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