Infection- Tuberculosis, Meningitis/ Bioterrorism & Epidemics

Active TB test results...

+ TB skin test + Blood test + sputum smear Abnormal chest xray

Latent TB test results

+ TB skin test + blood test Normal chest xray Normal sputum smear

TB Skin testing

0.1 mL of PPD in forearm Read in 48-72 hours Cant see induration, must feel it.

Positive TB skin test

10 mm or greater of induration and indicateds exposure to TB (latent or active) Except immunocompromised- positive test may be 5mm.

Bacterial meningitis treatment

2 weeks IV antibiotics

The nurse has been instructed to administer tuberculosis (TB) medication to a patient who has been noncompliant by directly observed therapy. Which statement by the nurse will assist the patient in understanding this therapy? A. "You must swallow your pills in front of me." B. "It is necessary for you to call me right after you take your medications." C. "I will check your pill bottles every day to make sure you are taking your medications." D. "I will meet you at the pharmacy to make sure you are picking up the correct prescriptions."

A A. "You must swallow your pills in front of me."

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client? A. Assessing neurologic status at least every 2 to 4 hours B. Decreasing environmental stimuli C. Managing pain through drug and nondrug methods D. Strict monitoring of hourly intake and output

A A. Assessing neurologic status at least every 2 to 4 hours

The nurse is teaching a patient newly diagnosed with tuberculosis (TB) about the medication and treatment regimen for this disease. What information does the nurse include when teaching this patient?A. Avoid alcohol while taking the medications unless the provider says otherwise. B. Do not participate in even nonstrenuous exercise while taking these medications. C. Have the skin test repeated periodically to evaluate the drug therapy's effectiveness. D. Most people can be effectively treated with one or two medications.

A A. Avoid alcohol while taking the medications unless the provider says otherwise. Because many first-line medications for TB treatment can cause hepatotoxicity, the patient should be cautioned against consuming alcohol. It is not necessary to avoid exercise.

A patient is about to begin drug therapy for the treatment of tuberculosis (TB). What information is most important for the nurse to give to this patient prior to the start of therapy? A. Do not drink alcohol. B. Take medications in the morning. C. Eat foods high in carbohydrates. D. Limit ingestion of orange or grapefruit juice.

A A. Do not drink alcohol.

A patient is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The patient calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampin

A A. Ethambutol Ethambutol can cause optic neuritis leading to blindness at high doses. When discovered early and when the drug is stopped, problems can usually be reversed.

A patient who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the patient? A. Isoniazid, rifampin, pyrazinamide (PZA), ethambutol B. Metronidazole, acyclovir, flunisolide, rifampin C. Prednisone, guaifenesin, ketorolac, pyrazinamide (PZA) D. Salmeterol, cromolyn sodium, dexamethasone, isoniazid

A A. Isoniazid, rifampin, pyrazinamide (PZA), ethambutol

A patient returns to the clinic to have the tuberculosis (TB) Mantoux test analyzed by the nurse, which was administered 2 days ago. The patient's left forearm shows a red raised area, which measures 10 mm in diameter. How does the nurse document this finding? A. Positive reaction that indicates exposure to and the possible presence of TB infection B. Positive reaction that indicates the presence of active TB infection C. Possible false-positive reading; the test will need to be read again at 72 hours D. Possible false-negative reading; the test will need to be administered again

A A. Positive reaction that indicates exposure to and the possible presence of TB infection

TB treatment is...

A rigorouse med regimen that can be difficult to follow through with and could cause drug resistant TB if not completed. MUST TAKE AS PRESCRIBED!

A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following actions should the nurse take when performing this technique? (Select all that apply.) A. Place client in supine position. B. Flex client's hip and knee. C. Place hands behind the client's neck. D. Bend client's head toward chest. E. Straighten the client's flexed leg at the knee.

A,C,D A. Place client in supine position. C. Place hands behind the client's neck. D. Bend client's head toward chest.

