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Tuberculosis Notes Nurs 301
Strategies for Adult Health Care I (Liberty
University)
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TB
- Agent – mycobacterium tuberculosis
- Sites of involvement – pulmonary or extrapulmonary
o Primarily lung but can involve other body parts
- Increased risk for TB if person is immunocompromised pts
- Seen a resurgence of TB
o HIV infected pts
o MDR strains
- Makes granulomas
- Modes of transmission
o Spread by airborne droplets
o G+ acid fast bacillus – very small
o Inhale and set up in alveoli
o Multiplies slowly and spreads via lymph system then
spreads to other organs/locations
o Stays airborne for minutes to hours
o Cannot be spread by fomite
o Not highly contagious
- Must be 6-8 inches and inhale
o Macrophages that ingest bacilli fuse and form granuloma
- Granulomas are encapsulated
- May never have active TB
- Types of TB
o Latent TB
- Asymptomatic
- Not active
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- TB in body, fought off by immune system, dormant, no
symptoms
- Cannot spread TB
- Usually positive TB test
- Normal chest X Ray
- Negative sputum smear
- Needs tx for latent TB to prevent active TB – usually isoniazid
- May never have active TB, may get active TB quickly, may occur
later
- Latent TB and positive PPD – MUST HAVE PROPHYLACTIC
MEDS FOR 6-9 MONTHS
o Active TB
- Symptomatic
- Fatigue
- Weight loss and anorexia
- Low grade fever
- Chills
- Night sweats
- Cough productive may contain blood – advanced
- Can spread TB to others Abnormal chest x ray
- Positive ppd
- Positive sputum smear
- Dx
o Tuberculin skin test (TST) – also known as Mantoux test, uses PPD
best way to diagnose latent TB
- Occurs 2-12 weeks after infection for + result
- Look for induration (hardened area) that is 10-15mm 48-72
hours after the infection
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● Patients with TB will have a 5 mm induration to be positive
because they are immunocompromised
- Once positive, don’t do a TST again because it is always
positive o CXR – can't diagnose using chest x ray
o Bacteriologic studies
- Test for acid fast bacilli
● 3 early morning smears
● 3 days in a row
● 3 negative sputums, not contagious
● Culture the sputum
o Quantiferon – TB (QFT)
- Blood test to check for latent and active TB
- Results are back within a few hours – will be positive for IFN
gamma -
- Nursing implications
o Most TB is treated on outpatient basis o If hospitalized use airborne
isolation
o Active TB tx Four drug tx in initial phase bc of resistance
● INH
● Rifampin
● Ethambutol
● Pyrazinamide
●MONITOR LIVER FUNCTION
● Directly observed therapy
o Latent TB
- Isoniazid orally daily for 6-9 months
o STRONG RISK FOR NONCOMPLIANCE
- Nursing care
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o Airborne infection isolation
- Negative pressure room
- Pt covers mouth with tissue when coughing, sneezing, then
discard
- Handwashing
● If patient leaves their room need to wear a isolation masks
● Masks for hospital personnel
- HEPA
- N95 respirator
o Need 3 negative sputum smears for acid-fast bacilli, effective
response to drug therapy and clinically improving signs to diagnose
patient as noninfectious
- BCG vaccine for TB – not approved for US – live attenuated
vaccine – efficacy not great – always have +PPD
