Transcript Tuberculosis - Austin Community College

Tuberculosis
Tuberculosis (TB)
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Caused by:
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Mycobacterium tuberculosis
In the United States:
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Rates declining
Incidence decreased with:
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Improved sanitation
Surveillance
Treatment of people with active disease
Rates still high in selected populations
The Disease Process:
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Chronic and recurrent
Affects the lungs
Can invade any organ
Resurgence of Tuberculosis!!
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1980s and 1990s
Causes
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HIV AIDS
Multiple drug resistant strains
Social Factors
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Immigration
Poverty
Homelessness
Drug Use
Continues to decline
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TB-control programs
Initiation and completion of appropriate medications
Worldwide TB
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Countries that account for 90% of world cases
of TB
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Countries of ASIA
Africa
Middle East
Latin America
In Austin Texas
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Large number of immigrants, college students and
visitors FROM:
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INDIA
MIDDLE EAST
LATIN AMERICA
Other Risk Factors for TB
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Overcrowded Conditions
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Nursing homes, Rehabilitation Facilities and
Hospitals
Homeless shelters
Drug treatment centers and Prisons
People with Altered Immune Functions
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Older Adults
People with AIDS
People on Chemotherapy
Spreading the Disease
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M. tuberculosis
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Slow-growing, rod shaped, acid fast
***Waxy outer capsule which makes it resistant to destruction
Transmission
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Infectious person
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Coughs, sneezes, sings or talks
Airborne droplets
Remain suspended in the air for several hours
Susceptible Host
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Breaths in microorganism
Normal defenses of the upper respiratory system do not protect.
Risk For Infection
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Characteristics of the Infected Person
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Extent of contamination of the Air
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TB is active
How much of the lung is involved
Coughing
Overcrowded Conditions
Air circulation
Susceptibility of the Host
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Immuno-compromised
Nutrition
Health
Infection Takes Hold
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Minute droplet nuclei inhaled ->
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Upper lobe
Lodges in Alveolus or Bronchiole
 Leads to Inflammation
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Neutrophils and macrophages isolate seal
off but cannot destroy
Sealed off colony of bacilli (tubercle)
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Inside infected tissue dies
Creating a cheese-like center
The Immune Response
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Adequate
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Scar Tissue encapsulates the bacilli
Inadequate
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Tuberculosis develops
Extensive lung destruction can occur
Spread by the blood to other organs
Genitourinary tract
 Brain (meningitis)
 Skeletal
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Tuberculosis Can Spread within
The Body
Signs & Symptoms
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Fatigue, malaise (late afternoon)
Low grade fever, Night sweats
Anorexia, weight loss
Hemoptysis
Frequent productive cough
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mucoid or mucopurulent
Tight, dull chest
Joint Pain
Skin testing
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Tuberculin Skin Test (Mantoux)
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positive test does not signify active disease
0.1 ml PPD intradermally
Read in 48-72 hours
Results
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Measure induration
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Positive 10 mm
Possible 5-9 mm
Negative 0-4
Repeat x2 or x3 if any clinical signs
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25% false negative
Diagnosing
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Skin test positive 3-12 weeks after
exposure
Chest x-ray
Sputum - Acid Fast Bacillus (AFB)
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Smear not definitive
Culture is only definitive diagnosis
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May need up to 8 weeks to grow
Newly converted to positive
PPD
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Isoniazid 300 mg X 6-9 months
prophylactive prevents active Tb
Medications
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Newly Diagnosed Patients with active disease
typical treated with Four medications
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isoniazid (INH) oral 300mg daily or 900mg twice a
week.
rifampin oral 600mg daily or twice a week
pyrazinamide (PZA) oral 15 to 30 mg/kg up to 2G
per day or 30 to 70 mg/kg once a week
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minimum 9 months
take in AM
90% have negative sputum in 3 months
ethambutal oral 15 mg/kg daily
Other Medications
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rifabutin
rifapentine
isoniazid
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Most effective TB drug
Take in AM with food
Continue until sputum negative 6 months
Adverse Effects:
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peripheral neuropathy
hepatitis
Monitor
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Liver Functions Studies (AST and ALT)
Avoid hepatotoxins (alcohol, acetominophen)
rifampin
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Take on empty stomach
Monitor liver function tests
Can cause:
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Hepatitis
Suppression of oral contraceptives
Do not stop medication
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Will cause flu-like syndrome and fever when resumed
Colors body fluids
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Sweat urine saliva tears: turn orange-red
pyrazinamide
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Increase fluids
Take with food
Adverse Effects
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Hepatotoxicity
Hyperuricemia
Monitor
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Uric Acid Levels
AST and ALT
Avoid hepatotoxins (ETOH; Tylenol)
ethambutol
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Protect from light
Adverse effects: retrobulbar neuritis, skin
rash, reversible with discontinuation of the
drug
Monitor color vision and acuity
Symptoms of Liver Toxicity
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loss of appetite
N/V
dark urine
juandice
malaise
unexplained elevated temperature
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for longer than 3 days
abdominal tenderness
Close Monitoring While Taking
Antituberculosis Medications
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Monitor liver Functions
Regular Office visits
Check for compliance
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Rifampin
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INH
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Check color of urine
Check urine for metabolites
Give medication
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Twice week in the office if compliance is a problem
Isolation
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negative flow room
vent to outside
masks, not ordinary
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molded to fit face
patient wears a standard mask when outside
room
ultraviolet light
General teaching
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cover mouth and nose to cough
dispose of tissues
hand washing
take meds as prescribed
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35% noncompliant
monitor side effects
Chronic Management
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Follow up in 12 months
5% recurrence, relapse
Test frequent contacts
Factors which can cause relapse
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immunosuppression
HIV/AIDS
prolonged debilitating illness
Compliance
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Therapeutic, consistent relationship
Understand lifestyle flexibility
Education
Reassurance, reduce social stigma
Take meds at clinic
Nursing Diagnosis labels appropriate
for the patient with tuberculosis
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Ineffective airway clearance
Impaired gas exchange
Nutrition, less than body requirements
Activity intolerance
Risk for noncompliance
Knowledge deficit
Ineffective health maintenance
The End