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Tuberculosis A bacterial lung infection

Tuberculosis A bacterial lung infection. What is the Cause?. Tuberculosis Causative Organism. Mycobacterium Tuberculosis Gram-positive, acid-fast bacillus ( AFB). Etiology and Pathophysiology. Brief exposure rarely causes infection

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Tuberculosis A bacterial lung infection

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  1. Tuberculosis A bacterial lung infection

  2. What is the Cause?

  3. TuberculosisCausative Organism Mycobacterium Tuberculosis Gram-positive, acid-fast bacillus (AFB)

  4. Etiology and Pathophysiology • Brief exposure rarely causes infection • Transmission requires close, frequent, or prolonged exposure • Inhaled bacilli pass down and lodge in the alveoli • Replicates slowly and spreads via the lymphatic system • Body immune system responds by initiating the inflammatory response.

  5. Transmission of Tuberculosis • How is Tuberculosis transmitted?

  6. Transmission of Disease • Spread via airborne droplets when infected person • Coughs • Speaks • Sneezes • Sings

  7. Ask Yourself? • Can the disease be spread by: • Hands • Books • Glasses • Dishes • Clothing • Bedding

  8. What is the difference between a TB infection and TB disease?

  9. Individuals at Risk • Poor, underserved • Homeless persons • Residents of inner-city neighborhoods • Foreign-born person • Older adults • Those in institutions (long-term care facilities, prisons) • Injection drug users • Immunosuppressed • Asian, native Hawaiian have highest reported cases

  10. Classification System for TB Description Type Class No TB exposure Not infected No history of exposure Negative reaction to tuberculin skin test 0 TB exposure No evidence of infection History of exposure Negative reaction to tuberculin skin test 1 TB infection No disease Positive reaction to tuberculin skin test Negative bacteriologic studies (if done) No clinical, bacteriological, or radiographic evidence of active TB 2 TB, clinically active M. tuberculosis cultured (if done) Clinical, bacteriological, or radiographic evidence of current disease 3 TB Not clinically active • History of episode(s) of TB • or • Abnormal but stable radiographic findings • Positive reaction to the tuberculin skin test • Negative bacteriologic studies (if done) • and • No clinical or radiographic evidence of • current disease 4 TB suspected 5 Diagnosis pending

  11. What can trigger reactivation of latent TB infection (LTBI) Answer: Host’s defenses become impaired

  12. Which of the following are Signs and Symptoms?Select all that apply • Fatigue • Non-productive cough • Weight loss • Sudden onset of high fever >1020 • Night sweats • Anorexia • Decreased movement of chest wall

  13. Signs and Symptoms • Cough becomes frequent • Produces white, frothy sputum • Hemoptysis is not common and is usually associated with advanced disease

  14. Complications • Pleural effusion and empyema • Caused by bacteria in pleural space • Inflammatory reaction with plural exudates of protein-rich fluid • TB pneumonia • Large amounts of bacilli discharging from granulomas into lung or lymph nodes

  15. Diagnosis

  16. TB Skin Test (Mantoux) Uses purified protein derivative (PPD) intradermal

  17. Administering the Tuberculin Skin Test • Inject intradermally • Produce wheal 6 mm to • 10 mm in diameter • Do not recap, bend, or break • needles, or remove needles from syringes • Follow universal precautions for infection control

  18. Reading the Tuberculin Skin Test • Read reaction 48-72 hours after • injection • Measure only induration • Record reaction in millimeters • Positive reaction • => 5 mm induration – high risk persons • => 10 mm induration – moderate risk persons • => 15 mm induration – low risk persons • Means that the person has been exposed to Tb and developed antibodies, does not differentiate between active and dormant Tb infection.

  19. Does a positive reaction mean the person has tuberculosis?

  20. Factors that May Affect the Skin Test Reaction Type of ReactionPossible Cause False-positiveNontuberculousmycobacteria BCG vaccination Anergy False-negative Recent TB infection Very young age (< 6 months old) Live-virus vaccination Overwhelming TB disease

  21. Who will have a positive test?

  22. If they have a negative test result does that mean that they do not have TB?

  23. If a person has other symptoms and has a negative skin test, then the HCP would likely order a __________ ________?

  24. Chest X-Ray • Does this chest x-ray confirm • the diagnosis of Tb? • Abnormalities often seen in apical • or posterior segments of upper • lobe or superior segments of • lower lobe Arrow points to cavity in patient's right upper lobe.

