The nursing management of Tuberculosis involves various aspects, including prevention, screening, diagnosis, treatment, and monitoring. Nurses play a critical role in the management of TB, as they are often the first healthcare professionals to come into contact with patients with suspected or confirmed TB. Nurses must be knowledgeable about the disease, understand its mode of transmission, and be aware of the appropriate precautions to take to prevent infection.
Prevention of TB involves identifying and addressing risk factors such as close contact with a person with active TB, immunosuppression, and poor living conditions. Nurses can educate patients about ways to prevent TB, such as maintaining good personal hygiene, improving ventilation in living spaces, and getting vaccinated against TB if available.
Screening for TB involves identifying individuals at increased risk for TB infection or disease and conducting tests to detect TB. Nurses can perform a thorough assessment of patients to identify risk factors and recommend screening tests such as the Mantoux skin test or the interferon-gamma release assay (IGRA
Causes of tuberculosis
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. The bacteria are spread from person to person through the air, typically when an infected person coughs, sneezes, or talks. However, not everyone who is exposed to the bacteria will develop TB. Several factors can increase the risk of developing active TB, including:
Weakened immune system: People with weakened immune systems, such as those with HIV/AIDS, those receiving chemotherapy, or those taking immunosuppressive medications, are more susceptible to TB.
Malnutrition: People who are malnourished, especially those who are deficient in vitamin D, are more likely to develop TB.
Close contact with someone who has TB: People who live or work closely with someone who has active TB are more likely to become infected.
Poor living conditions: Crowded or poorly ventilated living conditions can increase the risk of TB transmission.
Age: TB is more common in older adults.
Smoking: Smoking damages the lungs and can increase the risk of TB.
Substance abuse: Substance abuse, particularly injection drug use, can increase the risk of TB infection.
Migration: People who migrate from countries with high rates of TB are more likely to develop TB.
7 types of tuberculosis
There are mainly 7 types of tuberculosis (TB), including:
Pulmonary tuberculosis: This is the most common type of TB and affects the lungs. It is usually spread through the air when a person with TB coughs, sneezes, or talks. Symptoms may include coughing, chest pain, fever, and weight loss.
Extra-pulmonary tuberculosis: This type of TB affects parts of the body other than the lungs, such as the lymph nodes, bones, joints, kidneys, or central nervous system. It occurs when the bacteria spread from the lungs to other parts of the body. Symptoms depend on which part of the body is affected.
Drug-resistant tuberculosis: This is a form of TB that is resistant to one or more of the antibiotics commonly used to treat TB. It can occur due to incomplete or incorrect treatment of TB or due to exposure to someone with drug-resistant TB.
Latent tuberculosis infection: This is a type of TB in which the bacteria are present in the body but the person does not have active TB disease. There are no symptoms, and the person is not contagious, but the bacteria can become active in the future if the person’s immune system is weakened.
Miliary tuberculosis: This is a rare and severe form of TB that occurs when the bacteria spread throughout the body and affect multiple organs. Symptoms may include fever, cough, weight loss, and enlarged lymph nodes.
Multidrug-resistant tuberculosis (MDR-TB): This is a form of TB that is resistant to two of the most powerful first-line drugs used to treat TB: isoniazid and rifampin.
Extensively drug-resistant tuberculosis (XDR-TB): This is a form of TB that is resistant to both first-line and second-line drugs used to treat TB. It is a rare and difficult-to-treat form of TB.
Tuberculosis classification according to the American thoracic society
The American Thoracic Society (ATS) classification system for tuberculosis (TB) is a way of categorizing the different forms of TB based on their clinical presentation and the results of diagnostic tests. The classification system is used to guide the management and treatment of TB, and it helps to ensure that patients receive appropriate care based on their individual needs.
