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Tuberculosis (TB) is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. It affects the lungs mostly but can cause symptoms in your skin or other organs. TB is transmitted from coughs and sneezes where the bacterium is carried in the air. A third of the population of the world is infected with the tuberculosis bacterium but only one in 10 of these individuals will advance to developing the disease because of the body’s immune system, which fights the infection, and destroys the germs once it is inhaled. When the immune systems successfully fights off the bacteria, a defensive shield is formed around it, and although the bacteria will stay in the body no symptoms will be present, this is called latent TB. If the immune system fails to destroy the bacteria the disease will infect the lungs first and then usually the glands that are part of the immune system. In the United States, a few populations are more susceptible to TB, the population at highest risk is the underprivileged. Low-income families and uninsured are among populations at risk. Worldwide, healthcare workers are at risk. The tuberculin skin test can be useful in diagnosing individuals who are not ill, the skin test is placed on the forearm and then read by a nurse or other trained professional in 48-72 hours.
Positive skin tests are a sign that a person has had exposure to the tuberculosis germ. To detect active disease, further testing such as chest x-rays, blood tests, and sputum cultures need to be performed. Some of the testing can take several weeks to have results, which can cause treatment to be delayed. The majority of patients with either active or latent TB are treated with a combination of four antibiotic tablets for six months, which will kill the bacteria. TB can be cured with the treatment of antibiotics. Treating latent TB prevents the infection from becoming active in the future. You can also get a BCG (tuberculosis) vaccination, which will inject a small amount of bacterium into your body not enough to cause any disease but enough for your body to produce antibodies that will fight and remember the bacteria. The vaccine is 70-80% effective against the most severe forms of TB. Medications are used to treat Tuberculosis, but the treatments are given longer compared to other types of bacterial infections.
If one has Tuberculosis, the typical length of treatment with medications are six to nine months. The length of treatment depends on your age, overall health, the form of TB, and its location within the body. There are four medications that are commonly used to treat Tuberculosis and they are: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. There are a few side effects when taking these medications, although these are rare, they can be serious if they do occur. These medications can be liver toxic, so it is important that you seek medical attention if you experience any signs of liver injury. In order to control the spread of Tuberculosis hospitals use isolation procedures for patients with active infections. Isolation should last until the patient responds to treatment and is no longer coughing. Respiratory protection is used by healthcare workers that come into contact with patients that have TB.
One vital aspect for community health nurses working with high-risk populations to adhere to droplet precautions and to utilize a mask to minimize exposure and in order for the chain of infection to be broken. According to the Centers for Disease Control and Prevention (2014), prevention of exposing TB to individuals infected with HIV is of specific worry given that they are at an especially increased risk of having active tuberculosis if infected. Spread of TB among HIV infected individuals is rising. If a person has both HIV they are more likely to get Tuberculosis and it progress from latent to an active disease. Tuberculosis and HIV are very harsh on the body; which they each drive the progress of the other. Also, another reason we still see Tuberculosis is due to the drug resistant strains of the bacterium. Which makes the nurse’s role in recognizing, restraining, and caring for those with this disease extremely important. As always, the remainder of the everyday standard precautions and appropriate hand washing when providing care for infected patients continues to be a vital aspect of health-care and ending the transmission of the disease.
The nurse caring for these patients must assess their home environment, and support system as part of their assessment. Proper nutrition is important as well as teaching individuals to cover mouth and nose when coughing, correct way to dispose of tissues and practice proper hand- washing techniques. The nurse in the community will assess understanding of teaching and monitor ways to identify success or areas that need re-instruction.
The health care provider must consider reporting a patient that is at risk of non- compliance of the entire regimen of medications be to Public Health and their PCP. Direct intervention of observation of medication compliance by the community nurse should be considered. Although, a latent TB person is not considered contagious, a person with active TB disease is thought to be infectious for 2-4 weeks after completion of full regimen treatment. Monitoring by the community nurse for effectiveness of treatment and for any side effects associated with the medications. (Maurer & Smith, 2013)
The Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination’s (DTBE) strategic plan focuses on the following goals: Domestic to eliminate TB in the United States (defined as <1 case/million) and Globally contribute to decrease in global incidence and mortality by 50% each. This is compared to 1990 baseline, stemming on the Stop TB Partnership Global Plan to Stop TB (2006-2015). To achieve this, there are plans that are comprised of all-inclusive patient centered care and prevention aiming to diagnose TB in a organized manner including individuals that have been in contact with patients as well as high- risk groups.
Also, individuals identified as high-risk would receive preventative care. Overall health coverage, social protection and poverty relief emerged as policies and complementary networks. Expanded research and innovation to find new treatments and continued advancement on a vaccine.
Despite working with inadequate resources, nurses have contributed significantly to the work in delivering care to patients and families, as well as in implementing national TB control and prevention programs. A significant component of TB control is ensuring appropriate access to health services. Prompt diagnosis is, therefore, essential. As Tuberculosis continues to spread throughout the world, a variety of tests persist to help determine diagnosis, management, and avoidance, as well as national prevention programs.
Furlow, B. (2010). Tuberculosis: A Review and Update. Radiologic Technology. 82(1) 33-49 Retrieved 2/15/14 from: http://library.gcu.edu/ Global strategy and targets for tuberculosis prevention, care and control after 2015. (2013).WorldHealthOrganization.Retrievedfrom:http://www.who.int/tb/post2015_tbstrategy.pdf?ua=1 King, M.G. (2011). Four Responsibilities of the Tuberculosis Nurse, Circa 1919. Public Health Nursing. (28) 5. 469-572. Retrieved 2/15/14 from: http://library.gcu.edu/ Maurer, F.A. & Smith, C.M. (2013). Community/Public Health Nursing Practice. Health for Families and Populations. (5th ed.) St. Louis, MO: Saunders/Elsevier Multi-drug resistant TB (MDR-TB) Fact Sheet. Retrieved from: http://www.lung.org/lung-disease/tuberculosis/factsheets/multidrug-resistant.html National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of Tuberculosis Elimination. TB Elimination: Tuberculosis: General Information. Retrieved from: http://www.cdc.gov/tb/publications/factsheets/general/tb.pdf