Nursing Care of Patients with Tuberculosis
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Questions and Answers

What condition occurs when there is an adequate immune response to tuberculosis?

  • Skeletal tuberculosis
  • Active TB
  • Reactivation TB
  • Dormant (Latent) TB (correct)

Which factor may cause latent TB to reactivate later in life?

  • Strong immune system
  • Recent travel
  • Poor nutrition
  • Immunosuppressive drugs (correct)

In which situation would an individual with dormant TB become infectious?

  • Consistent exercise
  • Healthy diet
  • Adequate sleep
  • Weakened immune response (correct)

What is a common symptom of active tuberculosis?

<p>Fatigue (C)</p> Signup and view all the answers

What characteristic defines an individual with latent TB?

<p>Exposed and noninfectious (A)</p> Signup and view all the answers

Which symptom is least likely associated with an individual having dormant TB?

<p>Cough (A)</p> Signup and view all the answers

What is the classification for an older adult with reactivated TB after being symptom-free for many years?

<p>Reactivation tuberculosis (D)</p> Signup and view all the answers

Which of the following correctly describes a tubercle in active TB?

<p>It is unable to encapsulate (C)</p> Signup and view all the answers

What is considered a positive result for a PPD (Mantoux) test in all individuals?

<blockquote> <p>15mm induration (A)</p> </blockquote> Signup and view all the answers

Which symptom is commonly associated with active tuberculosis?

<p>Night sweats (C)</p> Signup and view all the answers

Which of the following tests is considered the gold standard for diagnosing tuberculosis?

<p>Sputum culture (A)</p> Signup and view all the answers

What is a potential limitation of the PPD test for individuals who had the tuberculosis vaccine?

<p>May produce false positive results (D)</p> Signup and view all the answers

In evaluating hemoptysis, what is the significance of the sputum smear test?

<p>Identifies the tubercle bacillus (B)</p> Signup and view all the answers

What is an appropriate nursing documentation for a PPD test result showing a 6-mm area that is slightly red and soft?

<p>Negative response (B)</p> Signup and view all the answers

Which symptom is least likely to be associated with tuberculosis infections?

<p>Severe joint pain (A)</p> Signup and view all the answers

What size induration would generally be considered a negative response on a PPD test?

<p>&lt;5mm (B)</p> Signup and view all the answers

Which of the following is a significant risk factor for tuberculosis that the nurse should assess?

<p>HIV/AIDS status (A)</p> Signup and view all the answers

Which condition represents a higher risk for developing active tuberculosis?

<p>Recent travel to a country with high TB incidence (D)</p> Signup and view all the answers

Which environmental factor is associated with an increased risk of tuberculosis?

<p>Residing in a poorly ventilated environment (D)</p> Signup and view all the answers

Which demographic characteristic should a nurse consider as a risk factor for tuberculosis?

<p>Being an immigrant to the United States (C)</p> Signup and view all the answers

What is the primary goal of pharmacologic treatment for tuberculosis?

<p>To make the disease noncommunicable to others (C)</p> Signup and view all the answers

Which of the following behaviors should a nurse identify as a potential risk for tuberculosis?

<p>Using injection drugs (A)</p> Signup and view all the answers

Which medication is known to cause body fluids to turn red?

<p>Rifampin (B)</p> Signup and view all the answers

What approach is recommended to increase compliance in tuberculosis treatment?

<p>Directly Observed Therapy (DOT) (A)</p> Signup and view all the answers

Which of the following is included in the first 2 months of treatment for ACTIVE TB?

<p>Rifampin, Isoniazid, Ethambutol, and Pyrazinamide (B)</p> Signup and view all the answers

Which medication should be taken for 6-9 months for LATENT TB?

<p>Isoniazid (D)</p> Signup and view all the answers

What side effect is associated with Ethambutol?

<p>Optic neuritis (D)</p> Signup and view all the answers

When treating patients with underlying HIV, the treatment for ACTIVE TB is typically how long?

<p>9 months (B)</p> Signup and view all the answers

What role does Vitamin B-6 play in the context of Isoniazid treatment?

<p>It helps prevent peripheral neuropathy (B)</p> Signup and view all the answers

What is the etiological agent of tuberculosis?

<p>Mycobacterium tuberculosis (D)</p> Signup and view all the answers

Which portal of exit is associated with the transmission of Mycobacterium tuberculosis?

<p>Inhalation of aerosols (B)</p> Signup and view all the answers

What is the primary site for infection of tuberculosis?

<p>Lungs (A)</p> Signup and view all the answers

Which of the following describes the nature of Mycobacterium tuberculosis?

