Tuberculosis

TUBERCULOSIS – Etiology, Risk Factors, Types, Pathophysiology, Clinical Manifestations, Diagnostic Evaluation, Management (Medical and Nursing)

TUBERCULOSIS

Tuberculosis is an infectious bacterial disease called by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

ETIOLOGY

• Mycobacterium tuberculosis
• Immunocompromised person
• Chemical industries

RISK FACTORS

• Aging
• Alcoholism
• Crowded living conditions
• Diseases that weaken the immune system
• Health care workers
• HIV infection
• Homelessness
• Low socioeconomic status
• Malnutrition, migration from a country with a high number of cases
• Nursing homes
• Unhealthy immune system

TYPES

• Pulmonary tuberculosis: if a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and prolonged cough-producing sputum.
• Extrapulmonary tuberculosis: in 15-20% of active cases, the infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as ‘extrapulmonary tuberculosis’. Extrapulmonary TB occurs more commonly in immunosuppressed persons and young children.
• Active tuberculosis: active TB means the bacteria are active in the body. The immune system is unable to stop these bacteria from causing illness. People with active TB in their lungs can pass the bacteria on to anyone they come into close contact with. When a person with active TB coughs, sneezes or spits, people nearby may breathe in the tuberculosis bacteria and become infected.
• Inactive tuberculosis: inactive TB infection is also called latent TB. If a person has latent TB, it means their body has been able to successfully fight the bacteria and stop them from causing illness. People who have latent TB do not feel sick, do not have symptoms and cannot spread tuberculosis.

PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS

• A cough lasting for more than 2-3 weeks
• Chest pain
• Chills
• Discolored or bloody sputum
• Fatigue
• Loss of appetite
• Night sweats
• Pain with breathing
• Severe headache
• Shortness of breath
• Slight fever
• Tiredness or weakness
• Weight loss

DIAGNOSTIC EVALUATION

• Injection of protein: by injecting a protein found in TB bacteria into the skin of an arm. If the skin reacts by swelling, then the person is probably infected with tuberculosis
• X-ray: Diagnosis of tuberculosis in the lungs may be made using an X-ray
• Sputum test: sample of sputum is tested in laboratory to diagnose the TB
• Bacteria: a culture of TB bacteria can also be grown in a laboratory. However, this requires specialized and costly equipment and can take six to eight weeks to produce a result.

MANAGEMENT

Medical Management

The five basic or ‘first-line’ TB drugs are:

• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol
• Streptomycin

Surgical Management

If medications are ineffective, there are three surgical treatments for pulmonary TB.

• Pneumothorax, in which air is introduced into the chest to collapse the lung
• Thoracoplasty, in which one or more ribs are removed
• Removal of a diseased lung

Nursing Management

Goals

The goals of management are:

• To control the inflammatory process
• To relieve symptoms
• To correct metabolic and nutritional problems and promote healing
• To achieve the previous health status

Nursing Assessment

• Promoting airway clearance
• Advocating adherence to treatment regimen
• Promoting activity and adequate nutrition
• Preventing spreading of tuberculosis infection

Nursing Diagnosis

• Ineffective airway clearance related to increased sputum
• Risk of infection related to lower resistance of others who are around people
• Ineffective breathing pattern related to inflammation
• Hyperthermia related to the infection process
• Fluid volume deficit related to fatigue due to lack of fluid intake
• Activity intolerance related to fatigue
• Imbalanced nutrition, less than body requirements related to decreased appetite
• Ineffective management, therapeutic regimen related to lack of  knowledge about the disease process
• Impaired gas exchange related to alveoli function decline

Intervention

• Ineffective airway clearance:

Auscultate lungs for wheezing, decreased breath sounds, coarse sounds

Use universal precautions if secretions are purulent even before culture reports

Assess cough for effectiveness and productivity

Note sputum amount, color, odor, consistency

Send sputum specimens for culture as prescribed

Institute appropriate isolation precaution if cultures are positive

Use humidity to help loosen sputum

Administer medications, noting effectiveness and side effects

Teach effective deep breathing and coughing techniques

• Risk for infection

Monitor sputum for changes indicating infection

Monitor vital signs

Teach patient and family the purpose and techniques for infection control, such as hand washing, patient covering mouth when coughing, and maintaining isolation if necessary

Teach patient the purpose, importance and how to take medications as prescribed consistently over the long-term therapy

• Deficient knowledge

Determine who will be the learner-patient or family

Assess ability to learn

Identify any existing misconceptions about the material to learn

Assist the learner to integrate the information into daily life

Give clear thorough explanations and demonstrations

• Activity intolerance

Assess patient’s level of mobility

Observe and document response to activity

Assess emotional response to change in physical status

Anticipate patient’s needs to accommodate

Teach energy conservation techniques

Refer to community resources as needed

• Ineffective therapeutic regimen management

Assess prior efforts to follow regimen

Assess patient’s perceptions of their health problem

Assess other factors that may affect success in a negative way

Inform patient of the benefits of conforming with the regimen

Concentrate on the behaviors that will make the most difference to the therapeutic effect

Include family, support system in teachings and explanations

Health Education

• Explain about the disease condition’s causes, risk factors
• Use universal precautions if secretions are purulent even before culture reports
• Assess cough for effectiveness and productivity
• Note sputum amount, color, odor, consistency
• Send sputum specimens for culture as prescribed or PRN
• Institute appropriate isolation precautions if cultures are positive
• Use humidity to help loosen sputum
• Administer medications, noting effectiveness and side effects
• Assess patient’s perceptions of their health problem
• Assess other factors that may affect success in a negative way
• Inform patient of the benefits of conforming with the regimen
• Concentrate on the behaviors that will make the most difference to the therapeutic effect

Complications

• Miliary tuberculosis
• Pleural effusion
• Emphysema
• Tuberculosis pneumonia