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  • Subject Name : Nursing

Mycobacterium Tuberculosis Complex

Table of Contents

Introduction.

Analysis of the case study.

Development of strategies.

Identification of Risk Factors.

Application of disease containment strategies.

Conclusion.

References.

Introduction to Infection of Latent Tuberculosis

In many developing and developed countries, the most common serious infection that occurs is tuberculosis. Infection of Latent tuberculosis (LTBI) is the condition of constant resistance to stimulation by Mycobacterium tuberculosis devoid of symptoms of clinically manifested active TB. If a person is infected with the TB bacteria, they have no signs of active TB as well as will not feel sick if they have latent TB. However, one may develop active TB in the future. This particular study will discuss the risk factors in associated in context to the case study. This study will further go on to analyze the clinical information that is provided in the scenario and identify any gaps that may impact on the healthcare user’s care needs and health outcomes.

Analysis of The Case Study

From the case study it has been conferred that a surgical specimen has been obtained from a healthcare user that shows positive test results in context to the Mycobacterium Tuberculosis Complex. The local microbiologist has found that the infected anal fistula has subjected positive in regard to the PCR test. The healthcare user is a 28-year-old business man named Dang, who arrived from Thailand two years ago. Shortly after arrival in Australia, Dang was tested for latent TB infection prior to commencing infliximab infusions for longstanding ankylosing spondylitis. His tuberculin skin test was reported as positive and interferon gamma release assay was reported as indeterminate. In this particular case study, there are several gaps that can be found. Firstly, no x ray of the chest was performed on the admission of the healthcare users. Since the healthcare user was suffering from latent TB it was very much needed that the healthcare experts to check him thoroughly. The healthcare userswere discharged from hospital 3 days ago without a proper check-up done and is currently being visited at home by the community nurse. The nurse is attending daily irrigation and packing of his surgical wound.

Development of Strategies

There are a certain thing that can be kept in mind in of a clinical nurse. In order to understand the healthcare user and his conditions it is required that the nurse makes:

Assessment: This is the first step in the nursing process. Assessment is defined as data collection and analysis in nursing diagnosis. The information collected may include physical, mental, socio-cultural, spiritual and economic information as well as issues related to risky behavior and lifestyle. Assessment is an integral part of the nursing process and involves the collaboration of healthcare users, caregivers, healthcare providers and others(Salgameet al.2015).

Diagnosis of nursing: Nursing Diagnosis is a statement of the nurse's treatment judgments that relates to the nature of the healthcare users’ health or the response to the condition or potential needs concerning the healthcare users’ health status after receiving, analyzing and documenting the diagnosis. Nursing is the basis for choosing nursing strategies for nurses who are responsible for achieving healthcare users care outcomes for diagnosing diseases.

Results / plans: At this stage, the healthcare provider establishes measurable and achievable goals in the short and long term and establishes a care plan with intervention strategies for each goal based on assessment data and diagnoses. During the planning process, all interventions developed must be related to an expected outcome, which must include a schedule for completion. The results plan should include an indicator or description of how the expected results will be measured.

Implementation: This stage consists of a combination of performance and implementation of the nursing strategies identified at the planning stage. Implementation requires planning communication with all participants involved in healthcare users care, including healthcare users and family members. At this point, the nurse continues to evaluate the healthcare users and record progress.

Evaluation: This last step of the nursing process records the healthcare users’ response to the interventions and the extent to which the expected results have been achieved. The nurse evaluates the healthcare users’ progress towards the stated goals using the results identified at the planning stage as the evaluation criteria. During treatment the healthcare users’state and the efficiency of nursing care should be constantly evaluated and the care plan should be changed if necessary (Rosser et al.2017).

In this context, it has conferred from the case study that Dang was prescribed Rifampicin for four months. In healthcare users without a contraindication, rifampicin may be the safest treatment option for latent tuberculosis (TB) infection, according to results of a study published in the Lancet Infectious Diseases. However, in this regard it has been conferred that there are four treatment regimens accessiblein aid of the treatment of latent TB infection (LTBI). The healthcare providers in this case need to be very careful and select the appropriate regimen for the healthcare user (Ravimohanet al.2018).

In relation to the case study it can be comprehended that there are certain measures that needs to be incorporated:

If active TB is suspected, Remicade treatment therapy ought to be discontinued until the diagnosis is excludedor the infection has been treated according to current guidelines.

