Full Answer
Which nursing intervention should have the highest priority for tuberculosis patients?
An individualized treatment plan shall be prescribed by providers licensed under [state licensure laws], for each person in their care who has suspected or confirmed active tuberculosis. The treatment plan must be consistent with current standards of medical practice and include information regarding: 1) provisions for treatment to cure; 2) provisions for follow-up; 3) …
What is the nurse’s role in TB treatment?
A Nursing Care Plan (NCP) for Tuberculosis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient.
What age group is the nurse teaching the patient about tuberculosis?
Treatment for 6-12 months. Risk of transmission reduced after 2-3 weeks of medication regimen; Nursing Concepts. Oxygenation. Monitor resp status and lung sounds; Monitor SpO 2; Infection Control. Obtain sputum and blood cultures before initiating antimicrobial therapy; Administer RIPE therapy; Adhere to Airborne Isolation Precautions; Patient Education
What is the treatment regimen for tuberculosis?
The preferred regimen for treating adults with TB remains a regimen consisting of an intensive phase of 2 months of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF.
What is the nursing management of a patient with tuberculosis?
First-line agents for the treatment of tuberculosis are isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide. Active TB. For most adults with active TB, the recommended dosing includes the administration of all four drugs daily for 2 months, followed by 4 months of INH and RIF.
What is the most effective method to monitor the TB treatment regimen?
The use of sputum smear microscopy and culture rather than sputum smear microscopy alone is recommended for the monitoring of patients with multidrug-resistant TB (MDR-TB) during treatment (conditional recommendation/very low quality evidence) (2).
What precaution is always necessary when treating a patient with tuberculosis?
In all settings, prompt recognition of individuals needing airborne precautions is the cornerstone to infection prevention. Airborne precautions are used in addition to standard precautions to prevent disease transmission from individuals known or suspected to have diseases spread by fine particles, including TB.
What is the role of nurse in tuberculosis?
TB nurse specialists can ensure that patients are given the correct medication and can provide support for patients and their relatives or carers to prevent lapses in treatment.
What is the public health nurses responsibility with TB in the community?
The essential role of the public health sector in TB control is to plan, coordinate, and evaluate TB control and prevention efforts. State and local TB control programs have the responsibility for developing TB control policies and procedures.
For what purpose is tuberculosis treatment monitored?
All patients should be monitored to assess their response to therapy (Standard 10 of the ISTC (1)). Regular monitoring of patients also facilitates treatment completion and allows the identification and management of adverse drug reactions.
How do you know TB treatment is working?
Physical signs of tuberculosis treatment success include:A reduction in symptoms, such as less coughing.Overall improvement in the way one feels.Weight gain.Increased appetite.Improvement in strength and stamina.
How effective is TB treatment?
TB treatment is effective. Worldwide, nearly 90% of cases of TB and 48% of cases of drug-resistant TB are cured. However, treatment is not quick or easy. The length of treatment and side effects from the drugs used pose huge problems for TB patients and for global efforts to tackle the disease.
What are the do's and don'ts of tuberculosis?
Don't rely only on X-ray for diagnosis of TB. Don't stop medicines before your physician discontinues them. Don't discriminate against TB patients. Don't spit indiscriminately.
Is tuberculosis airborne or droplet precautions?
Use Airborne Precautions for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster).
What three 3 measures can be taken to control tuberculosis on a community level?
According to the CDC guidelines1,2, a TB infection control program should be based on the following three levels of hierarchy: (1) administrative control, which reduces the risk of exposure; (2) environmental control, which prevents the spread of the disease and reduces the concentration of droplet nuclei; and (3) ...
What is the primary complex of TB?
The primary complex occurs when an inhaled bacillus in the lungs sets up a primary tubercle (nodular lesion) and spreads to the nearest lymph node. TB may then develop in the future. In a small percentage of cases the disease develops from the primary complex.
What are the risk factors for developing tuberculosis?
In most, but not all cases, close prolonged contact is required. Those most likely to develop TB are people who live or have lived in countries where it is endemic, and people who have impaired immunity. Most cases in the UK therefore occur in those born in countries with a high incidence of TB. Risk factors in the Caucasian population born in the UK include high alcohol intake, old age and homelessness.
Why should a specimen be sent for culture?
A specimen should be sent for culture if it is possible to obtain a specimen from the site involved. This will confirm the diagnosis and provide information about the antimicrobial susceptibility of the organism.
What is a smear positive TB?
The sputum of patients with a diagnosis of TB is described as ‘smear positive’. This means that when the Ziehl-Neelson stain is applied, the acid-alcohol fast bacilli (AAFBs) can be seen through a microscope. The absence of AAFBs does not rule out TB but indicates that the patient is much less infectious.
