Tuberculosis - Common Test 1
b. admitting the patient to an airborne infection isolation room Rationale: A patient with class 3 TB has clinically active disease, and airborne infection isolation is required for active disease until the patient is noninfectious, indicated by negative sputum smears. Cardiac monitoring and observation will be done with the patient in isolation. The nurse will administer the antitubercular drugs after the patient is in isolation. There should be no need for suction or extra linens after the TB patient is receiving drug therapy.
A patient diagnosed with class 3 TB (TB infection with clinically active disease) 1 week ago is admitted to the hospital with symptoms of chest pain and coughing. What nursing action has the highest priority? a. administering the patients antitubercular drugs b. admitting the patient to an airborne infection isolation room c. preparing the patients room with suction equipment and extra linens d. placing the patient in an ICU, where he can be closely monitored.
c. take all medications for full length of time to prevent multi-drug resistant TB d. wear a standard isolation mask if leaving the airborne infection isolation room e. maintain precautions in airborne infection isolation room by coughing into a paper tissue.
A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? a. expect routine TST to evaluate infection b. visitors will not be allowed while in airborne isolation c. take all medications for full length of time to prevent multi-drug resistant TB d. wear a standard isolation mask if leaving the airborne infection isolation room e. maintain precautions in airborne infection isolation room by coughing into a paper tissue.
a. arrange for directly observed therapy (DOT) by a public health nurse Rationale: Notification of the public health department is required. If drug compliance is questionable, follow-up of patients can be made by directly observed therapy by a public health nurse. A patient who cannot remember to take the medication usually will not remember to come to the clinic daily or will find it too inconvenient. Additional teaching or support from others is not usually effective for this type of patient.
A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the meds all the time. What is the best action for the nurse to take? a. arrange for directly observed therapy (DOT) by a public health nurse b. schedule the patient to come to the clinic every day to take the medication c. have a patient who has recovered from TB tell the patient about his successful treatment d. schedule more teaching sessions so that the patient will understand the risks for noncompliance.
Primary TB - occurs when the bacteria are inhaled and initiate an inflammatory reaction. The majority of people amount effective immune responses to encapsulate these organisms for the rest of their lives, preventing primary infection from progressing to disease. Latent TB - occurs in a person who does not have active TB disease. People with LTBI have a positive skin test but are asymptomatic. These individuals cannot transmit the TB bacteria to others but can develop active TB disease at some point. Immunosuppression, diabetes mellitus, poor nutrition, aging, pregnancy, stress, and chronic disease can precipitate the reactivation of LTBI.
Classification of TB-define:
Yes, these individuals cannot transmit the TB bacteria to others but can develop active TB disease at some point. Immunosuppression, diabetes mellitus, poor nutrition, aging, pregnancy, stress, and chronic disease can precipitate the reactivation of LTBI.
Can someone with latent TB develop it in the future? If so, how?
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It usually involves the lungs, but any organ can be infected, including brain, kidneys, and bones.
Define tuberculosis
Teach patients to cover the nose and mouth with paper tissues every time they cough, sneeze, or produce sputum. The tissues should be thrown into a paper bag and disposed of with the trash or flushed down the toilet. Emphasize careful hand washing after handling sputum and soiled tissues. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Minimize prolonged visitation to other parts of the hospital.
Describe nursing interventions regarding the education of clients on the spread of TB.
Number of organisms expelled into the air, Concentration of organisms (small spaces with limited ventilation would mean higher concentration), Length of time of exposure, Immune system of the exposed person
Factors that influence the likelihood of transmission include:
M. tuberculosis is a gram-positive, acid-fast bacillus that is usually spread from person to person via airborne particles expectorated when breathing, talking, singing, sneezing, and coughing. A process of evaporation leaves small droplet nuclei suspended in the air for minutes to hours. These bacteria are then inhaled by another person. TB is not highly infectious, as transmission usually requires close, frequent, or prolonged exposure. The disease cannot be spread by touching, sharing food utensils, kissing, or any other type of physical contact.
How is TB spread?
2 weeks
How long are patients with a sputum smear-positive TB considered contagious once treatment has begun?
8 weeks
How long can it take to receive the results of the TB sputum culture?
A sputum specimen for AFB smear and culture should be obtained at a minimum of monthly intervals until two consecutive specimens are negative on culture.
How many consecutive negative AFB cmalr and culture studies are required to declare the TB patient noninfectious after treatment has begun?
Only one if contains tubercle bacilli = definitive diagnosis
How many positive sputum cultures are required for a definitive diagnosis of TB?
1. Ineffective breathing pattern related to decreased lung capacity 2. Ineffective airway clearance related to increased secretions, fatigue, and decreased lung capacity 3. Risk for infection (spread of infection to others) related to cough and sputum production, lack of knowledge of disease process, and social/economic circumstances 4. Noncompliance and ineffective health management related to lack of knowledge of disease process, lack of motivation, long-term nature of treatment and lack of resources
List 4 nursing diagnoses for the patient with TB?
