1
Q
Risk factors for TB
A
- Homeless populations
- Incarcerated population
- HIV/AIDS clients - Leading killer of people with HIV infection
- Immunosuppressed clients
- Children younger than 5 or older adults
- Malnourished populations
- Alcohol abusers & IV drug users
- Drinking unpasteurized milk from infected cows
2
Q
All of the following are risk factors for what?
Homeless populations
Incarcerated population
HIV/AIDS clients
Leading killer of people with HIV infection
Immunosuppressed clients
Children younger than 5 or older adults
Malnourished populations
Alcohol abusers & IV drug users
Drinking unpasteurized milk from infected cows
A
TB
3
Q
Name 4 types of TB
A
- Latent TB Infection
- Primary TB Infection
- Primary Progressive (Symptomatic) TB Infection
- Multi Drug-Resistant TB infection
4
Q
What type of TB is this?
- No symptoms
- Not contagious
A
Latent TB
5
Q
Risk factors for LTBI
A
- HIV infection
- Long-term diabetes
- Chronic renal disease
- Long-term steroid administration
- Sepsis
- Malnutrition
6
Q
The following are S/S of what?
- Fatigue, lethargy
- Weight Loss, anorexia
- Low grade fever
- Night Sweats, chills
- Persistent cough with blood-tinged sputum
- Chest tightness & dull, aching chest pain
- Dyspnea, orthopnea, & rales as disease progresses
A
Primary Progressive TB Infection
Symptomatic
7
Q
Is primary TB infectious? asymptomatic?
A
No
8
Q
Expected inflammatory response in TB patients
A
Unexplained weight loss
night sweats
fever
chills
9
Q
What type of TB is this?
Resistant to one or more of the first line medications used for the treatment of TB
A
Drug resistant Mycobacterium Tuberculosis
MDR TB
10
Q
After a positive skin test is observed what needs to be done and why?
A
CXR to rule out active TB or to detect old, healed lesion
11
Q
When should a PPD skin test should be read?
A
48-72 hrs after administration
12
Q
How do you administer a PPD skin test with
A
- with a 1/4-1/2 in 27 g needle
- 0.1 mL of PPD
- intradermally into forearm
13
Q
Priority Nursing assessments for TB patients
A
Assess lung sounds (may hear wheezing or decreased sounds)
Assess oxygen saturation (indicates effectiveness of tissue perfusion)
Assess temperature (expect low grade fever with TB)
Assess sputum
14
Q
Tests used to dx TB
A
- Sputum Culture
- TB Skin test
- CXR
15
Q
Treatment goals for TB patients
A
- Cure the patient
- Minimize disease transmission
16
Q
What medication is this?
Classification: Antitubercular Drug
Actions: Bactericidal, stops growth of TB organism
Contraindications:
Do not use in clients with acute liver disease or hypersensitivity
Use with caution in clients with renal impairment and ETOH use
Use with caution in clients taking Dilantin
S/E: Peripheral neuritis, Neurotoxicity, hepatotoxicity/hepatitis, N/V, Dry mouth, Hyperglycemia, Vision changes
Used to treat TB
A
Isoniazid (INH)
17
Q
Contraindications for Isoniazid
A
- Do not use in clients with acute liver disease or hypersensitivity
- Use with caution in clients with renal impairment and ETOH use
- Use with caution in clients taking Dilantin
18
Q
Name S/E of Isoniazid
A
- Peripheral neuritis
- Neurotoxicity
- hepatotoxicity/hepatitis
- N/V
- Dry mouth
- Hyperglycemia
- Vision changes
19
Q
S/S of neuritis
A
- tingling
- numbness
- burning of the extremities
20
Q
S/S of Hepatitis
A
- anorexia
- N/V
- weakness
- fatigue
- dark urine
- jaundice
21
Q
S/S of hepatoxicity
A
- fever
- anorexia
- malaise
- N/V
- darkened urine
- yellowish discoloration of skin and eyes
- pain and swelling of the joints occurs
22
Q
The following are what types of foods?
- Cured, smoked, or processed meats
- Pickled veggies
- Soy sauce
- smoked aged cheese
- beer
A
Tyramine containing foods
23
Q
Nursing interventions for Isoniazid (INH)
A
- Assess for hypersensitivity
- Monitor for S/S of hepatitis:
- Monitor for S/S of neuritis:
- Assess mental status and vision changes
- Monitor glucose levels
- Administer medication 1hr before or 2hrs after meals to avoid delayed absorption
