Tuberculosis (TB) Symptoms, Treatment, Causes, Nursing NCLEX Review

this is cereth registered nurse orion coleman in this video i'm going to be going over tuberculosis in this video is part of an ink lex review series over the respiratory system and as always at the end of this youtube video you can access the free quiz that will test you on this condition so let's get started tuberculosis is a contagious bacterial infection caused by Mycobacterium tuberculosis and tuberculosis tinge to mainly affect the lungs specifically it resides in those upper part of the lungs so the apex and here in a moment you will know why but it's not just limited to the lungs once it gets in the body it can spread to the lymphatic system and it can travel to the brain the joins to live or the spine in the kidneys so remember that because a lot of times whenever people think of TV they think of oh it just affects the lungs but it can affect other areas of the body as well now let's talk about this bacterium Mycobacterium tuberculosis number one it is an acid fast bacteria which means whenever you collect sputum on this patient which you're going to be doing a lot for patients who you're testing for tuberculosis you will send it to the lab and they will do a special test where they're going to do an acid fast staining procedure and if this is indeed Mycobacterium tuberculosis it will stain a bright red color in addition this bacteria is aerobic which means that it absolutely loves oxygen so it needs lots of oxygen in order to thrive and grow which is why this bacteria likes to reside in those upper parts of the lobe the apex compared to the base because this is where you have the higher amount of oxygen now how is tuberculosis spread to other people because it's contagious well if you have a person like our little man here on the board if they have active tuberculosis which means that they're having signs and symptoms associated with the infection they've had a positive sputum culture for this bacteria their chest x-rays I'm normal and they've had like a positive skin test or blood test so they have active tuberculosis so anytime that this person creates an action that's going to make droplets that harbors this bacteria such as yelling coughing talking laughing when they expelled that out of through their nose on their mouth they're putting this bacteria into the atmosphere the air for others to come along and breathe in when they breathe it in it'll go down into their airway and this bacteria loves oxygen so it'll hang out in the lungs and depending on if this patient has a strong immune system what's going on with them they can develop active tuberculosis now why is this why is this airborne rather than like droplet well this bacteria is very small so it can suspend itself in the air instead of with like droplets those bacterial viruses are large they don't stay in the air very long at all and they fall onto the surfaces or wherever it can fall so as a nurse providing care to this patient what are you gonna wear well first of all there are airborne precautions what goes along with that you'll want to wear a respirator anytime providing care around that patient at all not a surgical mask because a respirator like an in 95 mask is special in that it will help filter out this small bacteria so you won't breathe it in in addition on top of that they will need special ventilation in the room and a negative pressure room to help prevent spreading that bacteria and you want to keep that door closed another thing is looking at your risk factors whenever you're getting these patients they're presenting maybe with signs of tuberculosis you want to look at those risk factors which we're going to go over here in a moment because winter bar closest the patient has to be in contact with others for a specific amount of time which is why patients who are in long term health care facilities they're inmates and Prisons homeless shelters where people are living in tight quarters with each other their risk for majorly spreading to it to other residents or other people who live there so now let's look at those risk factors and I would remember these factors for tests because test questions can't arise from this material so to help us remember the risk factors for someone developing tuberculosis let's remember the pneumonic TB risk TB sands fruits of our closest so RT of course what I just talked about is tight living quarters and these are your patients who are living close proximity together they are in long contact which just gives them time to be over exposed to this bacteria hanging out into the air and they can contract it next be below or at the poverty line and these are people who don't have great access to health care because they just can't afford it such as people who are homeless our refugees also immigrants who are coming from countries where they're high cases of tuberculosis next either immune system issues example a person who has HIV whenever a person has HIV they have a weak immune system so that makes them more susceptible to tuberculosis or they're taking immunosuppressant drugs which suppresses the immune system so anytime you see a test question says patient has HIV or taking these type of drugs think okay risk for tuberculosis yes for substance abusers these include people who use IV drugs or are alcoholics and last K for kids kids less than the age of five their immune system isn't fully developed it's weak so they are definitely at risk for tuberculosis especially if they're residing in a house with someone who has active TB so as a nurse we need to really assess for those risk factors and how do we do it well we ask specific questions on mission and your documentation the paper work that you're doing whenever you're admitting a new patient is going to have questions similar to this and if you have a patient who's coming in for respiratory issues you want to be thinking in this realm you know it's rare to have tuberculosis patients here in the US but you do have them I have provided care for patients who do have active tuberculosis so you want make sure you're thinking about it because it can happen still so you want to ask your patient have you traveled outside of the US or lived outside of the US if so where was it and how long are they from one of those countries that have high rates of tuberculosis next where do you