Teaching and counseling, Reminder systems, Incentives or rewards, Contracts & DOT
List strategies to improve adherence to TB treatment:
a. Dry cough that frequently becomes productive with mucoid or mucopurulent sputum (bad cough that lasts more than 3 weeks) b. Pain in the chest c. Fatigue/weakness d. No appetite e. Unexplained weight loss f. Night sweats g. Fever h. Dyspnea & hemoptysis (blood in sputum) i. A change in cognitive function may be the only initial presenting sign of TB in an older person
List the s/s of Active TB.
Hepatitis, asymptomatic elevation of ASL, AST. Hepatitis is the priority: alcohol may increase hepatotoxicity of the drug, instruct patient to avoid drinking alcohol during treatment, monitor for signs of hepatitis before and while taking the drug.
Of the side effects of isoniazid, which would be the priority?
False - the Health department is required. The public health nurse is responsible for follow-up on household contacts and assessment of the patient for adherence.
The health department does not have to be notified of any patient with a diagnosis of TB. True/False
b. using masks and effective ventilation systems to reduce exposure to irritants Rationale: although all of the precautions identified in this question are appropriate in decreasing the risk of occupational lung diseases, using masks and effective ventilation systems to reduce exposure is the most efficient and affects the greater number of employees. The safety inspections are required.
To reduce the risk for many occupational lung diseases, what is the most important measure the occupation nurse should promote? a. maintaining smoke-free work environments for all employees b. using masks and effective ventilation systems to reduce exposure to irritants c. inspection and monitoring of workplaces by national occupational safety agencies d. requiring periodic chest x-rays and pulmonary function tests for exposed employees
A patient's nonadherence that affects public safety.
Under what circumstances are HCPs justified in overriding a patient's autonomy or decision making in regards to TB?
Involve social services to assist in obtaining the necessary resources or support for the patient to complete a course of treatment.
What alternatives of care can be offered to patients with poor access to health care?
1. Administering Respiratory Medications 2. Promoting optimal Respiratory Function a. Prevent Healthcare-associated pneumonia b. Promote Immunization c. Support smoking cessation d. Position for maximum ventilation e. Assist with incentive spirometry f. Take aspiration precautions 3. Mobilizing secretions a. Teach deep breathing and coughing j b. Maintain hydration c. Perform chest physiotherapy 4. Providing Oxygen Therapy 5. Suctioning airways
What are interventions for the nursing diagnosis Ineffective breathing pattern related to decreased lung capacity?
1. Teaching and counseling 2. Reminder systems 3. Incentives or rewards 4. Contracts & DOT
What are some nursing interventions for the nursing diagnosis Noncompliance and ineffective health management related to lack of knowledge of disease process, lack of motivation, long-term nature of treatment and lack of resources?
1. Teach patients to cover the nose and mouth with paper tissues every time they cough, sneeze, or produce sputum. The tissues should be thrown into a paper bag and disposed of with the trash or flushed down the toilet. 2. Emphasize careful hand washing after handling sputum and soiled tissues. 3. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. 4. Minimize prolonged visitation
What are some nursing interventions for the nursing diagnosis Risk for infection (spread of infection to others) related to cough and sputum production, lack of knowledge of disease process, and social/economic circumstances?
TST can't distinguish between LTBI and active TB infection, has to be read after 48-72 hours - multiple visits, must have whole process redone if not read in the allotted time.
What are the cons to the Mantoux PPD test?
Isoniazid, Rifampin, Pyrazinamide, Ethambutol
What are the four medications typically used for previously untreated TB?
- Be placed on airborne isolation - Receive a full medical workup, including chest x-ray, sputum smear, and culture - Receive appropriate drug therapy
What are the initial interventions that the nurse should do for the patient suspected of having TB?
Comply with the therapeutic regimen, Have no recurrence of disease, Have normal pulmonary function, Take appropriate measures to prevent the spread of the disease
What are the overall goals for the patient with TB?
Inexpensive, relatively quick results compared to bacteriologic studies
What are the pros to performing the Mantoux PPD test?
a. Inspection b. palpation
What assessment is used to interpret the results?
a. Tuberculin Skin Test (Mantoux test) - using purified protein derivative (PPD) is the standard method to screen people. The test is administered by injecting 0.1 mL of PPD intradermally on the ventral surface of the forearm. b. Chest X-ray - Although the findings on chest x-ray examination are important, it is not possible to make a diagnosis of TB solely on chest x-ray findings. Findings suggestive of TB include upper lobe infiltrates, cavitary infiltrates, lymph node involvement, and pleural and/or pericardial effusion. c. Bacteriologic Studies - Three consecutive sputum specimens obtained on different days are sent for smear and culture. The definitive diagnosis of TB requires the demonstration of tubercle bacilli bacteriologically by sputum culture. d. QuantiFERON-TB test - INF-gamma release assays (IGRAs) provide another screening tool for TB. IGRAs are blood tests that detect INF-gamma release from T cells in response to M. tuberculosis.