Before starting treatment Remicade, healthcare users need to be assessed for inactive and active (“latent”) tuberculosis with a personal history of tuberculosis or a detailed history of personal contact with priorinteraction with tuberculosis as well as proper screening tests should be considered (Rosser et al.2017). Prescribers are reminded that fake negative tuberculin test results could be found in critically ill or immunoprecipitated healthcare users. If "latent" tuberculosis is diagnosed, measures should be taken to prevent tuberculosis activity and the healthcare users’ risk / benefit should be considered before starting re-mixed therapy (Cardona, 2017).

Healthcare users with tuberculosis signs and / or symptoms (e.g., persistent cough, nausea / weight loss, low fever) should be advised to seek treatment.

Identification of Risk Factors

Risk factor for the infection of latent TB

The progression of active TB disease from LTBI continues to add to the existing number of TB healthcare users each year. Several scientific studies have shown that reactivation of LTBI may be a major driving force behind both TB occurrence and recurrence. Appropriate understanding of these factors is necessary for setting up two different aspects of risk of infection and disease progression and TB control approaches. Besides, the danger of infection after TB infection is largely controlled through external aspectsas well as it isdogged by the amalgamation of behavioral and social risk factors, as well as contamination at the source, proximity to contact, and, alcohol, smoking as well as indoor air pollution. Besides that,bigger likelihood of social mixing in settings (including simultaneous overflow) will increase infection (Romanowski et al.2016). Similarly, conditions for prolonging the length of contact of infectious healthcare users include factors related to the late health system in diagnosing the disease. The reasons for the progression of the disease transmission are mainly pregnancy (host related). The most important of these are conditions that change the immune response and increase the hazard of disease progression with HIV synthesis. However, the impact of population levels of this risk factors may vary relied upon the regional interpretation of HIV. In addition, several factors, including tobacco smoke, diabetes, alcohol, indoor air pollution, andmalnutrition that affect a large portion of the populace and speed up the development of TB disease(Bisson, Zetola&Collman, 2015).

In this particular study dang has been tested positive for TB despite of his medications for latent TB for 4 months. Dang was admitted to the hospital in context to anal fistula. Anal abscess is a painful gathering of pus. An anal abscess typicallysubjects after a small gland immediately inside the anus becomes contaminated. The cause of the abscess is often unknown, although abscesses are more common in people with immune deficiencies. If an anal abscess bursts before it has been treated, it can sometimes cause an anal fistula to develop. Additionally, fistulas can occur if the abscess is not completely healed or the infected fluid is not completely removed. In his case latent Tb was the result of his infliximab infisions for a long period due to his ankylosing spondilitis.Infliximab is seen as beneficial in the treatment of active Crohn's disease and in enveloping arthritis and rheumatism and spondylitis. In Crohn's disease that has not been treated with infliximab, the occurrence of tuberculosis is unidentified; certainly, in the case of some healthcare users, it can be problematic to primarily isolate as a minimum one patient from another. Influximab increases the background risk of Crohn's disease as well as tuberculosis in rheumatoid arthritis by almost five times, in most cases but not all, the first three months of extracurricular and treatment cases occur(Hickey et al.2015).

Application of Disease Containment Strategies

Like all illnesses, TB prevention is forever better than cure. Even though there is currently no way to totallyavert TB infection, a number of steps can be taken to reduce the spread of the disease (Koesoemadinata et al. 2017). In context to this particular case study it can be comprehended that these steps can be useful to treat healthcare users like Dang:

BCG (Bacille Calmette-Guérin) is a live vaccine in context to tuberculosis. Besides, the vaccine is made from the strain of the weakeningbovine tuberculosis bacillus, Mycobacterium bovis. Also, the BCG is now only appropriate tuberculosis vaccine as well as it has been in usagefrom 1912. It is one of the mainly used vaccines in the world, but we still see about nine million new cases of tuberculosis every year - as evidenced by the inadequate effectiveness of the BCG(Madanseinet al.2015).

The BCG is:

  • Lesseffectual when provided in equatorial sections (because ofelevated levels of certainlyhappening environmental mycobacteria).
  • 80% efficient in the prevention of TB for 15 years
  • partial effectiveness in individuals over the age of 35
  • More successfulin contrast tothe complex form of TB in children

Treatment of TB is very important. In this particular case it has been observed that Dang was having latent TB for which medications were given. He also had the medications for 4 months. In this context it is very important to mention that Dang needed to have monitored his condition at regular intervals so that his TB could not be active. TB drug treatment in context to the prevention of TB, also called as chemoprophylaxis. This treatment can help in the elimination of TB (Hasan et al.2018).

