NR 503 Infectious Disease Paper

NR 503 Infectious Disease Paper

NR 503 Infectious Disease Paper

Description of tuberculosis

Tuberculosis (TB) is a contagious, life-threatening infectious disease that primarily affects the lungs and is caused by the mycobacterium germ (Delogu, Sali, and Fadda, 2013). General symptoms are a wracking cough, extreme weakness and fatigue, coughing up blood or phlegm (sputum), marked weight loss, fever and chills, profuse sweating, and severe chest pain while breathing or coughing (CDC: Signs and symptoms, 2016). A skin test or TB blood test are used to determine if a person has tuberculosis.

The TB mode of transmission occurs when a person with TB coughs, sneezes, speaks, or opens his or her mouth; mycobacterium germs are released into the air and remain for hours— even days (CDC: How TB spreads, 2016). Complications of pulmonary TB include structural, metabolic, vascular, and infectious conditions (Shah & Reed, 2014). An acute complication of TB is sepsis (Shah & Reed, 2014). Chronic complications are pulmonary mycetoma or focal neurologic deficits from tuberculomas; pulmonary complications include hemoptysis (coughing up blood) or pneumothorax (collapsed lung) (Shah & Reed, 2014). TB is treated with or more first-line drugs for 6 to 12 months: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and/or pyrazinamide (PZA) (CDC: Treatment for TB disease, 2016). If the strain of TB is resistant to first-line drugs, second-line group 2 drugs are given (CDC: Treatment for TB disease, 2016). Other TB drugs are categorized as second-line groups 3 and 4, and third-line group 5. The vaccine for TB is Bacille Calmette–Guèrin (BCG) (CDC: Treatment for TB disease, 2016).

Demographic of interest

The global mortality rate for tuberculosis is more than 50 percent in patients who do not receive adequate treatment (Adigun & Bhimji, 2018). The CDC (2018) reports the morbidity of TB as 10.4 million people around the world of which the mortality was 1.7 million (Adigun & Bhimji, 2018). The morbidity of TB cases in the U.S. was 9,547 cases reported in the U.S. in 2015, of which 470 people died; of the 9, 272 TB cases reported in 2016, the CDC has yet to compile mortality rates (CDC, 2017). The incidence rate for TB cases in the United States is 3.0 per 100,000 in 2015 and 2.9 per 100,000 in 2016 (CDC: TB Incidence…, 2017). WHO (2017) estimates the global incidence rate for TB decreases 1.5 percent every year; the prevalence of TB in the U.S. in 2015 was 0.00002974 percent in a population of 321 million; in 2016, the prevalence was 0.0000287058 in a population of 323.4 million people (Adigun & Bhimji, 2018).

Determinants of health/host, agent, environmental factors

Common TB determinants of health are socioeconomic factors, physical environment, and individual behaviors. Poverty is one of the leading social determinants of TB, as it determines the conditions in which people live. Undernutrition is also another risk factor for developing the disease. Malnutrition leads to secondary immunodeficiency, which amplifies a person’s susceptibility for TB infection (Narasimhan et al., 2013).  Smoking and alcohol abuse also increase a person’s chances of getting TB because these behaviors cause other medical conditions that weaken the immune system. Smoking damages the lungs in many ways, and people who smoke are 40 – 60 percent more likely to develop pulmonary TB, the leading form of the condition (Narasimhan et al., 2013). Excessive alcohol consumption damages the body and interferes with TB treatment drugs. People who have been diagnosed with cancer, diabetes, Crohn’s disease, chronic obstructive pulmonary disease, HIV/AIDS, or other medical conditions that attack the immune system are at great risk to contract TB. These conditions cause an already compromised immune system to become defenseless against TB (Narasimhan et al., 2013).

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Host factors for TB are general health practices, attitude about healthcare providers, psychological states, social status, previous exposure to disease, race, genetic diseases. The causative agent for TB is the mycobacterium tuberculosis microbe. Environmental factors that promote TB are poorly ventilated, crowded, filthy home and work environments. Settings that have a lot of air pollution, geographic areas with a high incidence of TB, or work environments with high levels of airborne or released toxins promote growth of the mycobacterium tuberculosis germ.

Role of the FNP

If FNPs want to effectively help communities eliminate and prevent tuberculosis outbreaks, FNPs must understand

NR 503 Infectious Disease Paper
NR 503 Infectious Disease Paper

and practice current CDC and WHO approved TB screening procedures, treatment guidelines, and community engagement methods. Case finding methods should include retrieving relevant TB source documents from local, national, and state health agencies, such as disease indices and pathology reports that identify reportable cases. FNPs should also go out in the community and collect data about members who have been treated for TB or who can recount stories of interactions with people who have been diagnosed with TB. FNPs can utilize their informatics and research skills to analyze their findings and experiences then compile them into a report. Once these experiences and evidence-based practices have been presented to the right sources, TB resources and clinical care for at risk populations will be more readily accessible.

References

Adigun R, Bhimji SS. (2018 Apr 20). Tuberculosis. In: StatPearls (Internet). Available from:

https://www.ncbi.nlm.nih.gov/books/NBK441916/

Centers for Disease Control and Prevention (CDC). (2016, March 17). Tuberculosis (TB): Signs & symptoms. Available from https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm

Centers for Disease Control and Prevention (CDC). (2016, July 26). How TB spreads. Available from https://www.cdc.gov/tb/topic/basics/howtbspreads.htm

Centers for Disease Control and Prevention (CDC). (2016, August 11). Treatment for TB Disease. Available from https://www.cdc.gov/tb/topic/treatment/tbdisease.htm

Centers for Disease Control and Prevention (CDC). (2017, November 13). Reported tuberculosis in the United States, 2016. Available from https://www.cdc.gov/tb/statistics/reports/2016/table1.htm

Centers for Disease Control and Prevention (CDC). (2017, November 13). TB incidence in the United States, 1953-2016. Available from https://www.cdc.gov/tb/statistics/tbcases.htm

Delogu, G., Sali, M., & Fadda, G. (2013). The Biology of Mycobacterium Tuberculosis

Infection. Mediterranean Journal of Hematology and Infectious Diseases, 5(1), e2013070. http://doi.org/10.4084/MJHID.2013.070

Narasimhan, P., Wood, J., MacIntyre, C. R., & Mathai, D. (2013). Risk Factors for Tuberculosis.

Pulmonary Medicine, 2013, 828939. http://doi.org/10.1155/2013/828939

Shah, M., & Reed, C. (2014). Complications of tuberculosis. Current Opinion in Infectious Diseases27(5), 403-410. doi: 10.1097/QCO.0000000000000090