How is TB spread?
TB is an infectious disease that is spread through droplet inhalation from coughs. Only those who have the disease in the lungs and who are coughing the organism out are infectious.
What are the risk factors for TB in the UK?
Risk factors in the Caucasian population born in the UK include high alcohol intake, old age and homelessness. TB is an infectious disease that is spread through droplet inhalation from coughs.
Is it necessary to clean a room after isolation for TB?
Routine infection-control procedures for the handling of body fluids and specimens should be used, but special cleaning of rooms following isolation for TB is not required as TB is spread by droplet inhalation (Joint Tuberculosis Committee of the British Thoracic Society, 2000).
What is the goal of a tuberculosis treatment plan?
The goal of the treatment plan is to achieve treatment to cure by the least restrictive means.
What is the duty of a person with tuberculosis?
If, upon examination, it shall be determined that such person has tuberculosis in an active stage or in a communicable form, then it shall be the duty of such [person with tuberculosis] to arrange for admission of himself or herself as a patient in some medical care facility qualified to treat persons with tuberculosis or when there is no danger to the public or to other individuals as determined by the health officer, such person may receive treatment on an outpatient basis. Kan. Stat. Ann. § 65-116b (2009).
What are the barriers to treatment for TB?
Patients with TB often face issues that complicate and can act as barriers to treatment, such as substance abuse, homelessness, unemployment, and lack of healthcare access. Effective case management may obviate the need for legal interventions.
What is case management in TB?
Descriptive Note: Case management is a critical part of TB programs’ and healthcare providers’ efforts toward ensuring that patients with TB are managed properly, rendered noninfectious, and cured of their disease. Patients with TB often face issues that complicate and can act as barriers to treatment, such as substance abuse, homelessness, unemployment, and lack of healthcare access. Effective case management may obviate the need for legal interventions. Case management requirements may appear in the form of guidelines or policy manuals, but some states have chosen to include case management provisions in their statutes and regulations. The second and third bullets below are examples of such laws, and have reportedly been effective in Florida and Massachusetts. The fourth bullet relates to case management in that it ensures continuity of care for patients with TB who are discharged from a hospital or any other institution which provides health care to residents.
What is direct observation therapy?
1) Health care providers may prescribe DOT as a method to monitor the adherence of a patient to his or her prescribed treatment for tuberculosis disease. Health care providers may utilize the Department’s TB Standards of Care as a guideline for appropriate utilization of DOT.
What is the responsibility of a health officer for testing for tuberculosis?
The health officer shall: 1) Direct that testing for tuberculosis infection using a Centers for Disease Control and Prevention approved method be performed on contacts of cases of tuberculosis in a communicable stage. 2) Recommend appropriate treatment for latent tuberculosis infection; and 3) Provide for the supervised presumptive treatment of latent tuberculosis infection for a child younger than 4 years old identified as a close contact to a confirmed case or suspected case of active pulmonary tuberculosis. Md. Code Regs. 10.06.01.21 (2009).
What is LTBI treatment?
The final two bullets address treatment for latent tuberculosis infection (LTBI). Treatment of LTBI is generally initiated after the possibility of TB disease is excluded, and has been proven to greatly reduce the risk that individuals latently infected with TB will progress to TB disease.
What is the most effective treatment for TB?
Ethambutol. RIPE therapy is the most common and most effective drug therapy against TB infections. In some cases, patients are resistant to isoniazide or have Multi-Drug Resistant TB. In these cases, other drugs may be given. Educate the patient on the importance of completing the ENTIRE course of treatment.
What is the pathophysiology of tuberculosis?
Pathophysiology. Tuberculosis is caused by infection by an organism called Mycobacterium tuberculosis. This organism most often (85%) presents as a lung infection due to its airborne transmission. It causes granulomas to form in the alveolar sacs, which will create cavitation as immune cells surround it. If the host’s immune system cannot fight it ...
How to help a patient with shortness of breath?
Educate patient to eat small, frequent meals. Patients may be fatigued, short of breath, and have a loss of appetite. Eater smaller, more frequent meals may be more appealing and take less energy – but will allow them to still get the nutrition their body needs to heal.
What is the purpose of antibiotic therapy?
To fully eradicate the infection with antibiotic therapy and to optimize and restore proper oxygenation and gas exchange within the patient’s lungs
How is TB spread?