  25. Bacteriologic Studies AFB (shown in red) are tubercle bacilli • Sputum for AFB • QuantiFERON-TB • Blood is obtained from patient and placed in container with mycobacterial antigens. If the patient is infected with TB, the lympocytes in the blood will recognize these antigens and secrete interferon, a cytokine produced by lymphocytes. Test results are available in a few hours.

  26. Sputum Cultures • Use to CONFIRM diagnosis of TB • Culture all specimens, even if smear negative • Results in 4 to 14 days when liquid medium • systems used Colonies of M. tuberculosis growing on media

  27. Treatment and Nursing Care

  28. Goals of Nursing Care • Goals: • Comply with therapeutic regimen • Have no recurrence of disease • Have normal pulmonary function • Take appropriate measures to prevent spread of disease

  29. Drug Therapy

  30. Four Drug Regimen • isoniazid [INH] • rifampin [Rifadin] • pyrazinamide [PZA] • ethambutol

  31. Drug Therapy • Active disease • Patients should be taught about side effects and when to seek medical attention • Liver function should be monitored

  32. Have newer drugs with combinations of these

  33. Treatment Guidelines • Initiation Phase of Treatment • Multiple-medication regimen of all 4 meds • Administered daily for 8 weeks • Continuation Phase of Treatment • d/c ethambutol and continue other 3 meds • Administered for 4-7 months • Patient begins to feel better in this phase

  34. Drug Therapy • Latent TB infection • Individual is infected with M. tuberculosis, but does not have the disease. Usually has been exposed to someone with tuberculosis. • Usually treated with INH for 6 to 9 months

  35. Monitoring Response to Treatment • Monitor patients bacteriologically monthly until • cultures convert to negative • After 3 months of therapy, if cultures are positive • or symptoms do not resolve, reevaluate for • Potential drug-resistant disease • Nonadherence to drug regimen • If cultures do not convert to negative despite 3 • months of therapy, consider initiating DOT

  36. Monitoring Response to Treatment • The patient asks how long before he can be considered non-contagious? What is the appropriate response?

  37. Answer this How would the nurse assess if the patient has been compliant with taking their medications?

  38. Direct Observation Therapy • Used with those patients who are noncompliant and do not show signs of improvement after treatment. Noncompliance is major factor in multidrug resistance and treatment failures • Provide drugs directly to the patient and watch patient swallow drugs • Costly, but preferred to ensure adherence • If refuses DOT then may have to put involuntarily in treatment facility to protect the community.

  39. Drug Therapy • Vaccine • BacilleCalmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of the world - once person receives this vaccine, will have a false testing with the TST (TB Skin Test). For assessment, must have chest x-ray.

  40. Nursing Interventions • What type of isolation is typically ordered? • What PPE is worn? Who wears this equipment? • What type of room are they in? • Patient Teaching • Cover nose and mouth with tissue when coughing, sneezing, or producing sputum • Hand washing after handling sputum-soiled tissues • Ambulatory and home care

  41. Fungal Infections

  42. Fungal Infections - Who is at Risk • Seriously ill patients being treated with • Corticosteroids • Antineoplastic drugs • Immunosuppressive drugs • Patients with AIDS • Patients with Cystic Fibrosis

  43. Fungal Infections • Histoplasmosis • Cocciidiodomycosis • Blastomycosis • Cryptococcosis • Aspreigillosis • Pneumocystis pneumonia • Nocardiosis • Actinomycosis • Candidiasis

  44. Diagnosis

  45. Treatment and Nursing Care

  46. Drug therapy • Amphotericin B • Intravenous • Side effects • Hypersensitivity reactions • Fever and chills • Malaise • Nausea and vomiting • Thrombophlebitis at injection site • Pre-medicate with Benadryl to increase tolerance and decrease hypersensitivity • Monitor renal function • Ensure adequate hydration

  47. Drug Therapy • Oral Antifungal agents • ketoconazole (Nizoral) • fluconazole (Sporanox; Difulcan) • Flucytosine (Anobon) • Monitor effectiveness with serology testing • Side Effects • N/V •  liver enzymes • Bone marrow depression – monitor WBC, platelets

  48. Lung Infection

  49. Lung Abscess Pus-containing lesion of the lung Formed by necrosis of lung tissue

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