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28 Cards in this Set

  • Front
  • Back
• Caused by Mycobacterium tuberculosis
• Involves:

– Lungs-usually found in lungs
– Larynx
– Kidneys
– Bones
– Adrenal glands
– Lymph nodes
– Meninges
• 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
– Multi drug-resistant strains of M. tuberculosis- d.t poor compliance of drug therapy
• Seen in:
– Poor
– Underserved
– Minorities
At risk-foreign born, homeless, IV drug users, native americans, institutionalized, health care workers, immunosuppressed
• 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
• 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
• 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
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
• 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
– 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
( 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
– 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
– Meninges
– Bone and joint tissue
– Kidneys
– Adrenal glands
– Lymph nodes
– Genital tracts
other organ involvement of TB
– 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
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
– 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
– Pus from an abscess
bacteriostatic studies-TB
• 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
• Hospitalization not necessary for most patients
• Drug therapy used to treat clinical disease and to prevent in infected person
collaborative care TB
• 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
– 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
• 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
• 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
• 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
• Ineffective breathing pattern
• Imbalanced nutrition: less than body requirements
• Noncompliance
• Ineffective health maintenance
• Activity intolerance
nursing diagnosis TB
• 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
• 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
• Patient will have:
– Complete resolution of disease
– Normal pulmonary function
– Absence of any complications
– No transmission of TB
evaluation of TB