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55 Cards in this Set
- Front
- Back
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How many months does TB tx usually last?
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6-12 months or until they are negative
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After TB tx, you want to ensure 2 things, what are they?
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Eradication & prevent relapse
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Referring to medications used to tx TB, what is considered the "primary" or first line resistance?
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they are resistant to one of first line meds & have not been previously treated.
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The first line combination of meds for tx of TB are?
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INH, Rifampin, pyrazinamide & (streptomycin OR ethambutol)
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First line drug treatment usually lasts about how long?
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For 8 weeks
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At the end of the first 8 weeks there is a culture & sensitivity done to find out about what?
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If there is still a sensitivity to the drugs being used.
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When the c/s determines continued sensitivity at the end of the first 8 wks of tx, what can be done?
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Streptomycin or ethambutol can be d/c'd.
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Secondary resistance (acquired resistance)means?
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pt is resistant to one or more of the meds and is already being treated.
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What is the 2nd line of TB drugs?
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Capreomycin, ethionamide, paraaminosalycilate, cycloserine, aminoglycosides, quinilones, rifabutin, and clofazime.
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What is d/c'd at 16 wks?
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pyrazinamide but contiue INH & rifampin for 4 months & tx cont'd till test neg.
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Patient's are noninfectious after ____ wks.
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2-3wks after initiation of multi-drug therapy beginning.
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What is given to prevent INH neuropathy.
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pyridoxine
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After TB has been identified, they are put in a negative pressure room. You know it is working properly when you....
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open the door holding a tissue and the tissue is pulled towards the inside of the room (hence negative pressure)
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An N95 is used for what?
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a disposable particulate respirator- the 95 represents the smallest size particle that can be filtered by the mask.
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A TB patient should remain in isolation until when?
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Until there is clinical evidence to prove they are not infective
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who gets tx w/INH?
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family members (prophylactic), HIV+ w/>=5mm induration, xray w/fibrotic lesions & >=5mm induration, change from prior PPD=recent exposure, IV drug user w/induration >=10mm, high risk comorbidities with induration >=10mm
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INH tx for prophylaxis, for other people w/PPD induration >=10mm, immigrants with high TB rates, high risk popul, institutionalized patients will be treated for how long?
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6-12 months of INH
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What lab work will be completed on TB patients?
How often are these done? |
Liver function tests, BUN, Creatinine.
Every month. |
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What is the 2nd line of TB drugs monthsw?
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Capreomycin, ethionamide, paraaminosalycilate, cycloserine, aminoglycosides, quinilones, rifabutin, and clofazime.
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What is d/c'd at 16 wks?
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pyrazinamide but contiue INH & rifampin for 4 months & tx cont'd till test neg.
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Patient's are noninfectious after ____ wks.
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2-3wks after initiation of multi-drug therapy beginning.
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What is given to prevent INH neuropathy.
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pyridoxine
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After TB has been identified, they are put in a negative pressure room. You know it is working properly when you....
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open the door holding a tissue and the tissue is pulled towards the inside of the room (hence negative pressure)
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The bacteria causing TB?
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Mycobacterium tuberculosis
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TB can affect what systems?
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Lungs mainly but can go outside the lungs to meninges, kidneys, bones, lymph nodes & brain
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When you hear tb is an "AFB", what does that mean?
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acid-fact bacilli
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In the mid 80's, what was the main factor causing a rise in tb cases?
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HIV infections
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Risk Factors for TB include?
7 specific listed |
Inhalation around tb, Immunocompromised, Substance abuse, No health care, Immigrants, overcrowding, healthcare workers
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With the risk factor of "immigrants", where typically is being referred to?
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Eastern Europe, Russia, former soviet states, mexico & south america
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Since we know tb transmission is inhalation, where does it rest after inhalation?
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In the alveoli
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When tb gets into alveoli, a natural immune response builds up calcium around the infection- is termed?
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walling-off
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Bronchopneumonia results from tb infection lasting about?
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2-10 weeks-INITIALLY
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Years after an initial tb infection is walled off, what can cause reactivation?
and tb becomes active & infective |
immunocompromise- cancer-chemo, HIV
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When tb is reactivated by an immunocompromise, what happens to the infection?
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eats through the calcified area and spreads throughout the lungs & becomes active
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Signs & symptoms of active TB?
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night sweats, low grade fever, no-productive or muco-puralent cough, fatigue, weight loss, hemoptysis
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When taking a hx for possible TB, what questions are important?
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been in prison? Immigrated? Immunocompromised? Been around anyone with TB?
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What does PPD stand for?
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Tubercle bacillus extract of purified protein derivative-
Your standard tb skin test |
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0.1 ml=5 tuberculin units are given how?
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intradermally
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When doing PPD, what does the nurse record? and is read ? hours after
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site, date, time, lot #- 48-72 hrs
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All diagnostics a nurse has available for tb detection?
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Phys exam, history, ppd, afb test, chest x-ray
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PPD results- a reaction with erythema & induration of
0-4mm= 5-9mm= >=10mm= |
Not significant-neg
at risk significant |
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5mm is considered + if?
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known or unknown HIV status & neg doesn't mean no TB
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Significant reaction can be caused by?
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tb exposure or bcg vaccine
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BCG vaccine is used routinely in Europe & Latin America & offers ?% resistance.
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76%
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Gerentological atypical s/s include....if these are present, you can repeat ppd in 1-2 weeks (poss delayed reaction)
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mental status changes, fever, anorexia, weight loss
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Multidrug resistance means they are resistant to?
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INH & Rifampin
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Nursing assessment includes
2 areas |
s/s; living conditions
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The priority intervention for TB pt is?
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Promote airway clearance b/c most will have bronchopneumonia
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Nsg interventions 2nd, 3rd.
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Adherance to tx, promoting activity & nutrition
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Complications w/tb include 4
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malnutrition, med side affects, multidrug resistance, spread of tb
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INH-isoniazid;
Side Effects? |
peripheral neuritis, hepatic enzyme elevation, hepatitis, hypersensitivity
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Rifampin;
Side Effects? |
Hepatitis, febrile rx, purpura rare, nausea, vomiting
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Rifabutin-mycobutin & streptomycin side effects?
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8th cranial nerve damage- deafness, nephrotoxicity
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Pyrazinamide Side Effects?
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Hyperuricemia, hepatotoxicity, skin rash, arthralgias, gi distress
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ethambutol-myambutol side effects?
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optic neuritis, blindness, skin rash
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