Tuberculosis Overview and Prevention
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Questions and Answers

What is the primary method through which tuberculosis (TB) is transmitted?

  • Consumption of contaminated food
  • Aerosolization (airborne route) (correct)
  • Transfer through bodily fluids
  • Direct contact with infected surfaces

Which of the following symptoms may indicate the presence of active tuberculosis?

  • Persistent cough and weight loss (correct)
  • Decreased sensitivity to cold
  • Consistency in sleep patterns
  • Increased appetite and energy

What is the approximate infection rate of tuberculosis in the United States?

  • 0.4/100,000
  • 5.0/100,000
  • 2.2/100,000 (correct)
  • 1.1/100,000

How long can the TB bacillus remain dormant before potentially causing disease?

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

Who should be screened yearly for tuberculosis, according to high-risk recommendations?

<p>Family members of TB patients and high-risk individuals (D)</p> Signup and view all the answers

Which risk factor increases the likelihood of developing tuberculosis related to living conditions?

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

What factor associated with socioeconomic status is a risk factor for tuberculosis?

<p>Lower socioeconomic status and without housing (B)</p> Signup and view all the answers

Which health condition is NOT considered a risk factor for tuberculosis?

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

Which of the following is a common risk factor related to demographics for tuberculosis?

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

Recent travel to which of the following areas is a risk factor for tuberculosis?

<p>Areas where TB is endemic (A)</p> Signup and view all the answers

Which symptom is commonly associated with tuberculosis according to expected findings?

<p>Persistent cough lasting longer than 3 weeks (A)</p> Signup and view all the answers

What atypical findings might older adults present when suffering from tuberculosis?

<p>Unusual behavior and lethargy (A)</p> Signup and view all the answers

Which of the following symptoms is least likely to be associated with tuberculosis?

<p>Severe skin rashes and itchiness (B)</p> Signup and view all the answers

Which symptom is characterized by the presence of purulent sputum when diagnosing tuberculosis?

<p>Blood-streaked or rust-colored sputum (D)</p> Signup and view all the answers

Which combination of symptoms is indicative of active tuberculosis in older adults?

<p>Altered mentation, weight loss, and fever (B)</p> Signup and view all the answers

What is the primary advantage of nucleic acid amplification testing for tuberculosis?

<p>It detects rifampin resistance. (C)</p> Signup and view all the answers

What is the main purpose of the QuantiFERON-TB Gold test?

<p>To determine if a person has been exposed to TB. (D)</p> Signup and view all the answers

Which action is essential when obtaining sputum samples for TB testing?

<p>Obtain samples in a negative airflow room. (A)</p> Signup and view all the answers

What does a positive acid-fast bacilli smear indicate in TB testing?

<p>An active tuberculosis infection may be present. (B)</p> Signup and view all the answers

What is one characteristic of the results from interferon-gamma release assays (IGRAs)?

<p>They are preferred for individuals vaccinated with BCG. (C)</p> Signup and view all the answers

What diameter of induration is considered positive for clients at high risk for TB?

<p>5 mm (D)</p> Signup and view all the answers

Which of the following could lead to a false-positive Mantoux test result?

<p>Bacillus Calmette-Guerin vaccine (D)</p> Signup and view all the answers

How long after a Mantoux test should the injection site be read?

<p>48 to 72 hours (B)</p> Signup and view all the answers

What type of response can immunocompromised clients exhibit in a Mantoux test?

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

Induration of what size is considered positive for individuals with risk factors for TB?

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

Which of the following statements about latent TB and the Mantoux test is true?

<p>Individuals with latent TB can have a positive Mantoux test. (B)</p> Signup and view all the answers

Who should be tested for TB prior to starting immunosuppressive therapy?

<p>Clients starting immunosuppressive therapy (D)</p> Signup and view all the answers

How long after exposure to TB can a Mantoux test potentially yield a positive result?

