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16 Cards in this Set
- Front
- Back
Pulmonary Tuberculosis
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-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 |
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Facts about TB
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-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 |
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M. Tuberculosis
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-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 |
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Risks for TB
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-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 |
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TB Pathphysiology
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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
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Clinical Manifestations of Active TB
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-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 |
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Diagnostic Tests
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-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 |
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Pharmacologic Therapy for LTBI
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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 |
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Pharmacologic Therapy for Active TB
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-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 |
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Acute Care
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-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 |
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Ambulatory/Home Care
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-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 |
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Active TB Key points
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-Exposed to TB: + skin TB test
-C x-ray: abnormal -Signs/symptoms present -Contagious -sputum: positive |
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LTBI Keypoints
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-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) |
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Definitive test
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Only sputum is absolutely definitive for active TB
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Related Nsg Diagnosis
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Ineffective airway clearance
Imbalanced nutrition, less than Risk for Ineffactive theraputic management Risk for noncompliance |
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Related Nsg Interventions
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Infection control> hospital and home
Nutrition> High protien, high carb, fluid intake, avoid alcohol |