A nurse evaluates the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible viral meningitis? (Select all that apply.) A. Clear B. Cloudy C. Increased protein level D. Normal glucose level E. Bacterial organisms present F. Increased white blood cells

A,C,D A. Clear C. Increased protein level D. Normal glucose level

A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include in the teaching? (Select all that apply.) A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum

A,C,D,E A. Persistent cough C. Fatigue D. Night sweats E. Purulent sputum

Which people are at greatest risk for developing tuberculosis in the United States? select all that apply A. an alcoholic homeless man who occasionally stays in a shelter B. a college student sharing a room in a dormitory C. a person with immune dysfunction or HIV D. a homemaker who does volunteer work at a homeless shelter E. immigrants (especially those from the Philippines and Mexico) F. an adult living in a crowded area such as a long-term-care facility

A,C,E,F A. an alcoholic homeless man who occasionally stays in a shelter C. a person with immune dysfunction or HIV E. immigrants (especially those from the Philippines and Mexico) F. an adult living in a crowded area such as a long-term-care facility

After several weeks of "not feeling well", a patient is seen in the health care provider's office for possible tuberculosis. If TB is present, which assessment findings does the nurse expect to observe? Select all that apply a. fatigue b. weight gain c. night sweats d. chest soreness e. low-grade fever f. shortness of breath

A,C,E,F a. fatigue c. night sweats e. low-grade fever f. shortness of breath

Which factors are associated with viral meningitis? (Select all that apply.) A. Condition is usually self-limiting; full recovery is expected. B. Manifestations vary according to the state of the immune system. C. Cerebrospinal fluid (CSF) is hazy. D. No organisms grow from the CSF. E. Outbreaks occur in crowded conditions such as dormitories.

A,D A. Condition is usually self-limiting; full recovery is expected. D. No organisms grow from the CSF.

The female patient is receiving isoniazid (INH) to treat tuberculosis. Which teaching points are essential for the nurse to review with the patient? Select all that apply a. do not take medications such as Maalox with this medication b. avoid drinking alcoholic beverages c. the urine will be orange in color d. take multivitamin with B complex e. if going out in the sun, be sure to wear protective clothing and sunscreen f. this drug reduces the effectiveness of oral contraceptives

A,D,B a. do not take medications such as Maalox with this medication b. avoid drinking alcoholic beverages d. take multivitamin with B complex

The nurse performs follow-up care for a group of patients who have previously had tuberculosis. Which patients are most at risk for developing secondary tuberculosis (TB)? Select all that apply. A. A 34-year-old with HIV infection B. A 55-year-old who recently had abdominal surgery C. A 14-year-old who is recovering from a broken femur D. A 75-year-old who is recovering from a hip replacement E. A 7-year-old who is undergoing chemotherapy for leukemia

A,D,E A. A 34-year-old with HIV infection D. A 75-year-old who is recovering from a hip replacement E. A 7-year-old who is undergoing chemotherapy for leukemia

A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse plan to take? (Select all that apply.) A. Implement seizure precautions. B. Perform neurological checks four times a day. C. Administer morphine for the report of neck and generalized pain. D. Turn off room lights and television. E. Monitor for impaired extraocular movements. F. Encourage the client to cough frequently.

A,D,E A. Implement seizure precautions. D. Turn off room lights and television. E. Monitor for impaired extraocular movements.

A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask? A. "Do you live in a crowded residence?" B. "When was your last tetanus vaccination?" C. "Have you had any viral infections recently?" D. "Have you traveled out of the country in the last month?"