<p>2 to 10 weeks (B)</p> Signup and view all the answers

What is an essential precaution when caring for clients who are hospitalized with tuberculosis (TB)?

<p>Use a N95 HEPA filter or powered air purifying respirator. (A)</p> Signup and view all the answers

Which of the following dietary recommendations is important for a client with tuberculosis (TB)?

<p>Promote foods rich in protein, iron, and vitamins C and B. (B)</p> Signup and view all the answers

What is the appropriate action when transporting a client with tuberculosis to another department?

<p>Have the client wear a surgical mask. (C)</p> Signup and view all the answers

Which environmental measure is necessary for a client diagnosed with tuberculosis (TB)?

<p>Put the client in a negative-airflow room. (D)</p> Signup and view all the answers

Which method is recommended for disposal of sputum by a client with tuberculosis?

<p>Use provided plastic bags or no-touch receptacles. (D)</p> Signup and view all the answers

What is a recommended treatment regimen for tuberculosis to prevent resistance?

<p>A combination of isoniazid, rifampin, pyrazinamide, and ethambutol (D)</p> Signup and view all the answers

Why is medication noncompliance a significant issue in tuberculosis treatment?

<p>It contributes to the development of resistant strains of tuberculosis. (C)</p> Signup and view all the answers

What is the duration for which tuberculosis medications are typically prescribed?

<p>6 to 12 months (C)</p> Signup and view all the answers

What is the primary purpose of completing the prescribed tuberculosis medication regimen?

<p>To ensure all bacteria are eliminated and decrease the chance of resistance. (C)</p> Signup and view all the answers

Which factor is contributing to the rise of resistant strains of tuberculosis?

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

What is the primary role of isoniazid in the treatment of mycobacterial infections?

<p>Inhibiting growth by preventing mycolic acid synthesis. (C)</p> Signup and view all the answers

Which nursing action is vital when administering isoniazid to a patient?

<p>Conduct liver function tests prior to treatment. (B)</p> Signup and view all the answers

Which of the following symptoms should be reported as a potential sign of hepatotoxicity in a patient taking isoniazid?

<p>Jaundice and malaise. (D)</p> Signup and view all the answers

Why is vitamin B6 commonly prescribed alongside isoniazid?

<p>To reduce the risk of neurotoxicity. (D)</p> Signup and view all the answers

What is an important patient education point for those prescribed isoniazid?

<p>Alcohol increases the risk of hepatotoxicity. (D)</p> Signup and view all the answers

What is the primary mechanism of action for Rifampin?

<p>Inhibition of DNA-dependent RNA polymerase (D)</p> Signup and view all the answers

What significant side effect should be monitored when a patient is on Rifampin?

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

Which statement about the urine color change associated with Rifampin is true?

<p>Urine will turn an orange color. (A)</p> Signup and view all the answers

What key patient education point should be provided regarding oral contraceptives when taking Rifampin?

<p>Rifampin may decrease the efficacy of oral contraceptives. (C)</p> Signup and view all the answers

What should patients taking Rifampin immediately report?

<p>Loss of appetite and jaundice (A)</p> Signup and view all the answers

What is a known adverse effect of pyrazinamide that requires assessment of patient history?

<p>Non-gouty polyarthralgia (A)</p> Signup and view all the answers

What is an important nursing action to monitor while a patient is on pyrazinamide?

<p>Monitor liver enzymes (B)</p> Signup and view all the answers

Which of the following is a recommended client education point for those taking pyrazinamide?

<p>Report any joint pain or swelling immediately (A)</p> Signup and view all the answers

What should patients taking pyrazinamide do to help prevent potential side effects?

<p>Drink a glass of water with each dose (C)</p> Signup and view all the answers

Which symptom should a patient report immediately while on pyrazinamide?

<p>Yellowing of the skin or eyes (B)</p> Signup and view all the answers

What is an essential nursing action when monitoring a patient on pyrazinamide?

