Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence)
Tumberculosis (TB) is a communicable chronic granulomatous disease caused by Mycobacterium tuberculosis. It primarily affects lungs; it may affect any organ or tissue of the body. Typically, the centres of tubercular granulomas undergo caseous necrosis. It is “spread through inhaling tiny droplets from the coughs or sneezes of an infected person”. Typically, its symptoms include; persistent cough for more than three weeks, in which the phlegm maybe bloody; weight loss; night sweats; high temperature; tiredness and fatigue; and loss of appetite. Primary Tuberculosis is the form of disease that develops in a previously unexposed, and therefore unsensitised, person. Elderly and profoundly immunocompromised person may lose their sensitivity to the tubercle bacillus and so may develop primary tuberculosis. Secondary Tuberculosis, or reactivation tuberculosis, is a disease that arises in a previously sensitized host. Primary form of the disease may cause erosion of blood vessels may result in hemoptysis. The infection may spread by direct expansion, by dissemination through airways and lymphatic channels. Miliary pulmonary disease occurs when bacteria drain through lymphatics, and finally to right side of the heart. In serious conditions pleural cavity may get involved resulting in pleural effusion, tuberculous empyema or obliterative fibrous pleuritis. It may also lead to endobronchial, endotracheal, and laryngeal tuberculosis. Systemic military tuberculosis may cause infection in the liver, bone marrow, spleen, adrenals, meninges, kidneys, fallopian tubes, and epididymis. Isolated-organ tuberculosis may appear in meninges, kidneys, adrenals, bones, and fallopian tubes. Also, intestinal tuberculosis has been contacted via contaminated milk. With proper treatment, tuberculosis can be usually be successfully cured. Antibiotics need to be administered for approximately six months. There are several different antibiotics that are used due to development of resistance. Commonly used anti-tubercular drugs are; isoniazid; rifampin; pyrazinamide; ethambutol; and streptomycin.
Infection, whether active or inactive, can be detected by the tuberculin (Mantoux) test, which reveals the development of skin sensitivity to tuberculoprotein. About 80% of the population of South India are tuberculin positive. In contrast, in 1980 in the United States, 5 to 10% of the population reacted positively to tuberculin, indicating the marked difference in rates of exposure to the tubercle bacillus. Of the approximately 15 million persons exposed to tubercle bacilli in the United States, only 23,000 developed active disease in 1986. Thus, only a small fraction of those who contact an infection develop active disease.
Describe the determinants of health and explain how those factors contribute to the development of this disease
“Tuberculosis flourishes wherever there is poverty, crowding, and chronic debilitating illness. Similarly, elders, with their weakened defences, are vulnerable”. In US, African-Americans, Native Americans, the Inuit, and Hispanics have higher incidence than others. Certain diseases are also risk factors; diabetes mellitus, Hodgkin’s disease, chronic lung disease, malnutrition, alcoholism, and immunosuppression. Where HIV infection is prevalent, it has become the single most important factor in the development of TB.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).
The epidemiological model has been devised by scientist to study health problems. The triangle has three corners; Agent, or microbe that causes the disease; Host, or organism harboring the disease; and Environment, or those cause the disease to transmit.
Agent or the microbe causing the disease is Mycobacterium tuberculosis. They are slender rods that sometimes show branching filamentous forms resembling fungal mycelium. They are described as Gram positive, “acid fast”, aerobic, nonmotile, noncapsulated and nonsporing.
Host condition has profound impact on the disease. Diseases that are risk factor for the development of TB are; diabetes mellitus, Hodgkin’s disease, chronic lung disease, malnutrition, alcoholism, and immunosuppression. Where HIV infection is prevalent, it has become the single most important factor in the development of TB
Regarding environmental factors, “Tuberculosis flourishes wherever there is poverty, crowding, and chronic debilitating illness. Similarly, elders, with their weakened defences, are vulnerable”. Poverty and tuberculosis go together, but with the progress of the AIDS pandemic, tuberculosis has become a problem for the rich nations also. Another complicating factor that has far graver consequence is the emergence and spread of multiple drug resistance and concomitant HIV infection.
Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
The role of the community health nurse is includes managing services of patients diagnosed or suspected of having TB. This would be from initiation to completion of the treatment; any change in the diagnosis; and even till death. In some of the programs, management of individuals with latent TB infection or even those are now healed. The role of the nurse requires an approach to able to anticipate and identify problems; and appropriate measures are used to deal with the problem even before they develop. Such an approach requires more time and energy by the nurse and others involved in the initiative. However, their role may vary depending upon the availability of resources in the day clinics or the health departments. Additionally, they may also be required to provide care and some or all TB control activities. In such situations, it is recommended that administrative oversight be established so as to ensure that all the activities are completed, and desirable outcomes are achieved.
Nurses at their own level would want to keep themselves updated on the modalities of the treatment. Their key responsibilities include; ensuring investigations are complete and documentation of outcomes; appropriate treatment is monitored and completed; and patient’s caregivers are also identified and treated. Besides they have critical role in adhering to treatment, treatment models, and patient education.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
The mission of the National Tuberculosis Controllers Association (NTCA) is to work towards the elimination of tuberculosis in the US. It aims to do that a collective and concerted effort of the state, local, and territorial governments. It is these governments that are empowered by their jurisdiction and have the responsibility of carrying out prevention and control programs of TB.
Their chief objective includes, developing and providing collective a unified approach to all the controlling organizations to advance their objective of TB control and elimination. They also “counsel agencies, organizations, committees, and task forces on the issues and actions affecting TB control and elimination at state, local, and territorial level”. It also works with these organizations towards advancement of TB control. They support those agencies and organizations that work towards advancement of TB control at state, local and territorial level. Finally, they advocate for “positions, policies, laws, and means to advance TB control and elimination”.
Bibliography
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CDC. (n.d.). Lesson 1 Understanding the Epidemiologic Triangle through Infectious . Retrieved from CDC: http://www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf
Global Tuberculosis Institute. (n.d.). Fundamentals of Tuberculosis Case Management. In Tuberculosis Case Management for Nurses (p. 5). New Jersey Medical School.
Herchline, T. E., & Amorosa, J. K. (2013, 11 4). Approach Considerations. Retrieved from Tuberculosis Treatment & Management: http://emedicine.medscape.com/article/230802-treatment
Lipscomb, M. F. (1992). The Respiratory System. In V. Kumar, R. S. Cotran, & S. L. Robbins, Basic Pathology (pp. 416 - 422). Philadelphia : W.B.Saunders Company.
NHS. (n.d.). Tuberculosis (TB). Retrieved from NHS: http://www.nhs.uk/conditions/tuberculosis/Pages/Introduction.aspx
NTCA. (n.d.). NTCA. Retrieved from National Tuberculosis Controllers Association: http://www.tbcontrollers.org/ntca-2/#.Uu59GvldUrU
Nursing Times. (2012, 07 06). Case management for tuberculosis. Retrieved from Nursing Times: http://www.nursingtimes.net/nursing-practice/clinical-zones/educators/case-management-for-tuberculosis/5046811.article