A. A. "Do you live in a crowded residence?"

TB Interventions

Airborne precautions Negative pressure room Educate client about importance of medication compliance Incentive spirometer Promote nutrition

Common Bioterrorism Agents

Anthrax Plaque Botulism Smallpox Ebola

Fungal meningitis treatment

Antifungals

Viral meningitis treatment

Antivirals

A home health nurse is teaching a client who has active tuberculosis. The provider has prescribed the following medication regimen: isoniazid 250 mg PO daily, rifampin500 mg PO daily, pyrazinamide 750 mg PO daily, and ethambutol 1 mg PO daily. Which of the following client statements indicate the client understands the teaching? (Select all that apply.) A. "I can substitute one medication for another if I run out because they all fight infection." B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area." D. "I am glad I don't have to have any more sputum specimens." E. "I don't need to worry where I go once I start taking my medications.

B B. "I will wash my hands each time I cough."

A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching? A. "You will need to continue to take the multi-medication regimen for 4 months." B. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication." C. "You will need to remain hospitalized for treatment." D. "You will need to wear a mask at all times."

B B. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication."

The nurse is caring for a patient who has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally each day. At what time should the nurse teach this patient to take this medication? A. An hour before bedtime B. An hour before breakfast C. Immediately after breakfast D. Immediately before breakfast

B B. An hour before breakfast Isoniazid must be taken on an empty stomach to ensure adequate medication absorption so the best time for the patient to take this medication is an hour before breakfast.

Which method is the best way to prevent outbreaks of pandemic influenza? A. Avoiding public gatherings at all time B. Early recognition and quarantine C. Vaccinating everyone with pneumonia vaccine D. Vaccination for pandemic influenzae

B B. Early recognition and quarantine

The nurse is reviewing the electrolyte values for a patient with bacterial meningitis and notes that the serum sodium is 126 mEq/L. How does the nurse interpret this finding? A. Within normal limits considering the diagnosis of bacterial meningitis B. Evidence of syndrome of inappropriate antidiuretic hormone (SIADH), which is a complication of bacterial meningitis C. A protective measure that causes increased urination and therefore reduces the risk of increased intracranial pressure (ICP) D. an early warning sign that the electrolyte imbalances will potentiate an acute myocardial infarction (AMI) or shock

B B. Evidence of syndrome of inappropriate antidiuretic hormone (SIADH), which is a complication of bacterial meningitis

A nurse is assessing a client who reports severe headache and a stiff neck. The nurse's assessment reveals positive Kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first? A. Administer antibiotics. B. Implement droplet precautions. C. Initiate IV access. D. Decrease bright lights.

B B. Implement droplet precautions

A patient with suspected tuberculosis is admitted to the hospital. Along with a private room, which nursing intervention is appropriate related to isolation procedures? a. airborne and contact isolation for sputum only b. strict airborne precautions and use of specifically fitted respirator face masks c. airborne isolation with surgical masks until diagnosis is confirmed d. only standard precautions are necessary until the diagnosis is confirmed

B B. strict airborne precautions and use of specifically fitted respirator face masks

A patient diagnosed with tuberculosis has been receiving treatment for 3 months and has clinically shown improvement. The family asks the nurse if the patient is still infectious. What is the nurse's best reply? a. "The patient is still infectious until the entire treatment is completed" b. "the patient is likely not infectious but needs to continue treatment for at least 6 months" c. "the patient is infectious until there is a negative chest x-ray" d. "the patient may or may not be infectious; a purified protein derivative test (PPD) must be done"

B b. "the patient is likely not infectious but needs to continue treatment for at least 6 months"

Which is the most effective way for a college student to minimize the risk for bacterial meningitis? a. Avoid large crowds b. Get the meningococcal vaccine. c. Take a daily vitamin. d. Take prophylactic antibiotics.

