Tuberculosis is caused by Mycobacterium tuberculosis (MTB) and is an airborne disease, which affects the lungs, resulting in severe chest pains, fever, and coughing. Even though current research on the disease within the past five years has offered valuable information into the diagnosis, transmission, as well as treatments of TB, a lot more should be done to reduce the incidents or even get rid of it (Sommerland et al., 2017). TB still places a lot of pressure on the public health considering that it is second after HIV/AIDS in causing high mortality rates.
This easy will describe this infectious disease, its current federal, state, and county statistics and offer nursing interventions necessarily for success.
Description Causes TB is caused by an infection of human tissues by the Mycobacterium tuberculosis bacterium. It is aerobic, slow-growing and can grow within body cells. It has a unique cell wall, which aids in protecting it from the defense mechanism of the body and offers mycobacteria the capability of retaining particular dyes such as fuchsin following an acid rinse that seldom occurs in other parasitic, fungal and bacterial genera.
The mycobacteria that can escape the body defense mechanisms might be spread through the lymphatic pathways or the bloodstream to most organs, especially the well-oxygenated ones such as bones, kidney, and lungs (Fogel, 2015). Typical TB lesion commonly referred to as granulomas normally comprise of central necrotic area, then a zone with lymphocytes, Langerhans cells, and macrophages, which becomes surrounded with immature macrophages, more lymphocytes, and plasma cells.
The granuloma also contains mycobacteria.
A fibrous capsule normally surrounds the granuloma in latent infections and certain cases; the granulomas calcify, but in case of a failed immune defense at the later time of initially, the bacteria continue spreading and disrupting organ functions. Incubation Period TB is a contagious disease and capable of spreading to others by airborne droplets during coughs, sneezes, as well via contact with sputum. As such, it is possible to get infected through close contact with an infected individual and an outbreak can occur in crowded places. The incubation period of the disease might vary from about two to twelve weeks (Fogel, 2015). An individual might remain contagious for a long period provided viable bacteria are present in sputum and can remain that way until an appropriate therapy is initiated for several days or weeks.
Testing and Diagnosis The definitive diagnosis of active TB depends on the mycobacteria culture from tissue biopsy or sputum considering that it may occur as either active or latent form. However, these slow-growing bacteria might take weeks for them to grow on specialized media. It is useful to determine if one is either actively infected, has latent infections or not infected with transmissible TB bacteria, considering that it is not necessary to isolate or administer immediate drug therapy for patients with latent TB. As a consequence, health providers require presumptive testing, which could reasonably offer assurance the individual is infected or not so that therapy can start. In addition, blood analysis by an enzyme-linked immunosorbent assay using the QuantiFERON-TB Gold (QFT-G) is a fairly quick test for the presence of Tuberculosis (XXXXXX). This blood test provides results in 24-hour period and is particularly useful in the acute care setting in which a symptomatic patient necessitates determination of TB (XXXXX).
The next test after getting a patient’s physical examination and history data is skin testing also known as the tuberculin skin test (TST). It involves the injection of an extract made from killed mycobacteria, tuberculin into the skin. The skin is then examined in about 48 to 72 hours for induration (Fogel, 2015). Testing positive for induration is a strong suggestion that the individual is either actively infected or has been exposed to live mycobacteria. A negative induration test is an indication that the individual is not infected. For individual who test positive on the skin test, a chest x-ray is used to distinguish between active TB or old, healed lesions (XXXXX). “Caseation and inflammation may be seen on the x-ray if the disease is active (XXXX).” County, State, and Federal Statistics and Trending Even though TB cases fell by almost 25% over the last decade, and by a whopping 62% since its peak in 1992 in the country, TB rates and cases according to Brown (2018) did not reduce from 2016 to 2017. Efforts to return the disease’s steeper decline trend as before will need a multi-prolonged approach. Today, in San Bernardino, California, TB disparities based on ethnicity and gender, as well as birthplace, continue to be experienced.
