Exam 3

spirometry

• Measures volume & speed of air inhaled or exhaled as a function of time

  • FEV1 – Forced expired volume in 1st second

  • FVC – Total volume of air exhaled from maximal inhalation to maximal exhalation

  • FEV1/FVC% - The ratio of FEV1 to FVC, expressed percentage.

    • Based on gender, size, race and age there are values (diagnosing severity) and predicts obstruction

    • Below 70% indicated obstruction

  • PEFR – fastest flow gas from lungs

COPD treatment

• Relieve symptoms

• Bronchodilators

  • Short acting - rescue drug

    • Beta agonist

    • sama

  • Long acting - daily relief

    • Lama

    • Laba

how COPD meds are prescribed

Step 1

• Quick acting bronchodilator 

• Short Acting Beta agonist (SABA) 

• Short Acting Muscarinic antagonists (SAMA) 

Step 2 

• Add long-acting bronchodilator 

• Long-Acting Muscarinic antagonists (LAMA) or 

• Long-Acting Beta agonist (LABA) 

Step 3 

• Add 2nd long-acting bronchodilator 

• Long-Acting Beta agonist (LABA) or 

• Long-Acting Muscarinic antagonists (LAMA) 

bronchodilators

Rapid, short-acting (4-8o) 

• Albuterol (SABA) 

• Ipratropium (SAMA) 

Long-acting 

• Antimuscarinic (LAMA) 

  • Tiotropium (24o), Aclidinium (12o) 

• Long-acting b2-agonist (LABA) 

  • Salmeterol (12o), Indacaterol (24o) 

inhaled steroid

• Last line treatment 

• Fluticasone 

• Budesonide 

• What are their effects 

  • Oral thrush 

    • Need to rinse mouth afterwards 

  • Hoarse voice 

  • Cough 

  • Throat irritation 

• Long term 

  • Adrenal insufficiency 

  • Cataracts 

  • Osteoporosis 

  • Bruising 

  • hyperglycemia 

inhalers

Pressurized (MDI) 

• Propelled by gas 

Dry Powder (DPI) 

• Drug inhaled as Powder

using a DPI

• Open it so you can see the mouthpiece. 

• Slide the lever until it clicks (loads medication). 

• Gently breathe out. 

• Do not exhale into the device 

  • Can clog it 

• Seal lips around the mouthpiece. 

• Inhale rapidly and deeply 

• Hold breath 10 sec. to deposit 

• Remove device from mouth, exhale. 

• Check if powder is gone; if not repeat. 

• Wait 1 min between puffs 

being less SOB

Pursed Lips Breathing 

• Inhale via nose with mouth closed 

• Exhale over 4-6 seconds thru pursed lips 

• Use when experience dyspnea 

• Prevents air trapping 

• Keeps airways open longer 

• Creates PEEP 

tripod position

• arms forward - raises clavicles and increases lung expansion

pulmonary rehab

• Strengthens upper arm muscles and improves muscle tone

• Helps with ADLs

• Teaches Self- Management 

• How to use equipment (inhaler, O2) 

• How to exercise, less dyspnea 

• Stress reduction 

• Keeps pts active 

when to give O2

sats below 88%

green zone

doing well

• usual activity and exercise level

• usual amounts of cough and sputum

• sleeping well at night

• appetite is good

actions

• take daily meds

• use O2 as prescribed

• continue regular diet/exercise plan

• avoid cigarette smoke, inhaled irritants

yellow zone

COPD flare

• more breathless

• less energy

• increase, change in consistency, and/or color of sputum

• poor sleep

• medications not wokring

actions

• continue medications

• use quick relief inhaler

• use O2

• used pursed lip breathing

• call provider if no improvement

red zone

Need urgent medical care

• severe SOB even at rest

• cannot tolerate any activity

• cannot sleep at all

• feeling confused or very drowsy

• coughing up blood

• fever or chills

actions

• call 911

asthma

• Airway hyperresponsiveness through many things

  • Exercise, mold, allergens

  • Release inflammatory mediators

allergic asthma

• Allergen exposure

• Antibodies are synthesized and secreted and bind to mast cells and whenever they are exposed again the mast cells will secrete mediators, histamines, leukotrienes, etc that give asthma side effects

non allergic asthma triggers

results from encounter trigger 

• Strong odors 

• Air pollution 

• Chemical 

• Exercise 

• Same sxs allergic asthma 

peak flow meter

• Measure speed gas leaves lungs 

• Provides # for self-management 

Three zones 

• Green = 80-100%

• Yellow – 50-80% 

• Red = < 50%  

How to use

• Move dial to bottom 

• Stand up 

• Deep breath 

• Blow into device hard & fast 

• Record value 

• Repeat X 3 

• Use highest value 

asthma symptom control

• No SAMA for asthma 

• Relievers (onset 1 minute, last 4-6 hours) 

