Tuberculosis Flashcards
(125 cards)
1
Q
What is Tuberculosis
A
- Infectious bacterial disease caused by Mycobacterium tuberculosis.
2
Q
What organ(s) does TB affect
A
- Primarily affects the lungs but can involve other organs like: kidneys, brain (meninges), bones, adrenal glands, and lymph nodes.
3
Q
What are 3 factors contributing to Multi-Drug Resistant (MDR) strains of tuberculosis?
A
- Poor compliance
- poor adherence to proper follow-up
- Ineffective RX
4
Q
How is tuberculosis (TB) spread?
A
AIROBORNE droplets from an infected person BY:
- Breathing
- Coughing
- Sneezing
- Singing
5
Q
How long do infectious droplets remain in the air?
A
Minutes to Hrs
6
Q
Ways TB is NOT through:
List 4
A
- touch
- kissing
- utensils
- bed linens
7
Q
What is the growth environment of Mycobacterium tuberculosis and why does it thrive in the lungs?
A
- thrives in the lung environment due to its aerobic nature
-requiring oxygen (O2) to survive and multiply.
8
Q
immunocompetent
A
funcitoning immune
9
Q
Can most immunocompetent adults clear M. tuberculosis from their system?
A
YES!
- In healthy individuals with a functioning immune system, the body can mount an effective immune response against M. tuberculosis, leading to the containment or eradication of the bacteria.
10
Q
What is the INITIAL defense against M.Tuberculosis for immunocompenten individuals?
A
trapping bacteria in MUCUS
-which can then be cleared out, preventing infection.
- prevents bacteria from reaching lungs
11
Q
Does having M.Tuberculosis trapped in the mucus make the person infectious?
A
No!
person exposed to TB but NOT INFECTED
12
Q
What happens to M.Tuberculosis if left over bacteria persist after initial defenses
A
If some bacteria evade initial clearance and persist in the body, the immune system can still contain them but in a non-replicating dormant state- This is known as latent tuberculosis (latent TB).
13
Q
So, is a patient INFECTED during the Latent TB phase?
A
Yes - patients are infected with M.tuberculosis but will NOT exhibit symptoms and are NOT contagious.
14
Q
Also, in Latent TB individuals are infected but DO NOT progress to
A
ACTIVE TB/ disease
15
Q
They are a hallmark of the body’s attempt to contain pathogens that are difficult to eradicate, such as M. tuberculosis.
A
Granulomas
- organized clusters of immune cells, primarily macrophages, that form in response to chronic inflammation or infection
16
Q
Granulomas are vital in which phase of TB?
A
Latent TB
17
Q
granulomas help prevent
A
replication and limit the infection
-often resulting in “healed” lesions.
18
Q
when granulomas are hardened they are considered
A
healed
19
Q
What are the TB test results for a patient in the Latent phase?
A
- Positive for TB
- But infection will NOT progress to further stages
20
Q
infection
A
a person is infected
21
Q
disease
A
signs of ACTIVE infection and associated health issues
22
Q
In Immunocompromised individuals, what happens to the granulomas?
A
Granulomas may form but are ineffective in halting bacterial replication.
23
Q
If Granulomas fail to contain bacteria, what happens to the bacteria M.TB?
A
- Leads to reactivation of bacteria.
- Bacteria mutates and progresses from Latent TB to Active TB.
24
Q
When Latent TB transitions to Active TB, symptoms of the disease may arise ___.
A
months or years later
25
Individuals at risk for TB
* Poor/underserved, homeless
* Immigrants, elderly
* IV drug users, alcoholics
* Immunocompromised individuals (HIV, chemotherapy).
* Children **under 5 years old**.
* Workers in high-risk institutions (prisons, hospitals, shelters).
26
Clinical Manifestations for **Latent TB**
**KNOW**
* No symptoms
* Does not feel sick
(cannot spread TB)
27
**DX results** for **Latent TB**
* (+) TB skin test
* (-) sputum smear
* normal chest x-ray
28
**Active TB**/TB disease
**Early S/S**
* Persistent dry cough leads to productive
-**lasts >3 weeks**
* chest pain (pleuritic)
* low-grade fever
* fatigue
* anorexia
* no appetite/weight loss
* night sweats, chills
29
**Active TB**/TB disease
**Late S/S**
* **hemoptysis**: *coughing up of blood or blood-stained sputum*
* **dyspnea**: SOB
30
If patients **show Active TB S/S**, what question should be asked?
**Have they traveled recently to**:
india (#1), china, indonesia, phillippines, S. Africa
31
What are the 3 complications associated with TB?
1. Cavitations
2. Miliary TB
3. TB Meningitis
32
What are **Cavitations**
**Destruction** of healthy lung tissue, forming "**caves**."
33
What is **Miliary TB**?
