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NURS 313R > Exam 2: Pulmonary TB > Flashcards

Exam 2: Pulmonary TB Flashcards

(56 cards)

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1
Q

Pulmonary Tuberculosis

A

Infectious disease cause by mycobacterium tuberculosis.

Usually involves lungs but can infect any part of the body.

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2
Q

Factors of resurgence of TB

A

High rates of TB among HIV patients

Emergency of MDR strain of M. Tuberculosis.

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3
Q

What is the leading cause of death from infection in the world?

A

TB

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4
Q

Risk Factors for TB

A
  • Contact with person w/ active TB
  • Immuno-compromised Status/Preexisting Medical Condition
  • Inadequate Health Care (d/t lack of screen and health promotion)
  • Immigration
  • Institution
  • Substance Abuse
  • Substandard Housing
  • High risk jobs
  • Overcrowding
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5
Q

Why are patients taking prednisone at an increased risk for TB?

A

Prednisone treats inflammation -> lowers resistance -> lowers WBC

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6
Q

Why do patients who have had transplants at an increased risk for TB?

A

D/t lifelong immunosuppressant therapy

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7
Q

TB occurs commonly in

A

Poverty
Minorities
Undeserved

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8
Q

Types of TB Drug Resistance

A

Primary Drug Resistance
Secondary Drug Resistance
Multiple Drug Resistance

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9
Q

Drug resistance results from

A

Incorrect prescribing
Lack of PH care management
Patient non-adherence

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10
Q

How is TB spread?

A

Via airborne droplets. Can also be spread vi lymph and blood.
Can be suspended in the air for minutes to hours.

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11
Q

Factors influencing the likelihood of transmission

A

of organisms expelled in air
Concentration of organisms
Length of exposure
Immune system of exposed person

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12
Q

Pathophysiology of TB

A
  1. Patient inhales m. Tuberculosis bacilli
  2. Infection of the tracheobroncheal tree
  3. Multiply in the alveoli
  4. Transport to other body parts via lymph/blood
  5. Inflammatory Process
  6. Neutrophils/macrophage engulf bacteria
  7. Accumulation of exudate in the lung/lobe
  8. Granulomas formation
  9. Transformation to a fibrous mass (Ghon tuberculi)
  10. Formation of a cheesy mass and cavitation of lobe tissue necrosis
  11. Calcification and form collagen scar
  12. Bacteria becomes dormant/no progression of the disease
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13
Q

Ghon Focus

A

Neutrophil and macrophage try to contain local bacteria

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14
Q

Granuloma

A

Defense mechanism -> walls off infection and prevents further spreading.
Secondary to exudate accumulation.

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15
Q

Ghon tuberculi

A

Starts to harden and adds weight to it
Circulation obliterated by weighing down on capillary blood vessels in lung
Oxygen deprived in tissue in lungs

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16
Q

Primary infection

A

Bacteria is inhaled and initiates inflammatory reaction

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17
Q

Latent TB Infection

A

Occurs in person who does not have active TB.
Cannot transmit to others
Treatment is important d/t being able to develop active disease.

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18
Q

Active TB Disease

A

immune response not adequate and bacteria replicates

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19
Q

Primary TB: develops w/i

A

first 2 years of infection

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20
Q

Postprimary TB or “reactivation”: disease occurring

A

2+ years after initial infection

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21
Q

Latent TB Infection: Clinical Manifestations

A

Positive skin test but is asymptomatic

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22
Q

Pulmonary TB: Clinical Manifestations

A 
Develops 2-3 weeks after infection/reactivation
Initial dry cough → productive cough w. mucopurulent sputum
Fatigue*
Unexplained weight loss*
Low grade fever*
Night sweats*
Dyspnea (late symp.)
Hemoptysis (late symp.)
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23
Q

Acute Symptoms of TB

Study These Flashcards
A 
Generalized flu symp. 
High fever
Chills
Pleuritic pain
Productive cough
24
Q

