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kol- Med Surg 320 Spring > TB > Flashcards

TB Flashcards

1
Q

What is TB caused by?

A

Mycobacterium tuberculosis

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2
Q

Tb- airborne or droplet?

A

airborne :survive for minutes to hours

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3
Q

which is more common- active or latent TB?

A

latent

-5-10% of those with latent develop active tb

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4
Q

Pathophysiology of latent TB

A
  • ->Bacillus enters lungs –> Bronchi or Alveoli
  • ->Exudative response–> Pneumonitis
  • ->Body develops immunity walling off with granuloma –> growth stops
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5
Q

-Cell-Mediated immunity (antibodies) develops _______ weeks after initial infection

Why do I care?

A

2-12 weeks

-will test positive for TB at this point

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6
Q

how do you get active TB?

A

become immunocompormised and breakdown of granuloma containing TB

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7
Q

Who is at risk of getting TB?

A
  • People repeatedly exposed with person with Active TB/ Untreated
  • Reduced immune response
  • Anyone living in a crowded area
  • Homeless Population
  • IV drug users
  • Alcoholics
  • Foreign immigrants
  • Low socioeconomic groups

(marginalized people)

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8
Q

When interview patient collect information regarding:

A

-Recent exposure?
-Previous test results/ Vaccination
-if vaccinated then can not have Mantoux PPD
test
-Travel/Country of origin

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9
Q

If you are vaccinated for TB you cannot have what TB test?

A

Mantoux PPD

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10
Q

sign and sxs of TB?

A
  • Fatigue
  • Productive Cough : blood tinged sputum
  • Weight Loss/decreased appetite
  • Night Sweats
  • Low Grade Fever
  • Adventitious Breath sounds maybe:
    • Bronchial Breath Sounds
    • Crackles
    • Wheezing
    • Whispered Pectoriloquy: person whispers and you hear increased sounds when auscultating
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11
Q

Psychosocial assessment for TB considerations?

A
  • Isolation
  • Support
  • Ability to cope
  • Ability to adhere to regimen*
  • Current living situation/ local resources available
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12
Q

Diagnosis of TB: 2 types of screening tests

A

1.TB skin test (Mantoux) -Inject 0.1 mL of purified protein Derivative into forearm (intradermal)
-cannot have if vaccinated for TB
2. Blood Tests:
:QuantiFERON-TB Gold In-Tube
:T-SPOT TB test (Mission) - can differentiate b/w antibodies from exposure vs. vaccinated

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13
Q

2 ways to get definitive diagnosis of TB?

A
  • Chest x ray

- Sputum Cultures

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14
Q

what is X-pert MTB/RIF?

A

Blood test. The test simultaneously detects Mycobacterium tuberculosis complex (MTBC) and resistance to rifampin (RIF) in less than 2 hours.

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15
Q

How to read a PPD- what does a positive result mean?

A

-A positive result means the person has been exposed to TB and has developed an immune response

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16
Q

> 15 mm

A

general public without risk factors (= robust immune system) is + if result is >15

17
Q

> 10mm

A

Residents of long term care facilities, IV drug abusers, Medically Underserved Populations, Healthcare Workers are + is result >10mm

18
Q

> 5mm

A

HIV+ or recent close contact with Active TB (=weakened immune system) is + if result >5mm

19
Q

the greater the induration means….

A

the more robust the immune response

20
Q

ppd stand for? what is it?

A

purified protein derivative (not a true antigen)

  • causes antibodies to come to surface to try and wall off the invader
  • indicator that someone has had cell mediated response and now has antibodies
21
Q

3 sputum tests for TB?

A
  1. Nucleic acid amplification (NAAT)
    • Results in 2 hours
    • Less accurate then culture
  2. Sputum AFB Smear
    - Only id’s presence of mycobacteria (not specifically TB)
  3. Sputum culture
    • Confirms diagnosis of TB
    • Takes about 4 weeks
    • Also used to confirm negative status after treatment: -requires 3 consecutive negative tests to come off of isolation
21
Q

3 sputum tests for TB?

A
  1. Nucleic acid amplification (NAAT)
    • Results in 2 hours
    • Less accurate then culture
  2. Sputum AFB Smear
    • Only id’s presence of mycobacteria (not specifically TB)
      - Sputum culture
    • Confirms diagnosis of TB
    • Takes about 4 weeks
    • Also used to confirm negative status after treatment:
      • requires 3 consecutive negative tests to come off of isolation
22
Q

What is NAAT test?

how long for results? accuracy?

A

Nucleic acid amplification (NAAT)

- Results in 2 hours
- Less  accurate then culture
23
Q

What does Sputum AFB Smear test for?

A

Only id’s presence of mycobacteria (not specifically TB)

*notify health department in + AFB

24
Q

What is sputum culture for TB? How long does it take? what do we use it for?

A
  • Confirms diagnosis of TB
  • Takes about 4 weeks
  • Also used to confirm negative status after treatment: -requires 3 consecutive negative tests to come off of isolation
25
Q

Nursing intervention for the old TB

A
  • Facilitate Adequate breathing/ oxygenation
  • Hydration
  • Deep Breath and Cough (Every 2 hours)
  • Incentive Spirometer (10X/hour)
  • Manage Anxiety
  • Nutritional consult
  • Fatigue
  • Case Management
  • Reduce Alcohol Intake (Eliminate)- interaction with TB drugs
  • Infection prevention
26
Q

what substance must ya avoid if ya takin dem TB medz?

A

ETOH- you’ll have to get drunk in a few months, sorry

–> interact with TB meds

27
Q

2 phases of medication treatment for TB?

A

-Initial Phase
Isoniazid, Rifampin & Pyrazinamide (2 months)
-Continuous
-Isoniazid & Rifampin (Up to 6-12 months)

28
Q

What is DOT?

A

Directly Observed Therapy

= go to health department to take pills

29
Q

How do we treat TB?

A

combination drug therapy!

30
Q

Infection prevention for TB?

A
  • Airborne Precautions in acute care setting Negative Pressure Room
    • Disposable Respirators (N95) or Powered Air Purifying Respirator
    • Negative Pressure Room
  • Patient
    • Mask in public
    • People living with person should be tested
  • Sputum Specimens every 2-4 weeks
    • Three Consecutive Negative Sputum Cultures 2 weeks apart = non-infectious
31
Q

how do we know when someone is no longer infectious after active TB?

A
  • Sputum Specimens every 2-4 weeks

- Three Consecutive Negative Sputum Cultures 2 weeks apart = non-infectious

kol- Med Surg 320 Spring (43 decks)

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