There are medications like Isoniazid which can be helpful to keep dormant TB from advancing to dynamic TB or TB infection. Isoniazid is a modest medication that is generally used in the treatment of TB. BCG vaccine can be used to treat patients with TB and this can help in creating an antibody. In the case of dang, he can be asked if he had a history of BCG vaccine. If not, he can be prescribed medicines accordingly, Isoniazid can be given to him as it can be used as a replacement of BCG vaccine (Yew et al. 2019).

However, in the case of Dang it has been observed that his TB was a result of the long going treatment of ankylosing spondylitis. In this case, it can be stated that healthcare experts and specialists need to investigate the side effects associated with drug therapy and then comprehend if the treatment will be suitable or not. This is a major way of keeping away infections (Pleskunaset al. 2017).

Conclusion on Infection of Latent Tuberculosis

Tuberculosis is considered as one of the very severeinfections that are widespread. It is very important that the healthcare providers and the healthcare experts take in account the health condition of the user and then determine which drug therapy will be useful. In this case the long-drawn therapy of Dang had led him to counter latent TB which then became active. The use of infliximab in a user can be comprehended considering a plan p linkedon their history, ethnicity, place of birth, period of residence, andchest x ray. It is expected that implementation of these suggestionsmayminimize the risk of TBintensely in the users of healthcare.

References for Infection of Latent Tuberculosis

Bisson, G. P., Zetola, N., &Collman, R. G. (2015). Persistent high mortality in advanced HIV/TB despite appropriate antiretroviral and antitubercular therapy: an emerging challenge. Current HIV/AIDS Reports12(1), 107-116.

Cardona, P. J. (2017). What we have learned and what we have missed in tuberculosis pathophysiology for a new vaccine design: searching for the “Pink Swan”. Frontiers in immunology8, 556.

Hasan, T., Au, E., Chen, S., Tong, A., & Wong, G. (2018). Screening and prevention for latent tuberculosis in immunosuppressed patients at risk for tuberculosis: a systematic review of clinical practice guidelines. BMJ open8(9), e022445.

Hickey, A. J., Gounder, L., Moosa, M. Y. S., & Drain, P. K. (2015). A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC infectious diseases15(1), 209.

Koesoemadinata, R. C., McAllister, S. M., Soetedjo, N. N., FebniRatnaningsih, D., Ruslami, R., Kerry, S., ... & Hill, P. C. (2017). Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia. Transactions of The Royal Society of Tropical Medicine and Hygiene111(2), 81-89.

Madansein, R., Parida, S., Padayatchi, N., Singh, N., Master, I., Naidu, K., ... &Maeurer, M. (2015). Surgical treatment of complications of pulmonary tuberculosis, including drug-resistant tuberculosis. International Journal of Infectious Diseases32, 61-67.

Pleskunas, J. A., Shea, K. M., Heeren, T., & Horsburgh Jr, C. R. (2017). The Influence of Age at Arrival and Duration of Residence in US on Prevalence of Latent TB Infection. Mycobact Dis7(233), 2161-1068.

Ravimohan, S., Kornfeld, H., Weissman, D., & Bisson, G. P. (2018). Tuberculosis and lung damage: from epidemiology to pathophysiology. European Respiratory Review27(147).

Romanowski, K., Clark, E. G., Levin, A., Cook, V. J., & Johnston, J. C. (2016). Tuberculosis and chronic kidney disease: an emerging global syndemic. Kidney international90(1), 34-40.

Rosser, A., Stover, C., Pareek, M., &Mukamolova, G. V. (2017). Resuscitation-promoting factors are important determinants of the pathophysiology in Mycobacterium tuberculosis infection. Critical reviews in microbiology43(5), 621-630.

Salgame, P., Geadas, C., Collins, L., Jones-López, E., &Ellner, J. J. (2015). Latent tuberculosis infection–revisiting and revising concepts. Tuberculosis95(4), 373-384.

Yew, W. W., Leung, C. C., Chang, K. C., Zhang, Y., & Chan, D. P. (2019). Can treatment outcomes of latent TB infection and TB in silicosis be improved?. Journal of Thoracic Disease11(1), E8.

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