B b. Get the meningococcal vaccine

Which test is the most accurate and rapid test for tuberculosis? a. chest x-ray b. nucleic acid amplification test (NAAT) c. tuberculin test (Mantoux test) d. sputum cultures

B b. nucleic acid amplification test (NAAT)

A public health nurse is providing education to a community about preparation for a possible influenza epidemic leading to a worldwide pandemic. What does the nurse instruct community members to do upon learning that an influenza outbreak has occurred? A. Attend meetings to learn how to manage the outbreak. B. Obtain a vaccine if not already vaccinated against influenza. C. Stock their homes with a 2-week supply of food and medicine. D. Take antiviral medications to prevent developing symptoms

B B. Obtain a vaccine if not already vaccinated against influenza.

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy? A. To allow for missed doses B. To shorten therapy by 6 months C. To treat highly resistant cases of tuberculosis D. To improve the patient's ability to tolerate medications

B B. To shorten therapy by 6 months Combination medication shortens therapy by 6 to 12 months.

A patient arrives in the emergency department reporting headache, fever, nausea, and photosensitivity. The patient has been living in close proximity with two people who were diagnosed with meningitis. Which diagnostic test does the nurse anticipate the physician will order to rule out meningitis? a. X-rays of the skull b. Lumbar puncture c. Myelography d. Cerebral angiogram

B b. Lumbar puncture

A nurse is planning care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Monitor for bradycardia. B. Provide an emesis basin at the bedside. C. Administer antipyretic medication. D. Perform a skin assessment. E. Keep the head of the bed flat.

B,C,D B. Provide an emesis basin at the bedside. C. Administer antipyretic medication. D. Perform a skin assessment.

Which statements about the precautions of caring for a hospitalized patient with tuberculosis (TB) are true? Select all that apply a. health care workers must wear a mask that covers the face and mouth b. negative airflow rooms are required for these patients c. health care workers must wear an N95 or high-efficiency particulate air (HEPA) mask d. gown and gloves are included in appropriate barrier protection e. strict contact precautions must be maintained f. careful handwashing is required before and after providing patient care

B,C,D,F b. negative airflow rooms are required for these patients c. health care workers must wear an N95 or high-efficiency particulate air (HEPA) mask d. gown and gloves are included in appropriate barrier protection f. careful handwashing is required before and after providing patient care

A patient has acute tuberculosis. Which drugs will the health care provider order during the initial phase of treatment? Select all that apply a. bedaquiline fumarate b. isoniazid c. rifampin d. bacilli Calmette-guerin e. ethambutol f. pyrazinamide

B,C,E,F b. isoniazid c. rifampin e. ethambutol f. pyrazinamide

Most deadly type of meningitis?

BACTERIAL

TB Prevention

Bacille Calmette-Guerin (BCG) Vaccine Will test positive on skin test for up to 10 years. Not routinely given in the US but is given in other countries. Annual screenings for healthcare workers, those from countries with high rates of TB, and those who are at high risk. Close contacts should get tested

Meningitis treatment

Broad specturm antibiotic until the CSF culture results Then treatment is dependent on the cause

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi-medication regimen. Which of the following instructions should the nurse give the client related to ethambutol? A. "Your urine can turn a dark orange." B. "Watch for a change in the sclera of your eyes." C. "Watch for any changes in vision." D. "Take vitamin B6 daily."

C C. "Watch for any changes in vision."

A nurse is preparing to administer a new prescription for isoniazid (INH) to a client who has tuberculosis. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. "You might notice yellowing of your skin." B. "You might experience pain in your joints." C. "You might notice tingling of your hands." D. "You might experience a loss of appetite."

C C. "You might notice tingling of your hands."

A patient has a positive skin test result for tuberculosis. What explanation does the nurse give to the patient? A. "there is active disease, but you are not yet infections to others" B. "there is active disease, and you need immediate treatment" C. "you have been infected, but this does not mean active disease is present" D. "a repeat skin test is necessary because the test could give a false-positive result"

C C. "you have been infected, but this does not mean active disease is present"

The nurse is teaching a patient about isoniazid (INH) and rifampin (RIF) drug therapy for tuberculosis (TB). The nurse instructs that while on these medications, the patient should avoid consuming which food? A. Dairy B. Red meat C. Alcohol D. Eggs

C C. Alcohol

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease? A. Eat a diet rich in Vitamin K. B. Do not drink alcoholic beverages. C. Take the medication exactly as prescribed. D. Contact the health care provider if you become ill.

