Introduction
Tuberculosis has become a worldwide pandemic as it is highly contagious to humans. Tuberculosis is a serious airborne disease that affects the breathing system, mainly the lungs. Most individuals infected by Tuberculosis do not show any signs or symptoms until their full-blown stage of development. Patients diagnosed with active tuberculosis symptoms demand a long-term treatment course by using multiple antibiotics. Individuals infected with Tuberculosis are most likely to infect the people they spend most of their time with for instance family members, work colleagues, classmates and friends. Tuberculosis is fatal if not treated with proper medications. Each year, Tuberculosis is recognized by the World Health Organization on 24 March to create awareness and educate the public about TB.
Pathophysiology of Tuberculosis
Tuberculosis (TB) is caused by Mycobacterium tuberculosis, which affects the lungs and other parts of the body such as the brain, spine, and kidney. Tuberculosis is an airborne disease spread through the air from one individual to another (Centre for disease control, 2021). The Mycobacterium tuberculosis is spread through the air when an individual infected with TB coughs, sneezes, or even speaks. People nearby may breathe the infected air, thus contracting Tuberculosis, which settles in the lungs and begins to mutate then. Inhalation of TB bacteria can lead to the following possible outcomes, immediate clearance of the bacteria by body antibodies, latent infection, the onset of primary disease, and active or dominant illness many years later.
Latent tuberculosis infection (LTBI) occurs when an individual is infected with Mycobacterium tuberculosis but lacks TB disease; therefore, it cannot spread to others (Serafino, 2021). During this stage, antibodies produced by the white blood cells fight the TB bacteria infection and prevent replicating. The onset of primary Tuberculosis begins after two years of illness with TB bacteria after the immune system fails to eliminate TB bacteria due to a person being exposed to the TB bacteria severally. TB bacteria then rapidly spreads to other body parts through the bloodstream, causing dominance of TB disease in the human body. During this stage the signs and symptoms of Tuberculosis become relevant for instant persistent cough with blood stains, high fever, and drastic weight loss. Individuals with TB disease spread TB bacteria to others, and therefore it is very important to successfully contain latent TB infection to protect the body against subsequent tuberculosis infection.
Clinical manifestations and psychosocial concerns of Tuberculosis
A person who has contracted the tuberculosis disease has the following signs and symptoms, persistent blood-stained cough for three or more weeks, frequent chest pains, drastic weight loss, general fatigue, night sweats, and body chills. There are several types of tuberculosis disease: pulmonary Tuberculosis, endobronchial Tuberculosis, pleural Tuberculosis, Central Nervous System tuberculosis (tuberculous meningitis), and spinal Tuberculosis. (Hopewell 428-428) The most commonly used diagnostic form of Tuberculosis is a skin test, sputum test, and blood test, which is the most elaborate test. Blood tests confirm and measure the immune system’s reaction to TB bacteria. During a skin test, tuberculin is injected below the skin surface inside the forearm after 72 hrs. or 48 hrs.; a healthcare professional checks the swelling on the arm formation of a red bump, which indicates one is likely to have a TB infection. Moreover, sputum samples are taken from individuals’ coughs to test TB bacteria.
Pulmonary Tuberculosis occurs when TB bacteria causes infection in the lungs and is very contagious. It spreads rapidly to other body organs such as the heart and kidney through the bloodstream. Endobronchial Tuberculosis is an infection of TB bacteria that affects the trachea and bronchus and is very common in young females (Hopewell 428-428). On the other hand, pleural Tuberculosis occurs due to severe TB infection and damage of lung tissue, causing the build-up of pleural fluid in the pleural space of the lungs. Pleural Tuberculosis causes the individual to experience difficulty in breathing. Tuberculous meningitis is caused when TB infection affects the Central Nervous System and usually has high mortality and morbidity rates to infected persons. Spinal Tuberculosis occurs when TB infection affects the spinal cord, and this causes deformities in an individual leading to paralysis.
Patient isolation, a strategy for treating Tuberculosis, affects the mental health of TB patients. An individual with Tuberculosis usually has depression and anxiety problems because of fear of stigmatization by the general public because of the contagious TB disease (Frieden 407-409). Tuberculosis patients usually have low self-esteem because they are discriminated against by the public and lack social support. TB patients with few symptoms of Tuberculosis live in fear of discovery of other symptoms, whereas the newly diagnosed patients are usually in shock and depressed to be informed about their serious health condition that requires long-term medical treatment.
