ADH2 Exam 2: TB

Define what TB is and the precaution it falls under:

• a lung infection caused by Mycobacterium tuberculosis—in dormant in Ghon Tubercle

• Airborne droplet

Whats the Primary prevention of TB? (2)

1. annual screening for high-risk ppl

• school setting

• healthcare/hospital setting

• prisons

• shelters

2. test household contacts if xposed

Whats the goal of secondary prevention? (2)

1. to catch TB early

2. treat “silent” TB before it becomes active!

What is latent TB? (5)

1. TB bacteria are dormant inside body

2. No Symptoms

3. Not contagious

4. BUT can awaken if immune system weakens

• HIV

• DM

• Older age

5. Positive Skin/Blood test ONLY

Whats Active TB? (5)

1. TB bacteria multiply

2. Symptomatic

3. Contagious

4. Positive skin/blood test AND Symptoms!!

5. Needs immediate tx!

Environmental/Social risk factors TB: (6)

1. Crowded living conditions (prisons, shelters)

2. Low income

3. Homelessness

4. Healthcare workers!

5. Recent immigration from high prevalence regions (India, Indonesia)

6. Close/frequent contact w/ active TB case (hospital)

Whos at higher medical risk of contracting TB? (3)

1. Immunocompromised

• HIV

• Transplant

• Chemo

2. Chronic Diseases

• DM

• Renal Failure

3. Old age!

Clinical findings TB:

respiratory (4)

systemic (6)

older adults (2)

resp:

1. persistent cough >3x/week

2. purulent/blood-tinged sputum

3. dyspnea

4. pleuritic CP

→ kinda same as HF symptoms

Systemic

1. fatigue

2. lethargy

3. weight loss

4. anorexia

5. night sweats

6. low grade fever

Older adults

1. confusion/ altered LOC

2. behavioral changes

What are hallmarks s/s of TB? (2)

1. night sweat

2. weight loss

What are the two TB blood tests done and its advantages (3)/ limitations (1)?

ex: QuantiFERON-TB Gold & T-Spot

Advantage:

1. Results in <24hrs

2. Requires 1 visit

3. Not affected by prior BCG vax

Limitations

1. Cant distinguish latent vs. active infx

Hows TB skin test (Mantoux Test) done? (2)

1. ID injection

2. Read at 48-72 hrs for induration (measuring the bump)

What size skin bump means positive in adults and immunocompromised?

• Adults: > 10 mm

• Immunocompromised: > 5mm

Diagnostic testing w/ Sputum and Imaging: (3)

1. Sputum:

• collect 3 early morning—NOT saliva

→ GOLD standard!

2. CXR: detects lesions, consolidations

3. CT Scan: severity

Hows TB confirmed??

1. Sputum culture confirmation gold standard diagnosis

What Isolation precautions needed in hospital? (6)

1. Air pressure lower than hallway

2. Negative pressure room (air sucked out, not spreading)

3. Closed door

4. Wear N95

5. Pt wear surgical mask when transported

6. Tissue and cough etiquette

• dispose in no touch receptacle

First line TB meds: (4)

1. Isoniazid (INH)

2. Pyrazinamide

3. Ethambutol

4. Rifampin

Nursing consideration for Isoniazid? (2)

1. Watch liver enzymes

2. No alcohol

• hepatotoxic!

Nursing consideration for Pyrazinamide: (2)

1. Hepatotoxic

2. No alcohol!

Nursing consideration for Ethambutol: (1)

• baseline eye exams 

  • Optic neuritis—affects vision)

Nursing consideration for Rifampin: (2)

1. Body fluids orange

2. Decrease OCPs effectiveness

Second line Tb med: (1)

Streptomycin Sulfate

Whats Streptomycin Sulfate used for? And what to monitor for? (3)

• Resistant TB!

1. Montor Ototoxicity!! (need to check for hearing)

2. Make sure they receive > 2L fluids/ day

• to flush med through and keep kidneys clear

3. Monitor renal function

How long is MDR-TB drug therapy?

> 18 months (1.5 yrs)

• Streptomycin Sulfate

What should pts need to know at home for TB maintenance? (6)

1. No need for airborne precaution but household contacts need to be tested

2. take meds full course

3. give sputum samples q2-4 weeks

4. wear mask in public till no longer infectious or dont go out

5. use tissues and dispose in sealed plastic bags

6. Continue monitoring for 1 yr post tx

What diet helps TB recovery? (4)

1. High protein

2. Iron

3. Vitamin B/C

4. Stay hydrated and rest!

How would we know TB tx is working? (7)

1. Negative sputum culture

2. No sputum/cough

3. No night sweats or fever

4. Stable or increased weight

5. Improved muscle tone/ skin turgor

6. Even, unlabored breaths

7. Better breathing/ O2