Question

Mr. Robert is a 45-year-old homeless man who comes to the emergency department and is diagnosed with tuberculosis.

1. What are the common symptoms of tuberculosis? What diagnostic tests are done to confirm this disease?
2. What are the four phases in the transmission and progression of TB and what are the healthcare concerns for patients and the public?
3. The TB infection is to be treated with a combination of isoniazid and rifampin. What should the nurse include in a teaching plan when discussing these medications with the patient?
4. Discuss strategies that will increase Mr. Robert’s compliance with drug therapy when he is discharged.

Answer 1

Tuberculosis

●Common symptoms

• Weight loss
• Night sweats
• Fever (continuous or spiking)
• Cough(more than 2 weeks) blood can be present
• Extreme tiredness
• Anorexia
• Shortness of breath ,pain at chest
• Phlegm

Diagnostic test

• Chest X ray the basic test
• Mantoux test is one of the confirmatory test
• Sputum culture (positive AFB in two or more sample)
• CT scan of the chest is also a confirmatory test

●Four phases and its progression

Phase 1 or stage 1

• In this phase the tuberculi bacilli enters the respiratory system. The immune system releases the macrophages to engulf this bacteria and stop its further multiplication or invasion of others region. This is mainly dependent on the level of immunity power.

Phase 2 or stage 2

• This takes place in the second week where the bacteria c starts to multiply and spreading .This is highly infectious period.

Phase 3 or stage 3

• In the third week the macrophages in more number are activated to fight this bacilli and keep it under control from multiplication.This is under control and infection cannot spread .This is called as primary complex and overtime depending upon the immune response it heals completely leaving a white scar in the lungs.

Phase 4 or stage 4

• When the primary complex is not met with the adequate or empowered by the immune ng e system ir leads to remultiplication of the bacteria and causing release of bacteria from ot .This is infectious and termed to be secondary infection

●Healthcare concerns for patients and public

• Patient should complete the drug regimen
• Follow cough etiquette during infectious periods
• Not supposed to share towels ,kerchief with family members
• Take a protein rich adequate diet
• The public should use the personal protective equipments by covering the face
• Hand hygiene

The nurse should include the following

• The medication to be strictly taken on empty stomach with plenty or adequate water
• The urine may turn orange due to the side effect of medication and this is normal
• The side effects like abdomen pain, confusion, convulsions, etc., has to be reported immediately
• Do not overdose or underdose

●The ways to increase compliance are

• Health education and creating awareness
• Encouraging family members to take part in helping the patient to strict to medication regimen
• Reminders
• Continuity of care
• Home visits
• Cost effective medication