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4Pulmo Tuberculosis
Alterations in Oxygenation r/t Infectious Processes MS1 exam2
| Question | Answer |
|---|---|
| pulmonary tuberculosis | chronic recurrent infectious disease airborne infection |
| which countries have the highest rates for TB | Asia, Africa, MiddleEast, LatinAmerica |
| reasons for TB resurgence | *>rate of tb with HIV pt *emergence of drug-resistant strains of M. tuberculosis (L569) |
| Mycobacterium tuberculosis | slow growing, rod shaped, acid fast bacilli -waxy outer capsule=resistant to destruction |
| how long one gets active TB? | after exposure, 8-10wks asymptomatic then becomes active |
| spread of TB | -REPEATED CLOSE contact to be infected (sneeze, cough) -Cant be spread by hands, glasses, dishes (L570) |
| individuals at risk | immigrants (Asia, Africa, MiddleEast, LatinAmerica), HIV/AIDs/immunocompromised, alcoholics,IVdrug users, homeless, children <5, residents of overcrowded institutions, healthcare workers working with TB pt |
| nonActive TB: LTBI (latent Tuberculosis Infection) | person has effective immune response; granuloma/tubercle/no replication=controlled |
| Active TB | person has inadequate immune response; slowly replicates, spread |
| chances of active TB with LTBI | 10-20% will have active TB within 1yr 5-10% within a lifetime |
| S/S Active TB | develop insidiously, initially nonspecific *night sweats, fatigue, <grade fever; <appetite, wt loss, dry cough then purulent/bloodtinged, dyspnea |
| tuberculin skin test(Mantoux test) | reading in 48-72hr, induration indicates exposure and development of antibodies (not redness) |
| TB skin test: SIZE of INDURATION | 5-9mm=HIV/AIDS, immunocompromised 10-15mm=immmigrants <5yrs, children<4, IV drug users, prisoner, homeless, DM, alcholics >15mm=anybody |
| false positive rxn | BCG vaccine (other countries); a live virus -person has developed antibodies from vaccine |
| false negative rxn | improper administration, read to soon |
| nurs responsibilites: TB skin test | *assess BCG vaccine prior; intradermal inj, bevel up/visible blob, use good light when reading, use marking pen, horizontal measurement |
| Bump/Induration: bigger/>15mm vs small/<9mm | >15mm=stronger immune <9mm=immunocompromised, <response to test due to immunity is fighting other organisms (L571) |
| skin test again after +result? | person with +skin test should not be tested again because sensitivity to tuberculin tends to persist throughout life (L571) |
| diagnostic test for TB | sputum smears for AFB/acid fast bacilli, sputum culture, CXR, quantiferon TB |
| Diagnosing active TB | *contagious; abnormal CXR, +sputum, symptomatic, +skin test (just a screening test) |
| LTBI | exposed but not active, not contagious; -CXR, asymptomatic, +skin test |
| testings prior drug therapy for active TB | liver function (AST,ALT), vision, audiometric testings |
| normal liver function tests | AST= ALT= bilirubin= |
| acute care for active TB pt | private room with airborne, infection control, pharmacologic therapy, nutrition, hydration, pt education |
| why is hospitalization rare? | pt can be treated as an outpatient this is because treatment is dependent on presenting symptoms |
| what is the mainstay of TB treatment? | Pharmacologic therapy (L571) |
| treatment for LTBI | INH (isoniazide) 300mg once daily 6-12months |
| treatment for active TB | *initial phase 2mos (INH, Rifampin, PZA/pyrazinamide, Ethambutol) then *continuation phase 2-6mos drug combination (Rifamate: INH/Rifampin) |
| purpose of sputum cultures | monitor therapeutic effectiveness, compliance to therapy, resolving symptoms; done at certain times |
| when is a pt not contagious anymore? | after 3 neg sputum cultures as well as completion of therapy and asymptomatic *but no golden parameters |
| nurs responsibility: pharmacologic therapy of HIV pt | be cautious of possible drug interactions between antiretrovirals and rifamycins (L572) |
| can TB pt stay home? | yes, if household contacts have been exposed and there is no exposure to >risk groups within that home |
| ambulatory and home care | notification of public health esp if drug compliance is questionable so follow up of close contacts can be accomplished (L575) *follow up care 12mos (eg sputum, CXR) |
| why is noncompliance a big concern? | there is a risk of development of drug resistant strains |
| what is implemented to avoid noncompliance? | -DOT (direct observational therapy) via a public health agency, community healthcare worker watch pt take med -combination of drugs to simplify therapy - isoniazid/rifampin (L572) |
| nurs interventions | infection control in hospital/at home, nutrition, hydration, support system, pharmacologic therapy, incentives, pt education |
| infection control in hospital | private room neg airflow, standard precautions recommended by CDC, PPE/HEPA-N95mask, <spread/contamination, proper collection of sputum specimen (brownpaperbag, biohazard - tightly seal), uncontrolled cough provide mask |
| infection control at home | cover mouth/nose with tissue, proper disposal of tissue (brownbag sealed, burned, flushed down the toilet), collect sputum in well ventilated area-outside, sleep alone, no visitors until noninfectious, no travel outside US till neg sputum |
| nutritional/hydration therapy | >protein, >CHO diet, >fluids, avoid alcohol/stop drug usage |
| what does neg airflow mean? | air out but not going back in |
| incentives to follow treatment program | coupons for food, free access/vouchers, money exchanges |
| pt education | med regime-1fullyr, infection control/<transmission |
| PCs r/t drug therapy | Sensory disturbances, ototoxicity, nephrotoxicity, hepatoxicity |
| Isoniazide (INH) | prohylaxis alone, drugcomb treatment SE: HEPATOXICITY, anemia *AST, ALT, bilirubin; CBC *avoid alcohol, >effects phenytoin/carbamazepine, disulfram(antabuse)-<coordination, psychosis |
| Rifampin | drugcomb treatment SE:HEPATOXICITY, GI distress, secretions ORANGE/Permanent discolor contact lenses *CBC, liver/renal fcn *<effect oral contraceptives/hypoglycemics/anticoagulants, theophylline, steroids, opioids, betablockers, benzodiazepines |
| Rifamate | comb of INH and Rifampin -INH and Rifampin given together for 6-12mos |
| Pyrazinamide (PZA) | treatment used for 2mos SE: hepatoxicity, HYPERURICEMIA (goutyflareups, joint/toe pains, anemia *CBC, liver fcn, URIC ACID LEVELS *>fluids |
| Ethambutol | drugcomb treatment SE: blurred vision *contra OPTIC NEURITIS *VISUAL ACUITY/COLOR, CBC, BUN/creat, liver fcn |
| Streptomycin | drugcomb treatment SE: NEPHROTOXICITY, OTOTOXICITY *IM inj, BUN/creat |
| pharmacologic therapy cautions | liver/renal dysfunctions, pregnancy/lactation, gouty arthritis, alcoholic, optic neuritis |
| normal renal function tests | BUN= creatinine= |
| CBC with differentials | RBC= hgb= hct= |
Created by:
sarahjqs
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