C C. Take the medication exactly as prescribed.

A previously infected patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which was likely a factor in this occurrence? A. Allergy testing 6 months ago B. Pneumonia vaccine 2 months ago C. Taking prednisone for the past 3 weeks D. Fracture of a rib 1 week ago

C C. Taking prednisone for the past 3 weeks Secondary TB is reactivation of the disease in a previously infected person. This most likely happens when the immune system is lowered, as occurs with corticosteroid drugs such as prednisone, which suppress the immune response

A nurse is reviewing the use of the meningococcal vaccine (MCV4) for the prevention of meningitis with a newly licensed nurse. Which of the following information should the nurse include? A. The vaccine is indicated to reduce the risk of respiratory infection. B. The vaccine is administered in a series of four doses. C. The vaccine is recommended for adolescents before starting college. D. The vaccine is initially given at 2 months of age.

C C. The vaccine is recommended for adolescents before starting college.

After being discharged from the hospital, a patient is diagnosed with tuberculosis at the outpatient clinic. What is the correct procedure regarding public health policy in this case? A. contact the infection control nurse at the hospital because the hospital is responsible for follow-up of this case B. there are no regulations because the patient was diagnosed at the clinic and not during hospitalization C. contact the public health nurse so that all individuals who have come in contact with the patient can be screened D. have the patient sign a waiver regarding the hospital and clinic's liability for treatment

C C. contact the public health nurse so that all individuals who have come in contact with the patient can be screened

The nurse is caring for a patient who was admitted for diagnosis of meningococcal meningitis. Which nursing action is specific to this type of meningitis? a. Administer an antifungal agent such as amphotericin B as ordered. b. Observe the patient for genital lesions. c. Place the patient in isolation per hospital procedure. d. Check to see if the patient is HIV-positive.

C c. Place the patient in isolation per hospital procedure

A patient taking ethambutol for tuberculosis is receiving discharge teaching from the nurse. What is the most important sign or symptom of a serious adverse reaction to this medication that the nurse should teach this patient? A. Fatigue B. Anorexia C. Changes in vision D. Aching of the feet

C C. Changes in vision

The nurse is counseling a young woman about drug therapy with isoniazid and rifampin to treat tuberculosis. Before developing the teaching plan, what must the nurse assess for first? A. Color blindness B. Susceptibility to sunburn C. Contraceptive methods used D. History of gout

C C. Contraceptive methods used

The nurse is caring for a patient who has symptoms and risk factors for bacterial meningitis. For which symptom must the nurse alert the physician? A. Capillary refill of 3 seconds B. Headache with nausea and vomiting C. Inability to move eyes laterally D. Oral temperature of 101.6F.

C C. Inability to move eyes laterally

Category C biological agents

Can be engineered for mass dissemination Easy to produce Potential for high morbidity and high mortality rates

TB Treatment

Combination drug therapy for 26 weeks - 2 years Directly observed

Fungal meningitis

Common in AIDS patients Caused by crytococcus neoformans

Sputum Culture

Confirms diagnosis Takes up to 4 weeks Usually negative after 3 months of treatment Done monthly during treatment Not contagious after 3 negative cultures

Active TB

Contagious only when showing symptoms. Risk of transmission is reduced after infected patient has been on medications for 203 weeks. Routine sputum tests determine when no longer contagious

TB s/s

Cough weakness weight loss night sweats chest tightness fever

A patient who has begun standard multidrug treatment for tuberculosis (TB) reports orange-tinged sputum and urine. The nurse tells the patient that this symptom represents which response to the treatment regimen? A. Drug resistance with spread of infection B. Hemolysis and a potential for anemia C. Hepatotoxicity caused by drinking alcohol D. Normal drug side effects of rifampin

