Title of Test: Anthrax
Pronunciation: AN-ther-ax
Type of Test: Blood; Tissue; X-ray
Body System and Functions: Hematological system; Pulmonary system; Integumentary system
Normal Findings: Negative for anthrax antibodies and negative for pulmonary involvement (seen in inhalation anthrax)
Estimated time to complete test: 5 min.
Test Results Time Frame: Blood: within 24–48 hours. Chest x-ray: 30–60 minutes
Test Description: Inhalation anthrax occurs when anthrax spores are inhaled deep into the lungs, where, once embedded, they release deadly toxins into the system. Inhalation anthrax is the most serious form of the disease. Symptoms at first resemble a common cold or flu, followed by difficulty breathing, a drop in blood pressure, swelling, internal bleeding, and other symptoms. Treatment in its later stages may have no effects.
Cutaneous anthrax is much less serious but also can kill if left untreated. About 95 percent of anthrax infections take this form. Cutaneous anthrax occurs when bacteria get into a cut or break in the skin. The infection usually starts as a raised, itchy bump resembling an insect bite. Within a day or two it turns into a darkening blister or one with a dark spot in the middle. The lesion may not appear in the same spot as the break in the skin through which the spores enter, so a lesion away from a cut cannot be assumed to be harmless. An invasive procedure is performed in a surgical setting. A scraping of the infected skin area is taken to obtain body tissue and is taken under sterile technique and examined microscopically for cell morphology and tissue anomalies.
Intestinal anthrax may occur after eating the undercooked meat of contaminated animals. Initial symptoms include nausea, loss of appetite, vomiting, and fever, followed later by abdominal pain, vomiting of blood, and severe diarrhea.
Treatment for anthrax is the use of antibiotics, such as Cipro or doxycycline, if given early. Treatment usually fails once the symptoms progress, since it does not accomplish positive results to eradicate the bacteria once they make large amounts of toxin.
CLINICAL ALERT: Whenever anthrax exposure is questioned, the Centers for Disease Control should be immediately notified. In addition, the health care worker should practice standard precautions with vigilance. Extreme caution should be used when there is suspected inhalation anthrax exposure. Clients should be informed to not take unnecessary antibiotics if the presence of disease is not confirmed. If taking a chest x-ray, a portable x-ray machine may be brought to the nursing unit if an inpatient client cannot be moved. Clients of reproductive age should have the testes and ovaries covered with a lead shield.
Consent Form: Not required
List of equipment: Blood: red top tube or serum separator tube; needle and syringe; alcohol swab. Pulmonary testing: nasal swab; x-ray machine and related equipment from radiology. Cutaneous testing: biopsy tray.
Test Procedure:
Blood:
1. Label the specimen tube. Correctly identifies the client and the test to be performed.
2. Obtain a 5 mL blood sample.
3. Do not agitate the tube. Agitation may cause RBC hemolysis.
4. Send tube to the lab.
Chest x-ray:
1. A routine chest x-ray is done with the patient in a standing position. If the client cannot stand, an upright position should be maintained. X-ray films taken in the supine position will not demonstrate fluid levels.
2. An anteroposition and left lateral views are taken.
3. The client removes street clothing to the waist and a hospital gown is worn. The hospital gown should not have buttons or snaps and all jewelry should be removed. Monitoring cables should be positioned out of view of the x-ray. These items may obscure a clear view of the chest.
4. The client is instructed to take a deep breath and exhale and then to take a second deep breath and hold it while the technician takes the x-ray image.
Tissue sample:
1. Place client in supine position.
2. A specimen of tissue is biopsied by excision or needle biopsy. Label the specimen and place in container. Correctly identifies the client and the test to be performed.
3. Send specimen to lab.
Clinical Implications and Indications:
Blood:
Diagnoses the presence of inhalation, cutaneous, or intestinal anthrax
X-ray:
1. Abnormal chest x-rays may indicate involvement of the anthrax organisms in the lungs.
2. Inhalation anthrax is the more deadly of the types of anthrax and requires immediate treatment with the appropriately prescribed antibiotics.
Tissue:
Diagnoses the presence of cutaneous anthrax
Nursing Care:
Before Test: Explain the test procedure and the purpose of the test. Assess the client’s knowledge of the test. Chest x-ray: remove jewelry and place monitoring cables off of the chest. Instruct the client that there will be no discomfort and explain the purpose and procedure of the test. Assist the x-ray technician in the proper positioning of the patient. Provide lead shields for the client and staff.
During Test: Adhere to standard precautions. For chest x-ray, instruct the client to remain motionless and to follow breathing instructions.
After Test: Apply pressure to venipuncture site. Explain that some bruising, discomfort, and swelling may appear at the site and that warm moist compresses can alleviate this. Clean site of skin scraping. Provide analgesia as necessary.
Potential Complications: Unnecessary use of antibiotics when anthrax is not confirmed may cause other problems for the client (e.g., gastrointestinal complications, pseudo-colitis). Bleeding and bruising at the site of the skin scraping.
Contraindications: X-ray testing is contraindicated in pregnancy.
Interfering Factors: Obesity and lack of full inspiration may interfere with diagnosis of certain conditions.
Nursing Considerations
Pregnancy: If an x-ray is necessary during pregnancy, the uterus should be covered with a lead shield.
Pediatrics: If the anthrax disease infects the infant, they are more at risk for critical complications, due to their underdeveloped immune system. Sedation is recommended for infants and children during skin scraping. Place the infant or child on a blanket for comfort. After postprocedure monitoring is completed and per health care provider’s order, the pediatric client is discharged with an adult who is given instructions.
Gerontology: If the anthrax disease infects the elderly, their immune systems may be more compromised related to the aging process. This consequently makes their morbidity and mortality rates higher than persons of younger ages.
Rural: The traditional methods of contracting anthrax would be in rural farm settings. However, due to the terrorism seen in the United States in September and October 2001 there are also increased levels of the disease in urban settings.
International: Various areas of the world have sporadic and routine anthrax contamination. There is a particularly high incidence of disease in parts of Africa and Asia.
Audio: No
Bibliography: Bussey, E. (2000). Senate hears testimony on anthrax vaccine shortage, Reuters Health News, July 18.
Handelman, A. (1999). S. Biohazard. New York: Random House.
Tucker, J. B. (2000). Toxic terror: Assessing terrorist use of chemical and biological weapons. Cambridge, MA: MIT Press.
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