live where's home for you are they from a long-term care facility like a nursing home are they an inmate and a prison which you'll usually be tipped off for that because they'll have a guard with them or do you live in a homeless shelter also do they use drugs if so what type of drugs because we're looking for really IV drug use because that not only puts them at risk for DeMarre closest but at risk for HIV and having HIV dramatically increases the chance of them having tuberculosis because of the weak immune system then you want to ask them were you born here in the u.s or were you born in another country as a child because in some countries they give the vaccine to prevent tuberculosis because they have high rates of tuberculosis called the BCG vaccine also known as the BAC sillas comment Gaye ran vaccine and this prevents tuberculosis but the thing you want to remember with this vaccine and I would remember this that if your patient has had this vaccine as a child they whenever you if you give them one of those skin tuberculin test the PPD test they will have a false positive because they've already been exposed to the Mycobacterium tuberculosis their immune system recognizes it because they had a vaccine so they're gonna have a false positive so it's best for them to have like a blood test which we're gonna go over the testing here in a moment and a chest x-ray to rule that out in addition you want to ask them about their signs and symptoms because when active tuberculosis presents they will have these specific signs and symptoms which are coughing that lasts for three weeks or more so ask them okay your coughing how long has this been happening also ask him what does their sputum look like are they coughing up blood do they have a fever night sweats fatigue unintentional weight loss chills a loss of appetite they just don't feel like eating or they're having chest pain or pain with breathing or coughing all can be related to an active tuberculosis infection and of course you also want to ask them have you had a TB skin test if so when was it and do you remember the results and you'll want to try to access those results if possible now let's talk about latent tuberculosis infections versus active tuberculosis infections and I would remember the differences between the two for testing purposes okay not everyone who actually inhales that Mycobacterium tuberculosis is going to develop a full-blown case of active TB because what happens is that when many people breathe this in our immune system recognizes it and it's strong enough to take care of it so what it does is it says hey this should not be here we are going to fix this so the army of our immune system comes in and it surrounds that bacteria and it encapsulates it now this person at this point has latent tuberculosis infection but the body is keeping it dormant now what can happen is that this bacteria can become active again why would it do that well when the immune system becomes weak or let's say the person gets HIV so it can become active again and it can turn into active tuberculosis which is what happens with a lot of these cases that we see many cases were person and held this wild back their immune system had it under control for a while but then the mean system broke down and this germ got out and was able to infect and cause an active infection so let's look at the differences between the two how how's your patient going to present so first with latent TB person has Justin held it their immune system is keeping it under control and most people are not going to develop an active infection they need that weakening of the immune system or something to make that germ come back alive so are they going to be contagious no the immune system has it under control will they have signs and symptoms no they're not going to they're going to have an abnormal chest x-ray no their chest x-ray is going to be normal because it's not causing any problems how's their sputum is it gonna have that Mycobacterium tuberculosis in it no it's going to be negative so they're not really going to know the only how they will know is whenever they go and get a skin test done the PPD tuberculin skin test or the blood test they will test positive for it and that is because their immune system have seen this bacteria before it's created this response to it so when we inject that the PPD in their forearm or they get a blood test we will see that their body reacts to it now do patients who have latent tuberculosis still need treatment yes they do because it'll prevent them from having a possible active infection in the future now according to CDC gov people who do not receive treatment about five to ten percent of them will actually develop an active TB infection so they still need treatment those medications now let's look at active tuberculosis are they contagious absolutely they have this bacteria in here that our immune system just can't deal with so it's flourishing and can't infect others are they going to have signs and symptoms absolutely they'll have those signs and symptoms that we just went over their chest x-ray is going to look abnormal they're gonna have a positive sputum culture because that bacteria is in there which is why it's contagious because they're putting it out when they call flyff breathe yell and one thing that these two will share is that this person of course will also have a positive tuberculin skin test and a positive blood test and with this active TB because it is in the system not being controlled by the immunes so it can easily spread via the lymphatic system and effect those other structures other than the lungs like the brain the joins the liver the kidneys and etc now let's talk about the testing that can be used to help diagnose a patient with tuberculosis because as a nurse you're going to play an important role in administering some of these tests and interpreting some of the results so first let's talk about the PPD skin test this has a lot of names it's also called the man to test TB skin test tuberculin skin test you may see it abbreviated TST all of us the same thing it just has a lot of names now what is this okay this is where a patient is injected with purified protein derivative with a tuberculin needles a special needle on the inner part of the forearm and as a nursing student and I know as a nurse you have had this type of