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16 Cards in this Set

  • Front
  • Back
Pulmonary Tuberculosis
-An infectious disease which caused 25% of all deaths in 17th century Europe
-In 2008, the WHO estimated that 1/3 of the global population was infected with the TB bacteria
-Highest rates in developing countries of Asia, Africa, Middle East and Latin America
-8.8 million new cases of TB develop annually according to the WHO
-CHRONIC DISEASE with high risk of recurrance
Facts about TB
-90% of TB cases occur in developing nations with poor resources and an increasing rate of people with HIV
-A person with untreated active TB will infect 10-15 people per year
-Resurgence of TB due to increased rates of TB among patients with HIV and the emergence of drug resistant strains of M. Tuberculosis
M. Tuberculosis
-A rod shaped, slow growing bacterium
-A gram positive, acid fast bacilli
-Spread via airborne droplet nuclei
-Waxy outer capsule of bacteria makes its resistance to destruction
-Need to have REPEATED CLOSE contact with and infected person
Risks for TB
-Persons with an HIV/AIDS infection
-Close, repeated contacts of individuals with active TB
-Foreign born person from high prevalence countries
-People who reside in poor urban areas
-Alcoholics, IV drug abusers
-Residents of long term care facilities (nursing homes, prisons, homeless shelters)
-The homeless and health care workers
-Immunosuppressed population
TB Pathphysiology
passed from person to person via droplet > bacteria inhaled into alveoli > macrophage engulfs bacteria but response is inadequate > replicates slowly and spreads via lymph system
Clinical Manifestations of Active TB
-In early stages people are asymptomatic
-Fatigue
-Diminished appetite
-Weight loss
-Low grade fever
-Night sweats
-Dry cough (3-4 wks), later becomes purulent or blood tinged sputum (very late in disease process)
-People with LTBI (latent tb infection) are asymptomatic
Diagnostic Tests
-Tuberculin skin test (Mantoux Test)
-Induration (hardness of bump) 48-72 hours after the test indicates patient has been exposed to TB and developed antibodies
-Size of induration
5 - 9 mm (hiv, aids, organ transplant, recent contact w/active tb, abnormal chest x-ray)
10 - 15 (immigrent w/in 5 yrs, high risk populations, chronic illness> DM, CA
> 15 mm Anyone
-False positive reactions
BCG vaccine, given in under-developed countries/developing countries
-False negative reactions
errors in reading, administration
inergy- often in elderly, lack of response by immune system
-On CXR - upper lobe infiltrates, cavitary infiltrates
-Sputum smears for AFB – three consecutive sputums on different days (Only definitive test)
-Sputum culture
-Quantiferon TB (QFT)
immediate results, often next day
Pharmacologic Therapy for LTBI
The goal for people with latent tuberculosis infection (LTBI) is to prevent TB from developing into active disease

-INH (isonioziad) 300mg once daily for 6-12 months
-(New research!!!) Rifapentine 900 mg and INH 300 mg once weekly for 3 months
Pharmacologic Therapy for Active TB
-4 drugs used in initial phase for effectiveness
INH (isonioziad)
Rifampin
PZA (pyrazinamide)
Ethambutol
-Initial phase of drug treatment used for 2 mths then continuation phase (2-6 mths) combination of drugs
Acute Care
-Hospitalization rare
-Private room with airborne isolation (negative pressure, N95 mask)
-Medication regime
-High protein, high carbohydrate diet
-Avoid alcohol
-Hand-washing
-Cough and expectorate into tissues; proper disposal of sputum/tissues
Ambulatory/Home Care
-Patient at home if household contacts have been exposed and no exposure to high risk groups
-Stress compliance and prescribed drug regimen
-Public health nurse responsible for DOT (direct observational therapy) if pt is noncompliant
-Follow up care for 12 months post drug regimen completed
Active TB Key points
-Exposed to TB: + skin TB test
-C x-ray: abnormal
-Signs/symptoms present
-Contagious
-sputum: positive
LTBI Keypoints
-Exposed to TB: + skin TB test
-C x-ray: normal
-Signs/symptoms not present
-Not Contagious
-sputum: negative
-if immune system compramised may become active (many occurances w/in 1 - 3 years)
Definitive test
Only sputum is absolutely definitive for active TB
Related Nsg Diagnosis
Ineffective airway clearance
Imbalanced nutrition, less than
Risk for Ineffactive theraputic management
Risk for noncompliance
Related Nsg Interventions
Infection control> hospital and home
Nutrition> High protien, high carb, fluid intake, avoid alcohol