Pneumonia & Tuberculosis Flashcards

Flashcards about Pneumonia and Tuberculosis

Pneumonia

Acute infection of lung tissue associated with significant morbidity and mortality rates.

Most effective Classifications of Pneumonia

Community-acquired (CAP) and Hospital-acquired (HAP) or nosocomial infection.

Types of Pneumonia

Viral, Bacterial, Mycoplasma, Aspiration, Necrotizing, Opportunistic

Inflammatory response in Pneumonia

Attraction of neutrophils, Release of inflammatory mediators, Accumulation of fibrinous exudates, red blood cells, and bacteria.

Pneumonia: Lung Pathophysiology

Alveoli fill with fluid and debris (consolidation). Increased production of mucus (airway obstruction). Decreased gas exchange.

Atelectasis

Absence of gas or air in 1 or more areas of the lung

Consolidation

Alveoli become filled with water, fluid and/or debris

Pneumonia Manifestations (1 of 2)

Cough (productive or nonproductive), Green, yellow, or rust-colored sputum, Fever, chills, Dyspnea, tachypnea, Pleuritic chest pain

Pneumonia Manifestations (2 of 2): Physical examination

Fine or coarse crackles over affected region, Consolidation (Fluid/mucous in the lung), Pleural effusion (Fluid between chest cavity and tissue lining lungs)

Diagnostic Studies for Pneumonia

History and physical examination, Chest X-ray, Thoracentesis and/or bronchoscopy, Pulse oximetry, Arterial blood gases (ABGs), Sputum gram stain, culture & sensitivity, CBC with differential

Pneumonia: Expected response to prompt treatment

Decreased temperature, Improved breathing, Less chest discomfort.

Implementation: Health promotion to reduce Pneumonia

Teach hygiene, nutrition, rest, Cough or sneeze into elbow. Avoid cigarette smoke. Avoid exposure to URIs; Identify risk factors. Influenza and pneumococcal vaccines

Implementation: Acute Care to reduce Pneumonia risks

Elevate HOB at least 30 degrees, Assess for presence of gag reflex before eating, drinking. Special aspiration awareness for patients with NG or orogastric tube. Twice-daily oral hygiene with chlorhexidine swabs

Tuberculosis (TB)

Infectious disease caused by Mycobacterium tuberculosis; Lungs most commonly infected but Can affect any organ

Risk Factors for TB

Poor, underserved, and minorities, Residents of inner-city neighborhoods, Foreign-born persons, Living or working in institutions, Needle drug users, Overcrowded living conditions, Poverty, poor access to health care, Healthcare

Etiology of TB

Gram-positive, acid-fast bacillus (AFB): M. tuberculosis; Spread via airborne droplets

Hallmark of primary TB infection

Ghon lesion or focus

Primary TB Infection

Starts when bacteria are inhaled, trigger inflammatory reaction; Most people have effective immune response here

Primary TB

Active disease within 2 years of infection; People co-infected with HIV at greatest risk

Post-primary TB or reactivation TB

Occurs >2 years after initial infection; Patient infectious if site of TB is pulmonary or laryngeal

Latent TB infection (LTBI)

Occurs when there is not active TB disease; Positive skin test but asymptomatic. Cannot transmit TB; can develop active TB later

Latent Tuberculosis Infection (LTBI)

Has no symptoms, Does not feel sick, Cannot spread TB bacteria to others, Usually has a positive TST or blood test result showing TB infection. Has a normal chest x-ray and a negative sputum smear, Needs treatment for latent TB infection to prevent active TB disease

TB Disease

Has symptoms that may include: Bad cough that lasts >3 week, Pain in the chest, Coughing up blood or sputum, Weakness or fatigue, Weight loss, no appetite, Chills, Fever, Sweating at night. Usually feels sick, May spread TB bacteria to others, Usually has a positive TST or blood test result showing TB infection. May have an abnormal chest x-ray or positive sputum smear or culture, Needs treatment for active TB disease

Multidrug-Resistant Tuberculosis (MDR-TB)

Resistance to first-line drug therapy (isoniazid and rifampin)

Clinical Manifestations of Pulmonary TB

dry cough that becomes productive, fatigue, night sweats, malaise, anorexia, weight loss, low-grade fever. Late: dyspnea and hemoptysis

TB manifestations

Immunosuppressed and older adults—less likely to have fever and other signs of an infection

Diagnostic Studies for TB (1 of 3)

Tuberculin skin test (Mantoux test); Screening for TB

Diagnostic Studies for TB (2 of 3)

Interferon-γ (INF-gamma) release assays (IGRAs)—screening tool

Diagnostic Studies for TB (3 of 3)

TB sputum culture is gold standard; 3 consecutive sputum samples at 8 to 24 hours intervals; at least 1 specimen in early morning

Implementation (1 of 3): Acute care for TB

Airborne isolation (Single-occupancy room negative air flow, N95 masks or respirators), Immediate medical workup: chest x-ray, sputum smear and culture, Appropriate drug therapy

Implementation (2 of 3): Ambulatory care for TB

May go home if responding clinically if household contacts already exposed, not posing risk to others

Patients considered adequately treated for TB when

Drug therapy completed, negative cultures, improved condition and evidence of improvement on CXR

Complications (2 of 2) of TB infects other organs

Spine (Pott’s disease), CNS—bacterial meningitis, Abdomen—peritonitis, Other: kidneys, adrenal glands, lymph nodes and urogenital tract