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Medical-Surgical Nursing

What continent has the most cases of tuberculosis? Asia
What bacterium causes tuberculosis (TB)? Mycobacterium tuberculosis
How is TB spread? By airborne droplets expelled by a person with TB when cough, sneeze, talk, etc.
True or False: TB cannot be spread by physical contact. True
What is the leading cause of mortality in HIV-infected patients? Tuberculosis
Describe Mycobacterium tuberculosis. A gram-positive, acid fast bacillus (AFB)
What is the focus of TB infection? Ghon lesion
What is the hallmark of primary TB infection? A calcified TB granuloma
How long after infection of TB does it take to develop a positive tuberculin skin test (TST)? 2-10 weeks
True or False: Infants younger than 6 months can have a false negative to the TST. True
What test is used to test for TB in vitro? Quantiferon-TB Gold (QFT-G)
What are the 3 presentations of TB? Primary, latent, and reactivated
Define primary TB. When active disease develops within the first 2 years of infection
Can a person with latent TB infection (LTBI) transmit TB? No
Does LTBI cause a positive TST? Yes
Can LTBI develop into active TB disease? Yes
Can a chest x-ray (CXR) diagnose pulmonary TB? No
How do you diagnose active TB? Obtain 3 sputum specimens, each on a different day, to smear and culture. Positive for TB if: Smear contains acid fast bacilli and the culture is positive for M. tuberculosis.
What is the best time of day to collect sputum specimens for TB testing? Early morning
What is the initial manifestation of pulmonary TB? A dry cough that frequently becomes productive
True or False: TB can only infect the lungs. False; TB can infect any organ as well as the bones
What are S/S of active TB? Fatigue, malaise, anorexia, unexplained weight loss, low-grade fever, and night sweats
What 2 manifestations of TB indicate severe pulmonary disease? Dyspnea and hemoptysis
True or False: Immunosuppressed patients and the elderly are less likely to have signs of infection with TB. True
What is often the initial only manifestation of TB in the elderly? A change in cognitive function
What is military TB? The widespread dissemination of the mycobacterium
What are S/S of pleural TB? Chest pain, fever, cough, and presence of unilateral pleural effusion
What is Pott's disease? TB infection in the spine
What is the Mantoux test? Tuberculin skin test (TST)
When should the Mantoux test be read? 48-72 hours after injection
When an induration of specified size AND erythema are present
Is erythema without induration a significant result of the Mantoux test? No
What size induration in the Mantoux test is considered positive in all people? 15 or more millimeters
What are interferon-Y release assays (IGRAs)? Blood testes that can detect interferon (INF) gamma release from T cells in response to M. tuberculosis
Is the Mantoux test affected by the BCG vaccine? Yes, the BCG vaccine will cause a false positive TST
Are IGRAs affected by the BCG vaccine? No
What are CXR findings suggestive of pulmonary TB? Upper lobe infiltrates, cavity infiltrates, lymph node involvement, and pleural and/or pericardial effusion
What is the standard treatment for adults and children of TB? Nine month regimen of daily isoniazid
What drug class should be administered to patients with TB who are HIV positive? Rifamycins (e.g., Rifabutin)
What drugs are contraindicated with use of rifampin? Protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTIs)
What 4 drugs are used in the first 2 months of treatment for active TB? Isoniazid, rifampin, pyrazinamide, and ethambutol
What drug classes should be given to treat MDR-TB? Aminoglycosides (e.g., Viomycin) and fluoroquinolones (e.g., ciprofloxacin)
Which TB drug causes optic neuritis? Isoniazid
What foods should be avoided while taking isoniazid and why? Foods containing tyramine (e.g., aged cheese, soy, tap beer) because it can cause hypertensive crisis
Which TB drug can cause body fluids to turn orange? Rifampin
Which TB drug can cause seizures and psychosis? Isoniazid
Which TB drug can cause DIC? Rifampin
Which TB drug can cause pseudomembranous colitis? Rifampin
Can rifampin affect hormonal contraceptives? Yes; advise women to use another method of birth control
Which TB drug can cause irreversible blindness? Ethambutol Conduct baseline and monthly visual acuity and color discrimination tests
Which TB drug can cause gout? Pyrazinamide
What interventions can be applied if TB drugs cause GI intolerance? Give at bedtime with food; divide doses; consider PPIs
Created by: shrewsburysd
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