Integrated Nursing Practice 2
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Introduction
Boris Vasilescu is a 62-year-old factory worker with a Romanian heritage. Over the last five months, he has had an ongoing productive cough coupled with intermittent chest pains and frequent sweating at night. His coughing is extreme, and in the last few days, he’s been coughing blood-stained phlegm. Also, it is reported he has not been eating properly and, as a result, has lost almost over 10 kgs since his symptoms first started.
After being presented in a hospital, Boris Vasilescu complains of chest pains, his skin gets clammy and exhibits shortness of breath with elevated temperatures of up to 38 degrees. An x-ray taken shows that the upper lobe and cavity have been infiltrated, suggesting TB. A few days later, after more checkups, he was diagnosed with TB and was provided the appropriate antimicrobial medicine upon discharge. After about one month since his discharge, Boris Vasilescu’s wife complains of his husband not taking his medication correctly and on time and is now worried about his husband’s long-term health. This paper is a reflection on why Boris Vasilescu must take his medication successfully, patient education regarding TB as well as its infectious period and infection control precautions.
Tuberculosis is a significant health problem in both developed and developing countries. It is considered to be among one of the frequent causes of death, especially for individuals aged between 24-69 years old. According to the world health organization, tuberculosis is an infectious disease caused by a microorganism called Mycobacterium tuberculosis. It has also been established that the microorganism gets into the human body through inhalation via the lungs. Once in the lungs, the microorganism tends to spread to the other parts of the body via the lymphatic system, airways, direct extension to other organs, or through the bloodstream.
Signs, symptoms and pathophysiological changes in the respiratory system associated with tuberculosis
Tuberculosis develops in the human body in two stages. According to the World Health Organization, the first stage is usually that of infection where an individual gets exposed to the microorganisms, and the second stage is the actual development of the disease; tuberculosis. In the infection stage, the likelihood of a patient infecting others is highly dependent on the number of microorganisms in the lungs and their ability to spread into the surrounding air. Smear-positive-cases include cases where the microorganisms are so numerous and can be detected using a microscope while smear-negative cases are those where microorganisms cannot be directly detected. The latter is less infections, but the former is more infections and can quickly spread the disease to others in their proximity. According to (Alsultan & Peloquin, 2014), most infectious tuberculosis patients spread the microorganism into the air in the form of tiny droplets while coughing, talking, sneezing, or laughing and gets suspended in their breath for several hours. Any individual within proximity can inhale the microorganisms, and they start to multiply in the lungs. It is, however, essential to note that scientists believe that these microorganisms are rapidly destroyed when exposed to sunlight and that their concentration in the surrounding air can be reduced through a good ventilation system. In the first few weeks of infection, people barely show any symptom of infection until it has spread.
According to (Grosset, Singer, Bishai, 2012), about 90% of infected individuals rarely become ill with tuberculosis unless their immunity system is compromised. It has also been established that the microorganism may stay in the human body for a long time, a period with which the disease develops. It is also essential to note that even though not all infected individuals may develop the disease, all individuals will continue with the risk of reinfection. A recent study by (Horsburgh, Barry, Lange, 2015), indicates that an approximate of about 5% of individuals who have been infected by the microorganisms will develop the disease, especially with the first two to three years after infection while another 5% will receive the condition sometime in their lifetime. The disease can occur in both pulmonary and extrapulmonary sites. Pulmonary TB mostly affects the lungs and is the most common type of TB. According to the World Health Organization, for instance, about 67% of all TB cases in the United States were pulmonary (Toczek et al, 2013). Even though a majority of TB cases are pulmonary, it can also occur in other sites other than the lungs, such as the brain, kidneys, and the pleura, which is often referred to as extrapulmonary.
In this particular case study, Boris Vasilescu has been diagnosed with pulmonary TB because the x-ray taken indicates that the upper lobe and cavity have been infiltrated, suggesting pulmonary TB. This kind of TB is often characterized by a bad cough that may last up to three weeks or longer, rampant chest pains and probably coughing up blood or sputum. Other signs and symptoms may include weakness or fatigue, overall weight loss due to lack of appetite, frequent chills, and fever due to elevated temperatures and sweating at night (Li et al, 2013).
A month since Boris Vasilescu was discharged from the hospital, his wife has been complaining that he has not been taking his medications properly. Based on the nature of the Tuberculosis infection and disease, Boris Vasilescu must take his medications properly because the disease or infection can be drug resistance. This is so because the currently used antibiotics were developed over sixty years ago, and for that reason, some Tuberculosis germs have developed the ability to survive despite medication (Rangaka et al, 2015). For this reason, Boris Vasilescu should continue to take his medication even after feeling better because he is still in the risk of infection. Additionally, his system needs antibiotics to combat the spread of the infection to other parts of the body other than the lungs to reduce the risk of developing extrapulmonary tuberculosis.
