3654842
Description
Flashcards by Natashia Reyes, updated more than 1 year ago
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Created by Natashia Reyes
over 8 years ago
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| Question | Answer |
| TUBERCULOSIS What is it Caused By Primary Cause of Leading Mortality In | Mycobacterium Tuberculosis Death worldwide from a curable infectious disease HIV patients |
| Risk Factors | Poor, Jail, Immunocompromised, foreign, institutions, IV drug users, Asians |
| MDR-TB XDR-TB | MDR-TB is resistant to INH and rifampin Extensive DR-TB is resistant fluorquines and injectable antibiotics |
| How is TB spread vs. Unlikely Routes What Are Factors That Influence Likelyhood of Transmission Size of Droplet Nuclei | Airborn breathing, talking, sneezing, and coughing vs. Not spread through kissing, touching, utensils, or physical contact Number of organisms expelled, concentration (small space limited ventilation), length of time and immune system of person exposed 1-5 suspended in air Requires close, frequent, or prolonged exposure brief exposure rarely causes infection |
| Local Inflammation Occuring Is Termed Hallmark of TB is TB Bacterium Favors | Gohn Focus Granuloma Air it is aerophilic with an affinity for the lungs but can spread anywhere such as kidneys, epiphyses, cerebral cortex, and adrenal glands |
| Primary Infection Latent TB Primary TB Post Primary/Reactivation TB | Bacteria inhaled inflammatory reaction encapsulation -Latent TB is not active (asymptomatic cannot transmit) -Active inadequate innate immunity or development within 2 years -Post/Reactivation two years after primary infection (HIV greatest risk, immunosupressed, DM, poor nutrition, aging, pregnancy, stress) |
| What Site Categorized as Infectious Charactersitic S/S Initial S/S Acute S/S Late Symptom Auscultation Elderly S/S | Pulmonary/Laryngeal Pulmonary dry cough becoming productive with mucoid or mucopurluent sputum Initial: fatigue, malaise, unexplained weight loss, low grade fever, night sweats Acute: highfever, chills, generalized flu, pleuritic pain, productive cough Dyspnea late symptom Aus: crackles, rhonci, bronchial breath sounds Elderly: change in cognition, dysuria, hematuria, severe pain, dissemination, hepto/splenomegaly |
| Renal TB Bone and Joint TB TB Meningitis Miliary TB | ---May cause dysuria and hematuria ---may cause severe pain ---may cause headaches, vomiting, and lymphadenopathy ---widespread dissemination of bacterium through blood stream to distant organs characterized by large amount of TB bacilli as result of primary or reactivation TB. Manifests in days, weeks, months common is Hepatomegaly, splenomegaly, and generalized lymphadenopathy |
| Pleural TB Now Your Pt has Pleura Effusion What is Your Next move? | Primary or reactivation pleura effusion (build up of fluid between tissue lining lungs and chest) caused by bacteria in pleura space triggering inflam response and pleura exudate of protein rich fluid empyema may develop (collection of pus in cavity, this case obviously pleura Thoarcostomy!!!! |
| TB in The Spine CNS involvement would cause Abdominal TB Can Lead to What | Potts Disease leads to destruction of the intervertebral discs and adjacent vertebra Bacterial meningitis Can lead to peritonitis (serous membrane lining abdomen and covering abdominal organs inflammation) |
| DIAGNOSTICS What is The Standard Method How Much Do You Inject and Where When Do You Read It | Tuberculin Skin Test TST using purified protein derivative (PPD) is STANDARD. 0.1mL of PPD intreadermally in dorsal forearm. Read it 48-72 hours later by induration not redness antibody development dev 2-12 weeks after in mm |
| If Immunocompromised What is Positive Reading If Health Care Professional What is + Reading How Do You Prevent Misinterpertation | 5mm or larger 10mm or larger (also standard for immigrants workers with constant exposure and iv drug users children under 4) Two Step TST testing |
| What Test is Available in Hours | Interferon-y assay such as QuanteriFERON-TB andT SPOT TB. One visit, no bias, not affected by bacillus Calmette-Heron (BGC vaccination) cost more but cannot determine if primary or latent |
