tuberculosis a bacterial lung infection
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Tuberculosis A bacterial lung infection. What is the Cause?. Tuberculosis Causative Organism. Mycobacterium Tuberculosis Gram-positive, acid-fast bacillus ( AFB). Etiology and Pathophysiology. Brief exposure rarely causes infection - PowerPoint PPT PresentationTRANSCRIPT
Etiology and PathophysiologyBrief exposure rarely causes infectionTransmission requires close, frequent, or prolonged exposure
Inhaled bacilli pass down and lodge in the alveoli
Replicates slowly and spreads via the lymphatic system
Body immune system responds by initiating the inflammatory response.
Individuals at Risk Poor, underserved Homeless persons Residents of inner-city neighborhoods Foreign-born person Older adults Those in institutions (long-term care facilities,
prisons) Injection drug users Immunosuppressed Asian, native Hawaiian have highest reported cases
Classification System for TB
No TB exposureNot infected
No history of exposureNegative reaction to tuberculin skin test
TB exposureNo evidence of infection
History of exposureNegative reaction to tuberculin skin test
TB infectionNo disease
Positive reaction to tuberculin skin testNegative bacteriologic studies (if done)No clinical, bacteriological, or radiographic evidence of active TB
TB, clinically active M. tuberculosis cultured (if done)Clinical, bacteriological, or radiographic evidence of current disease
TBNot clinically active
History of episode(s) of TBor
Abnormal but stable radiographic findingsPositive reaction to the tuberculin skin testNegative bacteriologic studies (if done)
andNo clinical or radiographic evidence of current disease
TB suspected Diagnosis pending
Class Type Description
0
1
2
3
4
5
What can trigger What can trigger reactivation of reactivation of latent TB infection latent TB infection (LTBI)(LTBI)
Answer:Host’s defenses become impaired
Which of the following are Signs and Symptoms?
Select all that apply
a. Fatigueb. Non-productive coughc. Weight lossd. Sudden onset of high fever >1020
e. Night sweatsf. Anorexiag. Decreased movement of chest wall
Signs and Symptoms
Cough becomes frequentProduces white, frothy sputumHemoptysis is not common and is usually associated with advanced disease
ComplicationsPleural effusion and empyema
Caused by bacteria in pleural spaceInflammatory reaction with plural exudates of protein-rich fluid
TB pneumoniaLarge amounts of bacilli discharging from granulomas into lung or lymph nodes
Administering the Tuberculin Skin TestAdministering the Tuberculin Skin Test•Inject intradermally
•Produce wheal 6 mm to 10 mm in diameter
•Do not recap, bend, or breakneedles, or remove needles from syringes
•Follow universal precautions for infection control
Reading the Tuberculin Skin TestRead reaction 48-72 hours after injection
Measure only induration
Record reaction in millimeters
Positive reaction => 5 mm induration – high risk persons => 10 mm induration – moderate risk persons => 15 mm induration – low risk persons
Means that the person has been exposed to Tb and developed antibodies, does not differentiate between active and dormant Tb infection.
Factors that May Affect the Factors that May Affect the Skin Test ReactSkin Test Reactionion
Type of Reaction Possible Cause
False-positive Nontuberculous mycobacteria BCG vaccination
Anergy
False-negative Recent TB infection Very young age (< 6 months old) Live-virus vaccination Overwhelming TB disease
If a person has other symptoms and has a negative skin test, then the HCP would likely order a __________ ________?
Chest X-RayChest X-Ray•Does this chest x-ray confirm the diagnosis of Tb?
•Abnormalities often seen in apical or posterior segments of upper lobe or superior segments of lower lobe
Arrow points to cavity in patient's right upper lobe.
Bacteriologic StudiesSputum for AFB
QuantiFERON-TBBlood is obtained from patient and placed in container
with mycobacterial antigens. If the patient is infected with TB, the lympocytes in the blood will recognize these antigens and secrete interferon, a cytokine produced by lymphocytes. Test results are available in a few hours.
