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61 Cards in this Set
- Front
- Back
Tuberculosis is the ______ leading cause of death from an infectious disease.
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second
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How many million people in U.S. are infected with TB?
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10-15 million
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Case rates of TB are higher where?
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for all ages in urban, low-income areas and nonwhite racial and ethnic groups...foreign born children have accounted for more than one-third of newly diagnosed cases in children 14 yo and younger in U.S.
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What organism is TB caused by?
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the human Mycobacterium tuberculosis and the bovine Mycobacterium bovis organisms
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Human disease caused by M. bovis occurs in children who ingest what kind of milk?
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unpasteurized milk or milk products
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Other factors that influence the degree to which the organism produces an altered state in the host include?
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heredity, which is resistance
to the infection genetically transferred gender, higher in adolescent girls age, lower resistance in infants, higher incidence in adolescence stress, emotional or physical nutritional state intercurrent infection, esp. HIV, measles, pertussis |
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Children with what type of infection have an increased incidence of tuberculosis?
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HIV...all children with HIV should be tested for TB
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What is the usual portal of entry for the TB organism?
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lung
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What do the epithelial cells of the lung do when TB bacilli enter it?
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a proliferation of epithelial cells surround and encapsulate the multiplying bacilli in an attempt to wall it off, forming a tubercle
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Extension of the primary lesion at the original site causes?
there's a discharge of material from foci to other areas of the lungs (e.g., bronchi, pleura) or produces PNEUMONIA |
progressive tissue destruction as it spreads within the lung...then what happens?
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Erosion of blood vessels by the primary lesion can cause widespread dissemination of the tubercle bacillus to near and distant sites. This is called?
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miliary tuberculosis
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What areas are frequently affected by miliary tuberculosis?
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lymph nodes
meninges bone |
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What is diagnosis of TB based on?
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physical exam
history tuberculin skin testing radiographic exam cultures of organism |
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The clinical manifestations of TB are extremely?
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VARIABLE
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What test is the most important indicator of whether a child has been infected from tubercle bacillus?
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tuberculin skin test (TST)
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The standard dose of purified protein derivative (PPD) is?
27-gauge and what size syringe? volar aspect of forearm |
5 tuberculin units...this is administered using what gauge needle?
1-ml syringe intradermally into what aspect? |
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What creation is crucial for accurate testing?
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a visible wheal
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What does a positive reaction indicate?
active disease |
that the individual has been infected and has developed sensitivity to the tubercle bacillus...however it does not confirm the presence of?
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Once individuals react positively, they will always react?
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positively
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A previously negative reaction that becomes positive indicates?
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that the patient has been infected since the last test
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What kind of evaluation should promptly be done of all children with a positive TST reaction?
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radiographic
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Define latent tuberculosis infection (LTBI)?
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used to indicate infection in a person who has a positive TST, no physical findings of disease, and normal chest radiographic findings
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Define tuberculosis disease?
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used when a child has clinical symptoms of radiographic manifestations caused by the M. tuberculosis organism
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A diagnosis of LTBI or tuberculosis disease in a child is a sentinel event usually representing recent transmission of which organism?
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M. tuberculosis
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What are the clinical manifestations of tuberculosis?
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may be asymptomatic or produce a broad range of symptoms:
fever malaise anorexia weight loss cough may or may not be present (progresses slowly over weeks to months) aching pain and tightness in the chest hemoptysis (rare) With progression: respiratory rate increases poor expansion of lung on the affected side diminished breath sounds and crackles dullness to percussion fever persists generalized symptoms are manifested pallor, anemia, weakness, and weight loss |
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Which children should have IMMEDIATE TST done?
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Contacts of persons with confirmed or suspected contagious tuberculosis (contact investigation)
Children with radiographic or clinical findings suggesting tuberculosis disease Children immigrating from endemic countries (e.g., Asia, Middle East, Africa, Latin America) Children with travel histories to endemic countries or significant contact with indigenous persons from such countries |
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Which children should have an ANNUAL TST?
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Children infected with HIV
Incarcerated adolescents |
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Which children do some experts think should be tested every 2 to 3 years?
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Children with ongoing exposure to the following people:
HIV-infected people homeless people residents of nursing homes institutionalized adolescents or adults users of illicit drugs incarcerated adolescents or adults migrant farm workers foster children with exposure to adults in the preceding high-risk groups are included |
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Which children do some experts think should be considered for TST at 4 to 6 and 11 to 16 years?
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Children whose parents immigrated (with unknown TST status) from regions of the world with high prevalence of tuberculosis
continued potential exposure by travel to the endemic areas or household contact with persons from the endemic areas (with unknown TST status) should be an indication for repeat TST |
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Children at Increased Risk for Progression of Infection to Disease?
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Children with other medical risk factors, including:
diabetes mellitus chronic renal failure malnutrition congenital or acquired immunodeficiencies deserve special consideration |
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An initial TST should be performed before initiation of which kind of therapy?
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immunosuppressive..including prolonged steroid administration, for any child with an underlying condition that necessitates immunosuppressive therapy
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Medical management of tuberculosis disease in children consists of?
