Term
| Where are children most likely to contract TB? |
|
Definition
| An immediate household member |
|
|
Term
| How long is the incubation period for TB? |
|
Definition
|
|
Term
| What areas can TB spread to in children (uncommonly) |
|
Definition
|
|
Term
| How long is the treatment regimine for drug-sensitive TB for children? |
|
Definition
|
|
Term
| Is TB Treatment for children typically in a hospital or home setting? |
|
Definition
| Typically home setting. Only most severe cases treated as in-patients |
|
|
Term
|
Definition
| A collection of air in the pleural space. Trapped air consumes space within the pleural cavity, and the affected lung suffers at least partial collapse |
|
|
Term
| How is pneumothorax treated? |
|
Definition
| needle aspiration and/or placement of a chest tube is used to evacuate the air from the chest. Some very small pneumothoraces resolve independently |
|
|
Term
| How is pneumothorax diagnosed? |
|
Definition
|
|
Term
| Clinical presentation of pneumothorax |
|
Definition
respiratory distress, tachypnea, retractions, nasal flaring, grunting.
Cyanosis, diminised breath sounds on affected side |
|
|
Term
| What age group of children is most likely to suffer pneumothorax? |
|
Definition
|
|
Term
| How do you handle a chest tube that becomes dislodged from a child's chest? |
|
Definition
| Apply vaseline gauze and an occlusive dressing, immediately perform appropriate respiratory assessment and notify the physician |
|
|
Term
| What should be kept bedside to clamp the tube should it become dislodged from drainage container? |
|
Definition
|
|
Term
| How often is the dressing around a chest tube changed? |
|
Definition
| The dressing around a chest tube is occlusive and not routinely changed. |
|
|
Term
| What type of assessment should be performed frequently on a child with a chest tube? |
|
Definition
|
|
Term
| What is the most appropriate fluid for oral rehydration of a child? |
|
Definition
ORS (oral rehydration solution)
NOT water, milk, juice, etc. |
|
|
Term
|
Definition
| Genetic disorder. Autosomal recessive disorder. |
|
|
Term
| Is CF more common in white or black individuals? |
|
Definition
|
|
Term
| What is the most common debilitating disease of childhood among those of european descent? |
|
Definition
|
|
Term
| What percentage of indivdiuals with CF live past the age of 30? |
|
Definition
|
|
Term
| What is the goal of therapeutic management of CF? |
|
Definition
| Minimizing pulmonary complications, maximixing lung function, preventing infection, and facilitating growth. |
|
|
Term
| Are people with CF larger or smaller than those without it? |
|
Definition
|
|
Term
| Is physical excersize encouraged or discouraged for CF patients? |
|
Definition
|
|
Term
| Chest physiotherapy with postural drainage is used to treat what? |
|
Definition
| used to mobilize secretions from the lungs in patients suffering from CF |
|
|
Term
| What is the problem with CF? |
|
Definition
| Epitheleal cells fail to conduct chloride, and water transport abnormalities occur. This causes thick, tenacious secretions. |
|
|
Term
| What areas of the body are most effected by CF? |
|
Definition
| Lungs, sweat glands, GI tract, Pancreas, gallbladder, and other exocrine tissues. |
|
|
Term
| What is tested for in sweat to diagnose CF? |
|
Definition
| Chloride levels will be high |
|
|
Term
| Why do CF patients have fertility issues? |
|
Definition
| Tenacious seminal fluid can cause blocking of the vas deferens. Thick cervical secretions limit penetration of sperm. |
|
|
Term
| What causes nutrient absorbtion issues in patients with CF? |
|
Definition
| Pancreatic enzyme deficiency. |
|
|
Term
| What can be given to CF patients to increase nutrient absorbtion? |
|
Definition
| Pancreatic enzymes must be administered with meals and snacks to promote digestion & absorbtion |
|
|
Term
| What vitamins in particular should be supplemented in a CF patient? |
|
Definition
|
|
Term
| What shape will the chest of a CF patient take on? |
|
Definition
| Barrel chest - transverse diameter equals anterior-posterior diameter |
|
|
Term
| What group offers local support for families of children with CF? |
|
Definition
| The cystic fibrosis foundation |
|
|
Term
| What percentage of children of parents with CF will be carriers of the gene? |