AFB (shown in red) are
tubercle bacilli
Sputum CulturesSputum Cultures•Use to CONFIRM diagnosis of TB
•Culture all specimens, even if smear negative
•Results in 4 to 14 days when liquid medium systems used
Colonies of M. tuberculosis growing on media
Goals of Nursing CareGoals:
Comply with therapeutic regimenHave no recurrence of diseaseHave normal pulmonary functionTake appropriate measures to prevent spread of disease
Drug TherapyActive disease
Patients should be taught about side effects and when to seek medical attention
Liver function should be monitored
Drug Side effects Nursing Implications
Isoniazid (INH) Noninfections hepatitisPeripheral neuropathyHypersensitivity
Give B6 pyridoxine as prophylactic against peripheral neuropathy
Assess for S&S of hepatitis (jaundice, yellow skin, dark urine, clay colored stools, pruritus)
Take on empty stomachAvoid foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts)
Check liver enzymes, BUN, Creatinine levels monthly
Rifampin (Rifadin)
GI disturbancesOrange discoloration of body fluids (sputum, urine, sweat, tears)
Metabolism of other meds and makes them ineffective such as cardiac meds and steroids.
Inform patient about orange discoloration of fluids/ urine
Discolor contact lenses
Drug Side effects Nursing Implications
Ethambutol Retrobulbar neuritis (decreased red-green color discrimination)
Get a baseline Snellen vision test and color discrimination and monthly when on high doses
Pyrazinamide (PZA)
Hepatoxicity, polyarthritis,Skin rash, hyperuricemia
Assess for S&S of hepatitis (jaundice, yellow skin, dark urine, clay colored stools, pruritus)
Monitor uric acid levels
Have newer drugs with combinations of these
Treatment GuidelinesInitiation Phase of Treatment
Multiple-medication regimen of all 4 medsAdministered daily for 8 weeks
Continuation Phase of Treatmentd/c ethambutol and continue other 3 meds Administered for 4-7 monthsPatient begins to feel better in this phase
Drug TherapyLatent TB infection
Individual is infected with M. tuberculosis, but does not have the disease. Usually has been exposed to someone with tuberculosis.
Usually treated with INH for 6 to 9 months
Monitoring Response to TreatmentMonitor patients bacteriologically monthly until cultures convert to negative
After 3 months of therapy, if cultures are positive or symptoms do not resolve, reevaluate for
Potential drug-resistant disease
Nonadherence to drug regimen
If cultures do not convert to negative despite 3 months of therapy, consider initiating DOT
Monitoring Response to Treatment
The patient asks how long The patient asks how long before he can be considered before he can be considered
non-contagious?non-contagious?
What is the appropriate What is the appropriate response? response?
Answer this
How would the nurse assess if the patient has been
compliant with taking their medications?
Direct Observation TherapyUsed with those patients who are noncompliant and do
not show signs of improvement after treatment. Noncompliance is major factor in multidrug resistance and treatment failures
Provide drugs directly to the patient and watch patient swallow drugs
Costly, but preferred to ensure adherence
If refuses DOT then may have to put involuntarily in treatment facility to protect the community.
Drug TherapyVaccine
Bacille Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of the world
- once person receives this vaccine, will have a false testing with the TST (TB Skin Test). For assessment, must have chest x-ray.
Nursing InterventionsWhat type of isolation is typically ordered? What PPE is worn? Who wears this equipment?What type of room are they in?
Patient TeachingCover nose and mouth with tissue when
coughing, sneezing, or producing sputum Hand washing after handling sputum-soiled
tissuesAmbulatory and home care
Fungal Infections - Who is at RiskSeriously ill patients being treated withCorticosteroidsAntineoplastic drugsImmunosuppressive drugs
Patients with AIDSPatients with Cystic Fibrosis
Fungal InfectionsHistoplasmosisCocciidiodomycosi
sBlastomycosisCryptococcosisAspreigillosis
Pneumocystis pneumonia
NocardiosisActinomycosisCandidiasis
Drug therapyAmphotericin B
IntravenousSide effects
Hypersensitivity reactionsFever and chillsMalaiseNausea and vomitingThrombophlebitis at injection site
Pre-medicate with Benadryl to increase tolerance and decrease hypersensitivity
Monitor renal functionEnsure adequate hydration
Drug TherapyOral Antifungal agents
ketoconazole (Nizoral)fluconazole (Sporanox; Difulcan)Flucytosine (Anobon)Monitor effectiveness with serology testing
Side EffectsN/V liver enzymesBone marrow depression – monitor WBC,
platelets
Signs and SymptomsProductive cough of purulent foul smelling and foul tasting sputum
Fever and chillsPleuritic painDyspneaWeight loss
Diagnosis
Sputum cultures – obtained first so can confirm
treatment modalities
Chest x-ray
Bronchoscopy
Treatment and Nursing CareDrug Therapy- Antibiotics
PenicillinClindamycin**Large doses of IV are required because the
antibiotic must penetrate the necrotic tissue and fluid in the abscess.
**May need to make home health referral for IV to be given at home
Antipyretics Chest physiotherapy and postural drainage