Sunday, January 15, 2006

tuberculosis (TB)

Tuberculosis is a highly infectious disease transmitted most commonly by direct contact with a person who has the active disease, through the inhalation of droplets from coughing, sneezing, and spitting. The disease is primarily airborne.
Resistance to the disease varies considerably with age, but generally the older the individual the less resistance they have. Tuberculosis has been a decreasing problem in the United States over the last 20 to 30 years, because of effective chemotherapy and public health programs. Presently, the greatest risk group is the population over 45 years of age. Overcrowding and poor hygienic conditions make the spread of disease more likely. The spread of the disease is on the rise in homeless people and other groups who suffer from a lack of nutrition and live in poor hygienic conditions as well. The highest morbidity and mortality rates occur in the most densely populated areas.
Factors that can lead to the development of tuberculosis are fatigue and poor nutrition, which lower resistance. Onset of symptoms is insidious. They may not appear until the disease is well advanced. This emphasizes the need for routine examinations. Early symptoms are vague and include fatigue, anorexia (loss of appetite), weight loss, and a slight nonproductive cough. Increased temperature in the late afternoon and evening and night sweats are frequent as the disease progresses. A productive cough, a mucopurolent (combination of mucus and pus) blood-streaked sputum (material coughed up from the lungs) and hemoptysis (coughing up of blood from the respiratory tract) may occur. Marked wasting and weakness, dyspnea (difficulty breathing), and chest pain are symptoms of the later stages of the illness.
Diagnostic tests consist of a tuberculin skin test, chest X-ray, and sputum examination. Serial sputum specimens may be necessary because the tubercle bacilli may not be recovered in a single specimen. Gastric lavage (washing out of stomach) or gastric aspiration may be useful to determine the presence of the organism.
Chemotherapy is the treatment of choice. Isoniazid (INH), streptomycin, ethambutal, and rifomipin are primary medications in the treatment of tuberculosis. Drug therapy usually lasts for 18-24 months. It must be stressed to the patient the necessity of taking the prescribed medications without interruption on a regular basis. Side-effects of drug therapy are toxicity and the tendency of the tubercle bacillus to develop resistance to the drugs. Combined therapy with two or more drugs decreases drug resistance and increases the tuberculostatic action of the drugs. Rest and a nutritious diet are also important. Surgical treatment may be required for patients with advanced disease or those who do not respond to medical treatment. When the disease is located in one section of the lung, a segmental resection or wedge resection may be performed. If the diseased area is larger, a lobectomy (surgical removal of lobe of lung) may be done. If the entire lung is diseased a pneumonectomy (removal of all or part of a lung) is performed.
Phipps, W. J., et al. Medical Surgical Nursing. St. Louis: C. V. Mosby Co., 1983.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1983.

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