Tuberculosis

Question 0

Tuberculosis

-Characterized by

Answer 0

1. Pulmonary infiltrates
2. Formation of Granulomas w/
   - Caseation
   - fibrosis
   - cavitation

Question 1

Tuberculosis

-Caused by

Answer 1

1. Mycobacterium tuberculosis (TB)

- bacterium that resembles a fungus

Question 2

Tuberculosis

-Causes & Incidences

Answer 2

1. 5% of infected people develop active TB w/in a year

2. Other 95% of people have Immune System that controls TB by enclosing it in a tiny nodule (Tubercle)

Question 3

Tuberculosis

-Risk Factors

Answer 3

1. Pt w/ Chronic disease (HIV)
2. Employees of hospitals and long-term care facilities
3. Injectable drug users
4. Persons in close living conditions
5. Persons born in countries with high prevalence of TB

Question 4

Tuberculosis

-Transmission

Answer 4

1. Droplet Nuclei
   - produced when infected person coughs, sneezes, talks, or sings
2. Person with cavitary lesions are particularly infectious because their sputum usually contains 1 to 100 million bacilli per milliliter

Question 5

Tuberculosis

-People w/ Cavitary Lesions

Answer 5

1. Persons with cavitary lesions are particularly infectious because their sputum usually contains 1 to 100 million bacilli per milliliter

Question 6

Tuberculosis

-Pathophysiology

Answer 6

1. Inhaled Tubercle bacilli settle in alveolus
2. Inflammatory response initiated
   - Alveolocapillary dilation and endothelial cell swelling occurs
3. Microphages engulf bacilli and contain infection and stop disease.

Question 7

Tuberculosis
-Pathophysiology
(The tubercle)

Answer 7

1. May heal, leaving scar tissue
2. May continue as a granuloma, then heal, or be reactivated
3. May eventually proceed to necrosis, liquefaction, sloughing, and cavitation

Question 8

Tuberculosis

-Complications

Answer 8

1. Respiratory Failure
2. Bronchopleural fistulas
3. Pneumothorax
4. Hemorrhage
5. Pneumonia

Question 9

Tuberculosis

-Signs & Symptoms

Answer 9

1. 4-8 week incubation period
   - Asymptomatic
2. May produce
   - fatigue, weakness, anorexia, weight loss, NIGHT SWEATS, and low grade fever

Question 10

Tuberculosis

-S/S of Reactivation

Answer 10

May Include:

1. A cough that produces muco-purulent sputum
2. Occasional hemoptysis
3. Chest Pains

Question 11

Tuberculosis

-Diagnostic Test

Answer 11

1. Chest X-ray
2. Sputum smears & cultures
3. Tuberculin skin test (PPD) purified protein derivative

Question 12

Tuberculosis

-Treatment – 1st line agents

Answer 12

1. Isoniazid
2. Rifampin
3. Ethambutol
4. Pyrazinamide

Question 13

Tuberculosis

-Treatment – Latent TB

Answer 13

1. Daily Isoniazid for 9 months or w/ Rifampin for 4 months if resistant to Isoniazid

Question 14

Tuberculosis

-Treatment – recommendation for most adults

Answer 14

1. All 4 drugs daily for 2 months
   Followed by
2. 4 months of Isoniazid (INH) and Rifampin (RIF)

Question 15

Tuberculosis

-Nursing Considerations

Answer 15

1. Initiate airborne and isolation precautions immediately for all pt’s suspected or confirmed to have TB
   - Private Room
   - Negative pressure room with a minimum of 6 exchanges per hour
   - HEPA mask (N95 masks) - need to be fit tested or use a PAPR

Question 16

Tuberculosis

-Nursing Considerations Cont…

Answer 16

1. Be aware that INH may lead to hepatitis
   - If Pt complains of left upper quadrant pain notify the MD immediately
2. Importance of drug compliance should be reinforced