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28 Cards in this Set
- Front
- Back
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• Caused by Mycobacterium tuberculosis
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TB
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• Involves:
– Lungs-usually found in lungs – Larynx – Kidneys – Bones – Adrenal glands – Lymph nodes – Meninges |
TB
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• Kills more people worldwide than any other infectious disease
• 19%-43% of world’s population estimated to be infected • 8 million new cases each year with 3 million deaths • Prevalence decreased in 1940s and 1950s • Resurgence from 1985-1992 – Epidemic of TB with HIV infection |
TB
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– Multi drug-resistant strains of M. tuberculosis- d.t poor compliance of drug therapy
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TB
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• Seen in:
– Poor – Underserved – Minorities At risk-foreign born, homeless, IV drug users, native americans, institutionalized, health care workers, immunosuppressed |
TB
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• M. tuberculosis is usually spread via airborne droplets (favorite environments for growth: lung and kidneys)
– Speaking – Sneezing – Singing • Cannot be spread by hands or objects • Brief exposure rarely causes infection • Transmission requires close, frequent, or prolonged exposure • Inhaled bacilli pass down the bronchial system to implant themselves on bronchioles or alveoli • Multiply with no initial resistance – Can continue to multiply within phagocytes • During activation of cellular immune response, bacilli can spread to lymph nodes • Favorable environments for growth: – Upper lobes of lungs – Kidneys – Epiphyses of bone – Cerebral cortex – Adrenal glands |
etiology and patho of TB
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• Tissue reaction (epithelial cell granuloma)
– Results when cellular immune system is activated – Fusion of infiltrating macrophages – Granuloma surrounded by lymphocytes – Ghon tubercle-granuloma becomes necrotic then liquifies and liquid drains into connecting bronchi • Central portion • Necrosis • Liquefactive necrosis • Liquid drains into connecting bronchi and produces a cavity |
patho of TB
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• Healing of the primary lesion occurs by:
– Resolution – Fibrosis – Calcification • TB lesion regresses as it heals – Infection enters a latent period where it may persist but does not produce illness-when latent does not spread • Can develop into clinical disease or remain dormant • If initial immune response is inadequate: – Control of the TB is not obtained until clinical disease results • Reactivation can occur as host’s defenses become impaired |
patho of TB
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Class 0 = No TB exposure
1 = Exposure, no infection 2 = Latent TB, no disease 3 = TB clinically active 4 = TB, but not clinically active 5 = TB suspect |
classification of TB
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• Early stages are usually free of symptoms
• Systemic symptoms(early in disease): – Fatigue – Malaise – Anorexia – Weight loss – Low-grade fevers – Night sweats • Cough becomes frequent-sputum white and frothy – Produces mucoid or mucopurulent sputum-productive cough • Dyspnea is unusual • Chest pain may be present • Hemoptysis common in advanced cases • Acute symptoms: (enhanced symptoms) – High fever – Chills – Generalized flu symptoms – Pleuritic pain – Productive cough |
clinical manifestations of TB
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– Necrotic Ghon complex erodes through blood vessel with large numbers of organisms invading the bloodstream and are spread to all organs –bacteria goes into blood stream and have systemic infection
– Fever – Dyspnea – Cyanosis -systemic s/s |
Miliary TB
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( fluid buildup around lung) and empyema (pocket of infection in lung)
– Caseous material released into pleural space – Inflammatory reaction and pleural exudate – Pleurisy appears localized as pain on inspiration – Empyema may occur from large numbers of organisms in pleural space |
pleural effusion
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– Large amounts of bacilli discharging from liquefied necrotic lesion into lung or lymph nodes
– Manifestations similar to bacterial pneumonia • Fever • Chills • Productive cough • Pleuritic pain • Leukocytosis |
TB pneumonia
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– Meninges
– Bone and joint tissue – Kidneys – Adrenal glands – Lymph nodes – Genital tracts |
other organ involvement of TB
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– Immune response demonstrated by hypersensitivity to PPD(purified protein derivative) of TB
