Alterations in Oxygenation r/t Infectious Processes MS1 exam2
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| pulmonary tuberculosis | chronic recurrent infectious disease
airborne infection
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| which countries have the highest rates for TB | Asia, Africa, MiddleEast, LatinAmerica
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| reasons for TB resurgence | *>rate of tb with HIV pt
*emergence of drug-resistant strains of M. tuberculosis (L569)
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| Mycobacterium tuberculosis | slow growing, rod shaped, acid fast bacilli
-waxy outer capsule=resistant to destruction
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| how long one gets active TB? | after exposure, 8-10wks asymptomatic then becomes active
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| spread of TB | -REPEATED CLOSE contact to be infected (sneeze, cough)
-Cant be spread by hands, glasses, dishes (L570)
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| 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
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| nonActive TB: LTBI (latent Tuberculosis Infection) | person has effective immune response; granuloma/tubercle/no replication=controlled
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| Active TB | person has inadequate immune response; slowly replicates, spread
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| chances of active TB with LTBI | 10-20% will have active TB within 1yr
5-10% within a lifetime
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| S/S Active TB | develop insidiously, initially nonspecific
*night sweats, fatigue, <grade fever; <appetite, wt loss, dry cough then purulent/bloodtinged, dyspnea
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| tuberculin skin test(Mantoux test) | reading in 48-72hr, induration indicates exposure and development of antibodies (not redness)
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| 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
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| false positive rxn | BCG vaccine (other countries); a live virus
-person has developed antibodies from vaccine
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| false negative rxn | improper administration, read to soon
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| 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
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| Bump/Induration: bigger/>15mm vs small/<9mm | >15mm=stronger immune
<9mm=immunocompromised, <response to test due to immunity is fighting other organisms (L571)
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| skin test again after +result? | person with +skin test should not be tested again because sensitivity to tuberculin tends to persist throughout life (L571)
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| diagnostic test for TB | sputum smears for AFB/acid fast bacilli, sputum culture, CXR, quantiferon TB
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| Diagnosing active TB | *contagious; abnormal CXR, +sputum, symptomatic, +skin test (just a screening test)
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| LTBI | exposed but not active, not contagious; -CXR, asymptomatic, +skin test
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| testings prior drug therapy for active TB | liver function (AST,ALT), vision, audiometric testings
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| normal liver function tests | AST=
ALT=
bilirubin=
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| acute care for active TB pt | private room with airborne, infection control, pharmacologic therapy, nutrition, hydration, pt education
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| why is hospitalization rare? | pt can be treated as an outpatient this is because treatment is dependent on presenting symptoms
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| what is the mainstay of TB treatment? | Pharmacologic therapy (L571)
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| treatment for LTBI | INH (isoniazide) 300mg once daily 6-12months
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| treatment for active TB | *initial phase 2mos (INH, Rifampin, PZA/pyrazinamide, Ethambutol) then *continuation phase 2-6mos drug combination (Rifamate: INH/Rifampin)
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| purpose of sputum cultures | monitor therapeutic effectiveness, compliance to therapy, resolving symptoms; done at certain times
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| when is a pt not contagious anymore? | after 3 neg sputum cultures as well as completion of therapy and asymptomatic
*but no golden parameters
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| nurs responsibility: pharmacologic therapy of HIV pt | be cautious of possible drug interactions between antiretrovirals and rifamycins (L572)
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| can TB pt stay home? | yes, if household contacts have been exposed and there is no exposure to >risk groups within that home
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| 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)
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| why is noncompliance a big concern? | there is a risk of development of drug resistant strains
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| 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)
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| nurs interventions | infection control in hospital/at home, nutrition, hydration, support system, pharmacologic therapy, incentives, pt education
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| 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
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| 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
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| nutritional/hydration therapy | >protein, >CHO diet, >fluids, avoid alcohol/stop drug usage
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| what does neg airflow mean? | air out but not going back in
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| incentives to follow treatment program | coupons for food, free access/vouchers, money exchanges
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| pt education | med regime-1fullyr, infection control/<transmission
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| PCs r/t drug therapy | Sensory disturbances, ototoxicity, nephrotoxicity, hepatoxicity
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| Isoniazide (INH) | prohylaxis alone, drugcomb treatment
SE: HEPATOXICITY, anemia
*AST, ALT, bilirubin; CBC
*avoid alcohol, >effects phenytoin/carbamazepine, disulfram(antabuse)-<coordination, psychosis
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| 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
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| Rifamate | comb of INH and Rifampin
-INH and Rifampin given together for 6-12mos
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| Pyrazinamide (PZA) | treatment used for 2mos
SE: hepatoxicity, HYPERURICEMIA (goutyflareups, joint/toe pains, anemia
*CBC, liver fcn, URIC ACID LEVELS
*>fluids
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| Ethambutol | drugcomb treatment
SE: blurred vision
*contra OPTIC NEURITIS
*VISUAL ACUITY/COLOR, CBC, BUN/creat, liver fcn
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| Streptomycin | drugcomb treatment
SE: NEPHROTOXICITY, OTOTOXICITY
*IM inj, BUN/creat
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| pharmacologic therapy cautions | liver/renal dysfunctions, pregnancy/lactation, gouty arthritis, alcoholic, optic neuritis
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| normal renal function tests | BUN=
creatinine=
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| CBC with differentials | RBC=
hgb=
hct=
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