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NCM 102 Health Education

GROUP TASK: Developing an Abstract for the Final Project

TUBERCULOSIS

BACKGROUND OF THE PROBLEM

In our generation, plenty of diseases are formed around the world. Some of these
diseases are causing end of one’s life and some are contagious diseases. One of the
ten deadly phenomenal diseases of the world is tuberculosis or TB. According to World
Health Organization (2018), about one-quarter of the world is infected by latent
tuberculosis and cannot transmit the disease. Thus, its wide spread affected the people
from different dimensions and cultures.
As stated by Vianzon (2013), one of the highest tuberculosis burden countries is
the Philippines. The morbidity rate in the country drops from year 2000 having 590 to
year 2017 with 554 per 100,000 people (WHO, n.d.). It is the sixth leading cause of
mortality rate in the Philippines, 26.3 deaths for every 100,000 population and accounts
for 5.1% of total death (DOH, 2010); mortality rate is heavier in male with 17,103 deaths
compared to female with 7,611. Though all age groups are at risk to tuberculosis (DOH,
2018), tuberculosis vary extensively between different age groups (Barry, Donald,
Marais, 2010). Adults particularly in their most productive years are most commonly
infected thus, people who suffers from other conditions of impair immune system have
greater risk of having active tuberculosis (WHO, 2018). They restrain the immune
system which makes it difficult to control tuberculosis.
What Causes Tuberculosis?

Tuberculosis is an infection caused by bacteria called Mycobacterium

tuberculosis (NHS, 2016). A person with active TB disease can spread the disease
through air by coughing, sneezing, laughing, etc (American Lung Association, 2018).
Spending a long time in closed spaces with a positive active TB patient can increase the
risk of acquiring it. Most people that are prone to this disease transmission are people
who work or people they are living together like family members and close friends, and
also people from parts of the world with high rates of TB, including Africa, Asia,
Caribbean Islands, Eastern Europe, Latin America, and Russia (Mayo Clinic Staff,
2019). Although tuberculosis is a communicable disease, it is less likely to be acquired
especially from strangers (NHS, 2016).

There are two types of tuberculosis the latent TB and the active TB as said by
Manisha (n.d.):
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Latent TB
 TB bacteria are asleep in your body
 you do not have symptoms and you feel well
 you cannot pass TB on to others
 it can only be detected through a blood test or TB skin test
treated with one or two medicines over three to six months
Active TB
 TB bacteria are awake and making you ill
 you will have symptoms that make you feel unwell
 you can pass TB to others if it is in your lungs
According to Mayo Clinic Staff (2019), people with impaired immune system can
also cause TB like:

 HIV/AIDS
 Diabetes
 Severe kidney disease
 Certain cancers
 Cancer treatment, such as chemotherapy
 Drugs to prevent rejection of transplanted organs
 Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis
 Malnutrition
 Very young or advanced age

SIGNS AND SYMPTOMS

Signs and symptoms of active TB include:

 Coughing that lasts three or more weeks

 Coughing up blood
 Chest pain, or pain with breathing or coughing
 Unintentional weight loss
 Fatigue
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 Fever
 Night sweats
 Chills
 Loss of appetite
Additional Symptoms include:
Tuberculosis can also affect other parts of the body, including kidneys, spine or
brain. When TB occurs outside the lungs, signs and symptoms vary according to the
organs involved. For example, tuberculosis of the spine may give you back pain, and
tuberculosis in your kidneys might cause blood in your urine (Mayo Clinic Staff (2019).