  • Dilate airways 

  • Short acting bronchodilator (SABA) 

• Standard Controllers (onset 5 minutes, last 12-24 hours) 

  • Reduce / prevent chronic inflammation 

• Inhaled corticosteroids (ICS) 

  • Dilate airways 

• Long-acting bronchodilators (LABA) 

  • Prevent release of mediators 

• Leukotriene antagonists (LTRA) 

• Biologic Controllers (last 2-4 weeks) 

  • Reduce effects IgE / eosinophils 

• Anti-IL-5 / Anti IgE 

asthma vs copd symptom control

What is missing versus COPD? 

• Muscarinic antagonists 

What is added versus COPD? 

• LTRAs 

• Anti-IgE 

What is different about the sequence? 

• Start with ICS 

black box warning

Pt with asthma should not take a long acting beta agonist (LABA) without also taking an inhaled corticosteroids

Silent chest phenomenon / asthma exacerbation

Wheezing and exacerbation → 30 min later no wheezing but a lot of tightness = silent chest phenom

Risk factors for sleep apnea

• Men more than women

  • Post menopausal women higher incidence

• Fat distribution in tongue - closes off airway

• Anatomy 

  • Small upper airway 

hypopnea index

• Amount of times they quit breathing within an hour

  • <5 is normal

  • 5-15 is mild

  • 15-30 is moderate

  • >30 is severe

sleep apnea test

Polysomnography (PSG) Sleep Study 

• in lab diagnostic sleep study

• records brain waves, heart rate, oxygen levels, and breathing

at-home sleep test

• wearable device used to determine if someone has OSA

sleep apnea treatment

• Positive airway pressure → keeps airway open bc positive pressure

• Cpap

• Bipap

  • Different on inspiration and expiration

• Apap

  • Automatically titrate to pt needs

sleep apnea symptoms

• Loud snoring 

• Partner reports apnea 

• Excessive daytime sleepiness 

• Memory, learning, mood problems 

• Impotence 

pneumatic air splinting

• must be used daily 

• most effective REM sleep (last night) 

• devices are portable, quiet, comfortable 

• very effective ↓ sx 

• adherence is poor 

mandibular jaw advancement

• Apnea (↑ CO2) 

• Arousal 

• Tongue moves 

• Muscles airway dilate 

• Device moves tongue and jaw forward 

• Not as effective as pos airway pressure

Hypoglossal nerve stimulation

In sleep 

• muscles pharynx relax, airway obstructs 

• Tongue position major factor 

• base tongue falls to back airway 

New technique 

• Impulse generator 

• Sensor intercostal muscle 

• Electrode stimulates hypoglossal nerve 

hiatal hernia symptoms

• Often asymptomatic 

• Usually do not need treatment 

• Pyrosis (heart burn) 

• Dysphagia 

• Regurgitation

S/S – paraoesophageal 

• Fullness in chest 

paraesophageal hiatal hernia

stomach moves into diaphragm next to the esophagus

hiatal hernia management

• Small frequent meals

• Elevate hob

• Sit up for 1 hr post food

• Smoking cessation 

GERD risk factors

• Asthma 

• Pregnancy 

• Obesity 

• Sedentary lifestyle 

• Smoking 

GERD causes

• Incompetent lower esophageal sphincter 

• Increased gastric volume (increased BMI increases gastric volume) 

• Delayed gastric emptying 

• Potency of refluxed material 

• Hiatal hernia 

GERD symptoms

• Burning in esophagus 

• Dyspepsia (indigestion) 

• Dysphagia and pain with swallowing 

• Hypersalivation 

• Esophagitis 

GERD management

• Smoking cessation 

• Dietary restrictions – avoid trigger foods 

• Sit up for 1 hour after eating 

• Do not eat for 3 hours before sleeping 

• PPIs: esomeprazole, lansoprazole, omeprazole, pantoprazole 

• H2RAs: famotidine, ranitidine 

• Prokinetic agents: domperidone, metoclopramide (increases GI motility) 