The ATS classification system divides TB into several categories, which are as follows:
Active TB disease: This category includes patients who have clinical or radiographic evidence of active TB, and who have positive cultures for Mycobacterium tuberculosis. Active TB disease is further subdivided into pulmonary TB, extrapulmonary TB, and disseminated TB.
Latent TB infection (LTBI): This category includes patients who have been infected with M. tuberculosis but do not have active disease. Patients with LTBI are asymptomatic and have normal chest X-rays, but they may have a positive tuberculin skin test or interferon-gamma release assay.
Possible TB: This category includes patients who have clinical or radiographic features suggestive of TB, but who do not have microbiologic confirmation of the disease. These patients may have negative sputum smears or cultures, but they may still be treated for TB based on clinical suspicion.
Unlikely TB: This category includes patients who have symptoms or radiographic abnormalities that are not consistent with TB, and who have negative microbiologic tests. These patients may have other respiratory infections or non-infectious conditions that mimic TB.
Signs and symptoms of tuberculosis
Tuberculosis (TB) can cause a wide range of signs and symptoms, which can vary depending on the type of TB and the stage of the disease. Some of the most common signs and symptoms of TB include:
Cough: A persistent cough that lasts for more than two weeks is a common symptom of TB.
Fever: A fever that lasts for more than a week, especially in the afternoon or evening, can be a sign of TB.
Night sweats: Profuse sweating at night, especially while sleeping, is a common symptom of TB.
Weight loss: Unintentional weight loss, especially over several weeks or months, can be a sign of TB.
Fatigue: A feeling of tiredness and lack of energy can be a symptom of TB.
Loss of appetite: A decreased appetite, or a feeling of being full even after eating very little, can be a sign of TB.
Chest pain: Pain or tightness in the chest can be a symptom of TB, especially if the disease has progressed to the lungs.
Shortness of breath: Difficulty breathing or shortness of breath can be a symptom of TB, especially if the disease has progressed to the lungs.
Coughing up blood: In severe cases, TB can cause coughing up blood or phlegm that may be streaked with blood.
Pathophysiology of tuberculosis
Tuberculosis (TB) is a bacterial infection caused by the Mycobacterium tuberculosis bacteria. The pathophysiology of TB is complex and involves a series of interactions between the bacteria and the immune system. In general, the progression of TB can be divided into two stages: primary infection and secondary infection.
Primary infection occurs when a person is first exposed to the bacteria. The bacteria enter the body through the airways and are taken up by alveolar macrophages in the lungs. Alveolar macrophages are specialized immune cells that patrol the airways and help to remove foreign particles, such as bacteria or viruses. In most cases, the initial immune response is able to control the infection, and the bacteria are destroyed or contained within the macrophages. However, in some cases, the bacteria are able to replicate within the macrophages and form small clusters called granulomas. These granulomas can serve as a source of ongoing infection and can persist in the lungs for years.
Secondary infection occurs when the bacteria are able to escape from the granulomas and spread throughout the body. This can occur for a variety of reasons, such as a weakened immune system or exposure to a new strain of bacteria. When the bacteria spread, they can cause the development of new granulomas in other parts of the body, such as the lymph nodes, bones, or kidneys.
The immune response to TB is complex and involves both innate and adaptive immunity. The innate immune response is the first line of defence against TB and includes the activity of macrophages, neutrophils, and natural killer cells. These cells help to contain the bacteria and prevent them from spreading. If the innate immune response is not able to control the infection, the adaptive immune response is activated. The adaptive immune response includes the activity of T cells and B cells, which can recognize and respond to specific antigens on the surface of the bacteria. In some cases, the adaptive immune response is able to control the infection and prevent the development of active TB disease. However, in other cases, the immune response can become dysregulated and lead to the development of chronic inflammation and tissue damage.
An example of the pathophysiology of TB can be seen in the case of a person with HIV/AIDS. HIV weakens the immune system and makes it more difficult for the body to control TB infection. In these cases, the bacteria are more likely to spread and cause the development of active TB disease. In addition, the development of TB can also accelerate the progression of HIV/AIDS by causing further damage to the immune system.