|
Definition
|
|
Term
| What is the leading cause of cancer related deaths worldwide? |
|
Definition
|
|
Term
| Why do only 14% of patients survive 5 years after lung cancer diagnosis? |
|
Definition
| Because most lung cancers are diagnosed at a late stage when metastasis is present |
|
|
Term
| Where does lung cancer most often metastesize to? |
|
Definition
| bone, liver, brain, and adrenal glands |
|
|
Term
| What causes paraneoplastic syndromes? |
|
Definition
| hormones secreted by tumor cells. Often occurs with SCLC |
|
|
Term
| How is lung cancer staged? |
|
Definition
T - Tumor
N - Nodes
M - Metastasis |
|
|
Term
| What percentage of lung cancer deaths are caused by cigarrete smoking? |
|
Definition
|
|
Term
|
Definition
| Increased vibrations felt on the chest wall that indicate where air spaces are replaced with tumor or fluid |
|
|
Term
| Superior vena cava syndrome |
|
Definition
|
|
Term
| What organs are most effected by CF? |
|
Definition
Lungs
Pancreas
Liver
Salivary Glands
Testes |
|
|
Term
| What conditions to CF patients often suffer from? (non-pulmonary) |
|
Definition
Malnutrition (pancreatic enzyme deficiency)
Male sterility
Cirrhosis of the liver
Osteoporosis
Diabetes mellitus |
|
|
Term
| what is the main cause of death for CF patients? |
|
Definition
|
|
Term
|
Definition
| Over time, bronchioles distend and have increased numbers |
|
|
Term
| hypertrophy (in context of CF patients) |
|
Definition
| increased mucous-producing cell size |
|
|
Term
| Arterial erosion and hemorrhage are complications of what lung disorder? |
|
Definition
|
|
Term
| What may be responsible for level of severity of CF symptoms? |
|
Definition
| Different gene mutations result in different degrees of disease severity |
|
|
Term
What test is used to test for CF?
What is a positive result?
Normal result? (non CF) |
|
Definition
Sweat chloride test
CF 60-200 mEq/L
Non-CF (normal) 5-35 mEq/L |
|
|
Term
| Abdominal distention, GERD, rectal prolapse, foul smelling stools, and steatorrhea are all symptoms of what disease? |
|
Definition
|
|
Term
|
Definition
|
|
Term
FVC & FEV1
What are they like for a CF Patient? |
|
Definition
Forced Vital capacity
Forced Expiratory volume in the first second of exhalation
Both decreased for CF Patient |
|
|
Term
| What will a chest X ray show for a CF patient? |
|
Definition
Increased anterioposterior diameter
Persistent infiltrates |
|
|
Term
| What would ABG studies show for patient with acute exacerbation of CF or end stage? |
|
Definition
Acidosis
Greatly reduced Pao2
Increased PaCO2
Increased Bicarb
Low pH |
|
|
Term
| What classes of maintenance drugs are used to treat CF? |
|
Definition
bronchodilators
Anti-inflammatory agents
mucolytics
antibiotics |
|
|
Term
| What would a 10% or greater decrease in FEV signify for a CF patient? |
|
Definition
| Forced Vital Capacity decrease of 10% or more would signify need for exacerbation therapy |
|
|
Term
| Why is every attempt made to avoid having a CF patient mechanically ventilated |
|
Definition
| Once they are ventilated it is hard to get them off the vent |
|
|
Term
| What special oxygenation technique may be used for a CF patient during exacerbation |
|
Definition
| Heliox delivery of 50% oxygen and 50% helium |
|
|
Term
| aerosolized tobramycin would be used for what? |
|
Definition
| a severe exacerbation of CF symptoms needing more than oral therapy and less than IV therapy |
|
|
Term
| What is the serious bacterial infections for patients with CF |
|
Definition
|
|
Term
| How is Burkholderia cepcia transmitted? |
|
Definition
| casual contact between CF patients |
|
|
Term
| What is the name for the organization that is most involved with CF matters? |
|
Definition
| Cystic Fibrosis Foundation |
|
|
Term
| What teaching is done to help CF patients protect themselves against Burkholderia Cepcia? |
|
Definition
Avoid CF foundation events (banned if infeted)
Avoid direct contact of bodily fluids
Don't routinely shake hands or kiss people in social settings
Handwashing |
|
|
Term
| What is done to treat bronchole bleeding from lung arteries, and what CF patients would be at greatest risk for this complication? |
|
Definition
Interventional radiology embolizes the bleeding arterial branches.
