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Questions and Answers
Which of the following is NOT a clinical manifestation of active tuberculosis in the lungs?
Which diagnostic test is primarily used for tuberculosis screening?
What is a common adverse reaction to tuberculosis treatment that nurses should monitor?
Which population is at higher risk for developing tuberculosis?
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Which of the following is a characteristic assessment finding for active tuberculosis outside the lungs?
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What is a hallmark clinical manifestation indicating active tuberculosis in a patient?
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In managing a patient with tuberculosis, which of the following factors is most critical for evaluating their response to treatment?
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When assessing risk populations for tuberculosis, which group is often overlooked but may be vulnerable?
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Which of the following statements regarding the Tuberculin skin test (TST) is accurate?
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What does the presence of anorexia and weight loss in a tuberculosis patient suggest?
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Which statement about tuberculosis treatment and monitoring is correct?
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What is an important requirement for patients who have received the BCG vaccine?
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Which factor distinguishes Extensively Drug-Resistant (XDR) TB from other forms?
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When interpreting the results of a TB skin test, what is the primary indicator for a positive response?
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Which precaution should be taken when administering Bedaquiline for TB treatment?
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Study Notes
Tuberculosis (TB) Pathophysiology
- Mycobacterium tuberculosis is an airborne bacteria.
- It causes tuberculosis (TB) by infecting the lungs and spreading to other parts of the body.
- When infected, the body initiates an inflammatory response.
- Granulomas form, which are walled-off areas of bacteria and immune cells.
- TB can be latent or active.
High-Risk Populations for TB
- Individuals with weakened immune systems are at higher risk.
- This includes people with HIV/AIDS, diabetes, and chronic kidney disease.
- Also at risk are those who live in crowded, poorly ventilated areas or who are homeless.
- Healthcare workers are also at risk, especially those who work with patients with TB.
TB Assessment
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History:
- Ask about recent travel to countries with high TB rates.
- Inquire about exposure to individuals with TB.
- Determine if any family members or individuals in close contact have TB or have been tested for it.
- Clinical Manifestations:
- Active TB in the lungs: - Persistent cough for more than 3 weeks. - Coughing up blood (hemoptysis). - Chest pain. - Shortness of breath. - Fatigue. - Anorexia and weight loss. - Night sweats. - Low-grade fever.
- Active TB outside the lungs: - Symptoms vary depending on affected organs. - Possible symptoms include: fever, night sweats, weight loss, pain, and swelling.
TB Diagnostics
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Tuberculin Skin Test (TST)/Mantoux Test/Purified Protein Derivative (PPD):
- A small amount of PPD is injected under the skin.
- The area is checked for induration (hardening) after 48-72 hours.
- A positive result can indicate a prior infection or a current infection.
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Other diagnostic tests:
- Chest X-ray.
- Sputum smear and culture.
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Diagnostic criteria:
- A positive TST and a suspicious chest X-ray.
- Positive sputum culture.
- Symptomatic individuals with clinical findings suggestive of TB.
TB Treatment
- Treatment typically involves a combination of antibiotics.
- These medications must be taken for 6-9 months for effective treatment.
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Common medications include:
- Isoniazid (INH).
- Rifampin (RIF).
- Pyrazinamide (PZA).
- Ethambutol (EMB).
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Common adverse reactions and nursing considerations:
- Nausea, vomiting, diarrhea, and liver function abnormalities.
- Close monitoring of liver function is essential.
- Discuss potential side effects and importance of medication adherence with patients.
Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) TB
- MDR TB is resistant to at least two of the most effective TB drugs, isoniazid and rifampin.
- XDR TB is resistant to isoniazid, rifampin, and other specific drugs.
- MDR and XDR TB are significantly harder to treat.
- Treatment regimens are longer and more complex.
Evaluating Response to TB Treatment
- Regular follow-up visits are essential.
- Evaluate patient progress based on clinical signs and symptoms, such as cough resolution and improvement in overall well-being.
- Monitor for adverse reactions to treatment.
TB Client Education
- Encourage adherence to the medication regimen.
- Emphasize completing the entire course of treatment.
- Educate patients about the contagious nature of TB and the importance of infection control measures, such as covering coughs and sneezes.
- Provide resources and support to patients and their families.
Tuberculosis (TB)
- Tuberculosis (TB) is a contagious bacterial infection primarily affecting the lungs.