In the case of a person with HIV/AIDS, the pathophysiology of TB can be more severe and can involve the development of multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB). MDR-TB and XDR-TB are forms of TB that are resistant to multiple antibiotics and are much more difficult to treat than regular TB. In these cases, the pathophysiology of TB can involve the development of chronic inflammation and tissue damage, which can lead to serious complications such as lung damage, kidney failure, or even death.
Diagnostic evaluation for tuberculosis
The diagnostic evaluation for tuberculosis typically includes a combination of tests, such as:
Tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to screen for latent tuberculosis infection.
Chest X-ray or CT scan to look for signs of active tuberculosis in the lungs.
Sputum or other bodily fluid tests to identify the bacteria that cause tuberculosis and determine drug susceptibility.
Other tests, such as bronchoscopy or biopsy, may be done if other tests are inconclusive or if extrapulmonary tuberculosis is suspected.
The procedure of the tuberculin Test
The tuberculin skin test (TST) is a simple and commonly used test to screen for latent tuberculosis infection. Here’s a detailed procedure for performing the test:
Clean the injection site on the forearm with an alcohol swab and let it dry completely.
Using a small needle, inject 0.1 mL of tuberculin purified protein derivative (PPD) just under the top layer of skin, creating a small raised wheal.
Mark the injection site with a pen or adhesive tape, as it may be difficult to see later.
Advise the patient to avoid rubbing or scratching the injection site, and to keep the site dry.
The test must be read 48 to 72 hours after injection. The site should be examined by a qualified healthcare provider to determine the presence or absence of induration (swelling or hardening) around the injection site.
The size of the induration is measured with a ruler, and the results are interpreted based on the patient’s age, risk factors, and other factors.
It’s important to note that the TST may not be reliable in certain populations, such as those who have previously received the BCG vaccine or those with a weakened immune system. A qualified healthcare provider should interpret the test results and determine the need for further testing or treatment.
Medical management of tuberculosis
Tuberculosis (TB) is a serious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs, but can also infect other parts of the body, such as the kidneys, spine, and brain. TB is spread through the air when an infected person coughs, sneezes, or speaks. If left untreated, TB can be fatal.
The medical management of tuberculosis involves a combination of medications that are taken for a specific duration of time. The main goal of treatment is to cure the disease and prevent transmission to others. Here’s a more detailed look at the medical management of tuberculosis:
Drug therapy: The cornerstone of tuberculosis treatment is a combination of several drugs. The specific drugs used and duration of treatment will depend on the type of tuberculosis, the patient’s age, weight, and other factors. The standard first-line drugs for tuberculosis include isoniazid, rifampicin, pyrazinamide, and ethambutol. These drugs work together to kill the bacteria that cause tuberculosis.
Patients are typically treated with a combination of drugs for a period of six to nine months, depending on the severity of the disease. Some patients may require a longer treatment course, such as those with drug-resistant tuberculosis.
Direct observation of therapy (DOT): To ensure adherence to the drug regimen, many healthcare providers recommend DOT. This involves a healthcare worker directly observing the patient take their medications, typically on a daily or weekly basis. DOT has been shown to improve treatment adherence and reduce the risk of treatment failure and drug resistance.
Monitoring and follow-up: Patients undergoing tuberculosis treatment must be monitored for drug side effects and evaluated for response to therapy. Regular follow-up visits and laboratory tests are essential to assess progress and ensure treatment success.
During treatment, patients may experience side effects from the drugs, such as nausea, vomiting, and liver toxicity. Healthcare providers must closely monitor patients for these side effects and adjust the treatment regimen as needed.
In addition, patients must be evaluated for treatment response. This typically involves a repeat chest X-ray and sputum test to determine if the disease is responding to treatment. If the disease is not responding, the treatment regimen may need to be adjusted.