• Bethanecol to increase lower esophageal sphincter tone 

• Cytoprotective agents: sucralfate 

• Nissan fundoplication 

Peptic ulcer disease causes

• Increased secretion of gastric acid 

• Damaged mucosa – decreased mucus secretion 

  • Damaged mucosa predisposes to H. pylori infection 

    • 70-90% of ulcers 

    • Produces ammonia, cytotoxins, mucous eroding enzymes → impaired bicarbonate production 

• ASA, NSAIDS 

  • 30% upper GI bleeds 

  • 30% deaths r/t ulcers 

• Stress, smoking, alcohol use 

• Zollinger-Ellison Syndrome 

  • Hypersecretion of gastric acid and multiple tumors resistance to medical treatment 

Peptic ulcer disease risk factors

• Age 40 – 60 

• H. pylori infection (most common cause) 

• ASA or NSAID use (second most common cause) 

• Increased gastric acid secretion 

Peptic ulcer disease symptoms

• Dull, gnawing pain or burning sensation in mid epigastrium or back 

• Pain relieved by eating or talking an alkali 

• Heartburn 

• Vomiting 

• Constipation or diarrhea 

• Bleeding and perforation 

• Belching 

• Bloating 

Peptic ulcer disease diagnosis

• Esophagogastroduodenoscopy 

• Biopsy 

• Tests for H. pylori - urea breath test, serologic and stool testing 

peptic ulcer disease management

• 2 antibiotics plus PPI x 10-14 days if ulcer caused by H. pylori 

• Patient education: take full course of antibiotics 

• PPIs, H2RAs 

• Smoking cessation 

• Dietary modification 

Surgical management 

• Vagotomy 

• Antrectomy 

• Biliroth I – gastroduodenostomy 

• Biliroth II – gastrojejunostomy 

post op GI nursing interventions

• Check gag reflex

• Anytime you have surgery in stomach area don’t manipulate ng tube

  • Could damage suture line and make it bleed

GI hemorrhage

complication of PUD

• S/S: hematemesis, hematochezia, melena, pallor, fatigue 

• PUD accounts for 50-80% of GI hemorrhage 

bariatric surgery

• Restrictive

  • reduce diameter of stomach lumen; capacity adjusted by silicone band 

• Laparoscopic banding

  • band placed around stomach to create pouch

• Roux en y

  • Staple off part of stomach and bypass duodenum

  • Decrease in food intake and at risk for dumping syndrome

  • High protein and fiber complex carb diet

• Want to not give oral fluids with food → 30 min between

Cholelithiasis risk factors

• Age 

• Native American, Northern European 

• Family history 

• Obesity 

• Rapid weight loss (bariatric surgery) 

  • Liver secretes extra cholesterol 

  • Can prevent proper emptying 

• Female > male 

• Pregnancy, use of oral contraceptives 

  • Hormones increase cholesterol levels 

• Diet 

  • High in calories and refined CHO 

  • Low in fiber 

Cholelithiasis symptoms

• Epigastric pain

• pain that could radiate to shoulder and back

• n/v with meals high in fat

• inflammation of gallbladder

• blockage of common bile duct

billiary obstruction

• Elevated direct/conjugated 

  • If liver is doing its job but there is a blockage in the gallbladder 

• Elevated indirect or unconjugated bilirubin 

  • Due to liver disease 

Elevated direct conjugated bilirubin bc liver is conjugating the bilirubin but can’t excrete it

cholecystitis management

• morphine/opioid

• Antiemetics

• Antibiotics

• NPO → low fat diet

• Cholesterol stone dissolution with ursodiol (Actigall) or chenodiol 

ERCP

• E = endoscopic 

• R = retrograde 

• C = cholangio 

• P = pancreatography 

• direct visualization of the common duct-can via an endoscope to retrieve stones & place stents 

• Check for gag reflex 

cholecystitis surgical management

• Removal of gallbladder

• Post op

  • Pain relief

  • Bile leak

  • Incisional care

  • Low fat diet when discharged

  • Abdominal assessment 

    • Ileus, bile leak 

  • Pulmonary toilet-CDB, incentive spirometry, AMBULATE 

  • Incisional care 

    • T-tube (choledochotomy) 

