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4Pulmo Tuberculosis

Alterations in Oxygenation r/t Infectious Processes MS1 exam2

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