Tuberculosis (TB)

• Description:

  • Highly communicable disease caused by Mycobacterium tuberculosis.

  • Primarily affects lung parenchyma, but can affect other body parts.

  • Associated with poverty, malnutrition, substandard housing, inadequate healthcare.

• Transmission:

  • Spread through airborne particles from coughing, laughing, sneezing, singing.

  • Droplets inhaled by individuals in close proximity.

• Pathophysiology:

  • Slow-growing, acid-fast bacilli.

  • Infects alveoli, where it multiplies.

  • Immune response involves phagocytes and lymphocytes, leading to granuloma formation.

  • Dormancy occurs when granulomas transform into fibrous tissue.

• Risk Factors:

  • Close contact with active TB patients.

  • Crowded living conditions and inadequate healthcare.

  • Immunocompromised individuals or those with pre-existing conditions.

  • Substance abuse and long-term health facility residency.

• Clinical Manifestations:

  • Progressive fatigue, weight loss, anorexia, low-grade fever.

  • Persistent cough, possibly producing mucopurulent sputum.

  • Night sweats, chills, and hemoptysis may appear.

• Diagnosis:

  • Clinical assessment, history, physical examination, skin tests, blood tests, and chest X-rays.

  • Skin Test (PPD):

    • Intradermal injection to test for TB exposure.

    • Result read 48-72 hours later: induration with erythema indicates infection.

  • Chest X-ray often reveals upper lobe lesions.

  • Sputum tests for culture and sensitivity confirm diagnosis.

  • Newer tests: NAA testing, QuantiFERON-TB Gold, T-SPOT for rapid diagnosis.

• Treatment:

  • Anti-TB agents for 6-12 months necessary to prevent relapse.

  • Drug Resistance:

    • Primary: resistance in patients without prior treatment.

    • Secondary: resistance in those on therapy.

    • Multi-drug resistant (MDR): resistance to both INH and rifampin.

  • Treatment includes an initial phase with an oral multi-drug regimen for 8 weeks, followed by a continuation phase for 4-7 months.

  • Patients are non-infectious after 2-3 weeks of treatment compliance.

• Nursing Management:

  • Promote airway clearance and adherence to treatment.

  • Educate on hygiene practices to prevent spread (cover mouth/nose while coughing, hand hygiene).

  • Monitor vital signs and look out for side effects (e.g., liver function tests, neurological assessment).

  • Educate about medication interactions and dietary restrictions (e.g., INH, Rifampin interactions).

• Patient Education:

  • Importance of medication adherence, symptom management, and routine monitoring.

  • Explanation of medication side effects, administration details (empty stomach, timing).

  • Notify about the importance of reporting TB to health authorities for controlling outbreaks.

Influenza

• Description:

  • Highly contagious respiratory infection affecting all ages, higher incidence in young adults.

  • Severity ranges from mild symptoms to severe respiratory failure.

• Transmission:

  • Spread via inhalation of respiratory droplets or contact with contaminated surfaces.

  • Contagious one day before symptoms appear and up to five days after.

• Pathophysiology:

  • Virus invades respiratory epithelium and causes cell death, impairing respiratory defenses.

  • Influenza virus categorized into Type A, B, and C with various strains.

• Risk Factors:

  • Weak immune system, young children, elderly, chronic illnesses.

  • Healthcare workers, close living conditions, absence of vaccination.

• Clinical Manifestations:

  • Rapid onset of headache, muscle aches, high fever, chills, fatigue.

  • Symptoms may vary in severity.

• Diagnosis:

  • Based on patient history, clinical examination, and diagnostic tests (i.e., throat swab, RT-PCR).

  • Chest X-ray to rule out pneumonia; CBC and ABG may be assessed.

• Treatment:

  • Focus on symptomatic relief and antiviral medications to shorten illness duration.

  • Antibiotics are prescribed only for secondary bacterial infections.

  • Supplemental oxygen in severe cases; hydration is vital.

• Prevention:

  • Annual influenza vaccine to prevent infection, updated based on circulating strains.

  • Patient education on hygiene practices (covering coughs/sneezes, hand hygiene).

• Patient Education:

  • Importance of vaccination, adherence to treatment, managing symptoms.

  • Proper hand hygiene, disposal of tissues, and staying hydrated.