    • For inflammation until swelling goes down 

appendicitis symptoms

• Mcburney point 

• Acute onset of pain 

  • Starts in umbilical area and then radiates down to RLQ  

• Increase temp 

• Rebound abdominal pain 

  • Push on abdomen - pain is when you let go 

• Pain with defecation and urination 

appendicitis test

Labs 

• WBC increase 

Ultrasound 

• Appendiceal diameter > 6mm 

CT scan 

• Appendiceal diameter >6mm  

• Occluded lumen 

• Thickening of appendix wall 

pre op appendicitis

• NPO 

• Fluid electrolyte monitoring 

• No laxatives and No enemas 

  • Do not want to stimulate the bowel to avoid rupture 

• antibiotics 

post op appendicitis

• Look at incision sites 

• Abdominal assessment 

• Antibiotics 

  • 24hours 

• NPO advance as tolerated 

• Semi fowlers 

• Moving 

• IS 

• Observe for complications 

  • Bowel leak 

  • Peritonitis 

• Pain 

  • In shoulder due to CO2 from procedure 

peritonitis symptoms

• PAIN 

  • Movement aggravates it 

• Fever 

• Abdominal distention  

  • “board like” abdomen 

  • Extremely hard 

  • Shifting of extracellular fluids into peritoneal cavity 

• Diminished or absent bowel sounds  

• Nausea and vomiting 

• Hypovolemia and shock 

  • From shift of fluids 

• Hiccups 

  • Irritation to phrenic nerve 

peritonitis

Acute inflammation of the peritoneum (serous membrane that lines abdominal cavity & covers visceral organs) leads to abscess formation and adhesions 

peritonitis treatment

• prevent extension of inflammation 

• correct fluid and electrolytes 

• minimize bowel obstruction 

  • Do not want adhesions 

• NG tube with continuous suction to rest GI 

• Antibiotics IV and place them in cavity 

• Complex wound care  

• Semi fowlers 

peritonitis complications

• Abscess formation 

• Septicemia 

• Septic shock 

• Hypovolemic shock (fluid loss) 

• Adhesions (bowel obstruction) 

• Mortality 

  • Overall, 40% 

  • Younger and with less contamination < 10% 

diverticular disease risk factors

• Western world diet 

  • Low fiber 

• Age 

• Constipation 

• Decreased physical activity 

• Laxative abuse 

diverticulosis treatment

• Due to deficient dietary fiber

• Increase in intraluminal pressure

• high fiber diet

diverticulosis symptoms

• Asymptomatic when not inflamed 

• Episodic pain in LLQ 

• Narrow stool 

• Weakness and fatigue 

diverticulosis interventions

• Increase fiber to 25-30mg a day 

• Bowel retraining 

• Fiber supplements 

• Avoid laxatives  

• Drink 8 glasses of water a day 

• Increase activity 

Diverticulitis vs diverticulosis

Diverticulosis 

• multiple diverticula are present without inflammation  

Diverticulitis 

• Diverticula become inflamed 

diverticulitis symptoms

• Increased defecation 

• constipation 

• N/V 

• Fever 

• Increase WBC 

• Abdominal distention 

• Ribbon like stool 

• Blood in stool 

diverticulitis treatment

• different from diverticulosis

• start with low fiber then build

diverticulitis interventions

• Antibiotics 

• Bowel rest 

  • Initially NPO -> clear liquids -> soft low fiber -> and continue 

  • Back to high fiber once infection is gone 

• Hydration 

• Pain relief  

  • No morphine 

  • Increases intralumal pressure 

• NO laxatives 

• Antispasmodics  

  • bentyl 

• Diet 

diverticulitis complications

• Perforation 

• Peritonitis 

• Abscess/fistula formation 

• Bowel obstruction 

• Urethral obstruction 

• Bleeding (hematochezia) 

