Tuberculosis Answers - tb notes PDF

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tb notes...

Description

TUBERCULOSIS Definition

Transmission

Pathophysiology

Incidence of TB

Prevalence (who is at risk)

Highly communicable disease caused by Mycobacterium tuberculosis. It is one of the most common bacterial infections worldwide The organism is transmitted via aerosolization (i.e., an airborne route). When a person with active TB coughs, laughs, sneezes, whistles, or sings, droplets are airborne and may be inhaled by others. Far more people are infected with the bacillus than actually develop active TB. M. tuberculosis is a slow-growing, acid-fast rod transmitted via the airborne route. People most often infected are those having repeated close contact with an infectious person who has not yet been diagnosed with TB. The risk for transmission is reduced after the infectious person has received proper drug therapy for 2 to 3 weeks, clinical improvement occurs, and acid-fast bacilli (AFB) in the sputum are reduced Worldwide, 8.7 million people were diagnosed and an additional 1.4 million people died from TB in 2012 The incidence of TB has been steadily decreasing in North America, although increases in incidence are seen in many other countries In North America, the people who are at greatest risk for development of TB are: Those in constant, frequent contact with an untreated person Those who have decreased immune function or HIV People who live in crowded areas such as long-term care facilities, prisons, homeless shelters, and mental health facilities Older homeless people Abusers of injection drugs or alcohol Lower socioeconomic groups Foreign immigrants (especially from Mexico, the Philippines, Vietnam, China, Japan, and Eastern Mediterranean countries

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Latent TB Active TB Clinical manifestations

History taking

Diagnostic test

Inactive TB; you have TB but show no signs Actually have the disease Progressive fatigue Malaise Anorexia Weight loss Chronic Productive Cough Night Sweats Hemoptysis (advanced TB) Pleuritic Chest Pain Lowe Grade Temperature in the late afternoon Assess the patient's past exposure to TB. Ask about his or her country of origin and travel to foreign countries where incidence of TB is high. It is important to ask about the results of any previous tests for TB. Patient has had bacille Calmette-Guérin (BCG) vaccine, which contains attenuated tubercle bacilli. Anyone who has received BCG vaccine within the previous 10 years will have a positive skin test that can complicate interpretation (Heavey, 2013). Usually the size of the skin response decreases each year after BCG vaccination. These patients should be evaluated for TB with a chest x-ray or the QuantiFERON-TB Gold test. Manifestation of signs/symptoms NAA test (results in 2 hr) – Rapid Results Blood analysis by an enzyme-linked immunosorbent assay using the QuantiFERON-TB Gold (QFT-G) is a relatively rapid test for the presence of M. tuberculosis. Results are ready in 24 hours Sputum smear for acid-fast bacillus Sputum culture of M. tuberculosis – Confirms Diagnosis Chest X Ray Tuberculin (Mantoux) test – PPD given intradermally in forearm Induration of 10 mm or greater diameter = Positive for exposure

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Patient education

Drug Isoniazid

Route PO

Rifampin

PO

Pyrazinamid e

PO

Ethambutol

PO

Strict adherence to the prescribed drug regimen is crucial for suppressing the disease. Strict adherence to the prescribed drug regimen is crucial for suppressing the disease. Teach him or her to prevent nausea by taking the daily dose at bedtime. Antiemetics may also prevent this problem. Instruct him or her to eat a well-balanced diet that includes foods that are rich in iron, protein, and vitamins C and B. When teaching the patient and family with either MDR TB or XDR TB, stress that it is the organism, not the patient that is drug resistant. Teaching infection control strategies is a priority and should be constantly reinforced. Side Effects Nursing Implications Impaired renal function Peripheral neuropathy, Elevated SGOT, SGPT, bilirubinemia, jaundice, nausea, vomiting, pancreatitis, metabolic acidosis, gynecomastia, rheumatic syndrome, SLE like syndrome Stain teeth GI disturbances, jaundice, HA, fever, pain in extremities Elevated BUN, uric acid, rash Hepatitis, liver dysfunction, gout, GI disturbances, arthralgia, myalgia, blood dyscrasias Dermatitis, pruritus, joint pain, GI upset, fever, malaise, headache, dizziness, confusion, peripheral neuritis, gout, reduced visual acuity, optic neuritis

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