The proportion of TB cases in California among the oldest residents according to Brown (2018) continue to grow. Figure 1. Tuberculosis Cases: California, 1930-2017 (Brown, 2018). Although there has been great progress made in controlling and curing the disease, it continues to affect and kill many in the country. For instance, in 2017, a total of 2,057 cases of active TB were reported in California, and 54 of these were from the County of San Bernardino. This was a very slight drop from 2,059 cases the previous year. In the same year, the annual TB incidence within California was reported as 5.2 cases per 100,000 people, a number that is virtually twice of the federal rate of about 2.8 (Brown, 2018). Cases of TB in 2017 were reported in 46 of the 61 California’s local health jurisdictions, with 30% of these reporting 1-4 cases. Primary, Secondary, and Tertiary Prevention It is the responsibility of the Public Health Nursing to identify a group or a community with a high disease burden and establish the cause, as well as biological implications, to put in place preventive measures of alleviating the burden.
Primary Intervention These are actions that are taken in preventing the development of a disease in an individual who does not have the disease in question. Such activities comprise disease prevention and health promotion activities. In the case of TB, such activities include vaccination using the bacille Calmette-Guérin (BCG) vaccine (Verkuijl, & Middelkoop, 2016). Another significant primary intervention method is environmental controls. For TB, environmental control includes ventilation and ultraviolet lights. Also, methods of decreasing overcrowding may be a form of primary presentation. Secondary Prevention This kind of prevention involves the identification of individuals who have already developed TB at an early stage in the natural history of the disease. The theory behind this form of prevention is that if a disease is detected early enough, the intervention measures are more likely to work effectively. TB’s secondary prevention involves the identification, as well as the testing of the target community or group with a greater likelihood of infection (Verkuijl, & Middelkoop, 2016).
Such groups include individual living in congregant settings such as nursing homes or jails, immunocompromised individuals, health care workers working with TB patients and individuals who have traveled to areas where the disease is endemic. Tertiary Prevention This can be described as the treatment process of those already identified to have been infected. An individual infected with the disease has the potential to infect others. Nonetheless, the infection site is also very significant when it comes to the determination of the spreading capability. For instance, the larynx and lungs are common sites where the disease can be highly infectious. Treatment is necessary in case the disease is localized to areas such as the outside of the lungs or lymph nodes even though it is not transmissible and as such not a major public health concern (Verkuijl, & Middelkoop, 2016). Treatment depends on whether or not it is a resistant infection or a standard TB. Treatment can take up to six months or more. The drugs used include pyrazinamide, isoniazid (INH), ethambutol and rifampin (RIF).
Nursing Interventions The nurse’s role is very critical in control and successful completion of therapy. After diagnoses, it is essential that the patient is placed under the correct treatment. The nurses play a significant role in ensuring patients are given the correct medications and offering support for patients, as well as their relatives or caregivers to avoid lapses during treatment. The nurses also have a social responsibility as they may be required to liaise with the home office, social services, and the national support services. The nursing intervention is also critical in determining the patient who poses a risk to others considering that the nursing of those who are suspected to have pulmonary TB should be done in a separate room until three negative smears of sputum are obtained (Sommerland et al., 2017). Further, patients are required to remain within their respective rooms under closed doors and wear masks whenever they want to leave.
TB remains a disease that requires a lot of protection and attention from the nursing departments. Further, TB is far from being a disease of the past considering that the high number of infections within the County of San Bernardino, in California and the US as a whole (Sommerland et al., 2017). As such, affected people, as well as their relatives and caregivers, require specialist care. The role of TB nurse specialists in collaboration with the infection control nursing departments is crucial when it comes to controlling and managing the disease effectively. Conclusion Even though there have been spirited efforts within the medical field to eradicate or at least reduce the impact of TB, a lot more remains to be done since the disease continues to devastate many at the county, state and federal level. As an infectious disease, its management remains a huge challenge, and the role of nurses and specialist caregivers is very crucial. It is a disease that requires a lot of collaboration in creating awareness about its impact and providing the necessary support and resources to the affected and their families.