world is it most common | asia, africa, middle east, latin america |
| who does it usually affect in the US | immigrants, ppl w/ HIV, disadvantaged population, ppl w/ altered immune function, |
| what is M. tuberculosis | a slow growing, slender rod shaped acid fast organism |
| M. tuberculosis: what increases its resistance to destruction | it's waxy outer capsule |
| M. tuberculosis: how is it transmitted | airborne droplet (coughs, sneezes, speaking, singing) |
| what increases ones risk for infection | small poorly ventilated or crowded environements and prolonged exposure, impaired immune function |
| Pulmonary TB: what is it | droplet nuclei containing the bacillus implant in an aleolus or respiratory bronchiole, usually the upper lobe |
| Pulmonary TB: what brings WBC to the site | an immune response |
| Pulmonary TB: what do the WBCs do to the bacteria | they can phagocytize and isolate it, but and unable to destroy them |
| Pulmonary TB: since the WBC can isolate the bacteria but not destroy it, what is formed | a sealed off colony called tubercle is formed |
| Pulmonary TB: what forms around the tubercle | scar tissue |
| Pulmonary TB: can the tubercles be seen on xray | yes |
| Pulmonary TB: what happens to a person whose immune system is impaired | the primary TB can progress and destryo lung tissue |
| Pulmonary TB: what is reactivation TB; how does it occur | when a previously healed lesion is reactivated(the bacilli multiply w/in tubercle until it ruptures, the bacilli spill into the bronchiole & spread into the respiratory system; when the immune system is suppressed by age, disease, immunosupressive drugs |
| what % of infected ppl develop active primary disease | 5% |
| what % of infected ppl develop active reactive TB later in life | 5% |
| TB in the older adult: most cases are caused by what | reactivation of dormant bacteria as cell-mediated immunity declines with aging |
| TB in the older adult: what living environement increases their risk | long term care |
| TB in the older adult: s/s | vague*, coughing, wt loss, anorexia, periodic fevers |
| s/s: do they develop gradually or abruptly | gradually |
| s/s: what are they | fatigue, wt loss, anorexia, low grade afternoon fever, night sweats |
| s/s: at first the cough is ________ and then it becomes _________ | dry; productive of purulent or blood tingled sputum |
| When does pt seek medical attention | when cough becomes blood tingled |
| Extrapulmonary TB: what is this | colonies of M. tuberculosis can develop in other organs |
| Extrapulmonary TB: can these sites be active or dormant | both |
| Extrapulmonary TB: what are common sites | kidneys, GU tract, wt bearing joints, |
| Extrapulmonary TB: def of tuberculosis arthritis | when TB is in the wt bearing joints |
| Extrapulmonary TB: def of miliary TB | it occurs when the bacteria sread throughout the body via the blood |
| Extrapulmonary TB: def Tb meningitis | reults when TB spreads to the subarachnoid space |
| Extrapulmonary TB: why do s/s vary | they do depending what system is effected |
| Extrapulmonary TB: s/s of TB of the GU tract | UTI s/s, prostatisitis, epididymititis, pelvic inflammations |
| Extrapulmonary TB:s/s of TB of the TB meningitis | HA w/ increased severity, behavior changes |
| Extrapulmonary TB:s/s of TB of miliary TB | generalized weakness, fever, chills, malaise and progressive dyspnea |
| what three things does interdisciplinary care focus on | early detection, effective Tx, preventing the spread to others |
| to pts w/ active TB need hospitalization often | no |
| when they are hospitalized what type of isolation is needed | respiratory |
| does it have to be reported to local and state public health | yes |
| Screening: how long does it take for ppl exposed to TB to develop an immune response to the bacillus | 3-10 wks after infection |
| screening: what is done in the TB test | injection of a small amount of purified protein derivative (PPD) of tuberculin activates this response |
| screening: if you are postivite for TB what will the TB test reveal | local inflammation`` |
| screening: what test if commonly used | the mantoux test |
| screening: where is the PPD injected | intradermally into the dorsal aspect of the forearm |
| screening: when is the test read | 48-72 hours after administeration |
| screening: how is the test recorded | as the diameter of induration (raised area) in millimeters (used to determine the infection ) |