Infection control: To prevent the spread of tuberculosis, patients with active tuberculosis must take precautions to avoid transmitting the disease to others. This includes covering the mouth and nose when coughing or sneezing and avoiding close contact with others.
Patients may also be advised to wear a mask in certain situations, such as when traveling on public transportation or when in crowded areas.
Treatment of latent tuberculosis: In addition to treating active tuberculosis, healthcare providers may also recommend treatment for latent tuberculosis infection (LTBI). This is an asymptomatic form of tuberculosis in which the bacteria are present in the body, but are not causing active disease.
Treatment for LTBI typically involves a course of isoniazid for six to nine months. This can help prevent the development of active tuberculosis in the future.
Conclusion: Tuberculosis is a serious infectious disease that requires prompt medical attention. The medical management of tuberculosis involves a combination of drug therapy, direct observation of therapy, monitoring, and follow-up, and infection control measures.
The goal of treatment is to cure the disease and prevent transmission to others. Healthcare providers must closely monitor patients for drug side effects and treatment responses to ensure treatment success. Patients must also take precautions to prevent the spread of the disease to others. With proper treatment and management, most patients with tuberculosis can be cured.
Nursing management of tuberculosis
Nursing management of tuberculosis involves supporting patients who have been diagnosed with TB, ensuring adherence to treatment, and educating patients and their families about the disease.
Nursing assessment for tuberculosis
Nursing assessment for tuberculosis (TB) involves a comprehensive evaluation of the patient’s medical history, physical examination, and laboratory testing to identify symptoms and risk factors associated with TB. Here are the key components of nursing assessment for TB:
Medical history: Nurses should ask the patient about their symptoms, such as coughing, chest pain, fever, night sweats, and weight loss. They should also ask about their medical history, including any past TB infections or treatments, and their exposure to TB.
Physical examination: Nurses should perform a physical examination to assess the patient’s respiratory status. This includes auscultation of the lungs for abnormal sounds, such as crackles or wheezes, and palpation of the chest for tenderness or swelling.
Diagnostic tests: Nurses may order diagnostic tests, such as a chest X-ray or sputum culture, to confirm the diagnosis of TB. They may also order a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to screen for latent TB infection.
Risk assessment: Nurses should assess the patient’s risk factors for TB, such as being immunocompromised, living in overcrowded or poorly ventilated environments, or having close contact with someone who has TB.
Psychosocial assessment: Nurses should also assess the patient’s psychosocial status, including their mental health, support system, and ability to adhere to treatment.
Infection control assessment: Nurses should assess the patient’s ability to comply with infection control measures, such as wearing a mask, covering their mouth and nose when coughing or sneezing, and avoiding close contact with others.
15 Nursing diagnoses for tuberculosis
15 possible nursing diagnoses for tuberculosis (TB):
Ineffective breathing pattern related to respiratory muscle weakness or inflammation
Impaired gas exchange related to alveolar damage and inflammation
Risk for infection related to exposure to Mycobacterium tuberculosis
Fatigue related to the body’s immune response to infection
Imbalanced nutrition: less than body requirements related to anorexia or difficulty eating due to coughing or fatigue
Anxiety related to uncertainty about the diagnosis and treatment of TB
Ineffective coping related to the emotional and psychological impact of TB diagnosis and treatment
Ineffective health maintenance related to inadequate knowledge about TB prevention and management
Deficient knowledge related to TB prevention, transmission, and treatment
Risk for social isolation related to TB stigma and fear of transmission
Risk for nonadherence to treatment related to treatment complexity, side effects, and lack of social support
Interrupted family processes related to the need for isolation and disruption of normal routines
Risk for impaired skin integrity related to adverse effects of TB medications
Ineffective therapeutic regimen management related to inadequate knowledge or lack of motivation to adhere to treatment
Disturbed sleep pattern related to coughing, shortness of breath, and anxiety.
