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nurs 126 U3 #1
TB
| Question | Answer |
|---|---|
| Who reports the incidence of TB? and to whom? | THe infectious disease nurse at the hospital--to the CDC. |
| What are 3 reasons why the inner cities are a risk factor? | crowded conditions, lack of knowledge to access health care, and poor respiratory hygiene. |
| Why are the elderly at risk for TB? | B/C of chornic illnesses and decreased immune response. |
| Explain why forgin born are at risk? | Other countries may lack disease control. |
| What are 3 chronic illnesses that a person may be compromised for TB? | DM, HIV, alcoholism, and chronic renal failure. |
| What are some other risk factors for TB? | Socioeconomically disadvantaged, kids under age of 2, prolonged emotional or physical stress, prisons or LTC facilities, and decline in public health screenings. |
| Name three immunocompromised situations that make TB a risk factor... | Cancer therapy, AIDS, and steroid therapy, and radiation. |
| Is TB curable? | yes |
| What is the name of the bacterial infection caused by TB? | Mycobacterium tuberculosis |
| Where can TB be found in the body? | Lungs(mostly), kidneys, bones, lymph nodes, meninges or other parts of the body. |
| What time period of incubationperiod does TB require? | 2-8 weeks |
| How does TB grow? | In colonies and reproduces slowly. THis delays diagnosis. |
| TB can produce a primary or post primary infection. Explain... | Primary infection-at the time of infectionPost infection- months to years after initial infection |
| TB has a high lipid wall. Why is this a concern? | Make it difficult to kill. It is responsible for acid fast staining (the wall) |
| Explain what kind of tranmission TB is? | Airborne microbe--must beinhaled. Cannot be transmitted on dishes (fomites) |
| TB is killed how? | Boiling(heat), for 5 minutes, sunlight, autoclave, or UV light. |
| What happens when TB attches to dust particles? | IT cannot penetrate the alveoli. |
| Tb is resistant to drying ....how long can it stay viable in particles of dried sputum? | For weeks. |
| TB is not highly contagious, but needs frequent prolonged contact. What precautions do you need to take? | Mask yourself when working with patients. |
| During primary infection, what 6 things happen? | Protective wall is formed--(may control growth for 10-25 years), antibodies are produced, patient becomes sensitized to TB antigen,(reacts positive to test), host remains asymptomatic, lesions become fibrotic and calcified even though Tb remains alive. |
| During progressive primary disease what happens? | Antibodies prove to be indadequate and inflammatory response occurs. A primary tubercle is produced. |
| Describe the tubercle. | small wite nodule, center contains bacilli, outer portion fibroses, blood supply inhibited, necrosis of center follows, gradually center becomes soft and cheesy. |
| Primary TB can be asymptomatic--calcification-describe... | appear as small sharply defined shadows on x-ray,and referred to as Ghon tubercles. |
| CAseation or symptomatic can be described as.... | center of caseated nodule liquefies, liquid is coughed up, cavitation results in lungs, spreads via lymphatics, and death results if not treated. |
| Can one infected with TB harbor if for life? | yes. It may be walled off and lie dormant or may be die with infected area, walled off and calcified. |
| TB can become active after being dormant in life with which conditions? | DM, COPD, AIDS< renal failure, immunosuppressants(steroids), and pregnancy or stress. |
| What are some early symptoms of TB? | Pallor, chills, night sweats, low grade fever, fatigue, anorexia, wt.loss, slight cough,(AM), scant mucous production. |
| What are some later symptoms of TB? | pruulent or bloody sputum,dyspnea, chest pain. |
| How do you diagnose TB? SKin tests..... | Montauk test and PPD Postitive test does not always mean absence of disease. |
| What are some other diagnostics? | Chest x-ray, sputum smears (positive 2-3 weeks of active disease), medical and social history, and physical exam |
| What are the goals of therapy? | prevent the spread, preventative therapy, vaccine(BCG), chemo suring primary disease and surgical removal of lung or lobe. |
| What is DOTS? | Direct Observation Therapy sort course |
| What is INH? | Isonizid..5 mg /day to max 300 mg/ day for 6 months-12 months. 12 months for HIV persons. 12 months for low immune persons. Bactericidal |
| INH is a drug therapy--what are the side effects? | peripheral heuritis, extremity tingling, and hepatitis. (drug induced). |
| How does INH work? | interferes with TB DNA sysnthesis. |
| What are some things to alert the patient to with INH? | nausea, fever, anorexia, and that alcohol interferes with absorption. |
| What is Rifampin? (RIF) | Bactericidal that decreases the effectiveness of other drugs. |
| What are the side effects of Rifampin? | orange colored urine, fever, purpura, hepatitis (drug induced). |
| How does Rfampin work? | interferes with TB RNA synthesis. |
| What is Streptomycin? | Bactreicidal |
| How does Streptomycin work? | Interferes with TB protein synthesis. |
| What are side effects of Streptomycin? | staggering gait, hearing loss, renal compromise ion the elderly. |
| What is Ethambutol? | Bacteriostatic |
| How does Ethambutol work? | interferes with TB RNA synthesis |
| What are side effects of Ethambutol? | optic nerve-peripheral vision toxicity. (reverses when drug is discontinued), may enhance renal disease. |
| Why should TB always be used with combination drug therapy? | In order to decrease the chance for drug resistance, and to kill the bacillus by mutiple mechanisms. |
| What are the protective precautions for airborne infection? | Hepa filer in vent. ducts, UV lights on walls or ceilings, disposable particulate respiratory mask, patient wears mask when leaving room and when leaving their house. |
| What kind of diet must be prescribed? | high protein, and increased fluids. |
| What should be done with collected tissues? | They should be labeled and burned. |
| Pts. should maintain exercise program with frequent rest periods. WHy? | to maintain muscle mobility. |
| do all members that come in contact with a positive tested pt need to be tested? | Oh duh..... |
| Is streptomycin a first line or second line drug? | 2nd line |
| Is moxiflaxacin 1st line or 2nd line? | 2nd line |
| PZA,Ehambutol, Rifampin, INH, are 1st or 2nd line? | 1st line |
| How does PZA work? (pyrazinamide) | Bacteriocidal and effective against dormand and semi-dormant organisms. |
| What are side effects of PZA? | GI symptoms, hepatotoxicity, n/v, skin rash, dermatitis, polyarthralgias. |
| What is moxifloxacin? | It is a quiolone and bacteriocidal.(penicillin) |
| What are the side effects of Moxifloxacin? | GI, neurologic effects..(dizzy, headache, rash). |
| MOxifloxacin is chosen why? | For drug-resistant TB caused byorganisms sensitive to this drug. |
| Rifampin is most used with what other drug? | INH |
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