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How many months does TB tx usually last?
6-12 months or until they are negative
After TB tx, you want to ensure 2 things, what are they?
Eradication & prevent relapse
Referring to medications used to tx TB, what is considered the "primary" or first line resistance?
they are resistant to one of first line meds & have not been previously treated.
The first line combination of meds for tx of TB are?
INH, Rifampin, pyrazinamide & (streptomycin OR ethambutol)
First line drug treatment usually lasts about how long?
For 8 weeks
At the end of the first 8 weeks there is a culture & sensitivity done to find out about what?
If there is still a sensitivity to the drugs being used.
When the c/s determines continued sensitivity at the end of the first 8 wks of tx, what can be done?
Streptomycin or ethambutol can be d/c'd.
Secondary resistance (acquired resistance)means?
pt is resistant to one or more of the meds and is already being treated.
What is the 2nd line of TB drugs?
Capreomycin, ethionamide, paraaminosalycilate, cycloserine, aminoglycosides, quinilones, rifabutin, and clofazime.
What is d/c'd at 16 wks?
pyrazinamide but contiue INH & rifampin for 4 months & tx cont'd till test neg.
Patient's are noninfectious after ____ wks.
2-3wks after initiation of multi-drug therapy beginning.
What is given to prevent INH neuropathy.
After TB has been identified, they are put in a negative pressure room. You know it is working properly when you....
open the door holding a tissue and the tissue is pulled towards the inside of the room (hence negative pressure)
An N95 is used for what?
a disposable particulate respirator- the 95 represents the smallest size particle that can be filtered by the mask.
A TB patient should remain in isolation until when?
Until there is clinical evidence to prove they are not infective
who gets tx w/INH?
family members (prophylactic), HIV+ w/>=5mm induration, xray w/fibrotic lesions & >=5mm induration, change from prior PPD=recent exposure, IV drug user w/induration >=10mm, high risk comorbidities with induration >=10mm
INH tx for prophylaxis, for other people w/PPD induration >=10mm, immigrants with high TB rates, high risk popul, institutionalized patients will be treated for how long?
6-12 months of INH
What lab work will be completed on TB patients?
How often are these done?
Liver function tests, BUN, Creatinine.
Every month.
What is the 2nd line of TB drugs monthsw?
Capreomycin, ethionamide, paraaminosalycilate, cycloserine, aminoglycosides, quinilones, rifabutin, and clofazime.
The bacteria causing TB?
Mycobacterium tuberculosis
TB can affect what systems?
Lungs mainly but can go outside the lungs to meninges, kidneys, bones, lymph nodes & brain
When you hear tb is an "AFB", what does that mean?
acid-fact bacilli
In the mid 80's, what was the main factor causing a rise in tb cases?
HIV infections
Risk Factors for TB include?
7 specific listed
Inhalation around tb, Immunocompromised, Substance abuse, No health care, Immigrants, overcrowding, healthcare workers
With the risk factor of "immigrants", where typically is being referred to?
Eastern Europe, Russia, former soviet states, mexico & south america
Since we know tb transmission is inhalation, where does it rest after inhalation?
In the alveoli
When tb gets into alveoli, a natural immune response builds up calcium around the infection- is termed?
Bronchopneumonia results from tb infection lasting about?
2-10 weeks-INITIALLY
Years after an initial tb infection is walled off, what can cause reactivation?
and tb becomes active & infective
immunocompromise- cancer-chemo, HIV
When tb is reactivated by an immunocompromise, what happens to the infection?
eats through the calcified area and spreads throughout the lungs & becomes active
Signs & symptoms of active TB?
night sweats, low grade fever, no-productive or muco-puralent cough, fatigue, weight loss, hemoptysis
When taking a hx for possible TB, what questions are important?
been in prison? Immigrated? Immunocompromised? Been around anyone with TB?
What does PPD stand for?
Tubercle bacillus extract of purified protein derivative-
Your standard tb skin test
0.1 ml=5 tuberculin units are given how?
When doing PPD, what does the nurse record? and is read ? hours after
site, date, time, lot #- 48-72 hrs
All diagnostics a nurse has available for tb detection?
Phys exam, history, ppd, afb test, chest x-ray
PPD results- a reaction with erythema & induration of
Not significant-neg
at risk
5mm is considered + if?
known or unknown HIV status & neg doesn't mean no TB
Significant reaction can be caused by?
tb exposure or bcg vaccine
BCG vaccine is used routinely in Europe & Latin America & offers ?% resistance.
Gerentological atypical s/s include....if these are present, you can repeat ppd in 1-2 weeks (poss delayed reaction)
mental status changes, fever, anorexia, weight loss
Multidrug resistance means they are resistant to?
INH & Rifampin
Nursing assessment includes
2 areas
s/s; living conditions
The priority intervention for TB pt is?
Promote airway clearance b/c most will have bronchopneumonia
Nsg interventions 2nd, 3rd.
Adherance to tx, promoting activity & nutrition
Complications w/tb include 4
malnutrition, med side affects, multidrug resistance, spread of tb
Side Effects?
peripheral neuritis, hepatic enzyme elevation, hepatitis, hypersensitivity
Side Effects?
Hepatitis, febrile rx, purpura rare, nausea, vomiting
Rifabutin-mycobutin & streptomycin side effects?
8th cranial nerve damage- deafness, nephrotoxicity
Pyrazinamide Side Effects?
Hyperuricemia, hepatotoxicity, skin rash, arthralgias, gi distress
ethambutol-myambutol side effects?
optic neuritis, blindness, skin rash

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