oxygenation 1

Spongebob

100

 

• What causes SARS & MERS?

• Coronavirus-viral

200

Who is at risk for developing SARS & MERS?

• close contact with infected & travelers
• Risk factors for poor outcomes:
• Older age, comorbidities, elevated LDH, atypical symptoms, acute renal failure

300

• How are SARS & MERS transmitted?

• Transmitted via respiratory droplets – airborne & contact

400

signs and symptoms of SARS

• Fever, cough, difficulty breathing
• HA, body aches, diarrhea
• Develop pneumonia

500

MERs signs and symptoms

• Fever, cough, difficulty breathing
• HA, body aches
• Develop pneumonia & kidney failure

Meridith grey

100

• How are SARS & MERS treated?  What kind of transmission-based precautions are put in place?

• Precautions; airborne & contact
• Treatment:
• Supportive care only
• Neg pressure room, PPE, hand hygiene, environmental hygiene

200

• How is tuberculosis transmitted?

• Airborne transmission

300

• What are risk factors for TB infection?

• Close contact with infected
• Immigrants  or recent travel (countries with high TB Rate)
• Children younger than 5yrs
• Homeless, low SES
• IV drug use
• HIV infection
• Immunocompromised
• HC worker or resident in high risk setting: nursing home, correctional facility, hospital, homeless shelter, group homes

400

Differentiate between LTBI and active TB disease

• LTBI
• Is not contagious and does not exhibit issues or symptoms
• 5 to 10% can develop into active TB

• Active TB
• Is very contagious
• Exhibits many symptoms and is the number one opportunistic infection killer in those with HIV

500

•  What are the s/s of active TB disease?

• Cough for 3+ weeks – non-productive, mucopurulent, or hemoptysis
• Chest pain
• Weakness or fatigue
• Weight loss
• Anorexia
• Chills, fever, night sweats

Inspector butters

100

• How are older adults with active TB disease likely to present?

• Older adults : AMS, fever, anorexia, weight loss

200

What three tests can be used to diagnose TB infection (LTBI or TB disease

• To diagnose TB disease:
• Sputum C/S for AFB
• CXR
• To diagnose TB infection (LTBI or TB disease):
• Mantoux method:
• Intradermal – tubercle bacillus extract (tuberculin), purified protein derivative (PPD)
• Positive – induration & erythema present in 48-72 hrs
• Induration:
• 5mm+ is significant for immunocompromised
• 10mm+ significant for normal immunity

300

• How is the TB skin test administered?

• Inner aspect of forearm – 4 in below elbow
• 0.1 mL to make 6-10 mm wheal
• Site, antigen, strength, lot number, date, time of test recorded
• Read 48-72 hours after injection
• BCG vaccine will produce positive result – given in Europe, Asia, Latin America
• Positive does not mean active TB
• Negative could still be positive in severely immunosuppressed – can’t develop immune response

400

• What would constitute a positive TB skin test?  What does a positive test confirm?  Would those who have received BCG test positive?

• 5mm+ is significant for immunocompromised
• 10mm+ significant for normal immunity
• It does not confirm that you have tuberculosis but suggests further testing
• Yes those who come from other countries will be positive do to BCG vaccine.

500

• How does the QuantiFERON-TB gold test detect TB infection? Would those who have received BCG test positive?

• Detects release of interferon-gamma from pt’s WBCs in contact with peptides similar to M. tuberculosis incubated overnight
• Results in 24 hrs
• Not affected by BCG

Ed, ED and Eddy

100

• What is the treatment for LTBI?

• isoniazid for 3-9 mos, rifampin 4 mos, or isoniazid + rifapentine for 3 mos

200

• What are the 4 first line anti-TB agents?

• Isoniazid (INH)
• Rifampin
• Pyrazinamide (PZA)
• Ethambutol

300

• How long until you are considered non-infectious?

• Non-infectious after 2-3 weeks of meds, improved symptoms, negative sputum cultures x 3

400

• What are some adverse effects of isoniazid (INH)?  For each, give symptoms of the adverse effect and how to prevent it.

• Liver toxicity –
• N/V/anorexia, fatigue, jaundice, dark urine, easy bruising, bleeding
• Baseline LFTs, repeat monthly
• Avoid ETOH

• Neuro toxicity - Numbness, burning, tingling of hands/feet
• Vitamin B6 to prevent neurotoxicity

500

• INH increases levels of what other drugs?  What problems could this cause for each medication?

• INH increases phenytoin & disulfiram levels
• Problems
• Phenytoin
• Experience vision changes, dizziness, drowsiness, confusion, n/v, lack of coordination and slurred speech
• Disulfiram
• Used for alcoholism and combined with INH and alcohol the patient experiences severe symptoms that they rather die than endure
• Severe chest pain
• Chest palipitations
• Liver toxicity
• Increase levels.

uncle phil

100

• Describe the drug-food interactions with INH.

• Avoid foods with tyramine (aged  cheeses, red wine, smoked meats)
• Tachycardia, flushing, chills, hypertension
• Avoid food with histamine (tuna, herring, mackerel, sardines, shellfish, anchovies, mushrooms, tomatoes, spinach, eggplant, vinegar)
• Sweating, flushing, palpitations, hypotension

200

• What are some adverse effects of rifampin and rifapentine?  For each, give symptoms of the adverse effect and how to prevent it.

• Liver toxicity – N/V/anorexia, fatigue, jaundice, dark urine, easy bruising, bleeding
• Baseline LFTs, repeat monthly
• Avoid ETOH
• Body fluids red-orange, stains contact lenses (use hard body lenses)
• food interferes with medication absorption (although taking medications on an empty stomach frequently results in gastrointestinal upset).

300

• Rifampin and rifapentine decrease levels of what other drugs?  What problems could this cause for each medication?

• Decreases levels of oral contraceptives, warfarin, sulfonylureas, methadone
• Oral contraceptives- more likely to get pregnant
• Warfarin- increase risk of blood clotting
• Sulfonylureas- blood glucose goes up

400

• What are some adverse effects of pyrazinamide (PZA)?  For each, give symptoms of the adverse effect and how to prevent it.

• Liver toxicity - N/V/anorexia, fatigue, jaundice, dark urine, easy bruising, bleeding
• Baseline LFTs, repeat monthly
• Avoid ETOH
• Assess for hx of gout – will cause nongouty polyarthralgias
• Drink a glass of water with each dose, increase fluids through day to prevent gout & kidney issues
• NURSE SHOULD ASSESS FOR GOUT LIKE PAIN.
• Should take it with food for sure

500

• What are some adverse effects of ethambutol?  What baseline testing needs to be performed and then routinely?  What patient education would the nurse give?

*can cause issues with inflammation of optic nerve that leads to vision issues

• Obtain baseline visual acuity tests, then monthly after that
• Determine color discrimination ability-
• Cannot be given to children < 8yo
• Stop immediately if ocular toxicity occurs – report vision changes immediately
• Changes in color
• Blurring of vision.