- Administer at least 1hr before antacids
- Pyridoxine (Vitamin B-6) to reduce risk of neurotoxicity
24
Q
How to reduce the risk of neurotoxicity in patients taking isoniazid
A
Pyridoxine or Vitamin B-6
25
S/S of hypersensitivity rxn
Fever
Chills
Headache
Muscle and bone pain
Dyspnea
26
# What medication is this?
Classification: Antibiotic
Actions: Bactericidal, stops growth of bacteria by inhibiting RNA synthesis
Contraindications:
Do not use in clients with hypersensitivity
Use with caution in clients with liver impairment and ETOH use
Use with caution in clients taking anticoagulants, hypoglycemics, digoxin, antifungals, dilantin, and some cardiac meds
S/E: Hypersensitivity reaction, heartburn, N/V/D, red-orange colored body secretions, hepatitis/hepatotoxicity, increased uric acid levels, blood dyscrasias, colitis
| used to treat TB
Rifampin (Rifadin)
27
S/E of Rifampin
* Hypersensitivity reaction
* heartburn
* N/V/D
* red-orange colored body secretions hepatitis/hepatotoxicity
* increased uric acid levels
* blood dyscrasias
* colitis
28
Contraindications for rifampin
* Do not use in clients with hypersensitivity
* Use with caution in clients with liver impairment and ETOH use
* Use with caution in clients taking anticoagulants, hypoglycemics, digoxin, antifungals, dilantin, and some cardiac meds
29
S/S of Colitis
* colicky abdominal pain
* urgency
* diarrhea
* tenesmus (continual/recurrent feeling of needing to poop)
30
continual/recurrent feeling of needing to poop
tenesmus
31
Nursing Interventions for rifampin
* Assess for hypersensitivity
* Monitor LFTs, APTT, PTNINR and uric acid levels
* Assess for S/S of hepatitis
* Assess for S/S of colitis
32
Client education about rifampin
* Urine, feces, sweat, and tears will be red-orange colored
* Soft contact lenses can become permanently discolored, as well as other items
* Notify PCP if jaundice develops or any unusual bleeding occurs
33
Teaching for patients taking ethambutol or myambutol
o Contradicted in patients with renal impairment, hepatic impairment, hypersensitivity and Optic neuritis
o Assess visual function during therapy, report any blurry vision or constriction
o Assess lung sounds and character of sputum periodically during therapy
o Monitor renal and hepatic functions, CBC and uric acid levels routinely.
o At risk for gout d/t increased uric acid levels.
o Administer with food or milk to avoid GI irritation
o Notify PCP if improvement in cough is not seen in 2-3 weeks
34
Teaching for patients takes pyrazinamide
o Inform patient with diabetes that medication may interfere with urine ketone measurements
o Notify PCP if no improvement after 2-3 weeks of therapy.
o Report any fever, anorexia, malaise, N/V, darkened urine, yellowish discoloration of skin and eyes, pain and swelling of the joints occurs.
o Advise to wear sunscreen and protective clothing
o Monitor hepatic function before and every 2-4 week during therapy. (AST and ALT may come back normal)
o Monitor serum uric acid concentrations, urine ketones
o Patients w/ impaired liver function should receive Pyrazinamide treatment only
o This medication may be given w/ Isoniazid
35
How to determine if TB is being treated adequately?
Collect sputum cultures every 2-4 weeks after 3-4 negative sputums they are considered no lonfer infectious and can resume normal activities
36
Rifampin will stain what red/orange?
* urine
* feces
* sweat
* tears
* contact lenses
37
Labs to monitor for rifampin
CBC
PT/INR
PTT
Uric Acid (for gout)
38
Labs to monitor for Ethambutol or myambutol
* Reanal function
* Hepatic function
* CBC
* Uric acid
39
When taking Ethabutol(Myambutol) and Pyrazinamide(Tebrazid) how long after initiation of therapy should improvement be seen and what should be done?
Cough should stop within 2-3 weeks if not call PCP
40
What should Ethambutol or Myambutol should be given with what and why?
Milk to avoid GI irritation
41
Labs to monitor for Pyrazinamide or Tebrazid
Hepatic function (every 2-4 wks during and every 2-4 wks after)
Uric acid
Urine ketones
42
Pyrazinamide can be given with what medication?
Isoniazid
43
Patients on Pyrazinamide should be taught to do what to prevent gout and kidney problems?
Increase fluids
44
How to collect sputum samples
* Collect in early morning
* Obtain in negative airflow room
* Give breathing ttmnt first if it is prescribed.
* rinse mouth before
* obtain every 2-3 weeks
* 3-4 negative sputums are needed to declare patient non-infectious and regular activities can be resumed.
45
S/S of Neurotoxicity
* Muscle numbness
* seizures
* tingling
* twitching
46
# PPD Induration that is positive in this population?
* HIV-infected persons
* Recent contact with TB infected client
* Clients with fibrotic changes of CXR
* Clients with organ transplants
* Immunosuppressed clients
> 5 mm
47
A PPD test with an induration of > 5mm is positive in what kinds of patients?
* HIV-infected persons
* Recent contact with TB infected client
* Clients with fibrotic changes of CXR
* Clients with organ transplants
* Immunosuppressed clients
48
# PPD Induration that is positive in this population?
Any person, including people with no known risk factor for TB
> 15 mm
49
# PPD Induration that is positive in this population?
* Recent immigrants from high prevelance TB countries
* IV drug users
* People in crowded living facilities
* Mycobacteriology lab personnel
* Staff with high exposure risks
* Children < 4 yrs old
* Infants children, adolescents exposed in high-risk categories
> 10 mm
50
A PPD test with an induration > 10 mm is positive in what kinds of patients?
* Recent immigrants from high prevelance TB countries
* IV drug users
* People in crowded living facilities
* Mycobacteriology lab personnel
* Staff with high exposure risks
* Children < 4 yrs old
* adolescents exposed in high-risk categories
51
In what kinds of patients would a PPD test with an induration of > 15 mm be positive?
Any person including people with no know risk factor
52
Contraindications for ethambutol or myambutol
patients with renal impairment, hepatic impairment, hypersensitivity and Optic neuritis
53
Diabetic patients taking pyrazinamide should me taught to what?
monitor their blood sugar closely
54
Complications r/t TB
* Respiratory failure
* Bronchopleural fistula
* Pleural effusions
* Meningitis
* Lymphadenopathy
* Bone disease
* Liver failure
* Kidney failure
55
an abnormal pathway or sinus tract that develops between the bronchus and the pleural space
| a complication of TB
Bronchopleural fistula
56
Coughing hygiene for TB patients
cover mouth AND nose, dispose of used tissue into plastic bags
57
Nutrition teaching for TB patients
foods rich in iron, protein, and vitamin C is a must
NUR 211 Krissa
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