Question

hi please answer the first 5 questions and please type the answers.

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Case Study #1-Tuberculosis Vladimir, age 46 years, has had a persistent unproductive cough for several months that did not respond to cough medications. Recently, he has developed a productive cough accompanied by fatigue, anorexia, and night sweats. Examination in the ER indicated abnormal chest sounds and weight loss. A chest X-ray showed a small cavity and infiltrate 1. Discuss the pathologic changes occurring during the development of active tuberculosis at the cellular level 2. Relate Vlad's signs and symptoms with those normally found in active TB. Remember that signs are an objective, observable evidence of a problem, and symptoms are what the patient says they are experiencing. Identify which of this patient's manifestations are signs and which are symptoms. 3. Discuss the transmission of TB and identify the conditions predisposing to the development of TB 4. List and discuss the common lab tests and diagnostic tools used to diagnose TB. Which one(s) is/are definitive, meaning, unmistakable? 5. Identify and discuss the precautions involved for family friends and health care patient. personnel coming into contact with this 6. List and discuss medications and medication regimens for patients with respiratory TB that the PCP will likely prescribe? Remember the PCP (primary care provider) can be an MD, a nurse practitioner or a physician's assistant. 7. What side effects of medications and teaching will you as a member of the healthcare team teach Vladimir and his family prior to discharge from the hospital? 8. What is DOT therapy and why is it used? 9. Provide at least two authentic patient centered websites that Vladimir can use to inform himself about his infection and how to manage it. 10. Describe at least two things you le arned because of th research you did on this case and how you feel your future actions in healthcare impact

Answer 1

1. During active stage, cellular lesions that do not heal spontaneously or with therapy progress to form cavities or spread to other parts of the lung and other organs of the body through lymphatic channels and the blood stream. This type of spread is known as miliary tuberculosis. T he histologic hallmark is caseating granulomata with Langhan's-type giant cells.The granuloma is a rounded collection of macrophages and lymphocytes containing multinucleated giant cells, the nuclei of which are arranged at the periphery in a horse-shoe shape.

2. Patient symptoms found to be dry cough with fatigue, Anorexia, and night sweats. Signs are observed in tests abdominal sound and weight loss. X ray report cavities and infiltrate due to damge.

3. Transmission: Tuberculosis (TB) bacteria get into the air when a person with TB speaks, coughs or sings. Other persons staying in the same indoor environment e.g. in the same room may breathe in this air and get infected.

However, not all people with TB disease spread it to others. TB bacteria are spread by those who have the disease in airways, usually in the lungs, and who generate many bacteria in their sputum.

Tuberculosis is not easily transmitted. Family members living together are at highest risk. Risk of transmission is very small in casual contacts. Only one third of exposed persons become infected.

TB is not transmitted through dishes, drinks, food, clothes or surfaces.

The risk of transmission can be reduced: The sick person should get rapidly evaluated for TB. He/she should follow the treatment instructions carefully. When the sick person learns a safe way to cough, it prevents the spread of bacteria into air. Regular ventilation reduces effectively the amount of bacteria in the room air. Outside, there is practically no risk of transmission.

4.Tests for TB diagnosis: There are several different types of TB test. There are TB tests available to diagnose TB. There are also TB tests to find out if someone has TB bacteria that are susceptible to tb drug treatment.

TB Culture Test: This test for TB is very accurate, it can take several weeks to get a result. It also requires expensive equipment and skilled personnel.

TB Interferon gamma release assays (IGRAs): IGRAs are blood tests that measure a person’s immune response to the bacteria that cause TB. The immune system produces some special molecules called cytokines. These TB tests work by detecting a cytokine called the interferon gamma cytokine. In practice you carry out one of these TB tests by taking a blood sample and mixing it with special substances to identify if the cytokine is present.

Sputum smear microscopy is inexpensive and simple, and people can be trained to do it relatively quickly and easily. In addition the results are available within hours. The sensitivity though is only about 50-60%.

Fluorescent microscopy: The use of fluorescent microscopy is a way of making sputum TB tests more accurate. With a fluorescent microscope the smear is illuminated with a quartz halogen or high pressure mercury vapour lamp, allowing a much larger area of the smear to be seen and resulting in more rapid examination of the specimen.

Chest X-ray as a TB test: If a person has had TB bacteria which have caused inflammation in the lungs, an abnormal shadow may be visible on a chest x-ray. Also, acute pulmonary TB can be easily seen on an X-ray. However, what it shows is not specific. A normal chest X-ray cannot exclude extra pulmonary TB.

Serological tests for TB: These tests carried out on samples of blood, and they claim to be able to diagnose TB by detecting antibodies in the blood. However, testing for TB by looking for antibodies in the blood is very difficult.

5. TB precautions, cough etiquette

TB is caused when a person breathes in TB bacteria that are in the air. So it is important that people with TB, who are not on effective treatment, do not release TB bacteria into the air when they cough. Cough etiquette means, covers mouth and nose with a tissue.

The BCG vaccine has been shown to provide children with excellent protection against the disseminated forms of TB. However protection against pulmonary TB in adults is variable. Since most transmission originates from adult cases of pulmonary TB, the BCG vaccine is generally used to protect children, rather than to interrupt transmission among adults.