Tuberculosis Study Guide
by Tsewang Rinzin
|Describe the pathophysiology of each problem (what is wrong and what causes it)||What are typical signs and symptoms of this disease process||Name any labs or diagnostic tests that maybe done and what they will show||List treatments and 3 common medications and why they are used||List several nursing responsibilities related specifically to this problem|
The tubercle bacillus (a rod) Mycobacterium tuberculosis
Description of disease:
TB is caused by inhaling droplets of mycobacterium tuberculosis from an infected person. It encases itself in a spore, a waxy coating that makes it difficult to get destroyed. It usually travels through our respiratory system and form a lump called tubercule. This tubercle remain latent until multitude of factors such as disease, poor nutrition, stress, and other immune system weakening process collectively enables this organism to multiply and become active – an active TB. The action of T lymphoctyes and macrophages with the help of lymph nodes on tuberculosis results in formation of granulomas in lungs, which is known as miliary tuberculosis due to hypersensitivity reaction. It is important to note that besides lungs other organs such as kidneys, brain, spine and bones also since blood can carry this pathogen.
|Early: In the early stages, when the person is just exposed to the TB the hypersensitivity reaction takes place where tubercle lesions, caseation necrosis, forms. Most healthy people resist the formation of granuloma and very small lesions develop, that is eventually walled off by fibrous tissue and results in calcification. It’s called Ghone complex.
At this stage, the infected individual doesn’t necessarily has an active TB or any symptoms, even though the tubercle is visible in the Chest X ray and PPD is positive.
It’s referred to as primary infection and the infected person is asymptomatic most of the time.
Late: During the secondary or reinfection stage, the active TB exists. Infected individual have decreased resistance and thus the pathogens are able to multiply without disruption. Cavitation, where destruction of lung tissue and blood vessels along with spread into other parts of the lungs occurs. Systemic signs often appear first with anorexia, fatigue, lethargy, and weight loss. They can be followed by low grade fever, night sweats, cough, purulent sputum, chest discomfort, dyspnea and most extremely a hemoptysis.
|Skin (mantoux) test – it reveals whether tubercle bacillus is present in the body or not. Positive PPD only means the mere exposure to TB microbe.
Chest X-ray – this test will reveal whether or not the granulomas and cavities are formed in the lungs or not. This test reveals whether the lung has been affected or not. This test is also not a definite prove of active TB infection since these cavities could have been formed long time ago or by some other pathogens.
Sputum test – This test look at sputum cultures for active tuberculosis bacilli. If the test if positive, it means the person has an active TB since the bacilli is actively circulating.
|If the infected individual is showing respiratory distress syndrome due to TB, he or she might receive respiratory therapy specific to that symptoms such as oxygen for shortness of breath, and nutrition supplements for weight loss, fatigue and loss of appetite.
Since TB is a bacterial infection, only way to treat is to use antibiotic drugs.
For latent tuberculosis, the patient will receive six to nine months of isoniazid therapy as a chemoprophylaxis, to keep from developing the actual active TB disease.
If the active TB is present, the patient receives isoniazid and rifampicin during the last four of the six month drug therapy. The first four month is treated with isoniazid, rifampicin, ethambutol and pyrazinamide, which actively fights the bacilli in the entire body system.
|Place the patient on isolation whenever suspected of having TB according to the facility policy.
Assess and educate patient about the anti-TB drug therapy and the importance of compliance.
Assure patient about the success rate of the treatment.
Monitor any adverse reactions to drugs.
Record nutrition and diet therapy.
Monitor vital signs, especially the respiration and lung sounds.
Make patient feel comfortable as he or she might get scared by the precautionary measures of masks and face shields.
What are the risk factors for catching tuberculosis?
Weak immune system – there are many factors that lead to weakened immune system such as old age, malnutrition, HIV/ AIDS disease, diabetes, liver and kidney dysfunction, and cancer.
Close airborne contact – tuberculosis transmission take place through airbone contact. Often time this happens when the people live in a crowded place together with poor cleaning conditions; a refugee camp or shelter is a good example.
Lack of medical health care – tuberculosis is not only preventable but also easily treatable if caught in its early stage of infection. Often time both money and lack of access to health care play the role in this.
People from poor countries – people who are from poor countries have all the problems listed above.
Substance abuse – drug use not only make our immune system weak, but sharing them also make us more susceptible to infection.
TB is considered to be a “reportable disease” and state and county health services generally become involved when a person is diagnosed because of medical compliance issues with a complex regime. Discuss why this is important beyond the curative issue for the patient diagnosed.
Health care workers are obligated to report mandated TB infection if they see any. In addition, the community health services usually gets involved in thoroughly helped the infected person get the proper treatment to an extent where they send a health care worker to watch the tuberculosis infected patient take all his or her TB medications as prescribed. This is done via DOTS (Direct Observed Therapy, Short-course) program often during first six months, when the patient is going through incubation and prodromal stages in which the patient’s TB is considered highly contagious. If the community doesn’t take these actions, there is high likelihood of other people getting infected as well since TB is a very easily communicable disease via air and droplets. This step is a preventative measure that will stop the chain of infection.
List some reasons why tuberculosis is on the rise within the United States.
There was an article called Trends in Tuberculosis – United States 2008 published by CDC in March 20, 2009 in its Morbidity and Mortality Weekly. According to that report, TB rate in the United States in 2008 reached the lowest rate since 1953; it declined 3.8% from 2007 to 4.2 cases per 100,000 populations. However, some of the reasons why tuberculosis cases have been on the rise in the United States are:
There have been surge in immigration population rates since the early 1990s, especially from poor countries where most population has been infected with TB at one point in their life.
Until recently there haven’t been many research conducted on the tuberculosis by research scientists and pharmaceutical companies to find a highly effective and short course treatment regimen. This is because most of the tuberculosis patients turn out to be from poor families, refugees and foreigners. Majority of the United States populations didn’t have TB illnesses and thus there wasn’t enough incentive for the scientists to study the treatment at its best.
It was only in early 2000s when United States started to aggressively pursue preventative measures such as DOTS program to fight against TB infection. So when infected people aren’t following (or not able to follow) the proper treatment regimen, a new set of bacterial pathogens start to grow that are resistant to the current antibiotics.
Other reasons include increasing numbers of people with HIV infection (becomes susceptible to TB due to weak immune response), substance abuse, and homelessness.
What infection control precautions are essential when taking care of a patient with active tuberculosis?
Infection control precautions that are necessary when taking care of patient with active tuberculosis are proper hand washing before and after coming in contact with the patient, wearing masks if coming in close contacts along with face shields if the patient is coughing out droplets, providing separate negative airway pressure room for patients with highly active in its initial stage and proper disposal of collected sputum samples as well as the instruments used for his or her treatment.
Negative pressure room can also prevent the spread of TB. Patients who are in a negative pressure room are able to breathe in air from his room and surrounding, but the air from the room doesn’t go out in the hallways. Instead the air in his room gets special filtration treatment and sent out of the building directly. This is because the air patient is breathing out is contagious and is capable of infecting anyone who comes in contact. Therefore, the nurse has to use special protective equipment devices such as masks, face shields, goggles and gloves while caring for the patient. The nurse also follows the standard precaution measure of washing hands before and after the treatment so that neither the nurse gets infected and spreads it and nor the patients gets more sick.
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