Tuberculosis

Chapter 23: Tuberculosis

Overview of Tuberculosis (TB)

  • Definition: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis.

  • Transmission: TB spreads through aerosolization (airborne route).

  • Symptoms and Effects:

    • TB primarily affects the lungs but can disseminate to other organs.

    • The body encapsulates TB bacteria in collagen, leading to tubercles (visible on x-rays).

    • Some cases remain dormant, evidenced by latent TB infection.

    • Only a small percentage of those infected develop active TB.

  • Contagion Risk: Reduces after 2-3 weeks of effective antituberculin therapy.

Health Promotion and Disease Prevention

  • Screening Recommendations:

    • Annual screening for those in high-risk areas.

    • Screening for family members of infected individuals.

    • Special focus on individuals born outside the U.S. and migrant workers.

  • Symptoms Indicating Need for Diagnosis:

    • Persistent cough, chest pain, weakness, weight loss, anorexia, hemoptysis (coughing blood), dyspnea, fever, night sweats, chills.

  • Latent TB: Presence of Mycobacterium tuberculosis without active symptoms.

Risk Factors for Tuberculosis

  • Close contact with untreated individuals.

  • Lower socioeconomic status and homelessness.

  • Immunocompromised conditions (e.g., HIV, chemotherapy).

  • Crowded or poorly ventilated environments.

  • Advanced age.

  • Recent travel or immigration from endemic areas.

  • Substance use and health care occupations with high exposure risk.

Expected Findings in TB Patients

  • General Symptoms:

    • Cough lasting longer than 3 weeks, purulent sputum (possibly blood-streaked).

    • Fatigue, lethargy, weight loss, anorexia, night sweats, low-grade fever.

  • Physical Assessment:

    • Older adults may exhibit atypical symptoms such as altered mentation and weight loss.

Laboratory Tests for TB Diagnosis

  • Nucleic Acid Amplification Testing:

    • Rapid test to detect M. tuberculosis; results in <2 hours.

  • QuantiFERON-TB Gold Test:

    • Blood test for TB diagnosis; results in <24 hours.

  • Acid-fast Bacilli Smear and Culture:

    • Positive test indicates active infection; culture confirms diagnosis.

Nursing Actions for TB

  • Sample Collection: Three early-morning sputum samples under negative pressure.

  • Preventive Measures: Use of personal protective equipment during specimen collection.

Chapter 23: Diagnostic Procedures

Mantoux Test

  • Administration: Intradermal injection of tuberculin, read in 48-72 hours.

  • Results Interpretation:

    • Positive result: induration of 10 mm or greater (5 mm for immunocompromised).

    • Indicates immune response, not necessarily active disease.

  • False Positives: May occur in individuals vaccinated with Bacillus Calmette-Guérin (BCG).

  • Immunocompromised Clients: Other testing may be required if Mantoux is negative despite potential infection.

Chest X-ray

  • Purpose: Detect active lesions in lungs for further evaluation.

Patient-Centered Nursing Care

  • Oxygen Therapy: Administer humidified oxygen as needed.

  • Infection Control: Use N95 masks, keep patients in negative pressure rooms, and practice hand hygiene.

  • Education: Teach patients proper sputum disposal and mask use.

  • Nutrition: Ensure balanced diet and increased fluid intake.

Chapter 23: Medications for TB

General Principles

  • Combination Therapy: Use of two or more medications due to resistance development.

  • Typical Regimen: Includes isoniazid, rifampin, pyrazinamide, and ethambutol.

  • Client Education: Emphasize completing the full course of treatment to prevent resistance.

Specific Medications

  • Isoniazid (INH): Bactericidal; monitor for hepatotoxicity and neurotoxicity. Should be taken on an empty stomach.

  • Rifampin (RIF): Observe for hepatotoxicity and changes in urine color.

  • Pyrazinamide (PZA): Monitor for gout development and hepatotoxicity.

  • Ethambutol (EMB): Monitor vision acuity, contraindicated in children <8 years.

  • Streptomycin: Ototoxic; used primarily for multidrug-resistant TB.

Chapter 23: Interprofessional Care

  • Resources: Contact social services for medication assistance; encourage follow-up at community clinics.

  • Home Care Education: Inform clients about medication adherence, home hygiene practices, and precautions during active TB.

Complications

  • Miliary TB: Can cause systemic symptoms including severe headaches, stiff neck, and respiratory distress.

  • Pericarditis: May present with dyspnea and hypotension, requiring similar treatment as pulmonary TB.