* Type of meningitis
* spread of TB bacteria throughout the body (in blood), resulting in **small lesions** (millet seeds) in multiple organs, often leading to systemic symptoms.
34
Miliary TB:
**Acutely ill S/S**
* Fever
* dyspnea
* **cyanosis**
* **organ enlargement**,
* **cognitive changes**
* **systemic symptoms**
(depends on where TB is located)
35
Miliary TB:
**Progression of illness S/S**
* **Weight loss**
* fever
* GI issues
* hepatomegaly
* splenomegaly
* renal changes
* cognitive changes
* **severe cough**
* dyspnea
36
What is **TB Meningitis**
specific form of meningitis resulting from **TB infection to the meninges** (protective covering of the brain) and **spinal cord.**
37
**S/S** of **TB Meningitis**
**know**
* Fever
* persistent HA
* altered mental status
* **stiff neck**
* **dislike bright lights** **
* loss of appetite
* vomiting
* seizures
38
**Most important** S/S of **TB Meningitis**
* **spread to Meninges leads to seizures** - most important **
39
**Complications** arrising from **TB Meningitis**
* **long term paralysis**
* **hearing loss**
* **blindness**
* **brain injury**
* **epilepsy**:*unprovoked seizures due to abnormal electricalf activity in the brain
* **hydrocephalus**: *accumulation of cerebrospinal fluid in the ventricles* of the brain*
* **death**
40
5 DX studies for TB
1. Tuberculin **Skin** Test
2. Blood Tests
3. Chest X-rays
4. CT scans
5. Sputum Smears and Cultures
41
Another name used for Tuberculin SKin Test
**Mantoux Test**
42
Which of the DX test is the **STANDARD** for tesing
Tuberculin Skin Test (Mantoux Test)
43
What is **injected into patient** when performing **Tuberculin Skin Test (Mantoux Test)**
**0.1 mL of PPD**= component of M. Tuberculosis
44
Is **PPD** a **live** bacteria?
**NO! NOT A LIVE BACTERIA**
45
What will the **skin appear** if patient tests **positive** for **Tuberculin Skin Test (Mantoux Test)**
**Hardening**, or **induration**, of skin at the injection site.
* redness is not enought to read results
46
How long after a Tuberculin Skin Test (Mantoux Test) does it take to **show positive if pt infected with TB**?
Will show **positive 2-12 weeks AFTER** a patient becomes infected with TB.
* can not read results before 2 weeks!!!
47
If a patient has had a **previous POSITIVE skin test**, what happens in future TB tests?
Will test positive for life.
48
Why will an infected TB patient **test positive for the rest of their lives** when taking a TB skin test?
Body will **always** continue to **make antibodies** agains TB
49
When should **TB skin test** be administered when it comes to LIVE **immunizations**?
* **SAME DAY** as LIVE virus vaccines
or
* **4-6 weeks AFTER** administration of live-virus vaccine
50
What vaccines contain a LIVE-VIRUS?
**Know**
* varicella-chkn pox
* MMR
* Rota Virus
* small pox
* yellow fever
* ORAL Pollio
* **BCG**: *Bacillus-Calmette-Guerin Vaccine*
* NASAL Flu (*has to be nasal*)
51
Is COVID a live-virus
NOPE
52
is an **IM flu vaccine** live-virus?
NOPE- only nasal flu is live
53
Is PPD a live-virus
NOPE
54
**BCG** recipients is **NOT** a direct contraindication to TB skin test but may result in
FALSE-POSITIVE test
55
Can Pregnant patients have the TB skin test (with PPD)?
YEs- safe to administer
56
Live-virus vaccines NOT safe for
pregnant patients
57
Why is an **adverse reaction** to the **TB skin test a contraindication** for future tests?
* body may react **inappropriately** to the test substance (tuberculin)
* Administering another skin test in the future could **trigger a stronger or dangerous immune response**
58
How would an immunocompromised state possibly affect TB skin test
* Immunocompromised patients are unablel to produce enought antibodies
* will give **FALSE NEGATIVE** result
* Anything greater than or equal to 5 = positive test
59
Steps when administering TB skin test
* 0.1mL of PPD solution (bevel up)
* 6-10mm in diameter bleb (will absorb quickly)
* brief delay b4 withdrawing needle
* standard precautions when administering (gloves)
60
What should you NOT THROW AWAY during a TB skin test?
VIAL!!! - do not throw away until you have documented
61
Things to know about TB PPD **VIAL**?
* dark brown in color- light sensitive
* do NOT draw before hand
* once opened good for **30 days** or **expiration date**- whichever comes FIRST
62
TB skin test should be read within
48-72 hrs after injection
63
how to measure **induration** (hardening or raised)
* Always **touch** induration
* measure **widest** diameter
* measure **transversely**
* record in **millimeters (mm)**
64
TB skin test:
Skin that is **red and inflammed**, should it be **included** in the **measuring of induration**?
