What is Tuberculosis?
An infectious disease that primarily affects lungs
- can affect other parts such as kidney, bones, and lymph nodes
How is TB spread?
Spreads by airborne transmission
- releases droplets through talking, coughing, sneezing or laughing.
- smaller droplets stay suspended in the air and can be inhaled
What is the pathophysiology of TB?
TB begins when.a susceptible person inhales mycobacteria and becomes infected.
- Travel through the airway to the alveoli where they deposit and begin to multiply.
- bacteria can be transported through lymph system
- body responds with an inflammatory reaction leaving exudate in the alveoli causing bronchopneumonia
What factors put a person at risk for TB?
Close contact with active TB
Immunocompromised status
Substance abuse disorder
Inadequate health care/ impoverished
Institutions -poorly ventilated, overcrowded
What are the clinical manifestations of TB?
- low grade fever
- night sweats
- fatigue
- weight loss
- persistent cough that last longer than 3 weeks
- mucopurlent sputum may be expected, possible blood tinged
How is TB diagnosed?
Needs a positive skin test, blood test or sputum culture
- Follow up with complete history, exam, TB test, chest X-ray and drug susceptibility testing
What is the Mantoux test? What do the results mean?
Manitoux test:
- intradermal injection of tuberculin
- should be read in 48-72 hours
- does not determine active infection
Positive result=an induration (bump), and redness are present
Induration of 5mm-
Induration of 10mm
Induration of 15mm
What would a negative skin test mean?
It means the person immune system did not react to the test
- TB is not likely
- anergy:- cannot develop an immune response that would produce a positive result
What two blood test can be used to detect TB?
TB- Gold
T-SPOT
- preferred diagnostic tests for patients who have received the BCG vaccine and for those likely not to return for follow up
- results available in 24-36 hours
What is a sputum culture?
- testing sputum
- presence of AFB on a smear may indicate disease but DOES NOT CONFIRM diagnosis.
How to treat TB?
TB agents
- for 6–12 months
- prolonged treatment to ensure eradication and prevent relapse
FIRST LINE: isoniazid, rifampin, pyrazinamide & ethambutol
- Initial phase: multiple medication regimen
- given daily for up to 8 weeks
- continuation phase
- last for 4-7 months
- considered non infectious after 2-3 weeks
- not simply duration of treatment but total number of doses taken
Which drug can be used prophylactically?
Isonizaid
Nursing Intervention’s for the patient with TB?
- Promoting airway clearance due to secretions that interfere with adequate gas exchange
- increasing fluid intake
- postural drainage - promote adherence to treatment plan
- treatment may fail due to complexity and duration - Promoting Activity and adequate nutrition
- willingness to eat may be altered due to fatigue from coughing, sputum production, chest pain
- weight loss is a symptom of- may need liquid calories - Preventing Transmission
- mouth care and covering your mouth and nose, proper disposal of tissues and hand hygiene
What is Miliary TB?
The spread of TB to non-pulmonary sites of the body.
- invasion of bacteria into the bloodstream
- results from late deactivation of a dormant infection
- VERY SERIOUS FORM
- observe for spikes in temperature, changes in renal or cognitive function. Few physical signs
- Treatment is the same
When should TB agents be taken? What interferes with it?
First thing IN THE AM
- either on a empty stomach or at least 1 hour before meals
- food interferes with medication absorption
What should people taking isoniazid avoid?
Foods that contain tyramine and histamine
- tuna, aged cheese, red wine, soy sauce)
- interaction may cause hypotension, lightheadedness, palpitations and diaphoresis
- Alcohol
What kind of room should a person with TB be placed in?
Negative Pressure private room
