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

The Concept of NR 1250/1610 Infection: Victoria Leonetti, MSN, RN Nursing Care of the Patient with Tuberculosis Course Student Learning Outcomes 01 02 03 04 Provide safe, Demonstrate Relate the impact...

The Concept of NR 1250/1610 Infection: Victoria Leonetti, MSN, RN Nursing Care of the Patient with Tuberculosis Course Student Learning Outcomes 01 02 03 04 Provide safe, Demonstrate Relate the impact Explain patient-centered, intermediate of quality management of evidence-based levels of critical improvement care concepts for nursing care thinking & clinical measures to adult patients guided by the reasoning to improved patient Caritas provide quality care philosophy patient care The Concept of Infection: Chain of Infection 1. Etiologic Agent – Mycobacterium tuberculosis 2. Reservoir – Human 3. Portal of Exit – Aerosolization 4. Mode of Transportation – Cough, sneeze 5. Portal of Entry – Inhalation 6. Susceptible Host – Human  Chronic infectious disease Recurrent Caused by mycobacterium Tuberculosis- tuberculosis Slender, rod-shaped organism- bacilli Waxy outer capsule resists destruction overview, Slow growing pathophysiolo 2-12 weeks to illicit an immune response Acid-fast bacilli (AFB) gy & etiology Primary site for infection- lungs (can “seed” into other organs) REPORTABLE DISEASE! Public health concern Epidemiology- Active Tuberculosis Cases in Ohio: 2022 Not very common! Lake = 0 cases Cuyahoga = 27 cases Summit = 5 cases Geauga = 0 Cases Ashtabula = 1 Cases Ohio 2019 Cases = 150 Pathophysiology & Etiology  Caused by Mycobacterium tuberculosis  Aerosolization of the bacilli enters the lung, implants into an alveolus or respiratory bronchiole, multiples and initiates an inflammatory response.  Phagocytic cells (neutrophils and macrophages) engulf the bacteria, isolating, preventing the spread.  A granulomatous lesion is called a tubercle is formed.  After 2-12 weeks, a cellular immune response can be elicited with a TB skin test. Pathophysiology & Etiology D O R M A N T ( L AT E N T ) T B ACTIVE TB If you have an If you have an adequate immune inadequate immune response, scar tissue response, the will form around the tubercle may rupture tubercle and bacteria and spread the will remain enclosed. bacteria. Bacteria Unable to temporarily encapsulate the inactive, but not tubercle dead Infectious Individual infected, Severe disease— but not sick and no erosion/cavitation symptoms of lung tissue  Active TB Exposed & Infectious Shows clinical manifestations NEED TO KNOW! Unable to encapsule the tubercle Dormant (Latent) TB Classification Exposed & noninfectious s No clinical manifestations Strong Immune system Reactivation TB You have latent TB but becomes active later in life due to weaken immune system Due to age, disease (HIV, immunosuppressive diseases), or use of immunosuppressive drugs  An older adult client experiencing a cough, hemoptysis, night sweats, anorexia, and weakness reports being told of having TB when younger. Which reason should the nurse suspect is responsible for the client’s current symptoms? A. Skeletal tuberculosis B. Reactivation tuberculosis C. New-onset tuberculosis D. Dormant tuberculosis  An older adult client experiencing a cough, hemoptysis, night sweats, anorexia, and weakness reports being told of having TB when younger. Which reason should the nurse suspect is responsible for the client’s current symptoms? A. Skeletal tuberculosis B. Reactivation tuberculosis C. New-onset tuberculosis D. Dormant tuberculosis  Immigrants, foreign-born (in the U.S.) HIV/AIDS Individuals with altered immune function Risk Factors Homelessness, homeless shelters Prison, detention facilities Overcrowded institutions, poor living conditions Poverty (no access to healthcare, poor sanitation) The nurse suspects that a client is at risk for tuberculosis. Which risk factor should the nurse assess in this client? Select all that apply. A. Being an immigrant to the United States B. Sharing clothes with an infected individual C. Having a compromised immune system D. Using injection drugs E. Living in a poorly ventilated environment The nurse suspects that a client is at risk for tuberculosis. Which risk factor should the nurse assess in this client? Select all that apply. A. Being an immigrant to the United States B. Sharing clothes with an infected individual C. Having a compromised immune system D. Using injection drugs E. Living in a poorly ventilated environment A nurse is assessing a patient for risk factors related to tuberculosis (TB). Which of the following factors is the greatest risk for developing active TB?  A) History of asthma B) Recent travel to a country with high TB incidence C) Family history of diabetes D) Occupation as a school teacher A nurse is assessing a patient for risk factors related to tuberculosis (TB). Which of the following factors is the greatest risk for developing active TB?  