Tuberculosis (TB), is an infection caused by Mycobacterium tuberculosis bacteria. Pulmonary TB is spread through these airborne bacteria.

Symptoms are persistent cough, fever, and weight loss. It is a growing and serious public health, social, and economic problem with approximately 8 million cases world wide each year. 95% of the cases are in developing countries but more are occurring in crowded urban settings in developed countries recently, too. Treatments are effective and readily available in developed countries, however, poor access to health care and inadequate health care coverage along with a reluctance to report suspected TB due to stigma, immigration issues, and misunderstanding of current therapy, has made it more and more difficult to identify, treat, and prevent. Cure rates can be low because of interrupted treatment, since the course of treatment is a long 6-8 months of medication therapy until the patient is verified as negative by sputum testing. Sputum checks are done at about two month intervals. It is critical that treatment is not interrupted to prevent development of drug-resistant TB which is far more difficult and costly to treat. For the patient, remembering to take the drugs for 6 to 8 months can be a problem. Education by nursing professionals is a key intervention. To answer the question about nursing interventions in this condition, an assumption will be made that the question is about pulmonary TB (TB can affect other areas of the body) and that the setting is outpatient or home care. Each Nursing Plan of Care must be individualized to a specific patient's needs. Ethnic, social, and economic differences, as well as education and living conditions are just some of the variables that play a role in

the

approach

to

care.

Some common Nursing Diagnoses and interventions for this condition would be: Risk for infection Monitor sputum for changes indicating infection Monitor vital signs Teach patient and family the purpose and techniques for infection control such as hand washing, patient covering mouth when coughs, maintaining isolation if necessary Teach patient the purpose, importance and how to take medications as prescribed consistently over the long term therapy Deficient knowledge Determine who will be the learner, patient or family Assess ability to learn Identify any existing misconceptions about the material to learn Assist the learner to integrate the information into daily life Give clear thorough explanations and demonstrations Noncompliance Determine if there has been past noncompliance and the reasons Ask to see prescription drugs periodically and count the remaining pills If economics are a reason for noncompliance, explore community resources Increase the amount of supervision provided, follow up visits, phone calls, etc. Ineffective therapeutic regimen management Assess prior efforts to follow regimen Assess patient's perceptions of their health problem

 Assess other factors that may affect

Assess to what degree environmental,

success in a negative way Inform patient of the benefits of conforming with the regimen Concentrate on the behaviors that will make the most difference to the therapeutic effect Include family, support system in teachings and explanations Instruct patient on the importance of ordering refills of medications several days ahead of running out. Activity intolerance Assess patient's level of mobility Observe and document response to activity Assess emotional response to change in physical status Anticipate patient's needs to accommodate Teach energy conservation techniques Refer to community resources as needed Ineffective airway clearance Auscultate lungs for wheezing, decreased breath sounds, coarse sounds Use universal precautions if secretions are purulent even before culture reports Assess cough for effectiveness and productivity Note sputum amount, color, odor, consistency Send sputum specimens for culture as prescribed or prn Institute appropriate isolation precautions if cultures are positive Use humidity to help losen sputum Administer medications, noting effectiveness and side effects Teach effective deep breathing and coughing techniques Ineffective health maintenance Assess patient's knowledge of health maintenance behaviors

social, intrafamilial disruptions, or changes have correlated with poor health behaviors Determine patient's motives for failing to report symptoms reflecting changes in health status Assess whether economic problems present a barrier to maintaining health behaviors Provide patient with a means to contact health care providers Involve family and friends in health planning conferences Nursing Interventions Infection for Risk for

The goal of care for this nursing diagnosis is to reduce the risk of spreading tuberculosis and making sure the patient's tuberculosis is effectively treated. The following nursing activities address these goals: Teach the patient about the infectious nature of tuberculosis and the need to prevent its spread. Place the patient in a negative pressure room and in a private room. All nurses and visitors entering the patient's room should wear an N-95 mask. Put a mask on the patient during transportation to other departments. Keep the door to the patient's room shut and place an isolation sign at a visible location near the door. Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing. Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag. Teach the tuberculosis patient to stay in well ventilated areas and limit

contact to other people while he or she is still able to spread the infection. Nursing Interventions for Ineffective Breathing Pattern Patients with tuberculosis may need to work harder to breathe due to coughing, nervousness or a high fever. Ineffective breathing pattern involves breathing at a faster or slower rate, use of accessory muscles to breathe and fast heart rates amongst other things. Nursing interventions for this problem are as follows: Administer oxygen if ordered and as ordered by a physician. Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs. Position the patient in a high fowlers position to reduce the work needed to breathe. Encourage and provide rest periods so the tuberculosis patient can have energy to breathe. Nursing Interventions to Improve Compliance with Tuberculosis Drug Regimen It is important for tuberculosis patients to take their medications as prescribed. Failure to do this may result in drug resistant forms of tuberculosis. This would make the patients tuberculosis difficult to cure. To increase compliance with the drug regimen for tuberculosis which can be very long, the nurse does the following:

observation therapy, where someone will watch them take their medication as they should.

