TUBERCULOSIS- SUP GUIDES

c. What might the RN wear or use in the hospital while caring for a patient with suspected/known TB?

*disposable particulate respirators* that fit snugly around the face. air purifying respirator -GOWN- possibiity of clothing contamination exists

how LONG must the nurse wait to READ the TB SKIN TEST once placed?

-test result is read *48 to 72 hours after injection.* -Tests read after 72 hours= tend to underestimate the true size of induration (raised hard area or swelling). -*delayed localized reaction*= person is *sensitive to tuberculin.*

how much VOLUME is injected?

0.1 mL of PPD is injected, creating an elevation in the skin, a well-demarcated wheal 6 to 10 mm in diameter

Who are more likely to spread TB?

Adults- produce strong cough

How does the clinician know if the client needs continual therapy?

CHEST X-RAY - shows improvement

RISK FACTORS- TB

Close contact with someone who has active TB. Inhalation of airborne nuclei from an infected person is proportional to the amount of time spent in the same air space, the proximity of the person, and the degree of ventilation. Immunocompromised status (e.g., those with HIV infection, cancer, transplanted organs, and prolonged high-dose corticosteroid therapy). Substance abuse (IV/injection drug users and alcoholics). Any person without adequate health care (the homeless; impoverished; minorities, particularly children <15 years and young adults between ages 15 and 44 years). Preexisting medical conditions or special treatment (e.g., diabetes, chronic kidney injury, malnourishment, selected malignancies, hemodialysis, transplanted organ, gastrectomy, and jejunoileal bypass). Immigration from or recent travel to countries with a high prevalence of TB (southeastern Asia, Africa, Latin America, Caribbean). Institutionalization (e.g., long-term care facilities, psychiatric institutions, prisons). Living in overcrowded, substandard housing. Being a health care worker performing high-risk activities: administration of aerosolized pentamidine and other medications, sputum induction procedures, bronchoscopy, suctioning, coughing procedures, caring for the immunosuppressed patient, home care with the high-risk population, and administering anesthesia and related procedures (e.g., intubation, suctioning).

3 GROUPS OF RISK- INTERPRETING THE MANTOUX

HIGH- MEDIUM LOW

Who are we most worried about acquiring TB and why?

HIV - immunocompromised; quick progression of TB

b. Isolation? What sorts of measures are taken?

Initiate AFB isolation precautions immediately for all patients who are *suspected or confirmed* to have active TB and *who may be infectious.* *private room with negative pressur*e in relation to surrounding areas and a minimum of six air exchanges per hour. Air from the room should be exhausted directly to the outside. The use of *ultraviolet lamps* and/or *high-efficiency particulate air filters* to supplement ventilation may be considered. Persons entering the AFB isolation room should use *disposable particulate respirators* that fit snugly around the face. Continue AFB isolation precautions *until there is clinical evidence of reduced* *infectiousness (i.e., cough has substantially* *decreased and the number of organisms on* *sequential sputum smears is decreasing).* If drug resistance is suspected or confirmed, continue AFB precautions until the sputum smear is negative for AFB. Use special precautions during cough-inducing procedures

5. Explain the difference in healthy, latent TB infection and active TB infection

LATENT TB- infected but DO NOT SHOW S&SX -immune system limits the infection by enclosing tb bacteria with in a ganuloma -as long as bacteria in contained in the granuloma, you will not show any sx, & ARE NOT CONTAGIOUS, -GRANULOMAS -can be seen in x-ray --------------------------

2. What is the name of the causative agent?

MYCOBACTERIUM TUBERCULOSIS

PPD

Purified Protein Derivative

a. Medications:

RIPE R-ifampin I-sonizaid P-yrazinamide E-thambutol

What four drugs are used in initial treatment? How long does it last?

RIPE Rifampin Isoniazid- INH Pyrazinamide Ethambutol -RIPE for 2 MONTH (INITIAL PHASE)

What meds are continued beyond into the next phase?

Rifamin INH -RI for 4 MONTHS (CONSOLIDATION PHASE)

LATENT TB

TB lives but does not grow in the body does not make a person sick or have sx cannot spread from person to person can advance to TB disease

TST

Tuberculin Skin Test

ACTIVE TB

active and grows in the body makes a person feel sick & have sx can spread from person - person can cause death if NOT TREATED

LOW risk TB >15mm

anyone -any person, inc persons w/ no known risk factors of tb

positive skin test

bulge, "indurated", red - does NOT mean that ACTIVE DISEASE IS PRESENT - BUT indicates prev exposure to TB or presence of INACTIVE (DORMANT) disease -once skin test is POSTIVE, CHEST XRAY is necessary to rule out ACTIVE TB, or to detect OLD HEALED lesions

7. Describe the lower respiratory tract symptoms found in clients with TB.

cough- chronic bloody sputum- hemoptysis trouble breathing chest pain - pleurtic

3. How is TB transmitted from person to person

coughing, sneezing, TALKING, SINGING, LAUGHING

6. Describe constitutional symptoms and list what they include for TB.

fever (low grade) / chills night sweats weight loss anorexia, not eating much, vomiting malaise

negative skin test

flat, red

induration?

hardening reaction occurs when both induration and erythema (redness) are present. After the area is inspected for induration, it is lightly palpated across the injection site, from the area of normal skin to the margins of the induration. *diameter of the induration (not erythema)* is measured in *millimeters at its widest part* (, and the size of the induration is documented. Erythema without induration is NOT considered significant.

proper route for placement of TB test

intradermalp purified protein derivative (PPD), is injected into the intradermal layer of the inner aspect of the forearm, approximately 4 inches below the elbow . Intermediate-strength PPD, in a tuberculin syringe with a half-inch 26- or 27-gauge needle, is used. needle, with the bevel facing up, is inserted beneath the skin. T

2. How do we prevent the spread of TB from one person to another?

medications- RIPE isolation- airborne

8. What is the time frame around active TB infection and presentation of symptoms

more than 3 wks

HIGH risk TB - >5 mm

positive: immunocomprised: - HIV positive or have HIV risk factors and are of unknown HIV status, - close contacts of someone with active TB, or suspected of having TB -clients w/ organ transplant (Recipients) -CORTICOSTEROID THERAPY - who have chest x-ray results consistent with TB.

MEDIUM risk TB > 10 mm

positive: normal or mildly impaired immunity - moved fr country where TB is prevalent/ IMMIgrants - live or work in highly populous settings -residents/ employees in high-risk congregate settings - IV drug users -mycobacteriology lab personnel persons w/ clinical conditions -children <4yrs old -infants/children/adolescents exposed to adults in high rish categores

4. How is it NOT spread (commonly)?

sharing food or drink, touching objects in environment

WHAT SHOULD PT WEAR when leaving the room for TEST or proedure

surgical mask

Why are multiple medications used?

to ensure eradication of the organisms to prevent relapse/ resistance

Goals of treatment include:

to prevent disabilitiy and death from infection to reduce the spread of infection to other individuals