Tuberculosis
Terms
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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.
- pyridoxine
- 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?
- walling-off
- 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?
- intradermally
- 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
0-4mm=
5-9mm=
>=10mm= -
Not significant-neg
at risk
significant - 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.
- 76%
- 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
-
INH-isoniazid;
Side Effects? - peripheral neuritis, hepatic enzyme elevation, hepatitis, hypersensitivity
-
Rifampin;
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