No. only induration (raised/hardening) of skin is measured.
65
if **induration** **present** pt will be monitored for how long
Continue to monitor for up to **1 week** -if needed
66
in a healthy person with normal immune system, an induration of 15mm is considered
a POSITIVE SKIN TEST.
* a positive reactino is a response by the immune system.
67
If test is not read between 48-72 hrs what needs to be done?
retake test
68
Who can read a TB test?
anyone who is trained
69
*Interpretation of results*:
**≥ 5mm** = **Positive** Test for:
* HIV Infected Individuals
* Immunocompromised (Organ Transplant, Cancer, Chemo, Etc.)
* Pts taking >15 mg/day of **PREDNISONE** for 1 month or longer
* Pts taking **TNF**-alpha antagonist
70
*Interpretation of results*:
* **≥10mm** = **Positive** Test for:
* Drug users
* Healthcare workers
* Children and Adolescents
71
*Interpretation of results*:
* **≥15mm** = **Positive** Test for:
* Persons with NO known risk for TB
* healthy immune patients
72
*Interpretation of results*:
**No induration**:
* Does not guarantee that pt may not have TB
* MANY factors can play a role
73
When is 'TWO-STEP testing' performed for TB test?
* if suspicion of a possible negative test or to ensure TB dx is not missed
* perfoming 2 skin tests: **1-3 weeks apart.**
* **Both test HAVE to be NEGATIVE in order to be considered NEGATIVE.**
74
2 Types of **Blood** Test for TB
* **IGRA**: *interferon-gamma release assay*
* **Quantiferon**-TB “Gold Test"
75
**Blood** test readings
* Negative results = not infected
* positive results = infected
76
Why is a **further evaluation** required for a **positive BLOOD test**?
to determine **if** Latent infx **or** Active dz
77
Blood tests are not usually done bc
they are expensive
78
A CXR or CT scans may be done
* AFTER a **positive skin test** to detect lung abnormalities (infiltrates) in upper lobes of lungs
* Does not confirm or rule out TB
79
Can CXR define the stage of TB?
Helps define if infection is latent or active but **NOT DEFINITIVE**
* Helps see how much is going on in the lungs
.
80
Which DX test is the MOST CERTAIN to determine stage of TB?
SPUTUM CULTURE!!!
**know**
81
*TB Testing: Culture & Sputum*:
What does the **Sputum SMEAR test** for?
*(not the same as sputum culture*)
**Acid-Fast-Bacilli (AFB)**
* type of bacteria, including Mycobacterium tuberculosis, that retain a specific stain (acid-fast stain) under a microscope. This property helps identify TB bacteria in diagnostic tests like AFB smears.
82
**AFB** smear DOES **NOT confirm dx of TB**, but it does indicate
TB disease
* due to some acid-fast-bacilli are not M.tuberculosis
* it’s NOT very sensitive and may not detect the bacteria if they are in **low numbers**.
83
How many **AFB Smear sputum tests** are need to be taken to confirm/deny TB?
**3 consecutive** sputum speciments collected on **DIFFERENT days.**
84
*Cultures*:
Is a **POSITIVE CULTURE** indicative of starting or continuing tx?
No
(idk why, PP just says this)
85
*Cultures*:
What does a **Positive Culture** test for M.Tuberculosis means?
confirms the **diagnoses of TB disease**
86
*Culture Tests*:
**Every** sample collected from a patient for TB testing MUST
Must undergo a culture test, even if a preliminary test, like an AFB smear, shows no bacteria, or regardless of AFB smear results.
87
Down side of Cultures
takes up to 8 weeks
88
*Culture*:
A **Negative CULTURE** test means
* patient is negative OR
* in **Latent stage** of TB
89
*Culture*:
A **Positive CULTURE** test means
patient is in **ACTIVE stage** of TB
90
What is the **primary treatment** for both **latent and active TB**?
drug Therapy
91
__ & __ is critical for treatment to be successful
Promoting and monitoring **compliance**
92
Hospitalization is reserved for
severly ill patients.
93
Main **class** of medications used to treat TB
Anti-Tuberculin - Antibiotics
94
Many of these Anti-tuberculin (Antbx) drugs can **cause**
* **hepatotoxic**: liver damage caused by toxic substances
* **hepatitis**: inflammation of liver
-need to monitor liver
95
What test are needed for **baseline** of **Liver function**
AST/ALT
(requirs ongoing monitoring)
96
S/S of hepatic involvement
* Nausea or vomiting
* loss of appetite
* **jaundice**
* **dark urine**
* fever: lasting **three or more days** and has **no obvious cause**
97
Which **stage** of TB requires **MULTIPLE MEDS** used in **combination**
* Active TB
98
Two types of **Anti-Tuberculin Drugs**
* **First line drugs**: need to know 4
* **second line drugs**: do not need to know
99
Combination of meds regimen usually lasts
26-39 weeks
(initial phase (plus B6) + continuation phases).