<p>Slender, rod-shaped organism (D)</p> Signup and view all the answers

How long does it typically take for tuberculosis to illicit an immune response?

<p>2-12 weeks (D)</p> Signup and view all the answers

What type of cellular immune response can be elicited with a TB skin test?

<p>Cell-mediated response (B)</p> Signup and view all the answers

What is a granulomatous lesion formed in response to tuberculosis called?

<p>Tubercle (B)</p> Signup and view all the answers

Which of the following is considered a reportable disease due to its public health implications?

<p>Tuberculosis (C)</p> Signup and view all the answers

What indicates a positive tuberculin skin test (TST) result in a healthy adult?

<p>Induration measuring 16 mm (A)</p> Signup and view all the answers

Which preventive measure is effective against TB transmission?

<p>Employing negative pressure isolation (A)</p> Signup and view all the answers

Which procedure may be necessary to obtain a specimen for TB diagnosis?

<p>Bronchoscopy (B)</p> Signup and view all the answers

What should be done when a patient with TB needs to leave their room?

<p>They should wear an N95 mask (B)</p> Signup and view all the answers

How is TB primarily transmitted?

<p>Through air from person to person (B)</p> Signup and view all the answers

Which of the following statements is true regarding a positive TB skin test?

<p>It requires further investigation to confirm active disease (A)</p> Signup and view all the answers

What is a commonly used method for sputum sample collection in TB diagnosis?

<p>Gastric lavage (C)</p> Signup and view all the answers

What type of light can help reduce TB transmission?

<p>Ultraviolet light (A)</p> Signup and view all the answers

Flashcards

Compromised Immune System

Individuals with weakened immune systems are more likely to develop active TB. This can be due to conditions like HIV/AIDS, organ transplantation, or medications that suppress the immune system.

Overcrowded Living Conditions

Living in crowded or poorly ventilated areas increases exposure to TB bacteria, raising the risk of infection.

Poverty

Poverty can lead to limited access to healthcare, poor sanitation, and overcrowded living situations, increasing the risk of TB.

Immigration from TB-Prevalent Regions

Immigrants from countries with high TB prevalence often have a higher risk of carrying latent TB or developing active TB.

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Dormant TB

People with dormant TB are at risk of reactivating the infection, especially if they have a weakened immune system or are exposed to TB.

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What causes tuberculosis?

Mycobacterium tuberculosis, a slender rod-shaped bacterium with a waxy outer capsule that resists destruction, is the causative agent for tuberculosis.

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Where does tuberculosis primarily infect?

The primary site of infection is the lungs, but it can spread to other parts of the body.

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Is tuberculosis acute or chronic?

TB is a chronic infectious disease, meaning it can persist in the body for a long time. It can also reappear or become active again.

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How is tuberculosis spread?

TB is contagious and can be spread through the air when an infected person coughs, sneezes, or speaks.

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What is formed when your body fights off tuberculosis?

The immune system encloses the bacteria in a protective wall called a granuloma or tubercle to prevent its spread.

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What test checks for TB infection?

A TB skin test is a common way to check if someone has been infected with tuberculosis.

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What happens when the immune system weakens?

The bacteria can remain dormant for years and become active again. This can be due to weakening of the immune system.

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What are some measures to control tuberculosis?

Public health measures are crucial to stop the spread of TB, which is a reportable disease.

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Positive TB Chest X-ray

An abnormal chest x-ray is considered a positive response in terms of tuberculosis (TB) screening.

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Positive TB Test

A positive tuberculin skin test (TST) does not necessarily mean active TB disease. It only reveals exposure to the bacteria.

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Routine TB Tests

Sputum and chest x-rays are routinely used to monitor for and diagnose tuberculosis.

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Precautions for Sputum Collection

Special procedures and personal protective equipment (PPE) are recommended for collecting sputum specimens to reduce the risk of spreading TB.

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Advanced Sputum Collection

There is a possibility of needing to collect a sputum specimen through additional methods like endotracheal suctioning, bronchoscopy, or gastric lavage. This depends on the individual case.

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TB Education

Patient and family education is crucial to prevent the spread of TB. It involves understanding the disease and its transmission.

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TB Transmission

TB is transmitted through the air, primarily from person to person.

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Positive TST Result

A 16mm induration is considered a positive result for a tuberculin skin test (TST) in a healthy adult with no known risk factors for TB.

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Dormant (Latent) TB

When a person is infected with tuberculosis bacteria, but their immune system is strong enough to contain the bacteria in a small area of the lung, forming a scar-like structure called a tubercle. The bacteria are dormant but not dead, and the individual is not sick or infectious.

