Pulmonary Tuberculosis
Pulmonary Tuberculosis is an infectious disease caused by the tubercle bacillus. The organism may attack other tissues in the body but the lungs are most frequently the primary site of invasion-although most organs in the body can be attacked. Infection is usually by inhalation of droplets bearing tubercle bacilli. The droplets has been exposed into the air by sneezing or coughing of a person with active disease. Tuberculosis is a disease of poverty, readily taking advantage of those with weakened resistance due to poor nutrition and general health. Social condition therefore play a large part in determining susceptibility to the disease. Homeless person and the elderly, together with members of ethnic communities’ organization from the Indian subcontinent, are perhaps a risk in the UK. Children and adolescents are at greater risk than adults. The incident of tuberculosis has increased in recent years from 5,778 new cases in the UK in from 1988 to 6,564 new cases in 1993 (Central Statistical Office).
Small rounded noodles, with a tendency towards central necrosis, develops at the site of tissue invasion by the bacilli. These are referred to as tubercles and composed of lung tissue cells, leucocytes, other phagocytic cells, fibroblasts and tubercle bacilli. If the body defenses are strong to destroy the organisms, the lesson heals and may calcify. In some instances, the reproduction of the tubercle bacilli may be minimal. A few continue to survive within the tubercle but remain confined and dormant. This person having been infected and still harboring live bacilli, will shoe a positive tuberculin test in approximately 2-10 weeks after the initial infection. Defensive cells have become sensitized and tend to inhabit or slow up the growth of tubercle bacilli. At a later date. If resistance is lowered, the reproduction of the tubercle bacilli may be accelerated and active diseases develops.
When the bacilli continue to multiply, the tubercle necrosis centrally producing soft caseous material. Which may eventually be discharged from the tubercle, leaving a casualty. This caseous discharge is highly infective. The initial infection does not affect pulmonary function. The later stages of tuberculosis which are becoming again more common in Britain and Europe, produce systemic and local symptoms. The constitutional symptoms are vague and non-specific. They include lassitude, fatigue, malaise, loss of appetite and weight, fever (usually low grade) in the latter part of the day. Tachycardia and night sweats symptoms produced by the local disease process at the site of the lesion in the lungs are cough, sputum, hemoptysis and dyspnea and chest pain if the pleura is involved.
The investigation of a patient for pulmonary tuberculosis involves tuberculosis involves tuberculin testing, chest radiography and bacteriological examination of sputum.
Patients remain at home and continue to work and live normal and useful lives during the course of their treatment. The principal factors in the plan of patient-care are prolonged chemotherapy, rest and patient and family education. The administration of specific antimicrobial drugs over a long period of time has proved very successful in the prevention and treatment of tuberculosis. Prevention therapy for susceptible contacts involved the administration of isoniazid 300 mg daily for 6 months. The recommended treatment for infected patients commences with an initial phase of 2 months treatment with isoniazid, rifampicin and pyrazinamide together to kill as many bacteria as possible, as quickly as possible. After 2 months of treatment, this may be decreased to isoniazid and rifampicin only for a further 4 months. Longer periods of treatment or other drugs may be needed if there is evidence of resistance to these antibiotics. The nurse should be familiar with the treatment plan and with the action and possible side effects of the drugs so that adverse reactions can be recognized early and the patient can be taught what to look for and what to do if side effects occurs.
The following drugs are used;
ISONIAZID
This is taken orally. The drug is usually well tolerated. Liver function should be checked before use as the drugs can be toxic to the liver. Peripheral neuropathy is the main side-effect. It’s usually associated with preexisting risk factors. These factors include; malnourished, alcoholism and diabetes.
This is used if resistance to first-choice drugs. likely patients receiving Ethambutol should be assessed for usual acuity before treatment and monitored for changes. As acuity and color blindness.
This is taken orally 1 hour before or 2 hours after the ingestion of food to promote maximum absorption. Adverse gastro intestinal effects such as heart bum. Epigastric distress, nausea and diarrhea may occur and can be minimized by administrating the drug with food. Patients should be helped to establish a routine that best suits their responses. Patients should be aware that rifampicin may impart a red-orange color to the urine, feces, sputum, sweat and tears. Soft contact lenses may become permanently discolored. The patient’s liver function is monitored regularly.
Streptomycin antibiotic is rarely used and only if resistance is a problem. It’s given infrastructural and serious side effects are damage of the auditory nerves and consequent loss of hearing.
Pyrazinamide drug is often added during the first 2 months of therapy. It occasionally causes hepatitis, hyper uricaemia, gastro intestinal disturbance or arthralgia. In view of the lengthy courses of chemotherapy required to treat tuberculosis. There is a significant risk of patients failing to take their medication correctly. Or simply stopping altogether. However, it contributes to the problem of emerging resistance to current medication. Close supervision and reinforcement of teaching about the importance of completing the full course are therefore required in the community care setting.
-Goals
-Objectives
-Guiding Principles
-Mission
-Strategies to achieve objectives.
-Blood
-Body fluids, secretions and excretions
-Mucous membrane
-Non-intact skin
– Hand-washing using soap/skin cleanser
-Decontamination using alcohol hand rub
-Decontamination using 4% chlorhexictine
-Before patient contact
-Before a procedure
-After a procedure or body fluid exposure risk
-After patient contact
-After contact with the patients surroundings.