1. By: Michelle Russell

2.  To become familiar with the disease process of TB Transmission symptoms Precautions  Nursing Diagnoses  Interventions

3.  TB is caused by Mycobacterium tuberculosis (aerobic acid-fast bacillus)  Most frequently affects the pulmonary system  15% experience the disease extra pulmonary  Transmission: respiratory droplets through sneezing or coughing

4.  Active TB- Have symptoms Contagious  Latent TB No symptoms Not contagious Bacteria remains in the body, but in an inactive form THIS CAN BE ACTIVATED

5.  Subjective: Purulent greenish-yellowish sputum or blood Generalized weakness and fatigue Shortness of breath Activity intolerance Weight loss and indigestion Difficulty sleeping, chills or night sweats Productive or non productive cough Chest pain while breathing or coughing

6.  Objective: Diminished or absent breath sounds Cyanosis because of decreased oxygen to the body Difficulty breathing- strider, crackles Fever PPD Skin test X-ray

8.  Ask about their….. Medical history Social history Most importantly:  Ask if the patient has been exposed to someone with TB, or if they are a healthcare worker.

9.  Prevalence: Most commonly affects the elderly, men (age: 24- 44), and immuno-suppressed. 70% of all TB cases are most prevalent among minorities in the U.S.  Mortality: Tb is one of the leading causes of death among the globe; 95% of all cases occur in countries that lack resources and have a high rate of HIV 8 million cases occur yearly, and of those 3 million die

10.  Center for Disease Control and Prevention recommend the use of 4 drugs: Isoniazid (6 months), rifampin (6 months), pyrazinamide (2 months), ethambutol (until sensitivity results are known) If it is MDR, treatment must last for 24 months  Monitor response of therapy  Provide monthly sputum specimens for AFB smear and culture

11.  DOTS-directly observed therapy, short course Passive case detection using smear microscopy Short course of chemotherapy Uninterrupted supply of drugs Reporting and recording system to allow evaluation  WHO- TB prevention among those with HIV

12.  Infection control  Medication management  Environmental management  Surveillance  Nutrition management  Teaching: disease process

13.  Patient scenario: 19yr old female started having a constant headache, the doctors were having difficulty finding the cause and by the time they did, it was too late, her TB had turned into meningitis. Her condition kept declining and a few months later, she had a massive stroke. Now she is alive, and is no longer contagious…. But she can’t talk or walk, and is paralyzed on the right side of her body from the neck down.

14.  The patient has been hospitalized since March (8 months)  No longer on isolation  Still fighting the infection and still receiving long course antibiotics  Taught the patient and her family about her disease  *she is attending physical therapy to help her recover from her stroke

16.  Primary: Risk for infection R/T tissue inflammation and infiltration  Secondary: impaired gas exchange activity intolerance Social isolation

18.  Air allergy. (n.d.). Retrieved from http://www.cameraphonesplaza.com/category/n95- mask/http://www.cameraphonesplaza.com/category/n95-  Butler, R., & Carr, J. (n.d.). Tuberculosis. Retrieved from http://www.bcm.edu/molvir/tuberculosis http://www.bcm.edu/molvir/tuberculosis  Hands in the world. (2011, April 13). Retrieved from http://handsintheworld.wordpress.com/2011/04/13/hand-washing-vs-sanitizer/  Infection control at sickkids. (n.d.). Retrieved from http://www.sickkids.ca/Nursing/Education-and-learning/Nursing-Student- Orientation/module-one-safety/infection-control-at-sickkids/index.html http://www.sickkids.ca/Nursing/Education-and-learning/Nursing-Student-  Networking the land: Rural america in the information age. (n.d.). Retrieved from http://www.ntia.doc.gov/legacy/otiahome/top/publicationmedia/rural2001/networkin g_the_land_with_illustrations.htm http://www.ntia.doc.gov/legacy/otiahome/top/publicationmedia/rural2001/networkin  Paul, M. K. (2001, February 01). Local problems, local solutions: improving, tuberculosis control at the district level in malawi. Retrieved from http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid= 11&hid=106&sid=31782fc9-f544-4dc4-99d0-6086d1857d46@sessionmgr110 http://web.ebscohost.com.ezproxy.hsc.u  Rising thoughts. (2008, November 17). Retrieved from http://www.clinicsrising.com/blog/?currentPage=8  Sommers, M. S. (2011). Tuberculosis. In Diseases and Disorders: A Nursing,Therapeutics Manual (4 ed.). Philadelphia, PA: Unbound Medicine.  Tips for prevention of tuberculosis. (2011, July 7). Retrieved from http://linssky.com/2011/07/tips-for-the-prevention-of-tuberculosis-tb/  Tuberculosis and rabies. (n.d.). Retrieved from http://topworldofhealth.blogspot.com/2011/09/tuberculosis-tuberculosis-or- tb.html http://topworldofhealth.blogspot.com/2011/09/tuberculosis-  Willis, K., & Vezeau, T. M. (n.d.). Nursing interventions for mdr-tb. Retrieved from http://www.jstor.org.ezproxy.hsc.usf.edu/stable/3471742?seq=2 http://www.jstor.org.ezproxy.hsc.usf.edu/stable/34717