Breaking The Chain: The Patient With An Infectious Communicable Disease Paper (Tuberculosis) Essay Examples

Introduction

Tuberculosis is a disease that has already infected one-third of the world’s population. Caused by the Mycobacterium tuberculosis, it is a disease that can attach not only the lungs, but also other parts of the body, such as the brain, kidney, and spine (World Health Organization, 2010). Most cases have been recorded in Southeast Asia and Africa, and if left untreated, it could lead to the patient’s death. In addition, each untreated incident of tuberculosis can result in another 10 to 15 people infected annually (World Health Organization, 2010). It is a disease that was considered eradicated; however, the latest statistics show that it has made a strong comeback with new strains that are more resistant to antibiotics. It is an airborne disease that spreads from an infected individual to another through coughing, singing, or speech (Centers for Disease Control and Prevention, 2012).

The Chain of Infection

Etiologic Agent
Any microorganism that causes the infection is the etiologic agent. For tuberculosis, it is Mycobacterium tuberculosis, whose ability to invade grow, and cause the disease plays a significant role in causing the infection (Sakamoto, 2012). Mycobacteria are defined as nonsporulating and nonmotile, acid-fast, gram-positive bacilli (Sakamoto, 2012). Under the microscope, they appear as either slightly curved or completely straight rods up to 4μm in length and 0.6 μm wide (Sakamoto, 2012).

Reservoir

The infection’s reservoir may be anything that can provide the microorganism with a place to reproduce, such an object (e.g. a doorknob), animal, or human. For Mycobacterium tuberculosis the only natural reservoir is the human host (Kamga, et.al, 2011).

Portal of Exit

In cases where the human is serving as the natural reservoir of an infectious agent, such as tuberculosis, the portal of exit is any orifice. In tuberculosis, it is the upper respiratory tract (Centers for Disease Control and Prevention, 2012). The microorganism leaves the reservoir through the nose and mouth when someone with tuberculosis coughs or sneezes, which allows a large number of Tuberculosis microbacterium to be released.

Mode of Transmission

The way the bacterium moves and spreads is defined as the mode of transportation. Since tuberculosis is an airborne disease, its bacterium can be transported via inhalation of tuberculosis droplet nuclei (person-to-person transmission), through singing and coughing (Zachary, 2013). When people with tuberculosis sneeze, cough, sing, or talk release the bacterium into the air, which makes it easier for those in the same room to inhale the infected air.
Those with active tuberculosis that has not been treated are contagious. In order to predict transmission, culture of cough aerosols for Mycobacterium tuberculosis, as well as acid-fast bacilli (AFB) smear-positive, with the latter being still controversial as to whether it comprises a potential marker (Zachary, 2013).
Any procedure that can lead to the spread of the disease (the nuclei droplets) is linked to an increased risk of tuberculosis transmission. Such procedures include bronchoscopy, aerosol treatments, endotracheal intubation, autopsy, sputum induction, and irrigation of tuberculous abscess (Zachary, 2013). Although pulmonary disease and extrapulmonary disease are both contagious, patients with isolated extrapulmonary tuberculosis cannot transmit the disease. However, they do need to be evaluated for laryngeal or pulmonary tuberculosis (Zachary, 2013). Finally, patients with their immune compromised by extrapulmonary tuberculosis should be tested for pulmonary tuberculosis (sputum samples should be negative), even if their chest radiography does not reveal any issues whatsoever. Therefore; they are always presumed to have the disease until proven otherwise (Zachary, 2013).

Portal of Entry

Microorganism can enter the human body through portals of entry, such as the skin (via any breaks present), the mouth and nose (mucus membranes) and other orifices. In tuberculosis, those surfaces that line the alimentary canal and the respiratory passages are the most important portals of entry (Cobbett, 2015). Moreover, other surfaces that may be invaded by bacteria, such as the mucus membranes that line with the genital and urinary passages may also be included in the entry portals of tuberculosis (Cobbett, 2015). However, it is difficult to determine the actual extent these are penetrated or how much the microorganisms may access them. On the other hand, even if one gets tuberculosis through penetration of these passages, it will be insignificant, compared to those that got the disease through their alimentary mucus membranes and respiratory (Cobbett, 2015). In other words, just as the tuberculosis bacterium can be transmitted through sneezing, singing, coughing, and laughing, it can also be inhaled by the mouth and nose.

