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Questions and Answers
What condition occurs when there is an adequate immune response to tuberculosis?
What condition occurs when there is an adequate immune response to tuberculosis?
Which factor may cause latent TB to reactivate later in life?
Which factor may cause latent TB to reactivate later in life?
In which situation would an individual with dormant TB become infectious?
In which situation would an individual with dormant TB become infectious?
What is a common symptom of active tuberculosis?
What is a common symptom of active tuberculosis?
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What characteristic defines an individual with latent TB?
What characteristic defines an individual with latent TB?
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Which symptom is least likely associated with an individual having dormant TB?
Which symptom is least likely associated with an individual having dormant TB?
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What is the classification for an older adult with reactivated TB after being symptom-free for many years?
What is the classification for an older adult with reactivated TB after being symptom-free for many years?
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Which of the following correctly describes a tubercle in active TB?
Which of the following correctly describes a tubercle in active TB?
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What is considered a positive result for a PPD (Mantoux) test in all individuals?
What is considered a positive result for a PPD (Mantoux) test in all individuals?
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Which symptom is commonly associated with active tuberculosis?
Which symptom is commonly associated with active tuberculosis?
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Which of the following tests is considered the gold standard for diagnosing tuberculosis?
Which of the following tests is considered the gold standard for diagnosing tuberculosis?
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What is a potential limitation of the PPD test for individuals who had the tuberculosis vaccine?
What is a potential limitation of the PPD test for individuals who had the tuberculosis vaccine?
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In evaluating hemoptysis, what is the significance of the sputum smear test?
In evaluating hemoptysis, what is the significance of the sputum smear test?
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What is an appropriate nursing documentation for a PPD test result showing a 6-mm area that is slightly red and soft?
What is an appropriate nursing documentation for a PPD test result showing a 6-mm area that is slightly red and soft?
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Which symptom is least likely to be associated with tuberculosis infections?
Which symptom is least likely to be associated with tuberculosis infections?
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What size induration would generally be considered a negative response on a PPD test?
What size induration would generally be considered a negative response on a PPD test?
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Which of the following is a significant risk factor for tuberculosis that the nurse should assess?
Which of the following is a significant risk factor for tuberculosis that the nurse should assess?
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Which condition represents a higher risk for developing active tuberculosis?
Which condition represents a higher risk for developing active tuberculosis?
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Which environmental factor is associated with an increased risk of tuberculosis?
Which environmental factor is associated with an increased risk of tuberculosis?
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Which demographic characteristic should a nurse consider as a risk factor for tuberculosis?
Which demographic characteristic should a nurse consider as a risk factor for tuberculosis?
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What is the primary goal of pharmacologic treatment for tuberculosis?
What is the primary goal of pharmacologic treatment for tuberculosis?
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Which of the following behaviors should a nurse identify as a potential risk for tuberculosis?
Which of the following behaviors should a nurse identify as a potential risk for tuberculosis?
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Which medication is known to cause body fluids to turn red?
Which medication is known to cause body fluids to turn red?
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What approach is recommended to increase compliance in tuberculosis treatment?
What approach is recommended to increase compliance in tuberculosis treatment?
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Which of the following is included in the first 2 months of treatment for ACTIVE TB?
Which of the following is included in the first 2 months of treatment for ACTIVE TB?
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Which medication should be taken for 6-9 months for LATENT TB?
Which medication should be taken for 6-9 months for LATENT TB?
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What side effect is associated with Ethambutol?
What side effect is associated with Ethambutol?
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When treating patients with underlying HIV, the treatment for ACTIVE TB is typically how long?
When treating patients with underlying HIV, the treatment for ACTIVE TB is typically how long?
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What role does Vitamin B-6 play in the context of Isoniazid treatment?
What role does Vitamin B-6 play in the context of Isoniazid treatment?
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What is the etiological agent of tuberculosis?
What is the etiological agent of tuberculosis?
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Which portal of exit is associated with the transmission of Mycobacterium tuberculosis?
Which portal of exit is associated with the transmission of Mycobacterium tuberculosis?
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What is the primary site for infection of tuberculosis?
What is the primary site for infection of tuberculosis?
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Which of the following describes the nature of Mycobacterium tuberculosis?
Which of the following describes the nature of Mycobacterium tuberculosis?
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How long does it typically take for tuberculosis to illicit an immune response?
How long does it typically take for tuberculosis to illicit an immune response?
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What type of cellular immune response can be elicited with a TB skin test?
What type of cellular immune response can be elicited with a TB skin test?
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What is a granulomatous lesion formed in response to tuberculosis called?
What is a granulomatous lesion formed in response to tuberculosis called?
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Which of the following is considered a reportable disease due to its public health implications?
Which of the following is considered a reportable disease due to its public health implications?
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What indicates a positive tuberculin skin test (TST) result in a healthy adult?
What indicates a positive tuberculin skin test (TST) result in a healthy adult?
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Which preventive measure is effective against TB transmission?
Which preventive measure is effective against TB transmission?
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Which procedure may be necessary to obtain a specimen for TB diagnosis?
Which procedure may be necessary to obtain a specimen for TB diagnosis?
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What should be done when a patient with TB needs to leave their room?
What should be done when a patient with TB needs to leave their room?
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How is TB primarily transmitted?
How is TB primarily transmitted?
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Which of the following statements is true regarding a positive TB skin test?
Which of the following statements is true regarding a positive TB skin test?
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What is a commonly used method for sputum sample collection in TB diagnosis?
What is a commonly used method for sputum sample collection in TB diagnosis?
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What type of light can help reduce TB transmission?
What type of light can help reduce TB transmission?
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Study Notes
Nursing Care of Patients with Tuberculosis
- Concept of Infection: Tuberculosis is an infection caused by Mycobacterium tuberculosis.
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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.
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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.
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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
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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.
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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.
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Active TB:
- Inadequate immune response: Tubercle ruptures, bacteria spread.
- Infectious stage: Erosion and cavitation of the lung tissue.
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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).
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Risk Factors for TB:
- Immigrants
- HIV/AIDS
- Impaired immune function
- Homelessness
- Overcrowded institutions, poor living conditions.
- Poverty, lack of access to healthcare, poor sanitation.
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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
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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.
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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.
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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.
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Collaboration: TB No Longer Considered Infectious When:
- Clinical improvement.
- Meds for at least 2 weeks.
- Three consecutive AFB negative smears.
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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.