100
4 main drugs used for **Active TB/Disease**
R.I.P.E MEDS
* Isoniazid (INH)
* Rifampin
* Pyrazinamide
* ethambutol
101
What can happen with pt's who are Non-adherence
List 3
* drug-resistant strains of M.TB.
* danger to public
* increases risk for reactivation of TB.
102
TB treatment:
What is **Directly Observed Therapy (DOT)**
**ensures** patients **swallow** their anti-tuberculosis medication.
103
**Directly Observed Therapy** is used for what patients
Used for **ALL** TB patients but **required** for pts who are **high-risk for non adherence**
104
Medication that **causes** **peripheral neuropathy**
Isoniazid ‘INH’
105
Isoniazid (INH) is often used for what TB stage?
Latent TB- used by itself.
106
**Causes** of **Isoniazid**
Remember **INH**
‘INH’:
**I**- interferes with B6 absorption (Low B6=peripheral neuropathy
**N**- neuropathy
**H**-hepatotoxicity - jaundice (yellow skin/sclera, dark urine, fatigue, elevated AST/ALT)
107
Patients on ISONIAZID should avoid
alcohol- any amount!!!
* if option says 'reduced alcohol'- DONT CHOOSE IT!!
108
With Rifampin remember "RED" because
Body fluids turn **red/orange**: tears, urine, sweat
THis is NORMAL
109
Pt education when taking **Rifampin**
* wear **glasses** (avoid contacts)
* use backup **non-hormonal** birth control- oral contraceptives wont work
* monitor for **jaundice**
110
How to take Rifampin
* **take on empty stomach**- 1 hr before meals (least effective with food)
* **Can make some meds less effective**: BB, digoxin, verapamil, anticoags - dont need to know drugs)
111
Patient education for **Pyrazinamide (PZA)**
* **Sun sensitivity**
* jaundice
* dark urine
* bleeding
* difficult urinating (potential liver damage)
* **No ALCOHOL**
112
For **Ethambutol** Pt education
Think '**EYE**'
* Risk of vision changes (blurry or color changes)- need to report!!!
* routine eye exams recommended.
113
Drug of choice for Latent TB infection
**Isoniazid (INH)**
* due to its effectiveness and inexpensiveness
114
What does Isoniazid (INH) cause?
Liver damag- so NO ALCOHOL
115
Pts on **Isoniazid (INH)** usualy take it how long?
**1x daily for 6-9 months**
(9months= optimal esp for children)
116
When will Isoniazid (INH) need to be monitored by medical personel?
when dosage is increased
117
**Combination therapy** primarily used for
resistant strains or toxicity cases
(ie: isoniazid and rifampin)
118
What is the **treatment duration** for **Multi-Drug Resistant (MDR)** TB?
ADDITION **20-30 months** of antbx **INJECTIONS**
119
How long after starting TB therapy are most patients no longer infectious?
* After 2-3 weeks of therapy
120
Why is **follow-up** with smears, cultures, and chest X-rays essential in TB treatment?
* to confirm recovery
* Tests will be done **throughout** the course of drug therapy.
121
Hospitalized clients:
Treatement of Active TB dz will include
* **Negative** pressure room.
* **Airborne** Isolation
* Nurse precautions: **N95 mask** (particulate mask), **wash hands before and after caring for patient**.
* Patient outside room: pt wears a mask (standard precautions), no mask for healthcare workers needed if pt has a mask.
* Drug Therapy: started ASAP
* CXR, Sputum & Cultures
122
TB client Education:
* **Teach infection control measures**: wear masks (1st three weeks), hand-washing, proper disposal of tissues- paper bag or toilet.
* **At home**: well ventilated, sleep alone, outdoors as much as possible, limit areas of dense population
* **Ensure strict adherence to medication regimens**: Teach side effects and ways to minimize.
* Reassure patients that **after 2-3 weeks of treatment, they are no longer contagious.**
* adequate **nutrition**
* No strict isolation for family members living with infected pt = **already exposed**.
* No new family or friends can visit until sputum cultures are negative.
123
Know for test:
do Latent TB pts need PPE when transported?
No- they are not infectious
124
If pt comes to ER with coughing up blood what should you ask the question immediately?
have they traveled recently?
125
Questions with Patient and Vitals:
1st thing to do if TB suspected
2nd thing to do
3rd thing to do
4th thing to do
1st: airborne isolation
1nd: O2
3rd: blood cultures BEFORE starting meds
4th: Meds