What diagnostics tests are performed for TB? Place a brief description next to each test.
It requires a single occupancy room with negative pressure and airflow of 6-12 exchanges per hour.
What does airborne infection isolation entail?
The BCG vaccine can cause false positive results, has variable effectiveness against adult pulmonary TB.
What implications does a foreign-born client who received the Calmette-Guerin (BCG) vaccine have with regards to the TB skin test?
Teach patients to cover the nose and mouth with paper tissues every time they cough, sneeze, or produce sputum. The tissues should be thrown into a paper bag and disposed of with the trash or flushed down the toilet. Emphasize careful hand washing after handling sputum and soiled tissues. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Minimize prolonged visitation to other parts of the hospital.
What information should be taught to patients that are on airborne isolation precautions to prevent the spread to visitors and healthcare workers?
The indurated area (if present) is measured and recorded in millimeters. Because the immunocompromised patient may have a decreased response to TST, smaller induration reactions (5 mm or larger) are considered positive. Other people are positive at 10 mm or greater.
What is considered a positive TB skin test result?
Involves providing the antituberculotic drugs directly to patients and watching as they swallow the medications. DOT is an expensive but essential public health measure.
What is involved in directly observed therapy (DOT)?
2 month initial phase with four drugs (isoniazid, rifampin, pyrazinamide, and ethambutol). If drug susceptibility test results indicate that the bacteria are susceptible to all drugs, ethambutol may be discontinued. If pyrazinamide cannot be included in the initial phase because of liver disease, pregnancy, etc., the remaining three drugs are used in the initial phase.
What is the basic primary treatment for TB?
The standard treatment regimen for LTBI is 9 months of daily isoniazid.
What is the standard treatment regimen for latent TB infection (LTBI)?
Nontuberculous mycobacteria & Previous BCG vaccine
What may cause a false positive result?
Homeless, people with poor access to healthcare/insurance/ poor people, etc.
What population(s) might DOT be utilized?
48 - 72 hours later
What time frame must the skin test be interpreted?
b. poor compliance with drug therapy in patients with TB Rationale: Drug-resistant strains of TB have developed because TB patients' compliance with drug therapy has been poor, and there has been general decreased vigilance in monitoring and follow-up of TB treatment. TB can be diagnosed effectively with sputum cultures. Anti-tubercular drugs are almost exclusively used for TB infections. The incidence of TB is at epidemic proportions in patients with HIV, but this does not account for multidrug-resistant strains of TB.
What was the resurgence in tuberculosis (TB) resulting from the emergence of multidrug-resistant strains of Mycobacterium tuberculosis related to? a. A lack of effective means to diagnose TB b. Poor compliance with drug therapy in patients with TB c. Indiscriminate use of antitubercular drugs in treatment of other infections d. Increased population of immunosuppressed individuals with acquired immunodeficiency syndrome (AIDS)
If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Minimize prolonged visitation to other parts of the hospital.
What would healthcare workers do if a patient on airborne isolation precautions do if the patient must be transported outside of the room to another department for a procedure? .
b. fatigue, low-grade fever, and night sweats Rationale: TB usually develops insidiously with fatigue, malaise, anorexia, low-grade fevers, and night sweats, a dry cough, and unexplained weight loss. Pleuritic pain, flu-like symptoms, and a productive cough may occur with an acute sudden presentation; but dyspnea and hemoptysis are late symptoms.
When obtaining a health history from a patient suspected of having early TB, the nurse should ask the patient about what manifestations? a. Chest pain, hemoptysis, and weight loss b. fatigue, low-grade fever, and night sweats c. cough with purulent mucus, and fever with chills d. pleuritic pain, nonproductive cough, and temperature elevation at night
a. Isoniazid b. Pyrazinamide c. Rifampin (Rifadin) f. Ethambutol (myambutol) Rationale: For the first 2 months, a four-drug regimen consists of Isoniazid, Pyrazinamide, Rifampin (Rifadin), and Ethambutol (myambutol). Rifabutin (mycobutin) and levofloxacin (levaquin) may be used if the patient develops toxicity to the primary drugs. Rifabutin may be used as first-line treatment for patients receiving meds that interact with rifampin (antiretrovirals, estradiol, warfarin)
Which medications would be used in four-drug treatment for the initial phase of TB? (select all that apply) a. Isoniazid b. Pyrazinamide c. Rifampin (Rifadin) d. Rifabutin (mycobutin) e. Levofloxacin (Levaquin) f. Ethambutol (myambutol)
a. Homeless b. Residents of inner-city neighborhoods c. Foreign-born people d. Those living or working in institutions (long-term care facilities, prisons, shelters, hospitals) e. IV injecting drug users f. Poor people g. Those with poor access to health care h. Immunosuppression
Who are at greatest risk for developing TB?