<p>Regularly check liver enzyme levels (A)</p> Signup and view all the answers

Which adverse effect is specifically associated with pyrazinamide that necessitates patient history assessment?

<p>Non-gouty polyarthralgia (A)</p> Signup and view all the answers

What instruction should be given to patients taking pyrazinamide to help prevent complications?

<p>Increase fluid intake throughout the day (B)</p> Signup and view all the answers

Which symptom should patients immediately report while taking pyrazinamide?

<p>Loss of appetite (B)</p> Signup and view all the answers

What is the recommended monitoring frequency for liver enzymes after initiating treatment with pyrazinamide?

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

What is the primary mechanism by which Ethambutol exerts its effects on bacteria?

<p>Suppressing RNA synthesis (A)</p> Signup and view all the answers

What specific visual tests should be conducted before starting treatment with Ethambutol?

<p>Both baseline visual acuity and color discrimination ability tests (B)</p> Signup and view all the answers

What should be done if ocular toxicity is suspected in a patient taking Ethambutol?

<p>Stop the medication immediately (B)</p> Signup and view all the answers

Which age group is Ethambutol contraindicated for?

<p>Children under 8 years of age (D)</p> Signup and view all the answers

What patient education should be provided regarding vision changes when on Ethambutol?

<p>Report changes in vision immediately (C)</p> Signup and view all the answers

What should clients specifically monitor to prevent ototoxicity while taking streptomycin sulfate?

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

Which population is most appropriate for the use of streptomycin sulfate, considering its toxicity?

<p>Clients with drug-resistant infections (A)</p> Signup and view all the answers

What fluid intake is recommended daily for clients taking streptomycin sulfate?

<p>2 liters (C)</p> Signup and view all the answers

Which of the following should be reported to the healthcare provider while a client is taking streptomycin sulfate?

<p>Significant changes in urine output (D)</p> Signup and view all the answers

What is a key nursing action when administering streptomycin sulfate to prevent severe adverse effects?

<p>Conducting regular hearing assessments (B)</p> Signup and view all the answers

What is the recommended duration for clients to continue medication therapy for tuberculosis (TB)?

<p>6 to 12 months (D)</p> Signup and view all the answers

Which action should be taken if family members are exposed to a client with active TB?

<p>They need to undergo TB testing. (D)</p> Signup and view all the answers

After how many consecutive negative sputum cultures is a client no longer considered infectious?

<p>Three consecutive negative cultures (A)</p> Signup and view all the answers

What is a potential complication of miliary TB?

<p>Spread to multiple body organs (D)</p> Signup and view all the answers

What is the appropriate disposal method for contaminated tissues from a TB patient?

<p>Disposing of them in plastic bags (A)</p> Signup and view all the answers

What is the primary action to take when a client with tuberculosis is transported to another department?

<p>Have the client wear a surgical mask during transport. (C)</p> Signup and view all the answers

Which personal protective equipment should a nurse wear when caring for a client diagnosed with tuberculosis?

<p>An N95 respirator or HEPA respirator. (D)</p> Signup and view all the answers

When managing a client with complications from miliary tuberculosis, which symptom should the nurse monitor for that may indicate a life-threatening situation?

<p>Drowsiness and neck stiffness. (C)</p> Signup and view all the answers

What is a key nursing intervention to promote adequate care for a client with tuberculosis?

<p>Encourage a well-balanced diet and adequate nutrition. (C)</p> Signup and view all the answers

In an effort to prevent the transmission of tuberculosis, which room setting is necessary for a client with the disease?

<p>A negative airflow room with airborne precautions. (B)</p> Signup and view all the answers

Flashcards

TB Transmission

Tuberculosis (TB) spreads through airborne droplets (aerosolization) when an infected person coughs, speaks, or sneezes.

Latent TB

Mycobacterium tuberculosis is present in the body, but the immune system has contained the infection. It may stay inactive for years.

TB Symptoms

A persistent cough, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats, or chills may indicate TB.