Tuberculosis treatment
The most common medications used for tuberculosis treatment include Isoniazid, Pyrazinamide, and Ethambutol. Tuberculosis treatment begins immediately after a person is diagnosed with latent tuberculosis infection or primary and secondary tuberculosis infection (Frieden 407-409). If an individual has drug-resistant TB bacteria, treatment is done by combining antibiotics such as fluoroquinolones and medical injections such as amikacin. Most tuberculosis medications are toxic to the liver and have side effects such as loss of appetite, darkened urine, blurred vision, jaundice and nausea. Patients under tuberculosis treatment should regularly contact medical personnel to issue proper supervision during treatment. Completing treatment is essential for TB patient as stopping treatment allows the bacteria to mutate and become resistant to drugs, making TB much more dangerous and difficult to treat.
Role of clinics in assisting undocumented Tuberculosis patients to cover cost of payment and resources available for TB treatment in community health centers
In the United States, efforts to enable a free tuberculosis state have been put in place; the majority of uninsured Americans are financially assisted by the federal government into the health care systems to cover medical costs. Improving Tuberculosis control efforts ensures all populations undergo regular medical checkups for Latent TB and TB infections and providing affordable and accessible TB treatment to all individuals (Balaban et al., 2015). Campaigns in schools, hospitals, and workplaces are being conducted to create TB awareness to all individuals and prevention measures against Tuberculosis. The Affordable Care Act has enabled insurance expansion to many undocumented patients to curb control and prevent tuberculosis infection.
The federal government has put measures in place to sponsor organizations in diagnosis, treatment, prevention, and control of Tuberculosis. The state and local TB programs are all responsible for providing essential TB services to Americans through Public and Private Health care services (Balaban et al., 2015). The development and support of training Tb related specialists other than physicians such as nurses have helped solve the Tuberculosis crisis in the United States. Subsidized health coverage in the United States is available at a reduced cost or no cost for individuals with a low household income below the federal poverty level. Unsubsidized health individuals require no financial assistance to cover health insurance and usually have high costs of premium in health coverage.
Implications of TB treatment for critical care and advanced practice nurses
Nurses play an important role in Tuberculosis diagnosis, treatment, prevention, and control measures. Poor medical treatment is a major cause of TB mutation and resistance to drugs; therefore, nurses and other medical practitioners must strictly adhere to TB treatment measures (Frieden 407-409). Nurses should ensure medication is completed and medical interruption by undisciplined patients avoided. Nurses should consider HIV/AIDS patients vulnerable to Tuberculosis infection as their immune system is more sensitive to bacteria. Capitalizing on advanced practice nurses specializing in Tuberculosis is key to ensuring quality care, critical care, and patient satisfaction during TB treatment.
Conclusion
Tuberculosis is a contagious airborne infection that primarily attacks the lungs. TB infection can lead to a latent, primary, and secondary infection that can spread to other body parts such as kidneys, lungs, and spine. A person infected with TB usually has a persistent cough with blood stains and chest pains as the primary symptoms. The main types of Tuberculosis are pulmonary and endobronchial Tuberculosis; TB treatment begins immediately after diagnosis with strict medication adherence. Tuberculosis is fatal if not treated with proper medications.
References
Balaban, V., Marks, S., Etkind, S., Katz, D., Higashi, J., & Flood, J. et al. (2015). Tuberculosis Elimination Efforts in the United States in the Era of Insurance Expansion and the Affordable Care Act. Public Health Reports, 130(4), 349-354. https://doi.org/10.1177/003335491513000413
Centre for disease control. (2021). transmission and pathogenesis of Tuberculosis. Retrieved 15 December 2021, from.
Frieden, T. (2007). Promoting adherence to treatment for tuberculosis: the importance of direct observation. The World Health Organization Bulletin, 85(5), 407-409. https://doi.org/10.2471/blt.06.038927
Hopewell, P. (2006). Tuberculosis care and control. The World Health Organization Bulletin, 84(6), 428-428. https://doi.org/10.2471/blt.06.032748
Serafino, R. (2021). Pathophysiology and microbiology of pulmonary Tuberculosis. Medical Journal. Retrieved 15 December 2021, from.
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