diverticulitis surgery

• Resect area with diverticulitis 

• Hartmann's procedure 

  • Temporary colostomy 

  • Reversed once infection is gone 

• Peritonitis 

• Abscess  

• Failure to respond to medical treatment 

• Hemorrhage 

UC vs Crohn’s

UC 

• Mucosa and submucosa 

• Colon 

• Stool 

  • Bloody and mucosy 

• tenesmus 

Chron’s 

• Multiple layers 

• Anywhere 

• No blood in stool 

UC

Affects 

• Only the large intestine 

Involves 

• Only the mucus and submucosa 

• Not every layer 

Exacerbations 

• Mild to severe 

• unpredictable 

Manifestations 

• LLQ pain 

• Bloody diarrhea with mucus 

• Tenesmus 

  • Pressure feeling of needing to pass a BM but dont have to 

• Weight loss 

• Anemia 

• Low albumin 

• Bleeding 

• Megacolon 

  • Dilation of colon 

  • Leads to perforation 

Crohn’s

• Seen in any age but usually younger people 

Affects 

• Anywhere 

• Mouth 

• Commonly in ileum and colon 

• Small ulcers 

Involves 

• Entire thickness of bowel 

Manifestations 

• Diarrhea 

  • Non bloody 

• Fatigue 

• RLQ pain 

• Anemia 

• Weight loss

• Malnutrition 

• Low albumin 

• Crohn’s disease of mouth 

• X-ray 

  • Shows cobblestone effect 

managment of IBD

• Nutritional treatment (TPN) 

• Bowel Rest (Severe) 

• Medications 

• Antibiotics 

  • Cipro  

• Immunosuppressants 

  • Methotrexate  

  • prednisone 

• Amino salicylates 

  • Change the way cells release certain chemicals (cytokines) 

  • Apriso  

  • Rowara enema 

• Anti-Tumor Necrosis Factor 

  • Slow progression of inflammation 

  • Humera  

• Janus Kinase Inhibitors 

  • Single transmission pathways for cytokines 

• Anti-diarrheal 

• Surgery 

IBD nursing care

• Pain relief 

• Maintain hydration 

• Maintain optimal nutrition 

• Promote rest 

• Reduce anxiety 

• Prevent skin breakdown 

• Medication education 

• Fewer, firmer stools 

ostomy post op

• Post op monitor fluid and electrolyte balance

• Ascending - liquid

• Transverse - slightly firmer

• Sigmoid - formed

• How it looks depends on ostomy placement

characteristics of stoma

• Rose to brick red

• Purple to black = emergency

• pale - anemia

ostomy interventions

• Clear liquid diet once ordered (+flatus, +BS) 

• Pain management 

• Activity 

• IS 

• SCD use 

• Provide private time for patient to discuss self-image and sexual concerns 

• Aseptic technique for dressing changes 

• Ostomy care 

ostomy complications

• Prolapse

  • Can have issues with keeping appliance on 

  • Can be repaired 

• Retracted stoma

  • Keeping ostomy appliance on is difficult 

Ileostomy and colostomy diet

• May start out with low fiber/low residue diet until intestinal swelling resolves 

• Advance to regular diet with balanced dietary fiber. 

• Take vitamin supplements as directed by physician 

• Add new foods gradually to determine tolerance 

  • Try foods several times before eliminating them 

• Eat at regular intervals (may benefit from more frequent and smaller meals) 

• Do not skip meals 

• Lactose intolerance is common 

peripheral artery disease

• Atherosclerosis most common chronic arterial disorder 

• Deposit of fat and fibrin obstructs and hardens arteries 

• 5 P’s (Signs and Symptoms of Acute Limb Ischemia) 

  • Pain 

  • Pulselessness 

  • Poikilothermic 

  • Pallor 

  • paresthesia 

• Most common cause of amputations 

peripheral vascular disease risk factor

• Men 

• African American 

• Family history 

• Smoking 

• HTN 

• DM 

• Metabolic syndrome 

• age 

peripheral vascular disease prevalence

• 70 or older 

• 40s if they have another risk factor 

intermittent claudication

• Pain when walking 

• From calf muscle  

• Increase in oxygen demand -> increase lactic acidosis -> increase pain 

• Dependent limbs can help with pain

PVD intervention

keeping legs warm bc they will vasoconstrict if they get cold

varicose veins treatment

Conservative 

• Compression stocking (augment muscle pumping action of legs) 

• Leg elevation 

  • Toes above the nose 

• Exercise 

Ablation Therapy 

• Heated catheter 

• Laser or radiofrequency 

• Heated catheter creates scare tissue and causes vein to close 

Sclerotherapy 

• Vein Stripping 

• Cut the vein above the affected area and below 

• Rip it out 

• Gotten away from 

varicose veins

Heaviness and discomfort in legs

DVT symptoms

• Dull, aching pain

• tenderness

• warmth

• erythema 

• Edema (Increase in extremity circumference) 