D D. Normal drug side effects of rifampin

A patient has been compliant with drug therapy for tuberculosis and has returned as instructed for follow-up. Which result indicates that the patient is no longer infections/communicable? A. negative chest x-ray B. no clinical symptoms C. negative skin test D. three negative sputum cultures

D D. three negative sputum cultures

After receiving the subcutaneous Mantoux skin test, a patient with no risk factors returns to the clinic in the required 48-72 hours for the test results. Which assessment finding indicates a positive result? A. test area is red, warm, and tender to touch B. there is induration or a hard nodule of any size at the size C. induration/hardened area measures 5mm or greater D. induration/hardened area measures 10mm or greater

D D. induration/hardened area measures 10mm or greater

The nurser is carefully monitoring a patient with a severe case of encephalitis for signs of increased ICP. what vital sign changes are associated with increased ICP? a. Tachycardia and shallow, rapid respirations b. Increased core temperature and bradycardia c. Decreased pulse pressure and tachypnea d. Widened pulse pressure and bradycardia

D d. Widened pulse pressure and bradycardia

A nurse prepares to provide perineal care to a client with meningococcal meningitis. Which personal protective equipment should the nurse wear? (Select all that apply.) A. Particulate respirator B. Isolation gown C. Shoe covers D. Surgical mask E. Gloves

D, E D. Surgical mask E. Gloves

Bacterial meningitis precautions...

Droplet

Ethambutol Side effects

E=EYES (changes to vision) Neuritis, blindness

Secondary Prevention (bioterrorism)

Early recognition: Increased # of disease from baseline Illness unusual for certain areas Clusters of unsual symptoms Implenting infection control measures (decontamination, quarantine) Screening for exposures Administering vaccines Educating the public

Airborne Respirator Precautions

Everyone must wash hands when entering and leaving room Staff must wear PAPR or fitted N95 mask prior to entering. Airborne infection isolation room required Keep door closed

Delivery for agents

Food and water contamination airborne droplet or blood contact

TB Risk factors

Frequent and close contact with an untreated individual Lower socioeconomic status and homelessness Immunocompromised (HIV, chemo, Kidney disease, diabetes, Crohn's disease) High populated areas Poorly ventilated, crowded environments (prison) Drug use Immigration Recent travel outside of the US to areas where TB is endemic Advanced age

Meningitis preventions

General vaccines: Haemophius influenzae B (Hib) Pneumococcal Mumps Varicella Meningitis vaccination: Meningococcal Prophylactic treatment: If exposed to N. meningitidis or H influenzae meningitis -Rifampin and ciprofloxacin or rocephin

Sputum testing (NAAT test = smear)

Gold standard Nucleic acid amplification tests (NAAT) Results available within 2 hours most accurate and rapid test

Meningitis symptoms in older children and adults

High fever headache joint pain aching muscles dislike bright lights sometimes red or purple spots or bruises on the skin confusion and sleepiness Stiff neck vomiting

Meningitis Symptoms in babies

High fever (may have cool hands and feet or shivering) Unusual crying Dislike bright lights Refusal to feed Sloppy or floppy or harder to wake stiff neck vomiting sometimes red or purple spots or bruises on the skin

mannitol drip if...

Increased ICP is present. helps decrease pressure in brain.

What is Meningitis?

Inflammation of the meninges of the brain and spinal cord Caused by organisms that enter the CNS directly or through the bloodstream

TB treatment continuation phase

Isoniazid and rifampin for the next 18+ weeks

Positive PPD skin test means...

It could be latent of active. will need more definitive testing to determine active/latent

Latent vs secondary

Latent hasn't caused illness yet Secondary was cured and has come back again (had it and not have it again)

Rifampin, pyrazinamide, and Ethambutol all cause...

Liver damage!