POSSIBLE MEDICAL TREATMENT

The number one priorities for people who are diagnosed with tuberculosis are to
get treated, finish the medicine and take the drugs that are exactly prescribed by the
doctors. However, treating tuberculosis takes much longer time than treating other
infectious disease and bacterial infection. If they stop taking the drugs or if they do not
take drugs correctly the TB bacteria that are still alive may become resistant to those
drugs thus, they will not be able to cure the disease (CDC, 2016). Also, tuberculosis that
is resistant to drugs leads to tuberculosis that is dangerous, difficult and more expensive
to treat.
Treatment and Common Tuberculosis Drugs
According to the Mayo Clinic (2019), active tuberculosis can be treated by taking
several drugs for 6 to 9 months. The exact drugs and the length of the treatment
depend on the age, overall health, possible drug resistance, and the location of the
infection in the body. If a client has latent tuberculosis, the client must need to take only
1 or 2 types of tuberculosis drug. In addition, active tuberculosis, especially if it is drug-
resistant strain, it must have several drugs at once.
The most common medications used to treat tuberculosis include:
• Isoniazid
• Rifampin (Rifadin, Rimactane)
• Ethambutol (Myambutol)
• Pyrazinamide
Moreover, a client that has drug-resistant tuberculosis, a combination of antibiotics
called fluoroquinolones and injectable medications, such as amikacin or capreomycin
(Capastat), are used for 20 to 30 months in most cases. Some types of tuberculosis are
developing resistance to these medications as well. On the other hand, some drugs
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may be used as add-on therapy to the current drug-resistant combination treatment,

including: Bedaquiline (Sirturo) and Linezolid (Zyvox).
Medications Side Effects and Precautions
Furthermore, the side effects in taking medication for tuberculosis are not common
but it can be dangerous and can jeopardize the client’s life if they occur. All tuberculosis
medications can be highly toxic to our liver. When taking medications, call a doctor
immediately if someone experience any of the following:

 Nausea or vomiting
 Loss of appetite
 A yellow color to your skin (jaundice)
 Dark urine
 A fever that lasts three or more days and has no obvious cause

Complementing Treatment is Essential

Treatment for tuberculosis is complicated and it takes a lot of time to be cured.
However, the only way to cure tuberculosis is to have continuous treatment. Doctors,
nurses, and other health care professionals can be helpful in reminding their clients in
taking care of their medication as well.

NURSING MANAGEMENT AND INTERVENTIONS

As futures nurses, the management and intervention with the client’s sickness is
one of the important matters for the patient’s well-being. To totally express care and
consistency is the same way as taking good care of ourselves; for patient it is to provide
them with knowledge and awareness of the disease, to recover towards their utmost
health, and to be capable of avoiding sickness.
Administer ordered antibiotics and antitubercular agents (Dan, 2011).

 Isolate the infectious patient in a quiet, properly ventilated room and maintain TB
precautions. Provide divisional activities and check on the patient frequently.

 Make sure the call button is near.

 Place a covered trash can nearby, or tape a waxed bag to the bedside for used
tissues.

 Tell the patient to wear a mask when outside his room.

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 Visitors and health care personnel should take proper precautions while in the
patient’s room.

 Make sure the patient gets plenty of rest.

 Provide for periods of rest and activity to promote health as well as conserve and
reduce oxygen demand.

 Provide the patient with well balanced, high-calorie foods, preferably in small ,
frequent meals to conserve energy. (small, frequent meals may also encourage
the anorexic patient to eat more.). Record the patient’s weight weekly. If he
needs oral supplements, consult with the dietitian.

 Watch for adverse reactions to medications.

 Administer isoniazid with food. This drug can cause hepatitis or peripheral
neuritis, so monitor levels of aspartate aminotransferase and alanine
aminotransferase. To prevent or treat peripheral neuritis, give pyridoxine (vitamin
B) as ordered.

 If the patient receives ethambutol watch for signs of optic neuritis report them to
the physician who likely to discontinue the drug. Check the patient’s vision
monthly and give the medication with food.

 If the patient receives rifampin, watch for signs of hepatitis, purpura and a flu
likesyndrome as well as other complications such as hemoptysis.

 Monitor liver and kidney function tests throughout therapy.

 Perform chest physiotherapy, including postural drainage and chest percussion,

several times per day

 Give the patient supportive care and help him adjust to the changes he may have
to make during illness include the patient in care decisions and let the family take
part in patient’s care whenever possible.