This occurs in older CF patients |
|
|
Term
| What complications occur in patients over time? |
|
Definition
severe GERD
Osteoperosis
Sensorineural hearing loss |
|
|
Term
| What is responsible for hearing loss over time in CF patients? |
|
Definition
|
|
Term
| What would be considered surgical management of CF? |
|
Definition
Lung replacement
Pancreatic transplantation |
|
|
Term
| Why is rate of transplant rejection high in CF patients? |
|
Definition
| poor intestinal absorbtion of anti-rejection drugs |
|
|
Term
| Why are fewer lung transplants performed compared with transplantation of other solid organs? |
|
Definition
|
|
Term
| Will a CF patient getting a lung transplant need to be put on cardiopulmonary bipass? |
|
Definition
If they are getting a single lung or lobe transplant - probably not
If they are getting a double lung transplant - probably yes |
|
|
Term
| How long will a patient be intubated after a lung transplant? |
|
Definition
|
|
Term
| bleeding after lung transplant surgery would be the biggest concern for which patient? |
|
Definition
| a patient who had been put on cardiopulmonary bipass during the procedure and received anticoagulant therapy |
|
|
Term
When are anti-rejection drug regimines started after lung transplant?
What does this put the patient at risk for? |
|
Definition
immediately after surgery
This puts a patient at risk for infection d/t immunosuppresion |
|
|
Term
| What is the most common bacterial infection worldwide? |
|
Definition
|
|
Term
|
Definition
| Aerosolization (airbourne) |
|
|
Term
| What percentage of peopel initially infected with mycobacterium tuberculosis develop active TB |
|
Definition
|
|
Term
| how long after infection does it take before patient will have a positive reaction to a TB test? |
|
Definition
|
|
Term
| What will primary infection of TB look like on chest X-Ray |
|
Definition
| will be so small you probably won't be able to see it |
|
|
Term
| What is caseation necrosis in TB? |
|
Definition
| necrotic tissue being turned into a granular mass. This occurs in the center of the lesion |
|
|
Term
| Whwat is Ghon's tubercule? |
|
Definition
| Granular mass in the center of the primary lesion |
|
|
Term
| What may happen to necrotic tissue in lungs during TB infection? |
|
Definition
| calcification or liquefaction |
|
|
Term
| What happens in TB patients of liquifaction occurs? |
|
Definition
Liquid material empties into a bronchus and the evacuated area becomes a cavity (cavitation)
Bacilli continue to grow in the cavity and spread |
|
|
Term
| How does TB spread in the lung |
|
Definition
|
|
Term
| What can happen if TB lesions extend thru the pleura |
|
Definition
| Pleural or pericardial effusion |
|
|
Term
| What is military or hematogenous TB |
|
Definition
| spread of TB throughout the body when a large number of organisms enter the blood. |
|
|
Term
| Where does TB spread to in the body? |
|
Definition
| brain, liver, kidney, or bone marrow |
|
|
Term
| Where is the initial infection of TB usually found? |
|
Definition
| Middle or lower lobes of the lung. |
|
|
Term
| when is a TB patient infectious to others? |
|
Definition
|
|
Term
| How long can a primary TB infection last before symptoms develop |
|
Definition
|
|
Term
|
Definition
| reactivation of the disease in a previously infected person. |
|
|
Term
|
Definition
| the upper lobes of the lungs most likely to be the site of reactivation for secondary TB |
|
|
Term
| What kind of bacteria is M tuberculosis |
|
Definition
| acid fast rod. Non moving. Slow growing |
|
|
Term
| How long does drug therapy take to make a TB patient non-infectious to others |
|
Definition
|
|
Term
| Who is at greatest risk for TB? |
|
Definition
Constant frequent contact with untreated person
Decreased immune function
HIV
Living in crowded areas (mental health facilities, prisons)
Older homeless people
Alcohol or drug abusersw
Lower socioeconomic groups
Forign immegrants |
|
|
Term
| What is the instance of Tb among recent immigrants vs. native born americans? |
|
Definition
|
|
Term
| What patient should be suspected of having TB? |
|
Definition
| any patient with a persistent cough or other symptoms such as weight loss, anorexia, night sweats, hemoptysis, SOB, fever, chills |
|
|
Term
| What is the vaccine used for TB in other countries? |
|
Definition
| bacille calmette-guerin (BCG) vaccine |
|
|
Term
| How should a patient who has received a BCG vaccine be tested for TB? |
|
Definition
| Chest X ray or QuantiFERON-TB Gold test |
|
|
Term
| What assessemnts of patient history are important for TB? |
|
Definition
Past exposure
Travel / Country of origin
Results of any previous TB tests
If they have had the BCG vaccine |
|
|
Term
| Clinical manifestations of TB |
|
Definition
progressive fatigue
lethargy
nausea
anorexia
weight loss
irregular menses
low grade fever
night sweats
cough and mucopurulent sputum
sometimes blood in sputum
chest tightness
dull aching chest pain |
|
|
Term
| What might produce localized weezing in a patient with TB |
|
Definition
| partial obstruciton of a bronchus from endobronchial disease or compression by lymph nodes |
|
|
Term
What rapid test for TB has been approved by the WHO?
