Immunology

Question 1

What does m. TB Organism affect

Answer 1

Primarily the lungs in the upper airway where oxygen content is the highest

Also - the brain intestines peritoneum kidneys joints and liver

Question 2

What can happen in the active phase of Tb

Answer 2

Necrosis and cavitation in the lesions which can lead for rupture and the spread of necrotic tissue

Question 3

What are the clinical manifestations of TB

Answer 3

May be asymptomatic I the primary infection
Fatigue
Lethargy
Anorexia
Weight loss
Low grade fever
Chills
Night sweats
Persistent cough and production of mucous and mucopurulent sputum which is occasionally streaked with blood
Chest tightness And a dull aching chest pain may accompany the cough

Question 4

Presence of what on an X-ray suggests TB

Answer 4

Multinodular infiltrates with calcification in the upper lobe

Question 5

On X-ray what would indicate active disease TB

Answer 5

Caseation and inflammation

Question 6

Describe advanced TB

Answer 6

Dullness with percussion over involved parenchymal areas
Bronchial breath sounds
Ronchi and crackles

Partial obstruction of the bronchus caused by endobronchial disease or compression by lymph nodes may produce localized wheezing and dyspnea

Question 7

QuantiFERON TB GOLD test - what is it and what is it for

Answer 7

Blood analysis test by an enzyme linked immunosorbent assay

A sensitive and rapid test that assists in diagnosis

Question 8

TB SPUTUM cultures - what are they looking for

Answer 8

M. Tuberculosis confirms the diagnosis

After medications are started sputum samples are obtained again to determine the effectiveness of therapy

Most are negative after 3 months of therapy

Question 9

Tuberculin skin test - what does it mean when the skin shows a positive reaction ?

Answer 9

Does not mean that the disease is active

Indicates previous exposure to TB or the presence of a dormant disease

Once the test is positive it will be positive in any future tests

Question 10

What happens after a positive skin test

Answer 10

CXR

To rule out active TB Or to detect old healed lesions

Question 11

Isolation precautions for TB

Answer 11

Airborne isolation
Negative pressure room
Door must be tightly closed to remain negative pressure
Nurse requires N95 mask
Hand washing
If client needs to leave the room pt needs a mask
When no longer infectious precautions are done

Question 12

How long does it take for the transmission risk to reduce in TB

Answer 12

2-3 weeks of therapy

Question 13

What happens if clients are not compliant with TB MEDS

Answer 13

Mutations in the tubercle bacilli resulting in resistant strains MDR -TB

Question 14

What happens to those who have been close to TB PTS

Answer 14

TST

And chest X-ray

Question 15

Steps of TB progression

Answer 15

1. Droplets enter lungs tubercle lesion is formed
2. Defence system makes a scar of lesion
3. If encapsulation does not occur, bacteria may enter the lymph system, travel to the nodes and cause an inflammatory response
   - granulomatous inflammation
4. Primary lesions form - may become dormant and become reactivated and become a secondary infection when reexposed to the bacteria

Question 16

Individuals who have received what vaccine are at risk for TB

Answer 16

Bacilli calmette guerin will have a positive test result and should receive an X-ray as the vaccine has attenuated tubercle bacilli

Question 17

TST Induration of 5 >5mm considered positive in

Answer 17

HIV Infected persons
Recent contact of a person with TB disease
Persons with fibrotic changes on CXR consistent with prior TB
Clients with organ transplants
Persons immunosuppressed for other reasons

Question 18

Indication 10 or >10mm considered positive in

Answer 18

Recent immigrants from high prevalent countries
Injection drug users
Residents and employees in high risk settings
Labs
Persons with clinical conditions that place them at high risk
Children under four
Infants children and adolescents exposed to adults in high risk categories

Question 19

Induration of 15 or >15 mm positive in

Answer 19

Any person including persons with no known risk factors for TB

Question 20

What foods are recommended for TB PTS

Answer 20

Foods high in iron protein and vitamin c

Question 21

Who is respiratory Isolation not necessary for

Answer 21

Family members because they have already been exposed

Question 22

What should TB PTS avoid

Answer 22

Exposure to silicone because this can further lung damage

Question 23

What are the names of the fist line medications for TB

Answer 23

Isoniazid 
Rifampin
Ethambutol
Pyrazinamine 
Rifabutin 
Rifapentine

Question 24

What are the second line medications for TB

Answer 24

Capreomycin sulfate 
Antibiotics 
 - aminoglycosides 
- fluroquinolones (not for children) 
Bactericidal 

Ethionamide
Aminosalicylic acid
Cycloserine
Streptomycin

Question 25

What can many TB medications cause

Answer 25

``` Hepatotoxicy Nephrotoxicity Neurotoxic Optic neuritis Ototoxic ```

Question 26

What is a pulmonary embolism

Answer 26

Occurs when a thrombus forms - commonly in a deep vein Detaches travels to the right side of the heart and then lodges in the pulmonary Artery

Question 27

Assessment findings of a pulmonary embolism

Answer 27

``` Apprehension and restlessness Blood tinged sputum Chest pain Cough Crackles and wheezes on auscultation Cyanosis Distended neck veins Dyspnea accompanied by anginal and pleuritic pain - exacerbated by inspiration Feeling of impending doom Hypotension Petechia over abdomen and axilla Shallow respirations Tachycardia and tachypena ```

Question 28

What do you do if you suspect a pulmonary embolism

Answer 28

Notify the response team Reassure the client and elevate the HOB Prepare to administer oxygen Obtain vital signs and check lung sounds Prepare to obtain arterial blood gas Prepare for the administration of heparin therapy or other therapies Document

Question 29

What is TB caused by ?

Answer 29

Myobacterium tuberculosis - aerobic organism

Question 30

What is systemic lupus erythematosus

Answer 30

Chronic Progressive Systemic inflammatory disease Major organs and systemic systems to fail

Question 31

What happens with SLE

Answer 31

Connective tissue and fibrin deposits collect in blood vessels on collagen fibres and on organs Deposits lead to necrosis and inflammation in the blood vessels lymph nodes GI tract and pleura No cure but remissions for those who manage well

Question 32

SLE ASSESSMENT

Answer 32

``` Assess for precipitating factors Butterfly rash Dry scaly raised rash on the face or upper body Fever Weakness malaise and fatigue Anorexia Weight loss Photosensitivity Joint pain Erythema of the palms Anemia Positive ANA test and LE prep Elevated ESR rate and C reactive protein ```