Concept Map Tuberculosis

Schiffman, George. (07, 2011). Tuberculosis. Retrieved from http://www. medicinenet. com/tuberculosis/page4. htm Tuberculosis. (01, 2013). Retrieved from http://www. mayoclinic. com/health/tuberculosis/DS00372/DSECTION=treatments-and-drugs Vyas, Jatin M. (11, 2012). Pulmonary Tuberculosis. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001141/ Schiffman, George. (07, 2011).

Tuberculosis. Retrieved from http://www. medicinenet. com/tuberculosis/page4. htm Tuberculosis. (01, 2013). Retrieved from http://www. mayoclinic. com/health/tuberculosis/DS00372/DSECTION=treatments-and-drugs Vyas, Jatin M. (11, 2012). Pulmonary Tuberculosis. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001141/ IMPLEMENTATION -Assess respiratory rate every 10-15 minutes Continuously note chest movement and use of accessory muscles during respiration -Auscultate breath sounds and note any areas with adventitious sounds, especially wet crackles -Document any respiratory secretions such as sputum: amount, character, and consistency -Keep patient in high Fowler’s position to allow optimum breathing -Check for obstructions or accumulation of sputum -Ask patient level of discomfort/pain on a scale of 1-10 -Record medication administrations and if therapeutic effects are occurring -Describe procedures and treatment expectations Encourage patient to follow drug regimens IMPLEMENTATION -Assess respiratory rate every 10-15 minutes -Continuously note chest movement and use of accessory muscles during respiration -Auscultate breath sounds and note any areas with adventitious sounds, especially wet crackles -Document any respiratory secretions such as sputum: amount, character, and consistency -Keep patient in high Fowler’s position to allow optimum breathing -Check for obstructions or accumulation of sputum -Ask patient level of discomfort/pain on a scale of 1-10 Record medication administrations and if therapeutic effects are occurring -Describe procedures and treatment expectations -Encourage patient to follow drug regimens PLANNING -Goals include treating any abnormal results such as dyspnea, abnormal breath sounds, irritability, and reducing or eliminating sputum levels -Give patient therapeutic effects regarding abnormalities found with little or no side effects -Help patient in making lifestyle changes that include making a safer work and home environment and getting the people who have the most contact with the patient treatment PLANNING Goals include treating any abnormal results such as dyspnea, abnormal breath sounds, irritability, and reducing or eliminating sputum levels -Give patient therapeutic effects regarding abnormalities found with little or no side effects -Help patient in making lifestyle changes that include making a safer work and home environment and getting the people who have the most contact with the patient treatment TUBERCULOSIS TUBERCULOSIS DIAGNOSIS Ineffective airway clearance related to poor cough effort as evidenced by abnormal breath sounds and dyspnea -Risk for infection related to settled secretions as evidenced by wet adventitious lung sounds such as crackles, and excessive sputum -Deficient knowledge related to condition, treatment plan, self-care and discharge needs as evidenced by questions/requests for information, statements about the problem, and the development of preventable complications DIAGNOSIS -Ineffective airway clearance related to poor cough effort as evidenced by abnormal breath sounds and dyspnea -Risk for infection related to settled ecretions as evidenced by wet adventitious lung sounds such as crackles, and excessive sputum -Deficient knowledge related to condition, treatment plan, self-care and discharge needs as evidenced by questions/requests for information, statements about the problem, and the development of preventable complications ASSESSMENT -Check for vitals; check for abnormal breath sounds, especially for wet crackles on inspiration -Assess for dyspnea, if using accessory muscles for respirations, or if the pt has elevated shoulders -Assess level, color, and consistency of any sputum Check for restlessness, irritability, or anxiousness -Report history of the patient, any existing illnesses such as pneumonia, cancer, family hx, workplace, home life, and lifestyle ASSESSMENT -Check for vitals; check for abnormal breath sounds, especially for wet crackles on inspiration -Assess for dyspnea, if using accessory muscles for respirations, or if the pt has elevated shoulders -Assess level, color, and consistency of any sputum -Check for restlessness, irritability, or anxiousness Report history of the patient, any existing illnesses such as pneumonia, cancer, family hx, workplace, home life, and lifestyle NURSING PROCESS NURSING PROCESS EVALUATION -Assess if medication and procedures are performing therapeutic effects -Check for levels of discomfort/pain on a scale of 1-10, make sure vitals and lab results are within normal ranges -Check if patient’s secretion amount diminished or stopped -Assess if patient’s restlessness and irritability was alleviated -Check if patient is continuously taking prescribed medications to prevent spread of disease EVALUATION Assess if medication and procedures are performing therapeutic effects -Check for levels of discomfort/pain on a scale of 1-10, make sure vitals and lab results are within normal ranges -Check if patient’s secretion amount diminished or stopped -Assess if patient’s restlessness and irritability was alleviated -Check if patient is continuously taking prescribed medications to prevent spread of disease ETIOLOGY -Caused by the bacteria Mycobacterium tuberculosis (M. uberculosis) by breathing in air droplets from a cough or sneeze of an infected person, resulting in primary TB -Risk factors include those who life with others who have active TB, poor or homeless people, elderly, infants, nursing home residents, prison inmates, alcoholics, IV drug users, those with malnutrition, working in health care, workers in refugee camps -Factors that elevate chances include diabetes, kidney disease, cancer, chemotherapy, and certain types of drugs ETIOLOGY Caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis) by breathing in air droplets from a cough or sneeze of an infected person, resulting in primary TB -Risk factors include those who life with others who have active TB, poor or homeless people, elderly, infants, nursing home residents, prison inmates, alcoholics, IV drug users, those with malnutrition, working in health care, workers in refugee camps -Factors that elevate chances include diabetes, kidney disease, cancer, chemotherapy, and certain types of drugs