TB findings upon auscultation

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A

Normal

Or reveal crackles, ronchi, bronchial breath sounds

25
Extra pulmonary TB
Depends on organs it affects | E.g. renal TB → dysuria and hematuria
26
Appropriately treated TB
Heals w/o complications | Scar and residual cavitation w/i lung
27
Military TB
Widespread of bacteria via bloodstream to distant organs | Fatal if left untreated
28
Pleural TB
From primary disease or reactivation Pleural effusion d/t bacteria in pleural space Causes inflammatory response → exudate of protein rich fluid
29
Acute TB Complications
d/t large amounts of tubercle bacilli discharged from granulomas into lung/lymph
30
TB: Diagnostic Studies
TB Skin Test AFB Smear CXR Sputum Culture/Sensitivity
31
TB Skin Test
..
32
CXR
Can’t make dx off CXR | Upper lobe filtrates, cavitary infiltrates, lymph node involvement
33
Sputum Culture
Dx of TB requires demonstration by tb bacilli | Stained sputum smears for AFB: 3 consecutive samples must be collected on different days
34
Management of TB
- treated primarily with chemo therapeutic agent for 6-12 mons (short / term chemo therapy) - use of multiple drug therapy
35
Patients with a positive TB sputum smear are considered
Infectious for first 2 weeks after starting treatment.
36
Drug Therapy: Main Treatment for TB
Two phases: initial and continuation | RIPE: Rifampin, INH, Pyrazinamide, ethambutol
37
Treatment for drug resistant TB
Sensitivity testing
38
MDR-TB therapy includes
Fluoroquinolones, injectable antibiotics
39
Directly Observed Therapy
Providing drugs to patients and watching them swallow meds. Ensures adherence. Fixed dose combo drugs increases adherence (i.e INH + rifampin or INH + rifampin + PZA)
40
Latent TB Infection Drug Therapy
Drug therapy helps prevent active TB Usually only one drug 9 months daily INH
41
BCG Vaccine
Live strain of mycobacterium bovis Given in high prevalence areas If meet criteria E.g. health care workers who are constantly exposed too
42
Assessment of TB
Previous hx TB, chronic illnesses, immunosuppressants | Social and occupational hx → determine risk factors
43
Health Promotion for TB
- Dx TB must be reported to PH - Improve access to health care and education - Minimize social determinants of TB - Cover nose and mouth w. tissue when sneezing or coughing - Hand wash
44
TB Intervention Goals:
Promote airway clearance d/t sputum. Promote activity and adequate nutrition. Advocate adherence to treatment regimen.
45
TB Interventions for Promoting airway clearance d/t sputum
- Patient position, cough and deep breathing - Postural Drainage - Suctioning - Medications: expectorant - Hydration (liquifies secretions) - Humidify air (loosens secretions)
46
Advocate adherence to treatment regiment to
Limit multiple drug resistance.
47
Promote activity and adequate nutrition because
Malnutrition is a risk factor for TB
48
If a patient is strongly suspected for TB, they
1. Are placed on airborne isolation (Negative pressure room → sucks in the air when the door opens and releases air outside to atmosphere and never comes back into room (doesn’t recycle air) + UV rays will kill mycobacteria) 2. Will receive medical workup 3. Will receive appropriate drug therapy
49
Ambulatory and Home Care of TB
Monthly sputum cultures obtained until 2 consecutive specimens are negative → not infectious Encourage to quit smoking
50
Monitoring and Managing Potential Complications of TB includes
Malnutrition Side Effects of Medication Therapy: INH and rifampin Multiple Drug Resistance Spread of TB infection
51
INH: Nursing Implications
- Take on an empty stomach (1 hour before or 2 hours after meals). - Extra vitamin B needs to be taken while on this drug. - Monitor for signs of liver damage - Avoid Alcohol
52
Adverse Effects: INH
- Can cause liver damage. - Asymptomatic elevation of ALT, AST (liver enzymes) - hepatitis
53
Adverse Effects: Rifampin
- Hepatitis - Thrombocytopenia - Orange discoloration of bodily fluid (sputum, urine, sweat and tears.) - Can cause liver damage (can lead to increased bleeding time)
54
Adverse Effects: PZA
- Hepatitis - Arthralgias: Pain in joint - Hyperuricemia: Excessive amount of uric acid in blood
55
Adverse Effects: Ethambutol
Ocular Toxicity (decreased red-green color discrimination)
56
Ethambutol: Nursing Implications
Monitor visual acuity and color discrimination regularly

NURS 313R (18 decks)

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