High-risk TB populations

People from high-risk areas, family members of TB patients, those born outside the U.S., and migrant workers need yearly TB screening.

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TB Diagnosis

Consider TB in clients with persistent respiratory symptoms, weight loss, or other systemic symptoms.

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TB Risk: Crowded Spaces

Living in tightly packed or poorly ventilated areas, like prisons or nursing homes, increases the risk of catching TB.

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TB Risk: Lower Socioeconomic Status

People with lower socioeconomic status, including homelessness, have a greater chance of developing TB due to factors like poor living conditions and limited access to healthcare.

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TB Risk: Immunocompromised

Conditions like HIV, cancer treatments, or organ transplants weaken the immune system, making people more susceptible to TB.

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TB Risk: Travel

Recent travel to regions where TB is common, such as parts of Asia, Africa, the Caribbean, and Latin America, increases the risk of being exposed.

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TB Risk: Healthcare Workers

Those healthcare workers who perform procedures involving respiratory secretions, like suctioning or coughing, are at a higher risk of contracting TB.

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Atypical TB Symptoms in Older Adults

Older adults with TB may present with unusual symptoms like altered mental status, unusual behavior, fever, anorexia, and weight loss, rather than the typical cough and chest pain.

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Key TB Symptom: Persistent Cough

A cough that lasts for more than 3 weeks is a major sign of TB, even if it's mild at first.

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TB Sputum: Purulent and Blood-Streaked

Sputum (mucus coughed up) from TB is often thick, yellow-greenish, and may contain blood.

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TB Symptoms: Fatigue and Weight Loss

Feeling tired and losing weight unexpectedly are common signs of TB, as the body fights the infection.

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TB Symptoms: Night Sweats and Fever

Having excessive sweating at night and a slight fever in the afternoon are characteristic signs of TB.

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Nucleic acid amplification testing

This TB test detects the presence of M. tuberculosis in respiratory secretions and can identify rifampin resistance, a common TB medication. It's the fastest and most accurate screening test, with results in under 2 hours.

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QuantiFERON-TB Gold and T-SPOT

These blood tests, called IGRAs (interferon-gamma release assays), detect the release of interferon-gamma (IFN-g) in your blood, indicating an active or latent TB infection. They are preferred for people who have received the BCG vaccine.

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Acid-fast bacilli smear and culture

The acid-fast test is a quick microscopic check, while the culture grows the TB bacteria, confirming the diagnosis.

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Early-morning sputum sample

Three consecutive early-morning sputum samples are required for TB diagnosis. This is because the bacteria are more concentrated in the sputum at this time of day.

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Negative airflow room

Sputum samples should be collected in a negative airflow room, which helps to prevent the spread of TB bacteria.

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Mantoux Test: Positive Result

A positive Mantoux test means your body has mounted an immune response to TB bacteria. This does not necessarily mean you have active TB disease.

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Mantoux Test: Reading Time

A Mantoux test is read 48 to 72 hours after the injection. This allows enough time for the body to react to the TB antigen.

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Mantoux Test: Induration

A positive Mantoux test is indicated by a raised, hardened area (induration) at the injection site. The size of the induration determines the risk level.

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Mantoux Test: Risk Factors

The size of the induration needed for a positive result depends on your risk factors for TB. High-risk individuals need a smaller induration.

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Mantoux Test: False-Positive

A positive Mantoux test can be a false-positive if you've received a BCG vaccine or had a previous positive test.

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Anergy: Immunocompromised

People with weakened immune systems (like HIV positive individuals) may not react normally to the Mantoux test even if they have TB.

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Latent TB: Treatment

If you have latent TB, meaning the bacteria is inactive but present, you can receive treatment to prevent the development of active disease.

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TB Screening: High-Risk Groups

People with weakened immune systems and older adults should be screened for TB regularly.

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Airborne Precautions for TB

These precautions help prevent the spread of TB bacteria through the air. They include placing the client in a negative-airflow room, wearing a respirator for healthcare workers, and having the client wear a mask when transported.