PATHOGENESIS -Droplets of fluid containing tubercle bacilli are released into the air and are taken into the nasal passages and lungs of a susceptible person nearby -Once inhaled, tubercle bacilli reach alveoli where macrophages take them up; bacilli then multiply and spread through lymph vessels into the lymph nodes and finally to distant organs; can remain ‘alive’ or become ‘inactive’ -Immune system responds which causes damage to the tissues; cells attack the bacilli, thus killing the infection

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PATHOGENESIS -Droplets of fluid containing tubercle bacilli are released into the air and are taken into the nasal passages and lungs of a susceptible person nearby -Once inhaled, tubercle bacilli reach alveoli where macrophages take them up; bacilli then multiply and spread through lymph vessels into the lymph nodes and finally to distant organs; can remain ‘alive’ or become ‘inactive’ -Immune system responds which causes damage to the tissues; cells attack the bacilli, thus killing the infection

SIGNS/SYMPTOMS -Common symptoms include unintentional weight loss, fatigue, fever, night sweats, chills, loss of appetite -Cough persisting three weeks or more, coughing up blood or sputum, or chest pain when breathing or coughing -If spread, TB of the spine leads to back pain and TB of the kidneys cause blood in the urine SIGNS/SYMPTOMS Common symptoms include unintentional weight loss, fatigue, fever, night sweats, chills, loss of appetite -Cough persisting three weeks or more, coughing up blood or sputum, or chest pain when breathing or coughing -If spread, TB of the spine leads to back pain and TB of the kidneys cause blood in the urine COMPLICATIONS -Medicines for TB can cause side effects such as liver problems, changes in vision, orange/brown colored tears or urine, rash -TB of the bones: joint destruction -TB of the brain: meningitis; swelling TB of liver or kidneys: impaired filtering of waste -TB of the heart: inflammation; fluid collections; impaired pumping abilities; cardiac tamponade COMPLICATIONS -Medicines for TB can cause side effects such as liver problems, changes in vision, orange/brown colored tears or urine, rash -TB of the bones: joint destruction -TB of the brain: meningitis; swelling -TB of liver or kidneys: impaired filtering of waste -TB of the heart: inflammation; fluid collections; impaired pumping abilities; cardiac tamponade TREATMENT/MANAGEMENT Patient recommended to stay in isolation and on bed rest until no longer contagious -Inactive TB: antibiotic called isoniazid (INH) is prescribed for six to twelve months; not prescribed to pregnant women; can cause liver damage and peripheral neuropathy -Active TB: INH is also prescribed along with rifampin, ethambutol, pyrazinamide; may also receive streptomycin; may be taken from months to years -Drug resistant TB: everything with active TB with several other drugs; longer treatment; may require surgery to remove damaged lung tissue TREATMENT/MANAGEMENT Patient recommended to stay in isolation and on bed rest until no longer contagious -Inactive TB: antibiotic called isoniazid (INH) is prescribed for six to twelve months; not prescribed to pregnant women; can cause liver damage and peripheral neuropathy -Active TB: INH is also prescribed along with rifampin, ethambutol, pyrazinamide; may also receive streptomycin; may be taken from months to years -Drug resistant TB: everything with active TB with several other drugs; longer treatment; may require surgery to remove damaged lung tissue

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