Patient education, infections period and control precautions
Treatment of tuberculosis includes two phases; the initial intensive phase and the continuation phase. The initial intensive phase often consists of a combination of drugs recommended by practitioners to eliminate microorganisms and minimize the spread of as well as tiny microorganisms resistant to drugs. According to (Lienhardt et al, 2012), the first phase is often for patients like Boris Vasilescu, who have never been previously diagnosed or treated for tuberculosis, and it is usually meant to prevent failure of the disease from responding to the treatment. The continuum phase, on the other hand, is undertaken to ensure that the patient is permanently cured and that chances or relapse after the treatment is complete is minimized.
The World Health Organization indicates that the quality of care given to patients is vital in determining the success of a treatment plan put in place and the reduction of risks. Poor treatment, on the other hand, increases the number of infectious cases for people within and the community at large (O’Donnell et al, 2016). Since the treatment of tuberculosis seems to be prolonged, it should be ensured that patients continue to take their medication correctly, following every prescription for the allocated amount of time.
Besides, many studies have shown that for successful treatment, it is essential that the patient understands what is happening. In this particular case, it has been reported that Boris Vasilescu refused to take medications as prescribed; this may be due to various reasons, including not knowing what is happening. According to (M’Imunya, Kredo, Volmink, 2012), a patient who understands the nature of their disease and treatment model in place is more likely to follow the treatment and every instruction to the latter compared to patients who barely understand their disease and its treatment. As a result, healthcare providers should establish good relationships with their patients to improve the quality of outcomes. In this case, involving Boris Vasilescu is his care will enable him to understand why he has to eat and take medications as prescribed.
Furthermore, the progress of treatment should be closely monitored by a healthcare provider. Since the results of sputum smear examination are usually recorded before treatment is initiated, bacteriological follow up examinations among smear-positive patients like the case of Boris Vasilescu is essential in assessing the progress of a patient. There should be a 2-month intensive phase treatment period followed by a compulsory 4-month continuation phase (Nglazi et al, 2013). Conclusion
As depicted above, tuberculosis is a deadly disease. For that reason, individuals diagnosed with tuberculosis should take a step towards protecting themselves and others, and this can only be achieved by finishing the entire course of medication. According to (Müller et al, 2018), where an individual terminates treatment in the early stages after diagnosis or skips some doses, there is a high probability that the TB bacterial will mutate, making the microorganisms resistant to TB drugs. Hard evidence suggests that the resulting drug-resistant strains tend to be more deadly and difficult to treat. For this reason, it is essential that a patient follows and sticks to the treatment plan put in place.
References
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Grosset, J. H., Singer, T. G., & Bishai, W. R. (2012). New drugs for the treatment of tuberculosis: hope and reality [State of the Art Series. New tools. Number 2 in the series]. The International journal of tuberculosis and lung disease, 16(8), 1005-1014.
Horsburgh Jr, C. R., Barry III, C. E., & Lange, C. (2015). Treatment of tuberculosis. New England Journal of Medicine, 373(22), 2149-2160.
Li, Y., Ehiri, J., Tang, S., Li, D., Bian, Y., Lin, H., … & Cao, J. (2013). Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC medicine, 11(1), 156.
Lienhardt, C., Raviglione, M., Spigelman, M., Hafner, R., Jaramillo, E., Hoelscher, M., … & Gheuens, J. (2012). New drugs for the treatment of tuberculosis: needs, challenges, promise, and prospects for the future. Journal of infectious diseases, 205(suppl_2), S241-S249.
M’Imunya, J. M., Kredo, T., & Volmink, J. (2012). Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane database of systematic reviews, (5).
Müller, A. M., Osório, C. S., Silva, D. R., Sbruzzi, G., de Tarso, P., & Dalcin, R. (2018). Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease, 22(7), 731-740.
Nglazi, M. D., Bekker, L. G., Wood, R., Hussey, G. D., & Wiysonge, C. S. (2013). Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review. BMC infectious diseases, 13(1), 566.
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Rangaka, M. X., Cavalcante, S. C., Marais, B. J., Thim, S., Martinson, N. A., Swaminathan, S., & Chaisson, R. E. (2015). Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection. The Lancet, 386(10010), 2344-2353.
Toczek, A., Cox, H., Du Cros, P., Cooke, G., & Ford, N. (2013). Strategies for reducing treatment default in drug-resistant tuberculosis: systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease, 17(3), 299-307.