Tuberculosis

By: Michelle Russell

Objectives To become familiar with the disease

process of TB• Transmission• symptoms• Precautions

Nursing Diagnoses Interventions

Pathophysiology TB is caused by Mycobacterium

tuberculosis (aerobic acid-fast bacillus)

Most frequently affects the pulmonary system

15% experience the disease extra pulmonary

Transmission: respiratory droplets through sneezing or coughing

Types Active TB-

• Have symptoms• Contagious

Latent TB• No symptoms• Not contagious• Bacteria remains in the body, but in an

inactive form• THIS CAN BE ACTIVATED

Signs & Symptoms Subjective:

• Purulent greenish-yellowish sputum or blood• Generalized weakness and fatigue• Shortness of breath• Activity intolerance• Weight loss and indigestion• Difficulty sleeping, chills or night sweats• Productive or non productive cough • Chest pain while breathing or coughing

Signs and Symptoms Objective:

• Diminished or absent breath sounds• Cyanosis because of decreased oxygen to

the body• Difficulty breathing- strider, crackles• Fever• PPD Skin test• X-ray

HPI Ask about their…..

• Medical history• Social history• Most importantly:Ask if the patient has been exposed to someone with TB, or if they are a healthcare worker.

Statistics Prevalence:

• Most commonly affects the elderly, men (age: 24-44), and immuno-suppressed.

• 70% of all TB cases are most prevalent among minorities in the U.S.

Mortality:• Tb is one of the leading causes of death among

the globe; 95% of all cases occur in countries that lack resources and have a high rate of HIV

• 8 million cases occur yearly, and of those 3 million die

Article 1 Nursing Interventions to MDR-TB

Center for Disease Control and Prevention recommend the use of 4 drugs:• Isoniazid (6 months), rifampin (6 months),

pyrazinamide (2 months), ethambutol (until sensitivity results are known)

• If it is MDR, treatment must last for 24 months Monitor response of therapy Provide monthly sputum specimens for

AFB smear and culture

Article 2

Local problems, local solutions: improvingtuberculosis control at the district level in Malawi

DOTS-directly observed therapy, short course• Passive case detection using smear

microscopy• Short course of chemotherapy• Uninterrupted supply of drugs• Reporting and recording system to allow

evaluation WHO-

• TB prevention among those with HIV

Nursing Interventions Infection control Medication management Environmental management Surveillance Nutrition management Teaching: disease process

Clinical Application Patient scenario:

• 19yr old female started having a constant headache, the doctors were having difficulty finding the cause and by the time they did, it was too late, her TB had turned into meningitis. Her condition kept declining and a few months later, she had a massive stroke. Now she is alive, and is no longer contagious…. But she can’t talk or walk, and is paralyzed on the right side of her body from the neck down.

Clinical relevance The patient has been hospitalized

since March (8 months) No longer on isolation Still fighting the infection and still

receiving long course antibiotics Taught the patient and her family

about her disease *she is attending physical therapy to

help her recover from her stroke

Real life precautions

Nursing Diagnosis Primary:

• Risk for infection R/T tissue inflammation and infiltration

Secondary:• impaired gas exchange• activity intolerance • Social isolation

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http://handsintheworld.wordpress.com/2011/04/13/hand-washing-vs-sanitizer/ Infection control at sickkids. (n.d.). Retrieved from http://

www.sickkids.ca/Nursing/Education-and-learning/Nursing-Student- Orientation/module-one-safety/infection-control-at-sickkids/index.html

Networking the land: Rural america in the information age. (n.d.). Retrieved from http://www.ntia.doc.gov/legacy/otiahome/top/publicationmedia/rural2001/networking_the_land_with_illustrations.htm

Paul, M. K. (2001, February 01). Local problems, local solutions: improving, tuberculosis control at the district level in malawi. Retrieved from http://web.ebscohost.com.ezproxy.hsc.u sf.edu/ehost/pdfviewer/pdfviewer?vid=11&hid=106&sid=31782fc9-f544-4dc4- 99d0- 6086d1857d46@sessionmgr110

Rising thoughts. (2008, November 17). Retrieved from http://www.clinicsrising.com/blog/?currentPage=8

Sommers, M. S. (2011). Tuberculosis. In Diseases and Disorders: A Nursing ,Therapeutics Manual (4 ed.). Philadelphia, PA: Unbound Medicine.

Tips for prevention of tuberculosis. (2011, July 7). Retrieved from http://linssky.com/2011/07/tips-for-the-prevention-of-tuberculosis-tb/

Tuberculosis and rabies. (n.d.). Retrieved from http://topworldofhealth.blogspot.com/2011/09/tuberculosis- tuberculosis-or- tb.html

Willis, K., & Vezeau, T. M. (n.d.). Nursing interventions for mdr-tb. Retrieved from http://www.jstor.org.ezproxy.hsc.usf.edu/stable/34717 42?seq=2

QUESTIONS?