Susceptible Host

There is an epidemiological triad that comprises the risk factors for tuberculosis: environment, host, and agent. The agent is, of course, tubercle bacilli, the environment is any environment that allows the bacilli to transfer and survive as they transmit from one host to another. Finally, the host is a susceptible person, and by that we mean any person that allows the tubercle bacilli to be released in the environment and then be transmitted through inhalation to another host-person. Those with a low immune system and already sick are welcoming hosts for the bacilli. For instance, tuberculosis can invade someone with HIV much easier than a healthy and young individual.
According to experimental data, Mycobacterium tuberculosis is a pulmonary pathogen, although the dissemination of infection from the lung is believed to be part of the pathogenesis of the disease. Mycobacterium tuberculosis can be found within various different parts of the body, with the lung being the primary portal of entry, as already mentioned. The outcome of the infection depends on the generated response by the immune system. Immune responses that are generated after the invasion of the disease can limit the growth of the Mycobacterium tuberculosis, completely eradicate it, or allow it to grow and continue to reproduce inside the host, leading to tuberculosis disease (Wang, Carruthers, and Turner, 2012). Among the many factors that affect one’s immune response is increasing age, malnutrition, and HIV (Wang, Carruthers, and Turner, 2012). Finally, people with Diabetes and chronic illnesses (e.g. kidney failure), alongside those taking immune suppressive medications (e.g. cancer patients) susceptible hosts of the disease.

Nursing Management

Treatment Options
There are two conditions related to tuberculosis (TB): TB disease and latent TB disease. Those with latent TB infection can live without ever becoming sick, because their body was able to fight the tuberculosis bacteria and prevented them from growing and reproducing. These people do not experience any symptom of TB and cannot transmit the disease to others. However, latent TB may become active and reproduce within its host, resulting in the person getting sick (Centers for Disease Control and Prevention, 2012). To detect TB bacteria, one can either get tested by giving blood or skin samples. Any positive reaction to either of them will lead the patient to other tests to determine whether they have TB disease or latent TB disease. Tuberculosis is treated with the use of drugs that should be taken for more than six months and up to nine months, and it is crucial that the patient finishes the medication and be very careful to take them as prescribed, in order to not get sick again and allow the germs still inside their body become drug-resistant (Centers for Disease Control and Prevention, 2012).
The standard regimen for people with latent tuberculosis is Isoniazid (INH) that should be taken daily for nine months, although a combination of INH and Rifapentine (RPT) is also recommended to otherwise healthy people older than 12 years of age that have a likelihood of developing TB (e.g. tuberculin test turning positive from negative) (Centers for Disease Control and Prevention, 2012). It should be noted that patients that do not take their medication exactly as recommended by their doctor not only run the risk to become sick again, but also spread the disease to others and make the disease antibiotic-resistant, which is harder to treat (Centers for Disease Control and Prevention, 2012).

Nursing Interventions

For Risk of Infection
Identifying the sources of infection will help eradicate the disease, thus break the chain of infection. In a relatively recent cross-sectional study conducted in Zimbabwe, in 2006 has shown that nurses that did not routinely ask for sputum examination for patients that had a cough were not able to detect tuberculosis (Chadambuka et.al, 2011). Therefore; it is important to examine patients with a cough or those that have recently been treated for cough and have re-presented in a healthcare facility to treat that persistent and coming back cough. Generally, to confirm tuberculosis suspicions, the nurse should retrieve the family’s history for tuberculosis and night sweats and then proceed to take the patient’s weight, pulse, respiration, and temperature. If a patient is a suspect, they should be referred to a sputum microscopy and a chest X-ray (Chadambuka et.al, 2011). Among children, nurses should check respiratory symptoms that last for more than three weeks after the child has completed their antibiotic treatment, and ask for family history with smear-positive tuberculosis. Any recent treatment for tuberculosis, as well as one’s failure in therapy with antibiotics should be considered a suspect and referred to a physician (Chadambuka et.al, 2011).
Controlling transmission will also help break the chain of events. In order to reduce the risk of spreading tuberculosis, the nurse should place the patient in a private room (negative pressure preferred), teach the patient about the contagious disease, and wear an N-95 mask when entering the patient’s room (this applies to everybody entering the room, not just the nurses). Also, the patient should wear a mask if and when s/he is transported to another department. During direct care, nurses should wear gowns and gloves, and wash their hands effectively. To limit the disease, the patient must stay in well ventilated areas and avoid contact with other people as much as possible, wash their hands thoroughly, and dispose their tissues into a plastic bag (closed) (Nettina, 2013).

