Tuberculosis as a Global Health Risk

Overview of the Health Issue and the Prevalence in the United States and Worldwide

Tuberculosis is an infectious ailment characterized by the rapid growth of tubercles within the tissues in the lungs. According to the CDC 2017 TB Surveillance Report, 9,272 cases of tuberculosis were reported across the US, which is a decrease from the previous year by 4% (CDC, 2018). The case rate of TB in 2017 declined to 2.9 cases for every 100,000 persons (CDC, 2018). At present, the percentage of drug-resistant TB cases in the US is at 7%.

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Across the globe, more than 10.4 million new cases of tuberculosis were recorded in 2017. 10% of these new cases were persons living with HIV. In the same year, 90% of the new TB cases were adults, with the male gender at 65%. The most affected continent was Africa, at 74% of all the global reports of new TB infection (CDC, 2018). This report examines the contributing factors of TB, prevention strategies, symptoms, diagnosis, medical management, advanced practice nursing role, and a follow-up care guideline.

Contributing Factors

The most common contributing factors are related to the index case, individual, socioeconomic or behavioral, and ethnicity. Under the index, cases are the bacillary load and proximity to an infectious incident (Narasimhan, Wood, MacIntyre, & Mathai, 2013). For instance, a patient who has sputum positive is able to infect more than ten individuals within a year when untreated. Moreover, close and consistent contact with a TB patient exposes an individual to the risk of contracting the disease. Under the factors related to an individual, the immunosuppressive conditions of a person might increase the risk of TB infection.

For example, HIV co-infection is an immunosuppressive risk catalyst for attracting active tuberculosis disease. This means that there is a high risk of TB infection in a population of HIV-positive patients. Moreover, studies have indicated that malnutrition increases the potential risk of tuberculosis due to an impaired immunity response (Narasimhan et al., 2013). Children are also known to have a higher exposure risk of contracting TB than adults. Other individual factors include diabetes and health worker exposure. In addition, lifestyle choices such as smoking, alcoholism, and poor air circulation might increase the chances of TB infection.

Prevention Strategies

The known TB prevention strategies include cough etiquette or precautions, BCG vaccine, TB education, and treatment, among others. Under cough etiquette or precaution, those infected with TB should cover their nose and mouth with a tissue when coughing to minimize the release of TB bacteria (Carlsson, Johansson, Eale, & Kaboru, 2014). The used tissue should then be disposed of in a closed bin. This should be followed by a thorough hand washing. The BCG vaccine has a TB prevention success rate of more than 80% in children and infants across the globe. Moreover, increasing awareness in the form of TB education is instrumental in the prevention and management of new and old cases. In addition, treatment prevents the spread of active TB (CDC, 2018).

Signs and Symptoms

The common signs and symptoms of TB are chest pain while coughing or breathing, chronic cough with blood, fatigue, sweating, chills, fever, and loss of appetite (Carlsson et al., 2014). Other signs are swollen lymph nodes, severe weight loss, weakened muscles, phlegm, and difficulty in breathing (CDC, 2018).

Diagnostic Tests

The TB blood or the Montoux tuberculin skin tests (TST) are often used to diagnose TB infection. Other diagnosis methods include the sputum exam by observing the chest X-ray and testing the mucus for the presence of TB bacteria (Carlsson et al., 2014).

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Advanced Practice Nursing Role and Management Strategies

In controlling TB, adherence to poor treatment is a serious contributor to drug resistance and relapse. Therefore, nurses have a significant role in continuously supporting TB patients during the treatment process. These roles include a systematic education of the patient, provision of the medication and monitoring intake, following up and observation during treatment, and maintaining the communication to support adherence (Carlsson et al., 2014).

Medical/Pharmacological Management

The drug therapy begins with an empirical treatment, which involves giving the new patient a cocktail of a 4-drug regimen consisting of Rifampin, Isoniazid, Streptomycin or Ethambutol, and Pyrazinamide (Hickey, 2016). The treatment should run consistently for two months. When the sixty days period elapses, Pyrazinamide should be stopped (Hickey, 2016). The patient should then be monitored and progress recorded.

Follow-Up Care

The symptoms of TB often improve after two weeks once the treatment commences. At the end of the second week of correct treatment, most TB cases are no longer contagious. The treatment process should adhere to the end, which is about six months. However, drug-resistant TB should be treated for eighteen months (Hickey, 2016).

Conclusion

The prevalence of TB is highest in Africa as compared to other parts of the globe. Some of the contributing factors to new cases of tuberculosis are lifestyle and proximity to a confirmed case of infection, among others. The BCG vaccine, cough etiquette, treatment, and TB education may be instrumental in preventing new cases of infection. Once a new case of TB has been reported, the patient should be subjected to an immediate and consistent treatment, which lasts between 6 and 18 months, depending on the bacterial strain. During this period, practicing nurses should perform close supervision and periodic follow-up to guarantee treatment adherence.

References

Carlsson, M., Johansson, S., Eale, R. P., & Kaboru, B. B. (2014). Nurses’ roles and experiences with enhancing adherence to tuberculosis treatment among patients in Burundi: A qualitative study. Tuberculosis Research and Treatment, 4(6), 31- 42.

CDC. (2018). Burden of TB in the United States. Web.

Hickey, A. J. (2016). Delivery systems for tuberculosis prevention and treatment. New York, NY: John Wiley & Sons.

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Narasimhan, P., Wood, J., MacIntyre, C. R., & Mathai, D. (2013). Risk factors for tuberculosis. Pulmonary Medicine, 12(3), 1-11.

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