Aguilera-janelle_careon-anthony_meer-rhinadell_tero-raven_vizarra-mira_ncm-102-topic-4.docx

LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine

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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

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Diabetes

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Severe kidney disease

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Certain cancers

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Cancer treatment, such as chemotherapy

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Drugs to prevent rejection of transplanted organs

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Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis

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Malnutrition

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Very young or advanced age

SIGNS AND SYMPTOMS Signs and symptoms of active TB include: 

Coughing that lasts three or more weeks

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Coughing up blood

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Chest pain, or pain with breathing or coughing

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Unintentional weight loss

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Fatigue

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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 

Fever

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Night sweats

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Chills

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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 drugresistant 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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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.

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Make sure the call button is near.

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

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

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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 

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

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Make sure the patient gets plenty of rest.

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

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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.

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Watch for adverse reactions to medications.

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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.

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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.

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

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Monitor liver and kidney function tests throughout therapy.

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Perform chest physiotherapy, including postural drainage and chest percussion, several times per day

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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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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 wellbeing 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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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine 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 Symptoms, Causes & Risk Factors. Retrieved (03/02/19) from https://www.lung.org/lung-health-and-diseases/lung-diseaselookup/tuberculosis/tuberculosis-symptoms.html  Barry, C., Donald, P., & Marais, B. (2010). The Lancet Journal. Age and the epidemiology and pathogenesis of tuberculosis. (Vol. 375, pp. 1852-1854) Retrieved (03/02/19) from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60580-6.pdf  Bastable, S. B. (2019). Nurse as Educator: principles of teaching and learning for nursing practice, Jones & Barlett Learning, LLC.

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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine  Bartlett, D., & Tortorice, J. (2015). CEUfast. Tuberculosis. Retrieved (03/03/19) from https://ceufast.com/course/tuberculosis?fbclid=IwAR2HFwa5e97TOT00_05e3krTj_67-gBDZrzRFC9a915xv0xUvXwGfCbxiI  CDC. (2016). Centers for Disease Control and Prevention. Tuberculosis (TB). Retrieved (03/01/19) from https://www.cdc.gov/tb/topic/treatment/tbdisease.htm  Dan, R. (2011). SlideShare. Tuberculosis-Medical and Nursing Managements. Retrieved (03/03/19) from https://www.slideshare.net/reynel89/tuberculosismedical-and-nursingmanagements  DOH. (2010). Department of Health. Magnitude of Tuberculosis in the Philippines. Retrieved (02/03/19) from http://www.ntp.doh.gov.ph/magnitudeTB.php  Dr. Gogne, V. (2016). lybrate. How To Prevent Tuberculosis(TB) From Spreading And Safeguard Yourself. Retrieved (03/01/19) from https://www.lybrate.com/topic/how-to-prevent-tuberculosis-tb-from-spreadingand-safeguard-yourself/5e4b59e4249d543ac95ad7f233103714  Kanabus, A. (2018). TBFACTS.ORG. TB Prevention - Precautions, vaccine, masks. Retrieved (03/01/19) from https://www.tbfacts.org/tb-prevention/  Manisha. (n.d.). Your essential guide to TB. WHAT IS LATENT TB?. Retrieved (03/03/19) from https://www.thetruthabouttb.org/latent-tb/what-is-latent-tb/  Mayo Clinic Staff. (2019). Mayo Clinic. Tuberculosis. Retrieved (03/01/19) from https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosistreatment/drc-20351256  Mayo Clinic Staff. (2019). Mayo Clinic. Tuberculosis. Retrieved (03/03/19) from https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptomscauses/syc-20351250  NHS. (2016). NHS. Causes - Tuberculosis (TB). Retrieved (03/03/12) from https://www.nhs.uk/conditions/tuberculosis-tb/causes/  TBa!ert. (n.d.). for a future without tuberculosis. TB and HIV. Retrieved (03/01/19) from https://www.tbalert.org/about-tb/global-tb-challenges/tb-hiv/  Vianzon, R. Western Pacific Surveillance and Response Journal. The tuberculosis profile of the Philippines, 2003–2011: advancing DOTS and beyond. Retrieved (02/03/19) from https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/201/272  WHO. (n.d.). The World Bank. Incidence of tuberculosis (per 100,000 people). Retrieved (03/02/19) from https://data.worldbank.org/indicator/SH.TBS.INCD?locations=PH  WHO. (n.d.). World Health Organization. Tuberculosis (TB). Retrieved (03/03/19) from https://www.who.int/tb/areas-of-work/preventivecare/ltbi_faqs/en/  WHO. (2006). Strengthening the teaching of tuberculosis control in basic training programmes. A manual for instructors of nurses and other health-care

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LPU – ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC. College of Allied Medicine workers. Retrieved (03/03/19) from https://apps.who.int/iris/bitstream/handle/10665/69383/WHO_HTM_TB_2006.3 67_eng.pdf;jsessionid=B3186CB8B3BE4439F530C00489EB591E?sequence= 1&fbclid=IwAR2ZWYO20qXghaQSVfGnZoX0rnf_1IUocq_A8bA8abu_QtbMpk6gR0HsuU  WHO. (2018). World Health Organization. Tuberculosis. Retrieved (02/03/19) from https://www.who.int/news-room/fact-sheets/detail/tuberculosis

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