Tuberculosis and Pneumonia

Question 1

tuberculosis infection

Answer 1

-any infection caused by bacteria mycobacterium
-MTB is aerobic bacillus-rod shaped and needs lots of oxygen to grow and proliferate

Question 2

tuberculosis

Answer 2

-characterized by granulomas in the lungs- nodular accumulations of inflammatory cells
-transmitted via humans, cattle or birds
-tubercle bacilli are transmitted in airborne droplets expelled by infected people
-slow growing organism

Question 3

active TB manifestations

Answer 3

-fatigue/lethargy
-weight loss/anorexia
-low grade fever
-productive cough
-anxiety
-night sweats

Question 4

TB screening and diagnosis

Answer 4

-high risk populations- IGRA
-non high risk- TB skin test
-confirm through a sputum stain and culture and look for the granulomas on chest x-ray

Question 5

5 drugs to treat TB

Answer 5

-INH
-rifampin
-ethambutol
-pyrazinamide
-streptomycin

Question 6

anti-tubercular drugs

Answer 6

-treat all infections caused by mycobacterium organism
-2 categories: first and second line

Question 7

Isoniazid (INH) MOA

Answer 7

disrupts cell wall synthesis essential functions of mycobacteria

Question 8

INH side effects

Answer 8

-peripheral neuropathy
-hepatotoxicity
-optic neuritis
-hyperglycemia

Question 9

INH nursing implications

Answer 9

-avoid antacids
-when given with rifampin can increase CNS and hepatotoxicity
-black box warning- related to increased risk of hepatitis: often given with pyridoxine
-given PO

Question 10

Rifampin MOA

Answer 10

inhibits protein synthesis via attacking the hydrocarbon ring structures

Question 11

rifampin side effects

Answer 11

-hepatitis
-hematologic disorders
-red-brown discoloration of the urine and other body fluids

Question 12

rifampin route

Answer 12

PO/IV

Question 13

ethambutol MOA

Answer 13

diffusing into the mycobacteria and suppresses RNA synthesis, which inhibits protein synthesis

Question 14

ethambutol side effects

Answer 14

-retrobulbar neuritis
-blindness

Question 15

ethambutol nursing implications

Answer 15

-given PO- first line bacteriostatic
-usually used in combo with INH and rifampin
-not for children less than 13

Question 16

pyrazinamide

Answer 16

-given PO
-bacteriostatic or bactericidal depending on drug concentration
-used in combo with other meds

Question 17

pyrazinamide side effects

Answer 17

-hepatotoxicity
-hyperuricemia

Question 18

pyrazinamide contraindications

Answer 18

-severe hepatic disease
-acute gout
-not for pregnant women in the US

Question 19

streptomycin MOA

Answer 19

-aminoglycoside: interfering with normal protein synthesis causing production of faulty proteins within the bacteria

Question 20

streptomycin side effects

Answer 20

-ototoxic
-nephrotoxic
-blood dyscrasias
-careful with people on anticoagulants: can increase bleeding

Question 21

streptomycin route

Answer 21

IM injection

Question 22

what to treat drug resistant TB with

Answer 22

-second line drugs

Question 23

pneumonia

Answer 23

defined as any type of infection of the lower respiratory system
-causes inflammation of the lung tissues, the alveolar air spaces become filled with purulent, inflammatory cells, and fibrin
-transmission occurs via inhaled infectious droplets

Question 24

pneumonia risk factors

Answer 24

-age extremes (<5, >70 or 80)
-compromised immunity
-underlying lung disease
-alcoholism
-altered LOC
-impaired swallowing
-nursing home resident
-hospitalization
-influenza

Question 25

what is hospital acquired pneumonia?

Answer 25

-developed within 48 hours AFTER admission -has worse outcomes than community acquired

Question 26

pneumonia patho

Answer 26

-aspiration of oropharyngeal secretions most common route -inhalation of droplets containing bacteria or other pathogens -inflammatory reaction is stimulated within the lungs- vasodilation occurs, infection begins to spread into the resp. tract and alveoli -goblet cells are stimulated and mucus is excreted -alveoli attempts to open and close against the purulent exudate but many cannot

Question 27

pneumonia patho (more basic)

Answer 27

-failure of cough reflex, the mucociliary clearance mechanism, and the immune system -failure of the mucociliary defense mechanism allows exudative fluid and inflammatory cells to invade the alveoli note: mucociliary clearance mechanism is INEFFECTIVE in smokers

Question 28

PNA manifestations:

Answer 28

-usually preceded by URI -proceeds to fever, chills, productive or dry cough, malaise, pleural pain, sometimes dyspnea and hemoptysis -bacterial-productive, purulent cough -viral-nonproductive, scanty cough -severe: tachypnea, signs of resp distress/failure

Question 29

PNA clinical diagnosis

Answer 29

-s/s on assessment -pulmonary consolidations: dullness to percussion, crackles, increased tactile fremitus, egophony -diagnostic tests: chest xray, CBC, + sputum for c&s

Question 30

bacterial pneumonia

Answer 30

-gram positive: staph aureus (most common for HAP) and streptococcus pneumoniae (most common for CAP) -gram negative: pseudomonas auruginosa, aceinetobacter, klebsiella pneumoniae

Question 31

aspiration pneumonia

Answer 31

-aspirated material from GI tract -can be silent of abrupt -dysphagia evaluation is crucial

Question 32

who is at risk for aspiration pneumonia?

Answer 32

-NG tube -decreased LOC -decreased gag reflex -decreased gastric emptying

Question 33

viral pneumonia

Answer 33

-influenza is major risk factor -virus alters the pulmonary immune defense and makes the lungs vulnerable to an additional bacterial infection

Question 34

s/s of viral pneumonia

Answer 34

-fever -chills -dyspnea on exertion -cough

Question 35

atypical pneumonias

Answer 35

-pneumocystis carini pneumonia -mycoplasma -legionella -aspergillus

Question 36

do you treat viral or bacterial pneumonia with antibiotics?

Answer 36

bacterial

Question 37

pneumonia prevention

Answer 37

-2 vaccines 1.)PCV13-prevents pneumococcal pneumonia caused by 13 strains of strep 2.)PPSV23-prevents against an additional 23 types of PNA

Question 38

what precautions are used for TB?

Answer 38

airborne