Tuberculosis is spread via airborne aerosolization of particles. If the host’s immune system is strong enough to resist initial infection, the infection may lay dormant in the form of “Latent TB Infection” for years until the host’s immune system is compromised. Countries with overcrowded populations or other crowded or closed environments (i.e. prisons, homeless shelters) carry higher risks, as well as a history of HIV, diabetes mellitus, substance abuse, cancer, end-stage renal disease, and smoking.
How long after placement to evaluate for redness?
Evaluate 48-72 hours after placement for signs of redness and induration. The size of the induration determines if the test is positive:
How to diagnose TB?
However, most facilities use Acid-Fast Bacilli or AFB smears instead because they’re cheaper. We will also use a chest x-ray to look for infection and the classic granulomas, as well as do a TB skin test to determine exposure. This is a test that you’ve all likely had done at least once already since it’s required for nursing school. You’ll also get one annually when you’re working as a nurse. The tuberculin is placed intradermally and the skin is evaluated 48-72 hours later. What we’re looking for is what’s called induration. That means it is raised and hard. Some people, like myself, will have severe skin reactions and have very large red areas, but since it isn’t raised, it’s considered negative. So how do we know what’s positive. Well for anyone, if the area of induration (the raised hard part) is greater than 15 mm in diameter, that’s considered positive. However, for those at higher risk, we have a lower threshold. For those with higher risk, for example healthcare workers or people who’ve traveled to high-risk countries, an induration greater than 10 mm is considered positive. And for anyone who is immunosuppressed or with known exposure, anything over 5mm is considered positive. Then, for people like me who have the crazy redness whose tests are deemed inconclusive, they can do this super expensive lab test called the Quantiferon Gold. It’s more accurate than the PPD skin test, but it’s cost-prohibitive to do it for everyone, so the TB skin test is standard.
How long does it take for tuberculin to be evaluated?
The tuberculin is placed intradermally and the skin is evaluated 48-72 hours later. What we’re looking for is what’s called induration. That means it is raised and hard. Some people, like myself, will have severe skin reactions and have very large red areas, but since it isn’t raised, it’s considered negative.
How long does RIPE therapy last?
Remember the classic signs of TB are night sweats and weight loss, plus a persistent cough, fever, chills, and fatigue. We use RIPE therapy for anywhere from 6-12 months to prevent the TB from laying dormant or becoming resistant. Educating our patients on the importance of compliance with their meds is a top priority.
How do you know if you have TB?
These are classic symptoms. Night sweats and unexplained weight loss especially. Remember this is an infectious process, so that’s where the fever, chills, night sweats come from. It’s a lung infection, so you’ll see a cough, chest pain, and possibly even hemoptysis (coughing up blood). Then, because their body is working hard to fight off the infection and they’re likely struggling to breathe, we see fatigue, anorexia, and weight loss because they aren’t eating as much and their body is working overtime.
Who is at risk for TB?
Anyone who has been exposed in the past will be at higher risk for contracting TB statistically. And, of course, those who are immunocompromised are at risk – that would be patients with HIV or AIDS, patients on chemotherapy, or patients who have recently had organ transplants.
Where is TB most commonly found?
Tuberculosis or TB is a contagious bacterial infection that can actually present in multiple places within the body. But, most commonly it’s seen in the lungs, so that’s what we’ll be discussing today. There are situations that put patients at higher risk for TB.
Is TB more common in Asian countries?
There are situations that put patients at higher risk for TB. One is that there are countries where TB is more common and therefore patients who are either from these countries or who have traveled there recently will be at higher risk for having been exposed to or being a carrier of TB. You can see it’s mostly Asian and African countries, as well as some in South America. It’s also common in those who live in tight quarters or near lots of people – examples would be prisons, homeless shelters, and even college dorms. Anyone who has been exposed in the past will be at higher risk for contracting TB statistically. And, of course, those who are immunocompromised are at risk – that would be patients with HIV or AIDS, patients on chemotherapy, or patients who have recently had organ transplants.
What to do when a client asks if it is necessary these medications while in the hospital?
The nurse should: 1. request that the healthcare provider (HCP) review the prescriptions for a duplication between isoniazid and ethambutol. 2. inform the client that all drugs will be discontinued until the client can eat solid foods.
What temperature is required for a bacterial pneumonia patient?
All options must be used. 1. an 85-year-old client with bacterial pneumonia, temperature of 102.2 F (42°C), and shortness of breath. 2. a 60-year-old client with chest tubes who is 2 days postoperative following a thoracotomy for lung cancer and is requesting something for pain.
What is the purpose of a room near the nurses station?
3. a room near the nurses' station to ensure confidentiality. 4. a room with windows to allow sunlight. 1. initiate airborne precautions. 47. The nurse is reviewing the history and phys- ical and healthcare provider (HCP) prescriptions on the medical record of a newly admitted client.