| screening: what does a postive response mean for the pt; what does it not mean | they have developed an immune response to the bacillus; that they have active TB or is currently infectious |
| screening: area of duration < 5mm = | negative response |
| screening: area of duration 5-9 mm = | positive for ppl who, are in close contact w/ someone who has active TB, have an abnormal chest xray, have HIV infection |
| screening: area of duration 10-15 mm = | positive for ppl with other risk factors (born in a high incidence country, low socioeconomic status, AA, hispanic, asian, america in poverty, injection drug use, resident in LTC facility) |
| screening: area of duration > 15 mm = | postive for all ppl |
| diagnostic tests: why is a chest xray used | to Dx and eval TB |
| diagnostic tests: why is fiberoptic bronchoscopy used | to obtain culture specimens |
| meds: why are antiTB meds used | to prevent and treat TB |
| meds: what is used for 6-12 months to prevent active TB | daily isoniazied (INH) |
| meds: when does TB bacillus become drug resistent | when only one antiinfective is used |
| meds: what is done then to prevent drug resistence | using two antibacterial agents |
| meds: why is >6 months needed for Tx | b/c the organism is protected by the tubercle |
| meds: how often is med taken in first 2 months; how much is taken after 2 months | three drugs daily by mouth; twice weekly |
| meds: adverse effects | toxic to liver |
| meds: teaching to clients | avoid alcohol, and acetaminophen |
| meds: what is the main cause of Tx failure | noncomplience |
| Nx Dx: risk for infection- why is a negative airflow room needed | prevents air circulating into the hallways or other rooms from that room; to prevent spread |
| Nx Dx: risk for infection- what type of respirator needed | a HEPA filtered |
| how does someone get the primary infection | from a person w/ infectious active TB, the droplets can suspend in the air for several hours |
| will primary infection have a postive TB test; how many weeks after exposure does test show postive | yes; 3-10 wks |
| how many ppl after exposure (out of ten) get active | 1 out of 10 |
| who is most likey to get extrapulmonary TB | severely comprimised ppl, aids |
| what is the true way to Dx it | sputum cultures |
| what vaccine will always make soneone postive | the BCG vaccine |
| how to read TB test | anly read raised area not theredness around it |
| who should it not be given to | ppl with a known positive reaction |
| meds: what ones are common | isoniazid (INH), pyrazinamide (PZA), rifampin (RIF), ethambutol (EMB) |
| meds: isoniazid (INH): most common adverse reaction (sign of toxicity) | neuropathy |
| meds: isoniazid (INH): adverse reactions | N/V, epigastic pain, fever, skin eruptions, hematologic changes, jaundice, hypersensitivity |
| meds: pyrazinamide (PZA): most common adverse reaction (sign of toxicity) | hepatoxicity is the most common adverse reaction |
| meds: pyrazinamide (PZA): adverse reactions | N/V, diarrhea, myalgia, rashes |
| meds: ethambutol (EMB): most common adverse reaction | optic neuritis (decrease in visual acuity and changes in color perception) |
| meds: ethambutol (EMB): adverse reactions | dermatitis and pruritus, joint pain, anorexia, N/V |
| meds: rifampin (RIF): most common adverse reaction | red orange secretions |
| meds: rifampin (RIF): adverse reactions | N/V, epigastric pain, heart burn, fatigue, vertigo, rash, reddish orange discoloaration of body fluids, hematologic changes, renal insufficiency |
| all of the meds for Tb are toxic to what | the liver (hepatotoxic) |
| what labs should be done before drug administration | liver enzymes, hepatic studies |
| biggest issue with med admin | compliance |
| s/s of hepatoxicity | N/v, poor appetite, RU adb. pain, jaundice, flu like fever, visual changes |
| when should sputum be rechecked after admin of meds | in 2-3 months |
| how does the cough start; and what happens to the cough over time | dry, productive with red tinged sputum |
| what does positive test only reveal | that they have been exposed |
| s/s of perihperal neuropathay | numberness and tinlging, |
| Tx for the side effect of INH, peripheral neuropathy | vit B |
| what med is used prophylactally for TB | INH |
| what should be avoided while on the Tb meds | alcohol, tylenol, OCT, |
| meds: what labs should be checked periodically | AST/ ALY |
Created by:
jmkettel
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