Early childhood and Middle and late childhood

A child with TB needs to be welcomed by the nurse. A child needs a guide and a
figure they can trust aside from their parents to help them get better. So forging a
rapport with the child will help manage the disease. Then explain to the child what’s
happening in words or a way he can understand. Then observe or ask all the things the
child needs help with.
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Adolescence and Young Adult

Since the nurse is dealing with adolescence, their way of teaching and managing
changes and in a way that they can express the whole disease and help them
understand it. The nurse can ask for their thoughts while assessing the adolescence
emotion, discuss about the goals that the adolescence and nurse both need to achieve,
pay respect to their norms, and such. At the same time, engaging with one on one
conversation with them and their parents can be helpful.
Older adulthood
Nurses must plan to avoid these patients to be depressed and help them cope
with the situation. Reinforcement of their hope is a great way of lighten up their mood as
well as setting goals that can provide them support.

PREVENTION MEASURES
Prevention of TB is better than cure. Although it is hard to find any solution to
prevent the spread of TB at this time, but there are preventive measurements to reduce
the spread of tuberculosis.
The BCG Vaccination
The BCG (Bacille Calmette-Guerin) is a live vaccine against Tuberculosis. It is
currently the only licensed vaccine against TB since 1921. It is 80% effective in
preventing TB for 15 years and effective in any forms of complex TB for children while
its effect is limited for people over the age of 35 (Kanabus, 2018).
Early Diagnosis
It is easier to prevent and to treat TB when it is early diagnosed. Once a person
is diagnosed with TB, it can affect 10-15 persons per year but when a person is early
diagnosed and given of medication, majority of patients are no longer infectious after
just two weeks.
Case Finding
We can limit the passing of TB to another person by finding or tracing
persons/people having the disease. When a person is diagnosed with infectious
disease, their close contacts are screened to prevent the spread of Tuberculosis.
Raising awareness about TB can help to prevent the infectious disease from spreading
and to inform and give knowledge to people in the community who are prone (Kanabus,
2018).
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Managing the Environment

