TB PPT

The Concept of Infection: Tuberculosis

Learning Objectives for TB

  1. Describe the pathophysiology and etiology for tuberculosis

a)Differentiate latent TB from active TB

2.Assessment

a)Identify anatomic, physiologic, and environmental factors that increase the risk of TB

b)Compare the different assessment findings between dormant/latent TB and active TB

c)Outline diagnostic and laboratory tests and expected findings to determine whether an individual has active or latent TB

3.Diagnosis

a)Formulate priority nursing diagnoses/problem for an individual with tuberculosis  

4.Planning

a)Create a plan of care for individuals with tuberculosis

5.Implementing to manage and prevent TB in collaboration with other members of the healthcare team

a)Dependent nursing interventions : pharmacological, complementary, and alternative therapy

B)Compare the different plan of care between dormant/latent TB and active TB

Diagnosis

  • Formulating Priority Nursing Diagnoses: Develop practical nursing diagnoses tailored to individuals with tuberculosis based on comprehensive assessments.

Planning

  • Care Plans: Design individualized care plans incorporating medical, nursing, and environmental interventions specific to TB management.

Implementation

  • Managing and Preventing TB: Collaboration with healthcare team members to enact effective TB prevention and treatment strategies.

  • Dependent vs. Independent Nursing Interventions: Differentiate interventions that require a physician’s order versus those that nurses can initiate independently.

Evaluation

  • Expected Outcomes Assessed: Establish metrics for evaluating treatment effectiveness in TB patients including resolution of symptoms, compliance to treatment, and prevention of transmission.

TB Chain of Infection Components

  • Susceptible Host

  • Portal of Entry

  • Infectious Agent

  • Chain of Transmission

  • Mode of Transmission

  • Reservoir

  • Portal of Exit

Pathophysiology & Etiology

Latent Tuberculosis

  • Causes: Mycobacterium tuberculosis pathogen enters lungs, triggering inflammation.

  • Mechanism: The bacteria multiplies in alveoli, leading to macrophage response, exudate accumulation, granuloma formation, and caseation necrosis (Ghon tubercle).

  • Result: This process results in the calcification and potential scar tissue formation within lung tissue, impacting pulmonary function.

Active Tuberculosis

  • Progression: Characterized by ulceration of Ghon tubercle, releasing necrotic material into the bronchi, leading to widespread inflammatory responses and possible cavitation.

  • Complications: If untreated, active TB can disseminate to other organs, exacerbating systemic illness.

Chest X-Ray Findings Comparison

  • Latent TB: Generally shows no notable lesions or significant abnormalities.

  • Active TB: Often presents infiltrates with cavitation primarily in upper/middle lung lobes.

Extrapulmonary Tuberculosis

  • Impacts: Particularly dangerous for immunocompromised individuals affected parts include:

    • Middle Ear

    • CNS (brain and meninges)

    • Musculoskeletal System: Bones, spine, psoas muscle.

    • Endocrine and Genitourinary Systems: Adrenal glands, liver, spleen.

Assessment: Risk Factors

  • High-Risk Environments: Close contact with infectious individuals, living in high-prevalence regions (Southeast Asia, Africa, Latin America).

  • Demographics: Individuals who are homeless or in overcrowded living situations.

  • Health Status: Management of weakened immune systems due to pre-existing conditions.

Assessment: Clinical Manifestations

General Symptoms

  • Low-grade Fever

  • Cough: May involve sputum/hemoptysis.

  • Night Sweats, Fatigue, Weight Loss: Clinical manifestations characteristic of TB.

Active vs. Latent TB

  • Active Tuberculosis:

    • Positive skin/blood tests

    • X-ray shows lesions

    • Infectious; requires immediate treatment.

  • Latent Tuberculosis:

    • Positive skin/blood tests but negative X-ray and sputum

    • Not infectious; receives prophylactic treatment only.

TB Skin Test Method

  • Mantoux test:

    • 0.1mL of PPD injected; read after 48-72 hours.

    • Measure induration, not redness; keep in mind false positives may occur due to prior BCG vaccine.

Size of Induration Results

  • Less than 5 mm: Negative for TB

  • At least 5 mm: Positive with specific risks (HIV+, history of TB exposure, organ transplant)

  • At least 10 mm: Positive in high-risk environments

  • 15 mm+: Positive in the general population

Screening Methods

Interferon-gamma Release Assays

  • Examples: QuantiFERON-TB, T-Spot test.

  • Indications: Ideal for individuals with difficulties returning for testing (e.g., prior BCG vaccine).

Who Should be Screened?

  • CDC Recommendations: High-risk individuals (HIV positive, those with medical risk factors), close contacts of possibly infectious TB cases, individuals from high-prevalence countries.

Assessment: Diagnostics

Sputum Samples

  • Gold Standard: Requires collection of 3 consecutive samples over 8-24 hour intervals.

  • Testing Methodology: Traditional culture methods utilized; results may take weeks to yield.

Chest X-ray

  • Purpose: Diagnosis and evaluation of TB; must check for infiltrates and cavitation in pulmonary imaging.

Case Study: Mrs. Smith

  • Background:

    • Consumes 3-4 oz. alcohol/day, smokes 1.5 packs of cigarettes/day, family history of TB.

    • Testing resulted in 30mm erythema, with 16mm induration; diagnosis confirms positive skin test for latent TB.

  • Latent TB Treatment:

    • Prophylactic Regimen: Key focused on preventing active TB development, using Isoniazid: Daily doses for 6-12 months, with liver enzymes monitored.

  • Nursing Diagnoses:

    • Knowledge Deficit about tuberculosis, evidenced by misconceptions about necessity of testing.

    • Risk for Non-compliance.

  • Interventions for Mrs. Smith:

    • Educate on the differences between active/latent TB.

    • Provide an overview of treatment regimen and importance of completing the antibiotic course.

Case Study: Steve

  • Background: 40-year-old homeless man with HIV presenting with persistent cough and fatigue.

  • Diagnostics Expected: Skin/blood tests, chest X-rays to establish infection.

  • Treatment Plan for Steve:

    • Regimen: RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) comprises a 4-medication daily regimen lasting 8 weeks, followed by 4-7 months of Isoniazid & Rifampin for maintenance.

  • Resistance Considerations: Address the necessity of multiple antibiotics to manage drug-resistant TB strains.

  • Interventions Related to Medications: Monitor hepatotoxicity, avoid alcohol when on specific antibiotics, ensure regular visual assessments prior to and during treatment with Ethambutol.

  • Nursing Diagnoses for Steve:

    • Ineffective Airway Clearance and Fatigue with a risk for non-compliance.

  • Interventions for Ineffective Airway Clearance: Aim to clear the airway and encourage hydration, appropriate positioning.

  • Non-compliance Interventions: Reinforce treatment importance, identify support systems, and explore direct observed therapy (DOT) options.

Care of Hospitalized Patients

  • Isolation Techniques: Implement strategies to prevent infection spread including negative airflow rooms; use of cough etiquette during patient transport.

Evaluation of Treatment Progress

  • Key Outcomes: Patients completing therapy for latent TB must not progress to active TB.

  • Monitoring Contacts: Evaluate contacts for TB exposure and treatment as necessary.