- The bacteria responsible for TB is Mycobacterium tuberculosis.
- TB is spread through the air when an infected person coughs, sneezes, or talks.
High-Risk Populations
- People living in crowded conditions
- People with weakened immune systems
- People with HIV/AIDS
- People who use drugs
- People who have recently traveled to countries with high TB rates
- Individuals with recent exposure to TB
- Healthcare Workers
- Workers in long-term care facilities
Assessment
- History: Important to gather information about travel, exposure, and previous TB tests or treatments.
- Clinical Manifestations: The most common sign is a persistent cough that lasts longer than 3 weeks, and may produce sputum.
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Active TB
- Persistent cough
- Fatigue
- Weight loss
- Night sweats
- Low-grade fever
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Active TB outside the lungs:
- Can affect lymph nodes, bones, joints, meninges (membranes surrounding the brain and spinal cord)
- Symptoms vary depending on the location of infection.
Diagnostics
- Tuberculin skin test (TST)/Mantoux test/Purified protein derivative (PPD): A small amount of tuberculin is injected under the skin. The test is read 48-72 hours after injection. Induration (hardening) of 5 mm or more is considered positive in high-risk individuals.
- Chest X-ray: Can reveal abnormalities in the lungs, such as cavities or nodules.
- Sputum culture: The most definitive way to diagnose active TB.
- Other diagnostic tests include blood tests, bronchoscopy, and biopsies.
Treatment
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Multidrug therapy (MDT): Typically includes 4 medications for at least 6 months:
- Isoniazid (INH)
- Rifampin (RIF)
- Pyrazinamide (PZA)
- Ethambutol (EMB)
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Common adverse reactions:
- Nausea
- Vomiting
- Diarrhea
- Hepatotoxicity
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Nursing considerations:
- Educate patients about the importance of taking their medication as prescribed.
- Monitor for signs of adverse reactions to medication.
- Provide emotional support to patients.
Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) TB
- MDR-TB is resistant to at least two of the most effective first-line TB drugs (isoniazid and rifampicin).
- XDR-TB is resistant to at least isoniazid, rifampicin, and any fluoroquinolone, and to at least one of the injectable second-line drugs, such as kanamycin, amikacin, or capreomycin.
- Treatment for MDR and XDR TB is much more complex and can take longer.
- The risk of drug resistance is further increased by incorrect or incomplete treatment.
Evaluating Response to Treatment
- Baseline testing
- Monitoring for improvement in symptoms
- Follow-up sputum cultures to confirm the effectiveness of treatment.
Client Education (Important)
- Importance of medication adherence.
- Signs & Symptoms of TB.
- Preventive measures, such as good hygiene (handwashing) and covering the mouth when coughing or sneezing.
- Contact investigation (Identifying all individuals who may have been exposed)
- How TB is spread.
- Proper use of masks and respirators in healthcare settings.
- Follow-up care, including repeat TB tests.
- Social support and resources available, including counseling and financial assistance.
Tuberculosis Transmission and Prevention
- Tuberculosis (TB) is spread through the air.
- Nurses working with TB patients should wear N95 masks.
- Patients with TB should wear surgical masks.
Risk Factors for Tuberculosis
- Individuals with compromised immune systems, such as those with HIV, are at increased risk of TB infection.
Tuberculosis Testing and Diagnosis
- Individuals who have received the BCG vaccine must undergo an IGRA test to determine TB infection.
- A TB skin test is read 48-72 hours after injection.
- The size of the induration (hardening), not the redness, determines a positive result.
Tuberculosis Treatment
- First-line therapy for TB typically involves isoniazid and rifampin.
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Rifampin can cause:
- Orange-colored bodily fluids
- Liver toxicity
- Low platelet levels (thrombocytopenia)
- Extensively drug-resistant TB (XDR-TB) is resistant to all fluoroquinolones.
- Bedaquiline, a drug used to treat MDR-TB, can have cardiotoxic effects.
- A negative TB test result requires three consecutive negative tests, at least 24 hours apart.
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Description
This quiz covers the pathophysiology of tuberculosis, detailing how Mycobacterium tuberculosis infects the lungs and triggers an inflammatory response. It also highlights the high-risk populations vulnerable to TB, including those with weakened immune systems and the importance of assessment in identifying potential cases.
