Medical 5-Ms34-Tuberculosis

Front 1

<Define tuberculosis?

Back 1

<very highly contagious
disease
caused by Mycobacterium
tuberculosis
airborne transmission by
passing from animals to
lungs, growing ends of
bones, cerebral cortex,
liver, kidney
may become dormant or walled
off by tissues
slow-growing
treated with antibiotics
<produces inflammatory and
necrotic lesions in the
lungs
only 5-10% infected will
develop active TB...the
risk of transmission is
reduced after about 2-3
weeks of treatment
incidence is steadily
increasing all over
(HIV patients have brought
this number up; anyone
in close contact can carry
it; foreign immigrants)

Front 2

<What are some of the manifestations of someone that has tuberculosis?

Back 2

<NIGHT SWEATS (a HALLMARK
SIGN)
weight loss

Front 3

<To diagnose TB, what test is done?

0.1 mL...and what does PPD stand for?

measure the induration...if it's 10 ml, then it's positive for TB...don't measure the redness, just the induration...in people that are immunocompromised...what size should there's measure to get a positive test?

72 hours

Back 3

sputum smear for acid fast bacilli...
sputum cultures for Mycobacterium tuberculosis...
Mantoux test is the most preferred test for diagnosing
TB...how much PPD solution is given for a TB test?

purified protein derivative...it's given intradermally in the forearm...how does one know if it's a positive test for somebody that's not immunocompromised?

5 mL...when is the best time to get an accurate test?

Front 4

<Interventions include a combination of drug therapy...what are the primary drugs?
Hint: RIPES

Back 4

<isoniazid (INH)
rifampin
pyrazinamide
ethambutol
streptomycin

Front 5

<What two drugs are used throughout TB therapy?

Back 5

isoniazid (INH)
rifampin

Front 6

<What are nursing implications of isoniazid (INH)?

Back 6

<increased toxicity if taking
phenytoin, carbamazepine,
primidone, warfarin
take on empty stomach
avoid antacids
monitor for signs of
hepatitis and neurotoxic
effects

Front 7

<What are some signs of hepatotoxic effects when taking isoniazid (INH)?

Back 7

<jaundice
liver pain
fatigue
enlarged liver
liver enzymes will be
elevated

Front 8

<What are neurotoxic effects of isoniazid (INH)?

Back 8

<peripheral neuritis which is paresthesias of the hand and feet...vitamin B6 helps

Front 9

<What are the nursing implications of rifampin?

Back 9

secretions and urine will be orange and drug will permanently discolor soft contact lenses...
hepatotoxic effects
decreased effectiveness or oral contraceptives..
hepatitis...
hematologic disorders

Front 10

<Pyrazinamide (PZA) nursing implications are?

Back 10

hepatotoxic>

Front 11

<Ethambutol (EMB) nursing implications are?

Back 11

<obtain baseline visual acuity and color discrimination (esp green)...so it affects rods and cones and their red-green shade color blindness and they should be told to repeat their vision testing every one to two months..can cause retrobulbar neuritis and blindness

repeat vision testing every 1-2 months>

Front 12

<Streptomycin nursing implications are?

Back 12

<eighth cranial nerve impairment and that affects hearing and this esp. affects elderly clients that are taking this medication..ototoxicity

Front 13

<Amikacin nursing implications are?

Back 13

ensure adequate hydration
monitor renal function
monitor hearing
because of renaltoxicity and ototoxicity>

Front 14

<Rifapentine (Priftin) nursing implications are?

Back 14

<doses must be separated by at least 72 hours
observe for hepatotoxic effects
metabolism of other drugs may be faster and cause need for higher dose>

<one reason why birth control pills don't work as well is because these meds cause metabolism of other drugs to be faster and the faster their metabolized, the lower the blood level of these drugs so they have to have higher doses>

Front 15

<Patient education regarding tuberculosis is?

Back 15

sputum specimens will be collected every 2 to 4 weeks once drug therapy has begun...once 3 negative cultures are obtained, then they're considered no longer infectious and they can go back to work...

take daily meds at bedtime...helps prevent nausea and reinforce that not taking their drugs as prescribed can lead to a superinfection and drug resistance...even though their tests are negative and they're feeling better, they'll still be on meds for six months or more...they need to continue regimen

need well-balanced diet to promote healing and encourage them to have foods that are rich in iron and protein and vitamin C

these patients are usually very fatigued and weak, so physical stamina is important to address...encourage them that their fatigue and weakness will decrease rapidly as they start medications>

Identify all contacts that they've had...they need to be tested...those that are high at risk may receive prophylactic therapy and they usually use "INA (INH)? " prophylactically
for those that have been exposed...

most patients can be treated at home..airborne precautions aren't necessary if they're treated at home because they've been around those people before they were diagnosed with it...so they've already been exposed...instruct them to cover their mouths and nose when they cough or sneeze and put it into a plastic bag before they dispose of it...they need to wear a mask whenevery they're out in public until cultures are negative...in the health care setting, they need to be in an isolation room that provides at least 6 air exchanges and preferably exchanges air to outside of the hospital...nurse should wear an N95 or higher respirator and gown and gloves....

nutrition...promote foods rich in iron, protein, and vitamin C

make them aware of healthcare resources including:
American Lung Association
Smoking cessation classes
Alcoholics Anonymous
Drug treatment programs