tests done and after injection it will look very similar to this picture right here it will be nice and raised up after they have injected that into the forearm now whenever you give this test to a patient you have to tell them that they have to come back and you have to assess the site or someone else who's qualified the site within 48 to 72 hours and anything over 72 hours they'll have to repeat it and what you're assessing for is in duration of that injection site which is is it hard and raised up and you're gonna measure it in millimeters we're not looking at the redness we're looking at the in duration so how do we interpret results and I would remember this for testing purposes because the results are based on certain criteria based on those risk factors we just went over which is why wanting to cover those with you so you're measuring the site if it measures 15 millimeters or more that is positive in every one if it measures 10 millimeters or more that is positive in a person who's an immigrant an IV drug user works or is living and those tight living quarter areas or a child less than four if the size is five millimeters or more that is positive in a person who has HIV or if the person's been in contact with another person who has active tuberculosis they've had an organ transplant or their immune system is suppressed say that they're taking drugs that suppress it so that would be considered positive now just remember that just because a patient has a positive result doesn't mean that they have active tuberculosis they could have latent or they could have active so you need to get a chest x-ray and a speedom culture to help dipper differentiate between that because this test does not do that another type of test is a blood test where instead of injecting the PPD in the forearm they will just draw blood and it look at the immune systems reaction to this Mycobacterium tuberculosis and they'll put that in these three special tubes so these tests are called interferon gamma release assays and IG are a lot easier to say and there's two types that are on the market currently you have the quan chi faire on TB gold the QFT test or the t spot test now the benefits over this blood test over the PPD test is that the patient doesn't have to return to have the results read in addition it's great for patients who have had that BCG vaccine the BAC sillas comment gay ran vaccine so they won't get a false positive with this and this test is becoming a little bit more popular than the PPD test now one thing this test doesn't do as long along with the PPD test is it does not tell if the patient has latent TB or active t v-- they will need a chest x-ray and the sputum culture to help differentiate that another thing that can be ordered is of course a sputum culture and we about that a little bit already where they can do and AFB smear and acid-fast box a little smear and they do that special stain and what color will it stain if it is this bacteria that bright red color and they can obtain the sputum through either the patient coughing it up or if the patient can't do that they can do a bronchoscopy where they can go in and collect sputum now as a nurse who's going to be collecting those sputum cultures you need to know that you will collect the sputum on three you'll collect three different collection specimens on three different days and it is best to collect it in the morning before the patient has breakfast because they've just got up and I was where there's a lot of those respiratory secretions from after they just got up from sleep and of course a chest x-ray can be ordered they can look at the imaging for that and look for specific findings that's found in tuberculosis here you can see a normal chest x-ray you can see the right and the left lung it's nice and clear however this patient has pulmonary tuberculosis and you can see the chest cavity in the lungs and you can see interstitial infiltrates on both of the lungs due to a TB infection now let's talk about nursing interventions and treatment for tuberculosis okay you have a patient who has active TB they're the ones with those signs and symptoms and they're contagious what are you going to do you want to put them in airborne precautions which entails what again following standard precautions plus always wearing a respirator while providing care to that patient in that patients room so that in ninety five masks and the patient will need to be in a negative pressure room that door stays closed all the time and if it does open it we'll let you know because it will start beeping also you need to ask yourself okay how about this patient has to leave the room to go down for testing a lot of times testing can be done in the room at the bedside but sometimes they have to go down to have a special procedure if they do have to leave the room for that you'll want to put a surgical mask on them so remember that now most patients with active tuberculosis unless they're having complications are treated as an outpatient at their home because treatment for this takes about six months to a year to treat they're gonna be on like four different medications and treatment would just be way too expensive for them to be in the hospital for that long so you want to provide some education pieces to the patient to educate them so if they have active t v-- they're being treated at home they will have to remain in isolation this means they can have absolutely no visitors they can't go to school they can't work they can't go to public outings the only place they can go if they have to is to medical appointments and whenever they do that they need to wear a surgical mask because they're contagious and can spread this to other people also if they live in a home with other people they have to keep a separate room and stay away from those people so they don't spread it especially if you have little children in the house and doors and windows need to stay closed at all times now the patient is coughing sneezing they always need to do that in a paper towel and dispose of that immediately by flushing it or keeping it in an air-tight baggie and disposing of that and when can this person come out of this isolation well whenever they have been on their medications for at least three weeks their mutant cultures will hopefully start to become negative and they will need three negative cultures and