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Humidified Oxygen Therapy for TB

Administering heated and humidified oxygen therapy as prescribed is a critical part of TB care. This helps with breathing difficulties and reduces the discomfort of coughing.

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Supporting a TB Patient's Nutrition

Encourage a well-balanced diet rich in protein, iron, and vitamins C and B to support a TB patient's immune system and help them recover.

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Emotional Support for TB Patients

Providing emotional support to a patient with TB is essential. This helps them cope with the diagnosis, treatment, and potential isolation.

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Managing TB Sputum Safely

Teach the client to cough and expectorate sputum into tissues, disposing of them properly in plastic bags or no-touch receptacles. This helps to prevent the spread of infection.

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TB Medication Regimen

A typical treatment for tuberculosis involves a combination of four medications: isoniazid, rifampin, pyrazinamide, and ethambutol.

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Why combination therapy?

Combining multiple TB medications is crucial because it helps to reduce the development of drug-resistant strains of tuberculosis.

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Medication Compliance for TB

Taking TB medications as prescribed for the full duration (6 to 12 months) is essential to ensure that all bacteria are eliminated and to minimize the risk of developing drug-resistant TB.

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Client Education: TB Medications

Educate clients with TB about the importance of completing the entire course of medication as prescribed. Explain that this helps prevent the development of drug resistance and ensures a full recovery.

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Why 6-12 months of TB Medication?

Because tuberculosis bacteria can be slow-growing, it takes a long time for medications to fully eliminate them. Taking medications for the entire duration ensures complete eradication.

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Isoniazid (INH)

A medication that kills tuberculosis bacteria by blocking their ability to build their outer walls.

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Isoniazid Side Effects

Isoniazid can cause damage to the liver (hepatotoxicity) and nerves (neurotoxicity), which can be seen as yellowing of the skin, loss of appetite, weakness, numbness, and tingling.

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Vitamin B6 (Pyridoxine)

This vitamin often accompanies isoniazid to protect against nerve damage, which is a potential side effect of this medication.

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Isoniazid and Alcohol

Mixing isoniazid with alcohol increases the risk of liver damage.

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Liver Function Tests (LFTs)

These blood tests are done before starting isoniazid and then regularly to monitor for any damage to the liver.

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RIF: What is it?

Rifampin (RIF) is an antibiotic that fights bacteria by stopping their DNA-dependent RNA polymerase activity. This means it blocks the bacteria's ability to make proteins, ultimately killing them.

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RIF Side Effects: Liver?

RIF can harm the liver (hepatotoxicity). It's important to watch for signs like jaundice, pain or swelling in the joints, loss of appetite, and feeling tired.

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RIF: Urine and Secretions?

When taking RIF, your urine and other bodily fluids will turn orange. This is normal and not a cause for concern.

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RIF: Birth Control?

RIF can make birth control pills less effective. You should use another form of contraception while on RIF.

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RIF: Contact Lenses?

RIF can stain your contact lenses. It's best to wear glasses while taking RIF.

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Pyrazinamide (PZA): What is it?

Pyrazinamide (PZA) is a medication used to treat tuberculosis (TB). It works by killing TB bacteria, but its exact mechanism is not fully understood.

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PZA: Potential Side Effect?

One potential side effect of pyrazinamide (PZA) is hepatotoxicity (liver damage).

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PZA and Gout?

Pyrazinamide (PZA) can cause a side effect called non-gouty polyarthralgia, which means joint pain that is not caused by gout.

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PZA: Client Education

Clients taking PZA should drink plenty of water to help prevent gout and kidney problems. They should also report any signs of liver damage (yellowing of skin/eyes), joint pain, loss of appetite, or fatigue immediately.

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PZA: Alcohol?

Avoid alcohol while taking pyrazinamide (PZA).

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What is Ethambutol?