– Once acquired, sensitivity remains for life – Positive reaction- takes 2-12 weeks for TB to show up • Indicates infection • Does not indicate if dormant or active – Response decreased in immunocompromised patients • Reactions >5mm considered positive (redness doesn’t count; measure sideways across arm) 15mm_>_ positive no matter what 10mm _>_ if high risk individual positive 5mm _>_ immunosuppressed people If first one negative and second one positive=infected – Two-step testing recommended for health care workers getting repeated testing and those with decreased response to allergens |
skin testing for TB
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can’t diagnose soley on CXR need sputum
– Not possible to make diagnosis solely on findings – Cavitation in upper lobes – Calcification |
chest x-ray for TB
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– Stained sputum smears examined for acid-fast bacilli
• Usually first bacteriologic evidence – Three consecutive sputum samples are collected on different days and sent for culture – Gastric washings – CSF – Pus from an abscess |
bacteriostatic studies-TB
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• Takes 6-8 weeks
• Most accurate method for diagnosis • Can detect small quantities – Nucleic Acid Amplification (NAA) • New test • Results in a few hours • Does not replace cultures |
culture of TB
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• Hospitalization not necessary for most patients
• Drug therapy used to treat clinical disease and to prevent in infected person |
collaborative care TB
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• Active disease
– Five primary drugs used: (INH + Rifampin + PZA+ one of the others) • INH-almost always used can cause peripheral neuropathy and hepatitis • Rifamate (antibiotic)- Rifampin-hard on liver; makes have orange urine • Pyrazinamide-PZA- causing hepatitis • Streptomycin-nephrotoxic-aminoglycoside antibiotic-ototoxic • Myambutol – Fixed-dose combinations enhance adherence – Other drugs used for resistant strains or development of drug toxicity – Newer drugs: ( not typically first line of therapy) • Cipro • Floxin • Zagam • Priftin – Short courses of therapy (6-9 months) have been shown to be effective – Drug regimens should be adapted to resistance pattern of geographic area evidenced by culture – Monitor for toxic effects of drugs – Co-infected patients with HIV (immunosuppressed) should receive treatment for TB at least 6 months beyond conversion of cultures to negative status |
Drug therapy TB
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– Follow-up care to ensure adherence
• Directly observed therapy (DOT) for patients at risk for noncompliance – Teach patient about drug side effects and when to seek medical attention – Liver tests-want baseling before start therapy |
Drug therapy TB
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• Latent TB infection-only treated with INH
– Individual is infected with M. tuberculosis but is not acutely ill – Usually treated with INH for 6-9 months – HIV patients should take INH for 9 months |
drug therapy TB
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• Vaccine
– Bacille Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of the world – Efficacy not clear – Can result in positive PPD reaction |
drug therapy TB
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• Productive cough
• Night sweats • Afternoon temperature elevation • Weight loss • Pleuritic chest pain • Crackles over lung apices –crackles in upper lobes of lungs not bases |
nursing assessment of TB
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• Ineffective breathing pattern
• Imbalanced nutrition: less than body requirements • Noncompliance • Ineffective health maintenance • Activity intolerance |
nursing diagnosis TB
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• Goals are that patient will:
– Comply with therapeutic regimen – Have no recurrence of disease – Have normal pulmonary function – Take appropriate measures to prevent spread of disease |
planning-TB
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• Selective screening programs in high risk groups to detect TB
• Identify contacts of patient with TB • Place patient suspected of having TB on respiratory isolation – HEPA mask • Drug therapy • Chest x-ray • Sputum specimen • Throw tissues in paper bag and into trash • Teach patient to cover mouth when sneezing or coughing • Teach patient hand washing after handling sputum soiled tissues • Provide flexibility in planning a program to assist adherence • Reassurance that patient can adhere to treatment • Discuss any feelings of stigma • Follow-up care may be indicated for 12 months to treat relapses Hepafilter masks; negative pressure rooms 3 negative sputum AFT tests to no longer be contagious |
nursing implementation TB
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• Patient will have:
– Complete resolution of disease – Normal pulmonary function – Absence of any complications – No transmission of TB |
evaluation of TB
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