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Isoniazid

A medication used to treat active tuberculosis. It prevents bacteria from forming, helping to eradicate dormant tuberculosis bacilli.

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Reactivation TB

When a person with dormant TB experiences a weakened immune system, the bacteria can reactivate and multiply, leading to active TB. This can occur due to factors like age, HIV infection, immunosuppressive diseases, or medications.

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Active TB

When a person's immune system cannot contain the tuberculosis bacteria, the tubercle ruptures, releasing the bacteria and causing active infection. The bacteria can spread to other parts of the body, leading to severe disease and complications.

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Rifampin

A medication that inhibits RNA synthesis, preventing the development of resistance to bactericidal drugs. Also used in combination with isoniazid due to its rapid resistance development.

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Active TB - Infectious

A person with active TB is infectious and can transmit the bacteria to others. This is because the tubercle has ruptured and the bacteria are circulating in the body.

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Ethambutol

A bacteriostatic drug that inhibits fatty acid synthesis in bacteria. It reduces the development of resistance to other first-line TB drugs.

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Dormant TB - Non-infectious

A person with dormant TB is not infectious because the bacteria are contained within the tubercle.

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Pyrazinamide

A drug that interferes with bacteria's ability to synthesize fatty acids. It can cause hepatotoxicity.

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Rifatar

A combination therapy used for treating active TB. It consists of rifampin, isoniazid, and pyrazinamide.

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Symptoms of Active TB

Active tuberculosis can cause a persistent cough, blood in sputum (hemoptysis), night sweats, weight loss, and weakness. These symptoms indicate that the immune system is struggling to contain the infection.

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Reactivation TB - Symptoms

An older adult reporting past tuberculosis and experiencing cough, hemoptysis, night sweats, anorexia, and weakness is likely experiencing reactivation tuberculosis.

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Directly Observed Therapy (DOT)

A treatment strategy involving direct observation of patients taking their TB medication. It is used for patients at risk of non-compliance.

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Reactivation TB - In Older Adults

Reactivation TB occurs when a person with latent TB experiences a weakened immune system, allowing the bacteria to become active. This is a common scenario in older adults.

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Latent TB

A type of tuberculosis where the infection is inactive and does not cause symptoms or spread. It is treated with isoniazid for 6-9 months.

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Active TB Treatment Regimen

A multi-drug regimen used to treat active TB, usually for 6-9 months. It starts with rifampin, isoniazid, ethambutol, and pyrazinamide, followed by rifampin and isoniazid.

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Mantoux test

A type of tuberculosis test that involves injecting a small amount of purified protein derivative (PPD) from Mycobacterium tuberculosis under the skin. The test is read 48-72 hours after injection by measuring the induration (hardening) at the injection site.

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Positive Mantoux test

A positive Mantoux test result is determined by the size of the induration (hardening) at the injection site. A measurement of >15 mm is considered positive for all individuals.

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Sputum smear for AFB

A test used to confirm an active tuberculosis infection by examining sputum samples for the presence of acid-fast bacilli (AFB).

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Sputum Culture

A confirmatory test for tuberculosis infection that involves growing the Mycobacterium tuberculosis bacteria from a sputum sample in a laboratory culture.

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Chest X-ray findings in Tuberculosis

Chest X-ray findings suggestive of tuberculosis include dense lesions, often in the upper lobes of the lungs, and the presence of cavities.

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Interferon-gamma release assays (IGRA)

Blood tests that measure the immune response to tuberculosis bacteria. They can be used in people who have received the tuberculosis vaccine.

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Culture

The gold standard laboratory test for confirming a tuberculosis infection.

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Negative Mantoux test

A 6 mm area of induration (hardening) that is slightly red and soft to the touch at the site of a Mantoux test is considered a negative response. Redness alone is not indicative of a positive test.