| Chest X-Ray What are findings suggestive of TB Bone Scan | Can't dx off this alone and may appear normal in pt with tb. Findings are upper lobe infiltrates, cavitary infiltrates, and lymph node involvement Bone scan more likely to diagnose early better to use |
| Bacteriology Studies How Must it Be Collected How Long For Results Do You Start Tx While Awaiting Results | Examinaton of Stained Sputum Smear for Action Fast Bacilli (AFB) On three different days (mornings best) Up to 8 weeks Yes start Tx if highly suggestive of TB |
| Option One Drug Treatment What Drugs Initial Phase Continuation Phase | 4 drugs INH, rimfampin, Pyrazinamide, othambutol Daily 8 weeks or 5 days a week DOT Continuation:INH, rifampin daily 18 weeks or DOT 5 days a week 18 weeks SO 8 then 18 preferred!!! |
| rimfapin(Rifadin) and rifabutin (Mycobutin) | May cause orange urination discoloration advise patient! |
| Isonazid (INH) | Make sure pt does not drink alcohol!!! Hepatotoxicity will occur |
| If Susceptibility Test Indicates They are Susceptible What Can Be Taken Out Also Not Used With Children | ethambutol |
| OPTION 2 | RIPE- 2 weeks 14 doses followed by twice weelky or 5 days/week 2 weeks 10 doses DOT then twice weekly 6 weeks( 12 doses) CONTINUATION: INH,R- twice weekly 36 doses or one weelk 18 doses |
| OPTION 3 | RIPE-3x week 8 weeks, continuation IR, 3xweek 18 weeks |
| OPTION 4 | IRE, 8 weeks or 5day/week DOR INH&R 31 weeks |
| How Long is The Continuation Phase | four to seven months. Four month phase used in pt with uncomplicated, noncavitary, drug-susceptible TB and documented sputum conversion in first two months. |
| Who Would Need Longer Continuation Phase | Patients with cavitary or extensive pulmonary TB caused by drug susceptible organisms whos sputum culture obtained at time of 2 months tx tested positive. Initial phase did not include PZA. Pt tx once weekly INH & RPT & sputum culture at time of inital phase (2months) positive |
| MDT-TB | fluoroquinolone and injectable abx. Bedaquiline (Sirturo) inhibits enzyme needed for M. Tuberculosis to replicate |
| HIV positive patients What Would You Not Use What if CD4 100/uL or Less | continuation INH plus Rifapentine NOT USED WITH ANY HIV pt. If CD4 less than 100/uL should be treated daily or 3x/week therapy in both initial and continuation. SHOULD BE refamycin |
| LATENT TB Treatment | Isoniazid 9months daily twice weekly minimum 270/76 children 2-11 years Isoniazid 6mo daily/2xweekly min 180/52 (6 month preferred) Isonazid and Rifapentine 3 mo once weekly Rifampin 4mo daily if cannot tolerate INH or INH resistant TB |
| Why would you use Isonaizid and RIfapentin Regime in Latent Tb | DOT once weekly for LTBI in healthy people 12 years or |
| EMB what are side effects | Ethambutol can cause blurred or changed vision and can change color vision |
| INH PZA RIF | May cause hepatotoxicity. S/S adb pain, abnormal LFT, dark urine, fatigue, fever 3 or more days, flu like, lack of app, nausea, vomit, YELLOW SKIN OR EYES |
| INH S/E | nervous system damage Dizziness tingling or numbness around mouth. Peripheral Neuropathy tingling in hands and feet. |
| PZA | Stomach upset, Gout: abronal uric acid level 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male) joint aches pyrazinamide |
| RIF | rifampin, Bleeding problems-easy bleeding slow clotting. Discoloration of fluids (orange sweat, tears), interferes with Methadone and birth control Sensitivity to sun-FREQUENT sun burn |
| BCGa Live Strain Vaccination | of Mycobacterium bovis given to infants in parts of the world where TB is prevalent but not in US b/c low risk of infection n interference with TST causing false positive only considered HCP & those with MDR-TB when infection precautions were not successful |
| Nursing Assessment | Ask: any productive cough, night sweats afternoon temperature elevations, weight loss, pleuritic chest pain, abnormal lung sounds |
| Admitted for Triage for TB should be | placed in airborne isolation receive a medical workup including chest x-ray, sputum smear, and culture Receive appropriate drug therapy |
| How Often Should negative pressure Air Flow Room Exchange be Done When is Pt considered NonInfectious What if Pt Has to Leave The Room | 6-12 hr After 3 negative cultures Make him wear mask |
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