RNSG 2573

HEALTH CARE CONCEPTS

3

Immunity Concept
Tuberculosis (TB)
Exemplar

KEY POINTS FOR TB

Most commonly affects the lungs (pulmonary TB
disease), but may affect other body systems
(extrapulmonary disease)
Individuals with altered immune function are at
greatest risk for infection
Two TB-related conditions existlatent TB infection
and TB disease

KEY POINTS FOR TB

Latent TB Infection

TB Disease

Infected with M. tuberculosis

Infected with M. tuberculosis

Do not have symptoms of TB disease

Have symptoms of TB disease

Cannot infect others

Can transmit M. tuberculosis to others

KEY POINTS FOR TB

Individuals suspected of:
pulmonary TB disease should have sputum specimens collected for
AFB smear and culture
extrapulmonary TB disease may require clinical specimens other than
sputum

Culture is the gold standard for confirmation of TB

disease

Negative AFB smears do not exclude

TB disease

KEY POINTS FOR TB

Regimens for treatment of TB disease must include multiple drugs
Standard treatment for TB disease is four-drug therapy for 6-9
months
First-line drugs are isoniazid, rifampin, ethambutol, and pyrazinamide
Second-line drugs are added or substituted as needed based on lab evidence of drug
resistance

KEY POINTS FOR TB

Drug resistance in treatment of TB is of special concern
Multidrug resistant TB disease (MDR TB) = resistance to isoniazid
and rifampin
Extensively drug-resistant TB disease (XDR TB) = resistance to
isoniazid, rifampin, any fluroquinolone and at least one of the 3
injectable second-line drugs
Inadequate treatment of TB disease can lead to ongoing
transmission and drug resistance
A specific treatment and monitoring plan in collaboration with the
local health authority is critical for individuals with TB disease
Directly-observed therapy (DOT) is a core TB management strategy

KEY POINTS FOR TB

Inadequate treatment of TB disease can lead to
ongoing transmission and drug resistance
A specific treatment and monitoring plan in
collaboration with the local health authority is critical
for individuals with TB disease
Directly-observed therapy (DOT) is a core TB management strategy

TB EXEMPLAR CORRELATION
TO
IMMUNITY CONCEPT
Compromised antecedents

Intact non-specific defenses or barriers

Optimal innate immune response
Functional lymphatic system
Functional inflammatory response

Attribute deficits
Normal WBC and differential
Negative bacterial cultures
Soft, non-tender lymph nodes

Negative consequences
Localized or systemic infection
Chronic inflammatory response

TB EXEMPLAR CORRELATION
TO
IMMUNITY CONCEPT
Interrelated Concepts
Cellular
Regulation

Tissue Integrity

Comfort

Functional
Ability

Thermoregulatio
n

Nutrition

Coping

RISK FACTORS FOR TB

Age

Socioeconomic
Status

Lack of
Knowledge of
Infection
Prevention

Other Illnesses,
Drugs and Medical
Treatment

Environmental
Factors

Lifestyle
Behaviors

ASSESSMENT FOR TB
Comprehensive history

Presence of symptoms of TB disease

Known exposure to person(s) with TB disease
Previous diagnosis with latent TB infection
Previous treatment regimen for TB disease
Underlying medical conditions that alter immune function,
especially HIV disease

ASSESSMENT FOR TB
CLINICAL MANIFESTATIONS
Pulmonary TB (Adults)

Extrapulmonary TB

Cough with or without sputum production

Hemoptysis
Chest pain
Anorexia
Unexplained weight loss
Night sweats
Fever
Fatigue

Depends on body system affected

Kidney (hematuria)
Meninges (headache and
confusion
Spine (back pain)
Larynx (hoarseness)

ASSESSMENT FOR TB
Diagnostic Tests
Tuberculin skin test (TST)
Interferon-gamma release assay (IGRA)
Bacteriologic exam of clinical specimenssputum, urine or CSF for
AFB or specifically M. tuberculosis
Chest x-ray
CT scan

CLINICAL MANAGEMENT
OF TB
Nursing Interventions
Secondary prevention
Screening of close contacts of individuals newly
diagnosed with TB disease
Implementation of respiratory protection programs
and infection control measures
Evaluation of compliance with and effectiveness of
pharmacologic therapies

CLINICAL MANAGEMENT
OF TB
Nursing Interventions
Tertiary prevention
Use of nutritional and/or physical therapy
Identification/control of adverse and toxic effects of
pharmacologic therapies
Ophthalmologist (visual changes)
Audiologist (hearing changes)

CLINICAL MANAGEMENT
OF TB
Collaborative Interventions
Pharmacologic
First-line anti-tuberculosis drugs
Second-line anti-tuberculosis drugs
Analgesics (chest pain)

Nonpharmacologic
Oxygen therapy
Nutritional therapy

Surgical
Chest tube insertion (pneumothorax)
Lobectomy or pneumonectomy

SOCRATIC QUESTIONS
FOR TB EXEMPLAR
1.

Does a positive TB skin test (TST) mean that an

individual is infectious to others?

2.

Why does latent infection with M. tuberculosis

complicate the prevention and control of
tuberculosis?

3.

Why do many individuals with culture-positive TB

disease have negative AFB smears?

4.

Why does the treatment of TB disease include at

least two or more drugs?

APPLICATION OF NURSING
PROCESS FOR TB
In the classroom, review the following TB Personal
Stories at the CDC website,

http://www.cdc.gov/tb/topic/basics/pers
onalstories.htm
:

Kennis Story
Marthas Story
Santos Story
Rick and Francenes Story