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Tuberculosis
Patient 45 years old, male Michael Jones. With wife in the hospital, preparing for discharge today.
Tuberculosis is a bacterium that affects the lungs and is an infectious disease that easily spreads through the air. Tuberculosis or TB is thankfully preventable and curable. You are being discharged today and your provider has sent your prescriptions to your pharmacy. You will be prescribed a combination of antibacterial medications that you will need to take for anywhere between 6 to 12 months. (Abi et al., 2023) The combination of medications your provider prescribed is pyrazinamide, rifampin and ethambutol. Some side effects to watch out for are itchy skin, nausea, vomiting, diarrhea, loss of appetite, blurred vision, or vision changes. These all need to be reported to your provider or healthcare team. (Abi et al., 2023) It is important to cover your mouth with a tissue and put the tissue in a bag when sneezing or coughing then throw it away. This will help prevent the spread of TB and be sure to wash your hands frequently. (Adverse Events | Treatment | TB | CDC, 2020) In your discharge instructions, I have some information from our dietician. It is important to eat a diet rich in complex B vitamins. These foods include whole grains and nuts. Leafy green vegetables, fish, dairy products, and more. This helps support your immune system during treatment for TB. (Tuberculosis Diet: Here’s What You Should Eat and Avoid – Nanavati Max Hospital, n.d.)
Once the patient’s education has been completed it is important to determine if the information provided was understood by the patient some way to determine this is by the teach-back method. This allows the patient in their own words to describe all the education that was provided, it also gives them the chance to ask any questions they may have about the education and teachings provided. Another way is depending on the patient’s learning level providing lots of diagrams, pictures, and brochures for individual needs in the discharge paperwork. Make sure phone numbers and appointments are highlighted so they are easy to see.
References
Abi, D., Ajik Magaji, Sumayya Al-Mansur, Jang, B., Ibrahim, A., Matthias Gamde, & Obeta, M. (2023). Knowledge gaps in tuberculosis among students and its implications for public health; A review. Microbes and Infectious Diseases (Print), 0(0). https://doi.org/10.21608/mid.2023.233372.1606Links to an external site.
Adverse Events | Treatment | TB | CDC. (2020, March 27). Www.cdc.gov. https://www.cdc.gov/tb/topic/treatment/adverseevents.htmLinks to an external site.
Tuberculosis Diet: Here’s What You Should Eat And Avoid – Nanavati Max Hospital. (n.d.). Www.nanavatimaxhospital.org. Retrieved April 2, 2024, from https://www.nanavatimaxhospital.org/blogs/diet-for-tuberculosis#:~:text=Foods%20rich%20in%20B%2Dcomplex%20vitamins&text=Foods%20rich%20in%20B%Links to an external site.
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Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Once inside the lung, the body encases the TB bacillus with collagen and other cells. This can appear as a round nodule on a chest x-ray. This disease most commonly affects the lungs, but it can also affect other parts of the body. (ATI, 2023). This is the first point that should be taught to the patient. I must ensure that they understand the disease and what causes it. The patient and family should also be educated on how tuberculosis is transmitted. It is commonly spread through aerosolization or the airborne route from a person who is ill with the disease (ATI,2023).
It is also important to teach the patient and family the appropriate precautions while at home. Airborne precautions are not necessary in the home setting because family members have already been exposed bit the family members that were exposed should be tested for TB. The medication therapy should be continued for its full duration of 6 to 12 months, even up to 2 years for multidrug-resistant TB. Failure to take the medications can lead to a resistant strain of TB. Sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness. Clients are no longer considered infectious after three consecutive negative sputum cultures and can resume work and social interactions and follow-up care must also be continued for 1 full year. Practicing proper hand hygiene, covering mouth and nose when coughing or sneezing, and disposing contaminated tissues in a plastic bag is important as well as wearing a mask when in public placed or in contact with crowds (ATI, 2023).
The patient should also be educated on medications and be directed to complete the series of prescribed medication to ensure all bacteria are eliminated to decrease the chance of resistance. For example, if a client is prescribed rifampin the client should be aware that urine and other secretions will be orange, to immediately report pain or swelling of the joints, loss of appetite, jaundice or malaise, the medication could also interfere with the efficiency of oral contraceptive, and discoloration of contact lenses can occur (ATI, 2023).
Educating the patient on the complications of tuberculosis is important because the patient must know what to report to the provider and what is normal or abnormal. A complication can be military TB. This is when the organism invades the bloodstream and can spread to multiple body organs with complications including the following: Headaches, neck stiffness, and drowsiness that can be life threatening as well as pericarditis. This includes dyspnea, swollen neck veins, pleuritic pain, and hypotension due to an accumulation of fluid in pericardial sac that inhibits the heart’s ability to pump effectively. Treatment is the same for pulmonary tuberculosis (ATI, 2023). The patient must always be able to recognize the manifestation of tuberculosis, when to call the provider, when to seek care, or contact emergency services (ATI, 2023).
After I have completed my teaching, it is important to make sure the patient understood the education that was provided to them. I could do so by using the teach back method. This is when the patient teaches the information they learned back to the nurse. This tells us that they understood the teaching and if they still need to develop any skills. If the patient did not understand the teaching, we would teach the information to them again. The patient should always be provided with resources such as pamphlets, brochures, and booklets about TB transmission. This will help because it will be written down for the patient to read and they may better understand because booklets and pamphlets could create a visual for them as well.
Sources
Assessment Technologies Institute. (2023). RN Adult Medical Surgical Nursing Edition 12.0.
