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1

infectious disease caused by mycobacterium tuberculosis

tuberculosis

2

tuberculosis most commonly infects the

lungs

3

what are the risk factors for tuberculosis

homeless, residents of inner city neighborhoods, foreign-born, living or working in institutions, IV injecting drug users, poverty, immunosuppression, asian descent

4

when does multi drug resistant tuberculosis occurs

when a strain develops resistance to two of the most potent first line anti TB drugs

5

what is one of the main causes for resistance to the drug to occur

not finishing treatment

6

how is tuberculosis spread

via airborne droplets

7

how long can the tuberculosis droplets be suspended in the air and why

minutes to hours because the droplet itself is so tiny

8

tuberculosis is NOT spread by

touching, sharing food utensils, kissing, or physical contact

9

once tuberculosis droplet is inhaled it lodges in bronchiole and alveolus and develops into a

granuloma

10

when the granuloma develops the infection becomes

walled off and typically stops further spreading

11

why does tuburculosis the lungs

its aerophilic (oxygen loving)

12

develops active infection within the first 2 years of being exposed is

primary infection

13

activated 2 years AFTER exposure is

latent TB infection

14

Tb comes back when immunocompromised

reactivation TB

15

where is the grandulome/TB found

upper to mid lungs

16

what does TB usually start with

dry cough that then becomes productive and frequent

17

what is a late sign of TB

coughing up blood and SOB

18

large numbers of organism spread via the bloodstream to distant organs

milary TB

19

fluid in the pleura space and causes inflammation

pleural TB

20

for the PPD what indicated that you have been exposed to TB (antibodies)

the presence of induration at injection site

21

low risk of TB at injection site is an induration of

>15

22

high risk of TB at injection site is an induration of

> 10

23

immunocompromised will have an induration at injection site of

>5

24

If there is an induration at injection site what is the next steps

chest xray and then sputum test (first thing in the morning)

25

what is the gold standard for testing tuberculosis

sputum

26

instead of getting a skin test every year if positive for TB you will get an

xray yearly

27

when do you prefer to obtain sputum culture

before placed on antibiotics

28

a TB patient is usually infectious the

first 2 weeks after starting treatment (if sputum +)

29

why should you report TB patient to health dept

so they can get in touch with people pt has been in contact with

30

what precaution will the TB pt be on

airborne precaution with negative pressure room

31

what PPE should you wear when bathing the pt

Gown, goggles, mask (n95) and gloves

32

what are S/S of tuberculosis

progressive fatigue, malaise, anorexia, weightloss, chronic cough, night sweats, hemoptysis, low grade fever, pleuritic chest pain

33

what is the treatment for TB

TB meds for 6 most of longer, isolation until - sputum results

34

what are the dx of Tb

Tb skin test, chest x ray then sputum (3 specimens collected on different days)

35

acute infection of the lung parenchyma

pneumonia

36

what could cause pneumonia

pollution, smoking, upper respiratory infections, tracheal intubation, aging

37

what are 3 ways organisms reach lungs

aspiration, inhalation of microbes in the air, hematogenous spread form primary infection elsewhere in the body

38

occurs in patients who have been hospitalized or resided in a long term care facility within 14 days of the onset of symptoms

community acquired pneumonia

39

occuring 48 hours or longer after admission and not incubating at time of hospitalization

Hospital acquired pneumonia

40

what is the #1 cause of pneumonia

streptococcal pneumonia

41

what causes HAP

not washing hands

42

what are major problems in treating HCAP

multidrug resistant organisms

43

what does aspiration pneumonia result from

abnormal entry of secretions into lower airway

44

why would you perform a sputum culture BEFORE antibiotics are given

antibiotics could give abnormal results

45

what are symptoms of pneumonia

cough, fever, dyspnea, pleuritic chest pain, rhonchi and crackles

46

what are a few complications of pneumonia

pleural effusion, atelectasis, bacteremia, meningitis, sepsis

47

what is the gold standard for dx pneumonia

chest xray

48

collaborative care for pneumonia would be

pneumococcal vaccine, antibiotic therapy, oxygen for hypoxemia, analgesics for chest pain

49

what is the minimum days for antibiotic therapy (pneumonia)

5 days

50

what should the pts nutritional therapy be for pneumonia

adequate hydration, hi calorie, small frequent meals

51

COPD includes

chronic bronchitis, emphysema

52

airflow limitation that is not fully reversible and is generally progressive

COPD

53

what are symptoms of a COPD patient

easily fatigued, frequent respiratory infections, use of accessory muscles to breathe, orthopneic, dysrhythmias, thin in appearance, wheezing, purse lipped breathing, chronic cough, digital clubbing

54

clubbing is a chronic sign of

hypoxia as well as cyanosis

55

presence of cough and sputum production for at least 3 months in each of 2 consecutive years

chronic bronchitis

56

for pt with chronic bronchitis the alveoli become _____

damaged

57

what are some clinical signs of a chronic bronchitis pt

frequent cough with foul smelling sputum
pulmonary infecitons, blue bloater appearance, dyspnea and activity intolerance

58

what are S/S of a blue bloater

frequent productive cough (3mx2yr)
digital clubbing
barrel chest
easily fatigued
smoke
dyspnea
leans forwatd to breath easier
uses accessory muscles
needs O2
easily fatigued
lots of respiratory infection

59

where is it best to locate cyanosis

lips, mucous membranes and fingers

60

what is the progressive destruction of alveoli

emphysema

61

emphysema _______ surface area of respiratory bronchioles, alveoli, and alveolar ducts

decreases

62

emphysema is the _______ of lung tissue and _______ your elasticity

destruction;lose

63

what are clinical manifestations of emphysema

chronic cough
exertional dyspnea
sputum production
persistent tachycardia
diminished breath sounds
"pink puffer"
"barrel chest"

64

why do emphysema patients not eat

because its hard to breath while eating and they would rather have oxygen

65

what are S/S of pink puffer

speaks in short jerky sentences, purse-lip breathing, barrel chest, destruction of alveoli walls, wheezing, smoke, permanent damage, frequent URIs, bronchi collapse on expiration, prolonged expiratory time, thin appearance, loss of lung elasticity, no cyanosis, anxious, easily fatigues

66

what does it mean when a person doesn't have enough endurance

shortness of breath while resting or with activity

67

what are assessment and dx findings for emphysema

pulmonary function tests, spirometry
ABGs

68

what is the gold standard for emphysema

spirometry

69

what are risk factors for emphysema

smoking
occupational exposure
air pollution
genetic abnormalities

70

what is the genetic risk factor for COPD

antitrypsin deficiency

71

what is an autosomal recessive disorder

AAT

72

some degree of emphysema is common because of physiological changes due to

aging

73

what are signs of severity for COPD exacerbationss

use of accessory muscles and central cyanosis

74

what are COPD exacerbation treatmens

short acting bronchodilators
coticosterioids
antibiotics supplemental oxygen therapy