Care of Patients with Tuberculosis and Influenza Flashcards
(39 cards)
Very Highly communicable resp infectious disease
Mycobacterium tuberculosis - bacteria
Transmitted via aerosolization - transmitted via air
5-10% people exposed to bacteria develop active TB most have active immunity that able control it; sometimes not develop active TB and then get secondary TB
5-10% develop progress developing cavitary lesions
90-95% primary lesion walled off and show scar but no active infection but could develop secondary later on
Only when have active TB that can transmit the infection; cavities liquifying and opening up into bronchioles and person can transmit it
Secondary TB
Patho: TB bacilli - gets into lungs and inflammatory process where collagen, fibroblasts, lymphocytes all go to where inflammation is caused by the bacilli and then causes cavities - necrosis - and necrotic tissue turns into granular mass and see on CXR - see necrotic cavity items and indicates active TB
Pulmonary TB
airborne route - in acute care setting on airborne precautions
Transmitted via aerosolization - transmitted via air
reactivation of the disease in a previously infected person
Been exposed and never probs with disease and then reactivated
More likely in older adults and people who are immunocompromised
Secondary TB
Higher risk
Those in constant, frequent contact with an untreated person
Those who have decreased immune function - immunocompromised
People who live in crowded areas
Older homeless people
Abusers of injections drugs or alcohol
Lower socioeconomic grps
Immigrants from countries with a higher incidence of TB - Foreign immigrants: more prevalent other areas of world indivs that immigrate from diff countries higher incidence of it or someone who traveled to one areas higher risk - look at with history
Pulm TB: Risk factors for TB
Ex. HIV - very common worldwide but decrease in US except in people immunocomprosed and when HIV came onto scene and more people immunocompromised
Those who have decreased immune function - immunocompromised
Ex. Homeless; prisons; living in shelters
People who live in crowded areas
Past exposure - someone in life active TB higher risk
Country of origin or travel to countries where incidence of TB is high
Results of previous tests for TB - previous + TB test
Had the BCG vaccine
Pulmonary TB: Assessment history
Within last 10 years always test + for TB so those pats will always have + skin test not able go get annual TB test via skin with IGRA or CXR
Contains attenuated tubercle bacilli
Anyone who has received the vaccine within the previous 10 years will have a positive skin test
Should be evaluated with a CXR or the QuantiFERON-TB Gold test
Had the BCG vaccine
Progressive fatigue and lethargy - BIG
Nausea and anorexia
Weight loss
Irregular menses
Low-grade fever - sometimes
Night sweats may occur - classic sign
Cough with mucopurulent sputum, may be streaked with blood
Chest tightness, dull aching chest pain may occur with the cough
Dullness with percussion over involved lung fields
Auscultation of lung fields may have bronchial sounds, wheezing or crackles
Very tired, weak, lethargic, not eating well, sweats at night; sputum and productive cough and blood streaks in those; sometimes chest tightness/dull chest pain - will have/can have abn lung sounds - wheezing/coarse crackles - dullness where lesions might be
Pulmonary TB: CM
NAA (nucleic acid amplification) test
QuantiFERON-TB Gold (QFT-G)
Sputum culture of M. tuberculosis confirms the diagnosis
Tuberculin (Mantoux) test
Chest x-ray
Pulm TB: Diagnostic assessment
Very Rapid test for TB with results available in less than 2 hours - used in areas where have higher incidence of TB - because communicability of it risk for transmitting it to lot other people and getting quicker results better
NAA (nucleic acid amplification) test
Blood serum test with results in 24 hours/day
Moved to lot here
Blood draw
QuantiFERON-TB Gold (QFT-G)
Requires 1-4 weeks to determine + or – results
Obtained after drugs are started to determine therapy effectiveness
Do when want to confirm the diagnosis
+ QuantiFERON-TB/skin test and if in-pat get serial (3 diff mornings) sputum cultures to test for TB - best if first morning sputum - send down and check for TB - also do after diagnosis for serial sputum cultures and once have 2-3 weeks of treatment and get 3 neg sputum cultures no longer considered contagious
Sputum culture of M. tuberculosis confirms the diagnosis
PPD given intradermally in forearm (0.1 ml)
Screening tool - very pop, cheap, easy; typ HCPs have done
48-72 hours check to see if any rxn
Tuberculin (Mantoux) test
Detect active TB or old, healed lesions
Chest x-ray
Area of induration (localized swelling with hardness of soft tissue), not just redness, measuring 10 mm or greater in diameter 48 to 72 hours after injection indicates exposure to and possible infection with TB
Looking for induration - have to redness of tissue, hardness, AND swelling; some people react to injection but it has to be indurated and swelling and hardness of tissue - measure at 48 hour and 72 hour marks - want 10 mm in diameter and considered +
If immunocompromised/had HIV - 5 mm be + decreased immunity body not react as severe as someone with full functioning immune sys
Positive reaction does not mean that active disease is present but indicates exposure to TB or the presence of inactive (dormant) disease. - get CXR to further clarify and confirm have active
Reduced skin reaction or a negative skin test does not rule out TB disease or infection in the (very) old or anyone who is severely immunocompromised. - everything else points to it and have - skin test do further testing
Pulm TB: PPD Skin Test
Best Treatment for pulm TB is give drugs
Combination drug therapy is most effective method of treatment and preventing transmission
All these drugs can affect liver function
Nausea is very common
Good thing for pats now; combined into one pill; less amount pills have take
Typical drug treatment is 6-12 months
Not taking the drugs as prescribed could lead to an infection that is drug resistant
Multidrug-resistant TB (MDR TB) strains are emerging
Discharge Education
Hospitalized patients
Pulm TB: Interventions
Avoid all alcohol
Report any dark urine or yellow changes in skin color
All affect liver func - no alcohol drinking during treatment of TB, report dark urine, skin changes, sclera changes - indicates liver func decrease; liver enzymes checked periodically
All these drugs can affect liver function
Take medications at night so nausea not as prominent; also give anti-nausea
Imp adhere to drug regiment can detere people from staying on meds and actively help them prevent this
Nausea is very common
Imp to take all drugs and stick to it for full course of treatment; so not as many drug resistant strains of TB because not finishing course of treatment; makes more diff to treat it
Not taking the drugs as prescribed could lead to an infection that is drug resistant
Resistant to first-line and second-line therapy
Drug therapy more limited
Absolute adherence to therapy is critical for survival and cure of the disease
Multidrug-resistant TB (MDR TB) strains are emerging
Super imp
Teach a lot about infection prevention - in infectious period of time avoid crowds of people and wear a mask; everyone in household tested and evaluated
Cover the mouth and nose with a tissue when coughing or sneezing and place tissues in plastic bags because not want bacteria get out to anyone else; handwash
Wear a mask when in contact with crowds until the drugs suppress the infection
All members of the household need to undergo TB testing
Sputum specimens are usually obtained every 2-4 weeks once drug therapy is initiated
Discharge Education
After 3 consecutive sputum cultures are negative, the patient is no longer infectious - same thing in hospital; take out isolation and airbone precautions
Sputum specimens are usually obtained every 2-4 weeks once drug therapy is initiated
Airborne precautions
Other appropriate precautions as needed
Hospitalized patients
