International notifications of TB 1980 1983

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International notifications of TB (1980 1983)
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Incidence of TB in Canada between 1925 and 1995
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Causes of death in Canada
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Distribution of reported TB cases among
population groups in Canada, in 1996.
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Risk Groups

• living with a person who has active TB
• Previously had active TB but received inadequate
  chemotherapy / none at all
• Immigrated from a country where TB was common
• Are an aboriginal person from native Indian or
  Inuit groups
• Reside in depressed socioeconomic area of a large
  city
• Canadian Lung Association 2001

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Mycobacterium Tuberculin Bacillus
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Types of Tuberculosis

• Avian tuberculosis form affecting various
  birds, due to M. avium, which may be communicated
  to humans and other animals

• Bovine tuberculosis infection of cattle caused
  by M. bovis, transmissible to humans and other
  animals

• Hematogenous tuberculosis carried through the
  blood stream from the primary site of infection
  to other organs

• Open tuberculosis lesions from the tubercle
  bacilli are being discharged out of the body

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• Lung most common site
• Pulmonary vs extra pulmonary
• Communicable disease - reportable

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M. tuberculosis occur any part body

• Abdominal cavity fatigue, slight tenderness,
  appendicitis-like pain

• Bladder painful urination

• Brain fever, headache, nausea, drowsiness,
  brain damage, coma

• Pericardium fever, enlarged neck veins, SOB

• Joints arthritis-like symptoms

• Kidney infection damage

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Path physiology
EXPOSURE?
Primary infection Small Ghon focus at the lung
periphery ?
Lymphatic spread involves the hilar lymph nodes?
Large caseous masses may form due to cell
mediated immunity ?
Calcified lesion remains ? Always dormant
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Secondary Infection
Recurrence of TB later in life reactivation or
re infection ?
The patients have immunity to TB and develop a
cell mediated response leading to CASEATION ?
The lesions typically affect the lung apices ?
Large cavitating lesions may develop with
surrounding fibrosis. Hilar Lymph nodes are often
involved
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Signs and Symptoms

• Variable with extent of disease

• Asymptomatic or symptomatic
• X-ray ? skin test may be only sign

• If overt symptoms then may have

• Fever, weight loss
• Malaise, anorexia, flu-like
• Cough with bloody sputum (hemoptysis)
• Aching pain, chest tightness SOB
• Night sweats, chills

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Mantoux test
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Mantoux Test
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Measurement
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Heaf Test
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Positive Result
A positive tuberculin skin test does not mean
that the patient has TB !!
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• Indicates exposure

• A person can be infected with the bacteria that
  causes TB, but only a few (10) go on to develop
  the disease.

• If a person has active TB regular checkups and C
  x R are performed for the rest of the persons
  life

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• Further testing is required

• Sputum needed, 3-8 weeks results

• C x R ?inflamed lesions or old lesions

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Acid Fast Bacillus
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Early TB
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Moderate- advanced
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Far advanced
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Nursing Diagnosis

• Ineffective airway clearance related to
  productive cough

• Impaired gas exchange related to asymmetry lung
  expansion

• Body image disturbance related to feelings about
  TB

• Social Isolation related to fear of spreading
  infection

• Knowledge deficit related to medication regime

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Management

• Promote adequate ventilation

• Reduce the spread of disease

• Promote nutrition

• Promote increased self esteem

• Health teaching

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Promoting adequate ventilation

• Prop up in Bed
• Encourage deep breathing and coughing
• Physiotherapy
• Teach pursed lip / Diaphramic breathing
• If required
• Administer antitussive, decongestants,
  bronchodilators
• High humidity /- oxygen
• O2 sats, ABGs
• Intermitted positive pressure, incentive
  spirometry,

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Reducing spread of disease

• Administer Medications
• Avoid direct contact with sputum
• Provide good circulation of air
• Implement respiratory precautions
• Communicable disease must be reported

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Promote Good Nutrition

• Increased Protein and Calories
• Small frequent feedings
• High fluid intake

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Promote increased self-esteem

• Encourage verbalization of fears and
  uncertainties
• Explain methods of disease prevention and screen
  other family members if necessary
• Encourage patient to maintain role in family
  while home treatment is ongoing and to return to
  home and social contacts as soon as it is safe to
  do so

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Health Teaching

• Prevention Screening

• Follow-up known cases annual C x R

• Prevent transmission

• Enhance compliance

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• Drug therapy

• Isoniazid (INH) is 1st line Rx for 6-12 months

• Rifampin another 1st line Rx for 6-12 months

• Discuss possible side effects

• A number of other combination 2nd line Rxs also
  available

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• CCompliance and follow-up vital to success of
  treatment
• MMay still get drug resistant strains
• Eeffectiveness determined by monthly sputum
  cultures
• EEnsure plenty of rest and good nutrition

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Treatment
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Isoniazid

• May be given 6-12 months prophylactically in high
  risk cases

• Family members, especially Mantoux test

• Person with Mantoux

• Mantoux, abnormal CxR, unconfirmed Dx

• Hx TB with inadequate Rx

• Mantoux chronic or immune disease

• Mantoux elderly, children, or alcoholic

• Not infectious after 1-2 weeks on drug therapy

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Multi-drug resistant TB

• Called MDR-TB

• New strains may eventually resist all medications

• Those at increased risk include

• People exposed to someone with drug resistant TB

• People who have stopped taking their medication
  unadvised

• 2nd time developer of TB

• Come from areas where drug resistant TB common

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Nursing Considerations
Assessment
Detailed history check contacts
Review Laboratory, clinical and radiological tests
Patient teaching regarding the importance of drug
therapy
Financial resources to ensure availability and
affordability of drugs
Maintain isolation precautions if hospitalization
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Prevention
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Indications for Vaccination

• Individuals that are repeatedly exposed to TB
  that is not handled properly, included children
  of families with a strong history of TB

• Health workers due to risk of handling infected
  specimens or nursing patient suffering from TB

• Newborn infants whose mother has infectious TB at
  the time of delivery

• Individuals traveling to TB laden areas for an
  extended period of time

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Contraindications

• Those with impaired cell-mediated immunity

• Burn patients

• Patients with extensive skin disease

• Vaccination of pregnant women is preferably
  delayed until after delivery, although no harmful
  effects on the fetus have been observed

Canadian Tuberculosis Standards (4th Ed) 1996
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Prevention