What is a positive Mantoux test?
A client had a Mantoux test result of an 8-mm induration. The test is considered positive when the client: 1. lives in a long-term care facility. 2. has no known risk factors. 3. is immunocompromised. 4. works as a healthcare provider (HCP) in a hospital. 4. 76-year-old grandmother. 54.
What is the highest priority in a client with tuberculosis?
2. Ensuring that the client is well educated about tuberculosis is the highest priority. Education of the client and family is essential to help the client understand the need for completing the prescribed drug therapy to cure the disease. Offering the client emotional support, coordinating various agency services, and assessing the environment may be part of the care for the client with tuberculosis; however, these interventions are of less importance than education about the disease process and its treatment.
What are the symptoms of tuberculosis?
1. Tuberculosis typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats. Increased appetite is not a symptom of tuberculosis; dyspnea on exertion and change in mental status are not common symptoms of tuberculosis.
What is airborne precaution?
Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g. mycobacterium tuberculosis, measles, varicella virus [chickenpox], and possibly SARS-CoV). The preferred placement is in an isolation single-client room that is equipped with special air handling and ventilation.
What is a DOT in a tuberculosis clinic?
Remind the client that tuberculosis can be fatal if it is not treated promptly. 1. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication.
Where is tuberculosis most prevalent?
2. Statistics show that of the four geographic areas described, most cases of tuberculosis are found in inner-core residential areas of large cities, where health and sanitation standards tend to be low. Substandard housing, poverty, and crowded living conditions also generally characterize these city areas and contribute to the spread of the disease. Farming areas have a low incidence of tuberculosis. Variations in water standards and industrial pollu-tion are not correlated to tuberculosis incidence.
What does a positive Mantoux test mean?
2. A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Expo-sure does not necessarily mean that active disease exists. A positive Mantoux test does not mean that the client has developed resistance. Unless involved in treatment, the client may still develop active disease at any time. Immunity to tuberculosis is not possible.
Why are elderly people at higher risk for contracting tuberculosis?
4. Elderly persons are believed to be at higher risk for contracting tuberculosis because of decreased immunocompetence.
What is the treatment for TB in a 28 year old female?
A 28 year-old female is treated for active TB with isoniazid (INH) and rifampin (Rifadin). She should be aware that:
How long does TB stay contagious?
Rationale: Treatment involves a complex regimen and daily dosing can be a problem. TB is no longer contagious after 2-3 weeks, but the medications must be taken for at least 6 months more. Compliance to the regimen is key. Directly observed therapy (DOT) results in higher completion rates, lower relapse rates, and less drug resistance.
How much of a drug is assumed to be taken by a patient?
D. "It is assumed that patients take about 50% of the prescribed drug."
How often should blood glucose levels be checked?
D. blood glucose levels should be checked at least monthly while on the medications
Transmission of TB
Diagnosis of Tuberculosis
Screening and Vaccination
- TB is a notifiable disease under the Public Health (Control of Disease) Act 1984, which means that the proper officer, usually the consultant in communicable disease control, must be informed of all new cases in the area. Each case is then investigated to determine which contacts should be screened. As the biggest risk is to household contacts, they are generally screened regardless o…
Treatment
- TB is a curable disease. Treatment should be started as soon as possible, particularly in infectious cases to prevent further spread of the disease. It consists of combination anti-TB drugs. TB cannot be treated with a solitary agent, as it easily becomes resistant. There are two phases of treatment - an initial phase lasting two months and a continuation phase lasting four …
The Role of The Specialist Nurse
- Patients with TB should be monitored regularly to ensure that: - No interruptions occur in treatment; - Serious side-effects from the treatment are quickly identified; - There is improvement in the patient’s condition, although this is often very gradual. Home visits are the best way of making a holistic assessment of the patient’s needs and progre...
Concordance with Treatment
- Occasionally patients do not take their tablets despite extra support. Supervised treatment or directly-observed therapy (DOT) must be given because of the risk to the wider population. This involves a nurse visiting the patient at home three times a week and administering the treatment. The dose of medication is increased because the treatment is not taken daily and therefore invol…
Infection Control Issues
- Hospital One of the main areas of confusion in the management of TB in hospital is cross-infection and the correct precautions required to prevent it. All health care professionals should have had their tuberculin status assessed before employment and should be given BCG vaccination if required. Patients with smear-positive sputum must be nursed in a side room to pr…
Conclusion
- TB is far from being a disease of the past and the number of cases is on the increase. Affected patients and their relatives require specialist care. The role of the TB nurse specialist in liaison with infection control nurses is vital to control and manage this disease effectively.