Ethambutol (EMB) is a medication used to treat tuberculosis (TB). It works by suppressing RNA synthesis, which prevents bacteria from building their outer walls.

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When is Ethambutol contraindicated?

Ethambutol should not be given to children younger than 8 years of age.

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How does Ethambutol affect vision?

Ethambutol can cause ocular toxicity (damage to the eyes). This may include vision loss, changes in color perception, and blurred vision.

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What should the nurse monitor when a patient is on Ethambutol?

Nurses should assess the patient's vision before starting and regularly throughout treatment. They should also monitor for any changes in the patient's color discrimination ability.

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Client Education: Ethambutol and Vision

Patients taking Ethambutol should be advised to report any changes in vision immediately, especially blurry vision or difficulty seeing colors.

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Streptomycin Sulfate: Use

Streptomycin sulfate is an aminoglycoside antibiotic used only for multidrug-resistant tuberculosis (MDR-TB) due to its high toxicity.

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Streptomycin Sulfate: Side Effect

Streptomycin sulfate can cause ototoxicity (hearing damage), so monitor the client's hearing function regularly.

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Streptomycin Sulfate: Nursing Action

Report significant changes in urine output and renal function tests as streptomycin sulfate can affect kidney function.

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Client Education: Streptomycin Sulfate

Clients taking streptomycin sulfate should drink at least 2 liters of fluid daily to help prevent kidney damage.

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Notify Provider: Hearing Loss

Clients taking streptomycin sulfate should notify their healthcare provider immediately if they experience any decline in hearing.

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Why is TB often treated at home?

Tuberculosis (TB) is typically managed at home because it is usually spread through airborne droplets and family members have already been exposed.

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How long is TB treatment?

TB treatment involves taking medications for 6 to 12 months, or even up to 2 years for multidrug-resistant TB.

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What happens if TB medication is not completed?

Failing to finish TB medication can lead to a resistant strain of TB, meaning medications might not be effective anymore.

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What is Miliary TB?

Miliary TB occurs when the TB bacteria spreads throughout the body via the bloodstream, affecting multiple organs.

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Pericarditis in TB

Fluid builds up in the sac surrounding the heart (pericardial sac), leading to pericarditis. This can cause shortness of breath, swollen neck veins, chest pain, and low blood pressure.

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Humidified Oxygen Therapy

Providing oxygen with added moisture to help with breathing difficulties and discomfort from coughing.

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Study Notes

Tuberculosis (TB) Overview

  • Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis.
  • Transmission occurs via aerosolization (airborne route).
  • The body encapsulates the TB bacillus in collagen and cells, forming a nodule/tubercle in the lungs (visible on chest x-rays).
  • US infection rate: 2.2/100,000 people.
  • Approximately 13 million people in the US have latent TB.

Active vs. Latent TB

  • Only a small percentage of infected individuals develop active TB.
  • The TB bacillus can remain dormant for years before causing active disease.
  • TB primarily affects the lungs but can spread to other organs via the bloodstream.
  • Transmission risk decreases after 2-3 weeks of antituberculin therapy.

TB Screening and Prevention

  • Annual screenings for individuals in high-risk areas.
  • Screening for family members of TB patients.
  • Prioritize screening for those born outside the US and migrant workers.
  • Early detection is crucial due to TB's slow onset.
  • Consider TB diagnosis in clients with persistent cough, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats, or chills.

Latent TB

  • Individuals exposed to TB but not developing the disease can have latent TB.
  • Mycobacterium tuberculosis is present but the body has successfully fought off infection.
  • Latent TB can remain dormant for years and become active later in life or during periods of immune compromise.

Global/National TB Goals

  • Increasing the percentage of clients completing TB treatment is a goal in national and global health agendas.

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Description

This quiz covers the essentials of Tuberculosis (TB), including its causes, transmission, and distinctions between active and latent forms. It also highlights the importance of screening and prevention strategies, particularly for high-risk populations. Test your knowledge on TB and its implications in public health.

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