How soon are results available? |
|
Definition
Fully automated nucleic acid amplification test (NAAT)
2 hours |
|
|
Term
| What happens with a sputum smear for a patient with TB |
|
Definition
| sputum is obtained, smeared on a slide, and stained with red dye. After the slide has dried, it is treated with an acid alcohol to remove the stain. TB does not de-stain and will remain red |
|
|
Term
What blood test is available to test for TB?
How soon are results available? |
|
Definition
QuantiFERON-TB Gold test
24 hours |
|
|
Term
| How long after treatment are sputum cultures negative for TB |
|
Definition
|
|
Term
| How long do sputum cultures take to get results? |
|
Definition
|
|
Term
|
Definition
| purified protein derivative |
|
|
Term
|
Definition
| Localized swelling with hardness of soft tissue |
|
|
Term
| When do PPD tests need to be read? |
|
Definition
|
|
Term
| What diameter of induration signifies exposure to TB |
|
Definition
|
|
Term
| When is the instance of false negatives greatest for PPD tests? |
|
Definition
| Closer to the 48 hour mark. If possible, re-evaluate at 72 hours |
|
|
Term
| What size induration represents a positive TB test for a patient with HIV? |
|
Definition
|
|
Term
| What is important to take into consideration for a very old or immunocompromised person being tested for PPD |
|
Definition
| Take it with a grain of salt. |
|
|
Term
|
Definition
| failure of a skin response because of reduced immune function |
|
|
Term
| How often should people who regularly come into contact with TB be screened? |
|
Definition
|
|
Term
| How can increased participation in TB screening programs be achevied for foreign-born people and migrant workers? |
|
Definition
| deliver care in a culturally sensitive and non-threatening mannor |
|
|
Term
| Who should be encouraged to have an annual TB test? |
|
Definition
| Anyone who is considered high-risk |
|
|
Term
| Once a person's PPD test is positive -what is the next step? |
|
Definition
| Chest x-ray to detect active TB or old, healed lesions |
|
|
Term
|
Definition
|
|
Term
| What is crucial for supressing TB |
|
Definition
| STRICT ADHERENCE TO THE PRESCRIBED DRUG REGIMINE |
|
|
Term
| What is the most important teaching in regard to TB |
|
Definition
| adherence to the drug regimine. Provide accurate information in multiple formats, pamphlets, videos, and worksheets. |
|
|
Term
What can first line drugs used as therapy for TB damage?
What should we tell patients? |
|
Definition
Liver.
Don't drink alcohol for the duration fo TB therapy. |
|
|
Term
| What can be done to alleviate the side efffect of nausea with TB drug therapy? |
|
Definition
| Take the dose at bedtime. Antiemetics can be prescribed if needed. Eating a well balanced diet can help |
|
|
Term
| What diet should be followed for TB patients |
|
Definition
| Well balanced diet high in iron, protein, vitamins C and B |
|
|
Term
| What is important teaching for a patient with MDR TB or XDR Tb |
|
Definition
| The patient isn't immune to drugs - the organism is. So if the organism is spread to another person, they will be resistant to drug therapy too |
|
|
Term
How often are specimins usually needed once drug therapy for TB has been initiated?
How many consecutive sputum cultures need to be negative to be considered non-infectious? |
|
Definition
Every 2 - 4 weeks
3 consecutive negative cultures = noninfectious |
|
|
Term
| What precautions are used in the hospital setting for patients with TB or suspected TB? |
|
Definition
HEPA or N95 fit tested respirator
Gowns & Gloves
Handwashing |
|
|
Term
| How long should a patient receive follow up care by a health care provider for TB? |
|
Definition
| At least 1 year during active treatment. |
|
|
Term
| Who is available for support and free information to patients with TB ? |
|
Definition
ALA (American Lung Association)
AA can help with alcoholism |
|
|