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adequate nutrition
chemotherapy general supportive measures prevention of unnecessary exposure to other infections that further compromise the body's defenses prevention of reinfection and sometimes surgical procedures |
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What is the recommended drug therapy for treating tuberculosis disease?
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combinations of isoniazid
(INH) rifampin pyrazinamide (PZA) |
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A 6 month regimen consists of what meds?
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INH
rifampin PZA (all of these are given for the first 2 months) then INH and rifampin is given 2 to 3 times a week by DOT (direct observation of therapy) for the remaining 4 months |
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How does DOT (direct observation of therapy) help?
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decreases rates of relapse, treatment failures, and drug resistance
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Define direct observation of therapy?
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means that a hcp or other responsible, mutually agreed-on individual is present when meds are administered to the patient
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What drugs are given if resistance is suspected?
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either ethambutol or an aminoglycoside is given until drug susceptibility results are available
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If the child has (((HIV AND TB))), optimal therapy has not yet been established so child should visit a?
three...and those should be continued for at least how many months? INH, rifampin, and PZA usually with ethambutol or an aminoglycoside should be given for at least 2 months...the three-drug regimen can be used after? |
specialist...how many drugs should ALWAYS be started initially?
nine months...what should be given for at least the first 2 months? drug-resistant disease is excluded |
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What is preventive therapy intended for?
latent tuberculosis infection in children |
to keep latent infection from progressing and to prevent initial infection in persons in high-risk situations...INH given daily for 9 months is recommended for?
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When might surgery be useful?
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may be required to remove source of infection in tissues that are inaccessible to chemotherapy or that are destroyed by disease
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When might orthopedic services be needed?
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for correction of bone deformities
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When might a bronchoscopy be needed?
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for removal of a tuberculous granulomatous polyp
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What has decreased the death rate and the hematogenous spread from primary lesions?
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antibiotic therapy
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Death seldom occurs in treated children, except in the case of?
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TB MENINGITIS
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When is TB the most serious?
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during first two years of
life adolescence when HIV positive |
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Most children recover from primary TB infection without?
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being aware of its presence; however, very young children have a higher incidence of disseminated disease
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What is the only definite means to prevent TB?
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avoid contact with the tubercle bacillus...infection can occur even though a person is in sound health...pasteurization and routine testing of milk and elimination of diseased cattle have reduced incidence of bovine TB
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What is Bacille Calmette-Guerin (BCG) vaccine?
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a live virus vaccine prepared from attenuated strains of bovine bacilli...not routinely given in U.S.
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Where do children with TB receive their nursing care?
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ambulatory settings
outpatient departments schools public health settings (most children are NOT CONTAGIOUS and require standard precautions) |
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Children with NO cough and negative sputum smears can be hospitalized where?
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on an open ward
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Children who ARE CONTAGIOUS and hospitalized with TB disease need what special accomodations?
use of a personally fitted air-purifying respirator (PAPR) for all patient contacts |
airborne precautions
negative-pressure room and what special precautions should hcp's take? |
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Definition of Positive TST Results in Infants, Children, and Adolescents
Induration greater than or equal to 5 mm? |
Children in close contact with known or suspected contagious cases of TB disease
Children suspected to have TB disease: Findings on CXR consistent with active or previously active TB Clinical evidence of TB disease Children receiving immunosuppressive therapy (incl. immunosuppressive doses of corticosteroids), or immunosuppressive conditions, incl. HIV infection |
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Definition of Positive TST Results in Infants, Children, and Adolescents
What are the side notes for this title? |
erythema at TST site does not indicate a positive test result
TSTs should be read at 48 to 72 hours after placement |
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Definition of Positive TST Results in Infants, Children, and Adolescents
induration greater than 10mm: |
Children at increased risk of disseminated disease:
those younger than 4yo those with other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition Children with increased exposure to TB disease: Those born, or whose parents were born, in high-prevalence regions of the world those frequently exposed to adults who are HIV-infected, homeless, users of illicit drugs, residents, or nursing homes, incarcerated or institutionalized, or migrant farm workers Those who travel to high-prevalence regions of the world |
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Definition of Positive TST Results in Infants, Children, and Adolescents
Induration greater than 15mm? |
Children 4 years of age or older without any risk factors
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Children with TB can attend school or day care facilities if they are receiving?
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chemotherapy...and may return to activities if compliant and symptoms diminished
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Children receiving chemotherapy for TB can receive which vaccinations?
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measles and other age-appropriate live virus vaccine UNLESS they are receiving high-dose corticosteroids, are severely ill, or have specific contraindications to immunization
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What can the nurse do to help a TB patient?
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assist with radiographic exam
perform skin tests and obtain specimens for lab exam |
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Skin tests reaction time is?
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48 to 72 hours
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Why are sputum specimens difficult or impossible to obtain from infants or young children?
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because they swallow mucus coughed from the lower respiratory tract
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What is the best method for obtaining material for smears or culture?
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gastric washing
ex: aspiration of lavaged contents from fasting stomach procedure is carried out and specimen obtained early in morning before customary breakfast time |