their signs and symptoms need to be improving in order for them to meet criteria to be out of isolation and be able to live a normal life again and another thing I want to point out so you're just familiar with it is dot directly observed therapy and this is when a person will actually come out to the person's house who has TB and they will give them their medications and actually watch them swallow the medications and observe them for any signs and symptoms of complications or answer any other questions and this is usually like a public health nurse or someone who's specially trained in doing this and this helps increase compliance with these medications because these patients have to be on these anywhere from 6 to 12 months and they're taking them at different times and it can get confusing or they can just forget to take them which is leading to an increase in drug-resistant TB so the CDC recommends that all patients with tuberculosis are on this dot program to help prevent non-compliance and prevent so much drug-resistant TB now let's switch gears and let's talk about the medications used to treat tuberculosis we're gonna talk about five different drugs but we're really going to concentrate on four of them because they are the ones that are mainline in treating tuberculosis so to help us remember those four drugs let's remember the word Peri Peri means surrounding around and what happens with TB is that normally our body will surround that germ and encapsulate it well our body's really not doing that so we have to have these medications onboard to surround and kill these bacteria so that's how I like to remember it so pee here as in amide which has bactericidal effects which is a fancy way of just saying it kills the bacteria now you need to watch this drug in patients who are diabetic have kidney problems or gal because Pierce in imide increases uric acid levels and we learned in our gout video that's the whole reason for a gout attack is whenever a patient's uric acid levels are increasing so the doctor is gonna be monitoring those uric acid levels you as a nurse need to be looking for signs and symptoms of a gout attack happening it usually likes to start in the big toe the great big toe and it'll be red and warm patient will have limited mobility and it'll be extremely painful in addition this drug can cause liver and kidney problems so be monitoring that as well looking for jaundice look at their urinary output and GI upset is common with this so a ministering that with food will help decrease that efore ethambutol and what this drug does is it stops RNA synthesis so it's bacteriostatic which means that it prevents the bacteria from reproducing now with this drug it can inflame the optic nerve so as the nurse be thinking about vision and educating your patients to immediately report if they have any vision changes like their visions become blurred or they have a change in how they perceive color and they will need regular check-ups it can also cause peripheral neuropathy and this is where you have damage to those peripheral nerves so be asking your patients are you feeling any numbness or burning in your extremities because this can happen and if you do have a patient report numbness burning in their extremities or vision changes you want to notify the physician immediately about this are for rifampin and this drug works to stop RNA polymerase and what that does is it kills the bacteria now there's some things you want to educate your patient on because there's one thing that they're probably going to notice and it can really make them scared if you don't tell them about it one thing is that it can turn their body fluids Orange and their tears their sweat their urine will be orange and you'll want to reassure them about that and tell them if they do wear contact lenses especially those soft kind it will permanently stain those so they'll want to switch and we're hard lenses in addition educate your patients who are on hormonal like birth control that it will be less effective so they want to use backup methods and watch going out in the Sun because they can sunburn easily it makes the skin more sensitive and absolutely no alcohol while taking this medication really with all these drugs for tuberculosis your patients want to avoid alcohol because the liver can be affected with almost all these drugs so no alcohol and teach them about signs and symptoms of liver issues like jaundice having issues bleeding I for isoniazid also I&H and what this drug does is it kills bacteria and stops its growth but one thing that this drug can also do is decrease vitamin b6 levels so what a patients who take this are going to be on supplements and you'll want to assess your patients for that peripheral neuropathy that can happen during low vitamin b6 levels like ask them are you having tingling in your extremities you feel excessively tired depression which can all point to that that Baumann b6 is low and again monitor liver function and for neurotoxicity and lastly streptomycin now this drug isn't as commonly used as those other four I went over because of its side effects but it is used in some patients and I want you to remember the big thing with that one thing is is salt protein synthesis and it kills bacteria but a big side effect of this that you want to watch out for is their hearing so you want to monitor the hearing and ask the patients are you having any issues with hearing for instance are you having ringing in the ears because this drug is odo toxic and it affects cranial nerve eight so always ask your patients who are taking streptomycin if they are having any hearing issues okay so that wraps up this video over tuberculosis thank you so much for watching 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Channel: RegisteredNurseRN

Views: 961,386

Keywords: tuberculosis symptoms, tuberculosis causes, tuberculosis treatment, tuberculosis definition, tuberculosis bacteria, tuberculosis transmission, types of tuberculosis, TB, tuberculosis nursing, tuberculosis NCLEX, tuberculosis nursing interventions, nursing responsibility of tuberculosis, nursing assessment for tuberculosis, tuberculosis pathophysiology, tb skin test, tuberculosis skin test, tb vaccine, tuberculosis vaccine, mycobacterium tuberculosis, PPD skin test

Id: Or9EncdUbx8

Length: 27min 58sec (1678 seconds)

Published: Sat Jun 16 2018