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Study Notes

Nursing Care of Patients with Tuberculosis

  • Concept of Infection: Tuberculosis is an infection caused by Mycobacterium tuberculosis.
  • Chain of Infection: Tuberculosis, as an infection, follows a chain:
    • Etiologic Agent: Mycobacterium tuberculosis
    • Reservoir: Human respiratory tract, gastrointestinal.
    • Portal of Exit: Aerosolization from cough, sneeze.
    • Mode of Transmission: Inhalation
    • Portal of Entry: Inhalation through respiratory tract.
    • Susceptible Host: Human.
  • Tuberculosis Overview, Pathophysiology, and Etiology:
    • Chronic Infectious Disease: Can recur.
    • Organism: Slender, rod-shaped bacilli with a waxy outer capsule.
    • Growth: Slow-growing.
    • Immune Response: Takes 2-12 weeks to elicit an immune response.
    • Acid-Fast Bacilli (AFB): Bacteria that resist decolorization with acid during staining.
    • Primary Site of Infection: Lungs; can "seed" into other organs.
    • Reportable Disease: Concern for public health.
  • Epidemiology- Active Tuberculosis Cases in Ohio (2022):
    • Not very common in Ohio.
    • Data on cases by county is presented.
    • Cuyahoga county had 27 cases.
    • Summit county had 5 cases
    • Lake and Geauga counties had zero cases
    • Ashtabula county had 1 case.
    • Total cases in Ohio for 2022: 145
    • Total cases in Ohio for 2019: 150
  • Pathophysiology & Etiology of Tuberculosis:
    • Aerosolization: Transmission via droplets in the air.
    • Lung Implantation: Bacilli implant in alveoli or bronchioles.
    • Inflammatory Response: Initiates an inflammatory response.
    • Phagocytic Cells: Neutrophils and macrophages encapsulate bacteria, preventing spread.
    • Tubercle Formation: A granuloma called a tubercle forms.
    • Cellular Immune Response: Develops in 2-12 weeks and can be measured by TB skin tests.
  • Dormant (Latent) TB:
    • Adequate immune response: Scar tissue forms, bacteria are enclosed, and are inactive but not dead.
    • Individuals can be infected but not sick, with no noticeable symptoms.
  • Active TB:
    • Inadequate immune response: Tubercle ruptures, bacteria spread.
    • Infectious stage: Erosion and cavitation of the lung tissue.
  • Classification of TB:
    • Active: Exposed & Infectious; shows clinical manifestations.
    • Dormant (Latent): Exposed but noninfectious; no noticeable symptoms.
    • Reactivation TB: Latent TB can become active later due to weakened immune systems (e.g., HIV, age, immunosuppressive drugs).
  • Risk Factors for TB:
    • Immigrants
    • HIV/AIDS
    • Impaired immune function
    • Homelessness
    • Overcrowded institutions, poor living conditions.
    • Poverty, lack of access to healthcare, poor sanitation.
  • Clinical Manifestations:
    • Asymptomatic in early stages: Initial infection.
    • Fever (typically low-grade)
    • Night sweats
    • Dry cough progresses to hemoptysis (bloody sputum).
    • Weight loss
    • Fatigue
    • Cough, pleuritic chest pain
    • Dyspnea
  • Prevention and Diagnostic Tests:
    • PPD Skin Test (Mantoux test): Intradermal test; read 48-72 hours post-administration; measure induration.

    15mm induration is positive in all people. Redness is not indicative of positivity.

    • Sputum Smear AFB: Rapid indicator of M. tuberculosis (active TB) but requires 3 specimens (8-24 hours apart).
    • Sputum Culture: Confirmatory diagnosis. Takes 4-8 weeks.
    • Chest X-Ray: Dense lesions in upper lobe, cavity formation are common findings.
    • Interferon-gamma release assays (IGRAs): "QuantiFERON-TB test" or "T-Spot test", used on those unable to return for TST read.
    • Culture: Gold standard for laboratory confirmation of active TB.
  • Collaboration: Pharmacologic Therapy:
    • Goals: Make the disease non-communicable to others; reduce symptoms; cure in the shortest time.
    • Antibiotics: Used to prevent and treat the infection.
    • Active TB pharmacologic therapy:
      • First 2 months: Rifampin, Isoniazid, Ethambutol, Pyrazinamide
      • After 2 months: Rifampin & Isoniazid for additional 4-6 months
      • Longer duration for people with HIV (often 9 months)
      • Increase compliance: Use combination drugs (e.g., Rifatar) or directly observed therapy (DOT).
    • Latent TB pharmacologic therapy: Isoniazid for 6-9 months
    • Monitoring/surveillance: Key to determine if treatment is working.
  • Collaboration: TB No Longer Considered Infectious When:
    • Clinical improvement.
    • Meds for at least 2 weeks.
    • Three consecutive AFB negative smears.

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The Concept of Infection: Nursing Care of the Patient with Tuberculosis PDF

Description

This quiz covers essential concepts in nursing care for patients with tuberculosis, focusing on the infection's pathophysiology and transmission. Understand the chain of infection and the immune response associated with tuberculosis. Test your knowledge on how to effectively care for patients dealing with this chronic infectious disease.

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