Tuberculosis is one of the diseases that is airborne or easily acquired from the air
with particles of coughs or sneezes from an infectious individuals. It can reduce the risk
of acquiring from air using these simple precautions: (1) good ventilation, (2) natural
light or UV light because it kills off TB bacteria, and (3) good hygiene like covering
properly the mouth and nose when coughing or sneezing to reduce the spreading of
bacteria (Kanabus, 2018). But in the healthcare settings, using of protective masks,
ventilation system, separating the TB patients from the other patients, and regular
screening of healthcare workers for TB.
Healthy Immune System
60% of healthy adults with strong immune systems, their body can kill TB
bacteria by their own (Gogne, 2016). People with weak immunity can acquire the TB.
So ensure that your immunity is strong and you are living a healthy lifestyle.
Tuberculosis Education
It is necessary to educate people with TB on how they should take care of
themselves and how they should take their medications properly (Kanabus, 2018). And
they also need to know how they can prevent passing the disease to other people.
Generally, TB education is not just for the patients but it is also for the awareness of the
public.
Hospital Infection Control
Controlling the spread of TB in the hospitals is a must due to patients with TB
that can infect other patients and even the hospital staffs. Patients who are initially
suspected to have TB are enclosed in an isolated room and instructed to wear a mask
always and respiratory and cough etiquette. And for the healthcare providers for those
patients should wear an N95 respirator. When collecting sputum from the patient, make
sure the area is well-ventilated and away from the other people or patients. The N95
respirator must be fitted to the user and must be used properly (Bartlett & Tortorice,
2015). Healthcare staffs should participate in TB testing and prevention programs.
HEALTH TEACHING STRATEGIES
Nurses and other health-care workers play a key role in assessing and providing
the tuberculosis patients with information and practices that are essential in their health.
Here are the various age group which can acquired TB and the teaching strategies
appropriate in their age:
Infancy-Toddlerhood
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According to Bastable (2019), children of this age group are dependent but still
have the capacity to understand some procedures and interventions to some extent
through experience. Building rapport is very much important as assigning primary nurse
and establishing time can reduce the child’s fear of strangers. For short term learning
provide them simple, concrete, and non-threatening explanations with visual and
touchable experiences whereas, children use coordination and integration of motor
activities with sensory perceptions. Also, the pace of teaching according to a child’s
responses and level of attention should be individualizing. For long term learning, focus
on rituals, imitation, and repetition of information in the form of words and actions to
hold the child’s attention. For example, practice covering of mouth when coughing.
Early Childhood
Children are now increasing their contact with the outside world although they
are still dependent on their family (Bastable, 2019). Interactions of patient and nurse at
this point is occasional therefore, nurse should take this opportunity to offer parents
instructions about medical recommendations related to tuberculosis. For short term
learning, give physical and visual stimuli because their language ability is still limited;
both for expressing ideas and for comprehending verbal instructions. Granting rewards
such as badges or small toys can encourage their cognitive and psychomotor skills. For
long term learning, parents as role model will be vital for children’s healthy habits and
access to support.
Middle and Late Childhood
In this phase of life, children are enthusiastic to learn and their minds are open to
varied ideas (Bastable, 2019). Nurse as educator have the responsibility to explain
tuberculosis, TB treatment plans, and TB procedures in simple and logical terms
according to child’s level of understanding and listening. For short term learning, allow
them to take responsibility for their own care by reason that they are willing and
capable. For long term learning, nurse must assist them in learning for their own well-
being and prevent TB from worsening.
Adolescence
The appropriate teaching strategies for adolescents are to address their fears
and concerns about outcomes of tuberculosis. Adolescents have short attention span. If
their interests are not determined, they will just get bored. Nurses need to catch their
attention by finding what can control their focus (Bastable, 2019). Providing reading
materials about TB in adolescents, audiovisuals like movies or documentary films, and
role plays can be of help. Group peers have a huge impact in an individual adolescent
therefore, arranging a group sessions in persons or virtually (e.g., blogs, social
networking, podcasts, online videos) in order to support and influence one another to
further understand circumstances of having TB and to prevent it from spreading onto
other people.
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Young Adulthood
At this stage, people are already self-directed. They use personal experiences to
enhance or interfere with learning, they are autonomous, able to think critically, and they
can already make decisions for themselves (Bastable, 2019). The teaching strategies
with people at this stage are to encourage them to participate in TB awareness and TB
programs, give information about TB that is problem-centered and focus on immediate
application of solutions and draw meaningful experiences from patients having TB and
already cured.
Middle-Aged Adulthood
If the patient has a past experience of TB illness and being cured, at this stage,
they have the confidence to teach youngsters about reality in life having TB. The best
teaching strategies to teach people at this stage are to assess the positive and negative
past experiences in life to ensure that they are not going to be offended while
discussing about TB. It is needed to assess their motivational level to participate in the
programs in the society for the TB awareness and prevention. Lastly, it is also important
to explore their emotional, financial, and physical support system.
Older Adulthood
At this stage, older adulthoods have low energy level and tend to have hearing
loss due to physical changes as they get older. It is important to speak slowly, avoid
shouting, use low-pitched tones and use visual aids to supplement verbal instruction
with large font size, clear background, and well-spaced print. Older adulthood have
decreased ability to think abstractly and slows the processing of information so it is
necessary to present one concept at a time, allow time for processing and for their
response, use repetition and reinforcement of information. Make sure that they are
comfortable and have safe environment for any precautions or accidents. They focus
more on past life experiences so ensure that concrete examples are use and make
information relevant and meaningful.
References:
 American Lung Association. (2018). Lung Health & Diseases. Tuberculosis
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 Barry, C., Donald, P., & Marais, B. (2010). The Lancet Journal. Age and the
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for nursing practice, Jones & Barlett Learning, LLC.
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 Bartlett, D., & Tortorice, J. (2015). CEUfast. Tuberculosis. Retrieved (03/03/19)

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workers. Retrieved (03/03/19) from

https://apps.who.int/iris/bitstream/handle/10665/69383/WHO_HTM_TB_2006.3
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