Aspergillus species are ubiquitous molds found in organic matter. Although more than 100 species have been identified, the majority of human illness is caused by Aspergillus fumigatus and Aspergillus niger and, less frequently, by Aspergillus flavus and Aspergillus clavatus. The transmission of fungal spores to the human host is via inhalation. Also see the eMedicine articlesAspergillosis (dermatology focus), Aspergillosis (pediatric focus), andAspergillosis, Thoracic (radiology focus).

teaches the patient about the importance of taking all prescribed medications because the bacteria that causes TB grows slowly and requires a long time to be eliminated. provide the TB patient with information about expected side effects of TB drugs so that they know when to seek a doctors care and when not to be alarmed. refer patients having a hard time sticking to their drug therapy for direct

Aspergillus may cause a broad spectrum of disease in the human host, ranging from hypersensitivity reactions to direct angioinvasion. Aspergillusprimarily affects the lungs, causing 4 main syndromes, including allergic bronchopulmonary aspergillosis (ABPA), chronic necrotizing Aspergilluspneumonia (or chronic necrotizing pulmonary aspergillosis [CNPA]), aspergilloma, and invasive aspergillosis. However, in patients who are severely immunocompromised, Aspergillus may hematogenously disseminate beyond the lung, potentially causing endophthalmitis,endocarditis, and abscesses in the myocardium, kidney, liver, spleen, soft tissue, and bone. Aspergillus is second to Candida species as a cause of fungal endocarditis. Aspergillus -related endocarditis and wound infections occur in the context of cardiac surgery. ABPA is a hypersensitivity reaction to A fumigatus colonization of the tracheobronchial tree and occurs in

conjunction with asthma and cystic fibrosis (CF). Allergic fungal sinusitis may also occur alone or with ABPA. Bronchocentric granulomatosis and malt worker's lung are 2 hypersensitivity lung diseases that are caused by Aspergillus species, but they are rare.

An aspergilloma is a fungus ball (mycetoma) that develops in a preexisting cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, CF, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall; however, it may cause hemoptysis. CNPA is a subacute process usually found in patients with some degree of immunosuppression, most commonly that associated with underlying lung disease, alcoholism, or long-term corticosteroid therapy. Because it is uncommon, CNPA often remains unrecognized for weeks or months and can cause a progressive cavitary pulmonary infiltrate. Invasive aspergillosis is a rapidly progressive, often fatal infection that occurs in patients who are severely immunosuppressed, including those who are profoundly neutropenic, those who have received bone marrow or solid organ transplants, and patients with advanced AIDS[1] or chronic granulomatous disease. This infectious process is characterized by invasion of blood vessels, resulting in multifocal infiltrates, which are often wedgeshaped, pleural-based, and cavitary. Dissemination to other organs, particularly the central nervous system, may occur

Aspergillus causes a spectrum of disease, from colonization to hypersensitivity reactions to chronic necrotizing infections to rapidly progressive angioinvasion, often resulting in death. Rarely found in individuals who are immunocompetent, invasive Aspergillus infection almost always occurs in patients who are immunosuppressed by virtue of underlying lung disease, immunosuppressive drug therapy, or immunodeficiency. Aspergillus hyphae are histologically distinct from other fungi in that the hyphae have frequent septae, which branch at 45 angles. The hyphae are best visualized in tissue with silver stains. Although many species ofAspergillus have been isolated in nature, A fumigatus is the most common cause of infection in humans. A flavus and A niger are less common. Likely, this relates to the ability of A fumigatus, but not most other Aspergillusspecies, to grow at normal human body temperature. Human host defense against the inhaled spores begins with the mucous layer and the ciliary action in the respiratory tract. Macrophages and neutrophils encompass, engulf, and eradicate the fungus. However, many species of Aspergillus produce toxic metabolites that inhibit macrophage and neutrophil phagocytosis. Corticosteroids also impair macrophage and neutrophil function. Underlying immunosuppression (eg, HIV disease, chronic granulomatous disease, pharmacologic immunosuppression) also contributes directly to neutrophil dysfunction or decreased numbers of neutrophils. In individuals who are immunosuppressed, vascular invasion is much more common and may lead to

infarction, hemorrhage, and necrosis of lung tissue. Persons with CNPA typically have granuloma formation

and spreading to other organs and systems in the body. Sarcoidosis - A disease of unknown origin characterized by the formation of granulomatous lesions that appear especially in the liver, lungs, skin, and lymph nodes. Also calledsarcoid. ZalvosCiprofloxacin (tab: HCl; infusion: lactate) (Treatment of mild to moderate lower resp tract, skin & skin structure, bone & joint & GI infection; septicemia, endocarditis; UTI) Appebus (Anorexia in underwt patients when prevention of vit B deficiency is indicated.)

and alveolar consolidation. Hyphae may be observed within the granulomata. Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways: an allergic reaction in asthmatics; a colonization in scarred lung tissue; and an invasive infection with pneumonia which can affect the heart, lungs, brain and kidneys. coccidiomycosis - an infection of the lungs and skin characterized by excessive sputum and nodules cystic fibrosis - A hereditary disease of the exocrine glands, usually developing during early childhood and affecting mainly the pancreas, respiratory system, and sweat glands. It is characterized by the production of abnormally viscous mucus by the affected glands, usually resulting in chronic respiratory infections and impaired pancreatic function. Also called mucoviscidosis. Histoplasmosis - A disease caused by the inhalation of spores of the fungus Histoplasma capsulatum, most often asymptomatic but occasionally producing acute pneumonia or an influenzalike illness

Myrin-P Forte (Initial phase treatment & re-treatment of all forms of TB in category I & II patients caused by susceptible strains of mycobacteria.) Inox (Treatment of the following conditions: Systemic Mycoses: Systemic aspergillosis and candidiasis, cryptococcosis (including cryptococcal meningitis), histoplasmosis sporotrichosis, paracoccidiodomycosis, blastomycosis and other rarely occuring systemic or topical mycoses. Dermatological/Ophthalmological: Onychomycosis, pityriasis versicolor, dermatomycosis and oral candidiasis. Gynecological: Vulvovaginal candidosis.)