week 2 tuberculosis

Question 1

define what tuberculosis is?

Answer 1

contagious chronic bacterial infection that primarily affects the lungs and spreads from person to person

Question 2

what is caused tuberculosis

Answer 2

mycobacterium tuberculosis: rod shaped bacterium with a waxy capsule

Question 3

what are the 3 classifications of TB

Answer 3

1.primary TB
2.reactivation TB
3. Disseminated TB

Question 4

define what happens during the Primary TB /primary infection stage

Answer 4

Pt first exposure to the Tb pathogen
-Bacili inhaled and implants in the alveoli
-caused inflammation in the lungs
-lung tissue surround infected area slowly produced a protective cell called wall tubercle or granuloma
-create domant TB-not contagious

Question 5

explain what happens in the reactivation TB/reinfection stage

Answer 5

-reappearance of TB months or years after initial infection
-reactivate any time/ highly contagious

Question 6

what are the risk factors that increases reactivation

Answer 6

1. malnourishment
   2.institutionalized housing: nursing home,prison,shelter
   3.overcrowded living conditions
   4.immunosuppressed pt:organ transplant, cancer
   5.human immunodeficiency virus (HIV)
   6.alcohol abuse

Question 7

explain what happens in the disseminated TB stage

Answer 7

-TB travels to other sites of the body via blood stream or lymphatic system

-gather and muliply in areas with high oxygen contents

Question 8

which oxygen content areas do TB occur

Answer 8

-apex of the lungs
-lymph nodes
-kidneys
-long bones
-genital tract
-brain
-meninges

Question 9

what are the pathological changes of the lungs with TB

Answer 9

1. alveolar consolidation
   2.alveolar-capillary membrane destruction
   3.caseous tubercles/granulomas
   4.cavity formation
   5.fibrosis
   6.dilation of bronchi:bronchiectasis
   7.increased bronchial secretions

Question 10

how is TB transmitted

Answer 10

-aerosol droplets produced by coughing,sneezing, or laughing
*individual must be active
-droplets remain suspeneded in air for several hrs
-particle sizes <5um
-living in closed rooms w limited sunlight and fresh air are at high risk

Question 11

what isolation precaution/ PPE should be taken with a TB pt?

Answer 11

isolation: active TB must be places in airborne isolation , negative pressure rooms

PPE: N95 mask, gloves, hand hygiene
*eye/gown-necessary if risk contact w bodily fluid

Question 12

which test diagnose TB

Answer 12

1. montoux skin test
2. quantiFERON-TB gold test
   3.Acid fast bacteria test

Question 13

what is the montoux skin test

Answer 13

-injection of purified protein derivative (PPD)
-size of injection measured 48-72 hrs

Question 14

what are the results of the montoux skin test

Answer 14

-induration/wheal less than 5mm is negative
-induration/wheal of 5-9 mm is suspicious, retest
-induration/wheal of 10mm or greater is postive
*if positive get Chest xray or sputum sample

Question 15

what is the quantiFERON-TB gold test

Answer 15

-more accurate than mantoux
-blood drawn once and sent to lab
-can detect TB-active and latent
*if positive get Chest xray to confirm

Question 16

explain what the acid-fast bacteria test is

Answer 16

-sputum test
-TB organism has waxy coating on surface
-cells are impervious to stain
-appear bright red rods if found

Question 17

in order to discharge a TB pt what is needed

Answer 17

3 days of negative acid fast bacteria test
-consecutive

Question 18

what are the clinical manifestations of TB

Answer 18

1. increased alveolar capillary membrane thickness
   2.consolidation

Question 19

what are the physical examination of a pt with TB

Answer 19

1.Vital signs:
-Tachypnea
-Tachycardia
-Hypertension

2.Chest pain

3.Decreased chest expansion

4.Cyanosis

5.Digital clubbing

6.Cough & sputum production
-Hemoptysis

7.Peripheral edema and venous distension
-Distended neck vein
-Pitting edema

8.Chest assessment findings
-⬆️ tactile & vocal fremitus
-Dull percussion
-Crackles and wheezing
-Pleural friction rub

Question 20

as TB progresses PT may develop which severe symptoms?

Answer 20

1.Violent coughing
2.Hemoptysis
3.Low grade fever
4.Anoerexia
5.Fatigue
6.Night sweats
7.Pleuritic chest pain

Question 21

explain the PFT results of pt with TB

Answer 21

moderate-extensive case
-restrictive
↓ :FVC
N or↓: FEV1, FEF 25-75, FEF 50, FEF200-1200, PEFR, MVV
N or↑: FEV1/FVC ratio

lung volume and capacity
↓: IRV, ERV,RV,VC,IC,FRC,TLC
N: RV/TLC ratio
N or↓: Vt

Question 22

what are the ABG result of pt with moderate TB

Answer 22

-acute respiratory alkalosis
ph↑, PaCO2↓,HCO3↓,PaO2↓, SaO2/SpO2↓

Question 23

what are the ABG results of a pt with extensive TB w/ pulmonary fibrosis

Answer 23

• chronic respiratory acidosis
  pH N, PaCO2↑,HCO3↑,PaO2↓, SaO2/SpO2↓

Question 24

what is the chest radiograph of a pt with TB

Answer 24

1.Increased opacity
2.Cavity formation
3.Cavitory lesion containing an air-fluid level
4.Pleural effusion
5.Calcification & fibrosis
6.Retraction of lung segments or lobe
7.Right ventricular enlargement

Question 25

what are the most common agents to treat TB

Answer 25

1. Isoniazid: most effect antituberculosis agent 2.rifamoin:antibacterial 3. pyrazinamide: antimicrobial 4.ethambutol:bacteriostatic 5. streptomycin: antibacterial

Question 26

what the two types of treatment plans

Answer 26

-4 months -9months

Question 27

what is the major problem with the treatment plan

Answer 27

non compliance -directly observed therapy (DOT) is recommended to prevent this

Question 28

what are the therapy protocols

Answer 28

1. O2 therapy -treat hypoxemia,↓ wob,↓myocardial work 2.airway clearance therapy -enhance the mobilization of bronchial secretions 3.mechanical ventilation 4.infection control measures -isolation until 3 sputum AFB are negative