For Infective Breathing Pattern

If the patient has trouble breathing properly, meaning they either breathe too slow or too fast, of if they have high fever and nervousness, the nurse should administer oxygen, give fluids, place the patient in a position that makes it easier to breathe (high fowlers position) (Nettina, 2013). Giving fluids to patients with tuberculosis will help them remove secretions from the lungs, allowing them to breathe better. It is also important the patient has all the required energy to breathe, which is why they should be provided with rest periods.
The patient’s nutritional status is also paramount to treat tuberculosis and fight off infections. To improve that status, a nurse needs to explain the significance of proper nutrition to the patient with TB, monitor their weight to determine whether it has maintained or improved, provide small meals frequently, and administer vitamin supplements, if considered necessary (Nettina, 2013).
As already said, taking medication exactly as prescribed is critical, in order to prevent the disease from becoming medication-resistant. The drug regime for tuberculosis may be long, which is why the nurse makes sure the patient is aware of the importance of taking their medication as prescribed for as long as required, and notify the patient of possible side effects of their drug regime, so they know when they should be alarmed and seek for health care (Nettina, 2013).

Conclusion

Tuberculosis is a disease that has made a strong comeback after it has been perceived eradicated and infects mainly the lungs. It is caused by the Mycobacterium tuberculosis bacterium and can lead to the patient’s death if left untreated. In order to prevent contagion for the disease it is important all necessary precautions are taken (e.g. use of gloves and mask) and if one is infected with TB, they should be informed about both the disease’s specifications and the importance of taking their medication exactly as prescribed. It is a disease that has already infected one third of the world’s population and could easily spread from one host to another, if proper measures are not taken, since it is an airborne disease.

References:

Centers for Disease Control and Prevention (2012). Basic TB Facts. Retrieved Jan. 21, 2015 from: http://www.cdc.gov/tb/topic/basics/default.htm
Centers for Disease Control and Prevention (2012). Principles of Epidemiology in Public Health Practice, Third Edition: An Introduction to Applied Epidemiology and Biostatistics. Retrieved Jan. 21, 2015 from: http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section10.html
Centers for Disease Control and Prevention (2012). Fact Sheet: Treatment Options for Latent Tuberculosis Infection. Retrieved Jan. 21, 2015 from: http://www.cdc.gov/tb/publications/factsheets/treatment/LTBItreatmentoptions.htm
Chadambuka, A, Mabaera, B, Tshimanga, M, Shambira, G, Gombe, NT, Chimusoro, A. (2011). Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006. Afr Health Sci. Jun 2011; 11(2): 190–196. PMCID: PMC3158527.
Cobbett, Louis (2015). The Causes of Tuberculosis: Together with Some Account of the Prevalence and Distribution of the Disease. CUP Archive. p.136-140
Kamga, H. L. F., Weledji, P., Fon, N. P. and Atah, A.S. (2011). An Evaluation Study of the Sputum Smear Concentration Technique for the Laboratory Diagnosis of Pulmonary Tuberculosis. AFR. J. CLN. EXPER. MICROBIOL. 12(1): 22-25.
Nettina, Sandra (2013). Lippincott Manual of Nursing Practice. LWW; Tenth, North American Edition edition. ISBN-10: 1451173547.
Sakamoto, K (2012). The Pathology of Mycobacterium tuberculosis Infection. Veterinary Pathology May 2012 vol. 49 no. 3 423-439. doi: 10.1177/0300985811429313.
World Health Organization (2010). Fact sheet N°104: Tuberculosis. Retrieved Jan. 21, 2015 from: http://www.who.int/mediacentre/factsheets/fs104/en/print.html
Zachary, Kimon (2013). Tuberculosis transmission and control. UpToDate, Wolters Kluwer Health. Retrieved Jan. 21, 2015 from: http://www.uptodate.com/contents/tuberculosis-transmission-and-control
Wang, Shu-Hua, Carruthers, Bridget, Turner, Joanne (2012). The Influence of Increasing Age on Susceptibility of the Elderly to Tuberculosis. Open Longevity Science, 2012, 6, 73-82.