Latent TB

Lives in the body but doesnt make you sick. May turn to active TB if not treated especially in those who are immunocompromised.

Category B biological agents

Moderately easy to disseminate Have high mobidity rates Low mortality rates

Meningitis interventions

Monitor neurological status q2-4h Vascular assessment q4h Decrease environmental stimuli Monitor for signs of increased ICP and hydrocephalus Seizure precautions Manage pain

Viral meningitis

Most common type No organisms cultured from CSF Caused by enterovirus, herpes simplex, varicella zoster, HIV, and mumps

Physical assessment findings (TB in Older adults)

Often present with atypical symptoms of the disease Altered mentation or unusual behavior fever anorexia weight loss

TB Chest Xray

Ordered on patient with +PPD Can show active disease or old healed lesions. Old TB= scarring New= encapsulated and infection

Epidemic

Outbreak over a greater area

Primary prevention (bioterrorism)

Participate in planning for response in the event of attack Plans for measures to contain and control spread if attack occurs - drills - vaccine supplies - treatments

TB Assessment findings

Persistent cough (longer than 3 weeks) purulent sputum, possibly blood-streaked Fatigue lethargy weight loss and anorexia night sweats and low grade fever in the afternoon

Pyrazinamide side effects

Photosensitivity

TB treatment Initial phase

RIPE Rifampin Isoniazid Pyrazinamide Ethambutol for the first 8 weeks. Different than RIPE if drug resistant TB

Secondary TB

Reactivation of TB in previously infected person.

Tertiary prevention (bioterrorism)

Rehabilitation of survivors Monitoring medication regimens and referrals Monitor effectiveness of the plan

Rifampin side effects

Secretion discoloration and decreased effectiveness of birth control

Meningitis Complications

Seixures Increased ICP SIADH d/t stimulation of the hypothalamic area of the brain SIRS/Sepsis

TB Blood tests

Show you have TB. QuantiFERON TB GOLD Xpert MTB/RIF Ultra

Outbreak

Specific area Within a time period > than expected

Precautions for other types of meningitis

Standard

Miliary TB

TB spread throughout the body. More systemic symptoms Lesions

Isoniazid nursing considerations

Taken on empty stomach Monitor for hepatotoxicity Vitamin B6 (pyridoxine) is used to prevent neurotoxicity from isoniazid Liver function testing should be completed prior to and then monthly during treatment Do not drink alcohol

Meningitis imaging

Try to locate the source of the original infection if not obivous CT scan or MRI of brain X rays of chest, sinuses, and mastoids Throat cultures Blood cultures Urine cultures

Most common type of Meningitis?

VIRAL!

Class A agents

Vaccines are no longer given for most of the agent that are used as weapons Agents that are highly fatal with low survival rates are chosen Easily transmissible agent

What is bioterrorism?

When a biological agent or toxin is eliberately used to cause death, illness, harm, fear, or economic damage

Pandemic

Widespread

Bacterial meningitis

caused by streptococcal pneumoniae and neisseria meningitidis Neisseria meningitidis causes meningococcal meningitis Medical emergency Deadly within 24 hrs if not treated Highly contagious Most often in highly populated areas (colleges) There is a vaccine for this type of meningitits

Endemic

confined to a particular country or area (specific location) Constant

Chest x ray...

helps determine latent or active TB

What is TB?

highly communicable disease that is caused by a bacteria called mycobacterium tuberculosis

Meningitis testing

lumbar puncture with CSF analysis. Determines what organisms are present

Agents

manufactured in a lab or grown in nature

Rifampin nursing considerations

observe for hepatotxicity Liver function testing should be completed prior to ad at least monthly after starting RIF

Meningitis Neuro checks

q2-4h Looking for changes ICP--> altered LOC, confusion, lethargy Impaired clotting --> amputation (complication)

Seizure precautions

suction, O2, padded rails, low bed, IV access Possible prophylactic antiseizure meds