• Could be asymptomatic and pulmonary emboli is first sign

DVT risk factors

• Hospitalized, immobile 

• Surgery – 20% increase 

  • 50% increase for orthopedic surgery 

• Obesity 

• Smokers 

• Oral contraceptives 

• Central Venous Catheters 

DVT diagnosis

Doppler

IV heparin therapy

• Baseline PT/PTT, Anti-Xa, H/H and Platelet count required before therapy is initiated 

• Platelet count and H/H QD 

• Assess for “HIT” (Heparin-induced thrombocytopenia) 

  • Report Plt count <150,000 or a 30-50 % reduction 

  • start on different anticoagulant

• Assess for signs of bleeding 

  • stool guiac 

  • hematuria 

• Reversal agent 

  • Protamine Sulfate 

Management-Warfarin 

• Coumadin is given simultaneously with heparin until Coumadin is therapeutic and then Heparin is discontinued. 

• Coumadin should be given same time every day 

• On Coumadin 3- 6 months usually 

• INR monitored frequently 

  • INR range that is therapeutic is 2-3 usually 

• Patient education essential - safety 

• Dietary instruction 

  • Vitamin K reversal agent 

  • need consistent level

• Do not take any over the counter medication or herbal supplements without consulting MD first 

• Wear a med alert bracelet 

• No smoking 

• No alcohol 

• Obtain blood work as ordered 

• Take precautions to avoid bleeding 

• Report to ED for episode of bleeding 

• Careful with G herbal supplement

Anticoagulants

• Factor Xa Inhibitors 

  • Rivaroxaban (Xarelto) 

  • Apixaban (Eliquis) 

• Does not effect platelet aggregation 

• Short half-life so can discontinue 2 days before surgery and resume 6-10 hours post-surgery 

• Interacts with many meds and over the counter herbals 

• Contraindicated in renal impairment (CrCl < 30ml/min) and Hepatic impairment 

aneurysms

• If asymptomatic and <5.5 cm → typical treated medically w bp control and serial imaging

• Once 5.5 then go in and surgery on it

AAA management

Medical Management 

• If asymptomatic 

  • Aggressive BP control 

  • Serial imaging 

  • Surgery when ≥ 5.5 cm 

Surgical Management 

• Two types 

  • Endovascular grafting (EVSG or EVAR) 

    • Up through the groin and place a stent 

    • Avoids pressure on the weakened wall 

  • Open approach 

    • Clamp above and below aneurysm

    • Mortality 

      • ≤ 5% elective; 40% emergent 

AAA patient teaching

BP control and surveillance

aortic dissection

Type A

• Ascending aorta 

• Emergent surgery 

  • High risk for life threatening complications 

  • Only contraindication for surgery is if presence of comorbidities impact survival to one year or less 

Type B

• Descending aorta 

• Surgery reserved for development of complications related to dissection 

• If uncomplicated generally managed medically 

• Medical management 

  • Blood pressure control 

  • Imaging surveillance 

HIV

• Specific type of virus (a retrovirus) 

  • Carries genetic information as RNA 

• Enters body, infects cells CD4 antigen 

  • Uses enzyme to convert RNA to DNA 

  • DNA is duplicated in cell division 

• Can remain inactive years 

  • Creates antibodies (seroconversion) 

  • Detected as early as 2 weeks to 4 weeks 

HIV Stages

Stage 1

• Transmission and Seroconversion 

• Short, flu-like illness or no symptoms 

• Highly contagious at this time 

• Seroconversion detected: 

• 2-4 weeks 

Stage 2

• Clinical Latency Period 

• Lasts for average 8-10 years 

• Usually no symptoms 

• May be swollen glands 

• Level HIV blood drops to very low levels 

• HIV antibodies are detectable in the blood 

Stage 3

• AIDS 

• The immune system weakens 

• Illnesses become more severe leading to an AIDS diagnosis 

HIV nursing care

• Changes over course of disease 

• Early stages 

  • Preventive health measures 

  • Health maintenance activates 

  • Education 

  • Psychosocial support 

• Disease progresses 

  • Physical symptom management 

  • Education on infection prevention 

  • Continued psychosocial support

tuberculosis symptoms

• Pulmonary issues 

• Cough 

• Fever 

• Weight loss 

• Anorexia 

• Night sweats 

tuberculosis treatment

• Airborne isolation 

• Antitubercular meds 

• Admin of 4 drugs over 6 month course 

• Infection control and med compliance