A) History of asthma B) Recent travel to a country with high TB incidence C) Family history of diabetes D) Occupation as a school teacher  MUST KNOW Asymptomatic in early stages, initial infection Fever (typically low grade) Night sweats Clinical Dry cough, progressing to hemoptysis (blood- Manifestation tinged sputum) Weight loss s Fatigue Cough, pleuritic chest pain Dyspnea (shortness of breath) Prevention and Diagnostic Tests  PPD Skin Test, TST, Mantoux test  Intradermal- read 48-72 hours  Measure INDURATION  >15mm is positive in ALL people  Redness NOT indicative of positive test MUST KNOW  O W T KN U S Sputum smear AFB M positive (active TB) Prevention Rapid indicator of the tubercle bacillus and At least 3 specimens needed, Diagnostic 8-24 hours apart One sputum Sputum Culture should be an early Tests morning specimen confirmatory diagnosis of infection with M. tuberculosis Time consuming: 4-8 weeks for detection (slow growing) Collaboration: Diagnostic Tests  Chest X-Ray  Dense lesions (apical, upper lobe), cavity formation  Interferon-gamma release assays (IGRA)  “QuantiFERON-TB test” or “T-Spot test”  Can be used on those who have received the tuberculosis vaccine  Used for those unable to return to have TST read **CULTURE remains GOLD STANDARD for laboratory confirmation of tuberculosis** A client has a 6-mm area that is slightly red and soft to the touch at the site of a PPD (Mantoux) test. Which finding should the nurse document for this client? A. Positive response B. Indeterminate response C. Positive response if the client had an abnormal chest x-ray D. Negative response A client has a 6-mm area that is slightly red and soft to the touch at the site of a PPD (Mantoux) test. Which finding should the nurse document for this client? A. Positive response B. Indeterminate response C. Positive response if the client had an abnormal chest x-ray D. Negative response  A positive TB test does not indicate active disease Prevention Sputum and chest x-rays are routinely used and Diagnostic Special procedures and PPE should be used when obtaining Tests sputum specimen Occasionally, endotracheal suctioning, bronchoscopy, or gastric lavage is necessary to obtain a specimen  Provide Spread patient and through the family air- person Collaboratio education to person TB n: transmission Airborne reduced by isolation- direct “negative sunlight/ pressure”; Prevention & ultraviolet HEPA filter light Place mask Precautions on patient if N95 masks leaving room Keep patient door closed A nurse is evaluating A. Redness measuring the results of a 16 mm tuberculin skin test (TST) 48 hours after it B. Induration was administered. Which of the following measuring 16 mm findings would indicate a positive test result in C. Induration a healthy adult with no measuring 5 mm known risk factors for tuberculosis? D. Redness and induration measuring 3 mm A nurse is evaluating A. Redness measuring the results of a 16 mm tuberculin skin test (TST) 48 hours after it B. Induration was administered. Which of the following measuring 16 mm findings would indicate a positive test result in C. Induration a healthy adult with no measuring 5 mm known risk factors for tuberculosis? D. Redness and induration measuring 3 mm Collaboration: Pharmacologic Therapy  Antibiotics are used to prevent and treat tuberculosis infection  Goals of the pharmacologic treatment of tuberculosis are the following: 1. To make the disease noncommunicable to others 2. To reduce symptoms of the disease 3. To effect a cure in the shortest possible time  Collaboration: Pharmacologic Therapy Isoniazid Rifampin Ethambutol Pyrazinamide A first-line drug for Inhibits RNA Bacteriostatic drug Inferences with treating ACTIVE syntheses which that reduces the bacteria's ability to TB. prevents bacteria development of synthesis fatty Helps eradicate from forming resistance to the acids dormant Used in bactericidal first- Can causes tuberculosis bacilli combination with line agent. hepatotoxicity Can causes isoniazid due to Inhibits RNA peripheral resists develops syntheses neuropathy rapidly Can causes optic (Vitamin B-6 & Can causes body neuritis pyridoxine can fluids to turn red help) (sweat, urine, saliva, tears) Collaboration: Pharmacologic Therapy ACTIVE TB First 2 months: rifampin, isoniazid, ethambutol and pyrazinamide After 2 months for at least additional 4-6 months: rifampin and isoniazid Longer for patients with underlying HIV, usually 9 months Increase compliance: Rifatar: combination drug (rifampin, isoniazid & pyrazinamide) Directly Observed Therapy (DOT) Helps with adherence Used for noncompliant patients Example: Active TB (ODH.OHIO.GOV) 1st month- rifampin, isoniazid,  If underlying HIV ethambutol and pyrazinamide  7th month- rifampin, isoniazid 2nd month- rifampin, isoniazid,  8th month- rifampin, isoniazid ethambutol and pyrazinamide  9th month- rifampin, isoniazid 3rd month- rifampin, isoniazid 4th month- rifampin, isoniazid 5th month- rifampin, isoniazid 6th month- rifampin, isoniazid Collaboration: Pharmacologic Therapy LATENT TB  Isoniazid—for 6-9 months  You do not have TB disease and cannot spread TB to others.  This medicine will help you PREVENT getting TB disease.  Rifampin for 4 months if indicated  Monitoring/surveillance for manifestations  Must know Clinical improvement has been Collaboration: demonstrated TB No Longer Considered On medications for at least 2 weeks Infectious When: Three (3) consecutive AFB smears are negative Resources  CDC website  https://www.cdc.gov/tb/ (This a very good, comprehensive overview of the disease process and treatment protocols)  Ohio Department of Health website