Approach Considerations

Patients with tuberculosis (TB) should be isolated in a quarantined room with a negative pressure or high-efficiency particulate modern air filters. Nursing staff taking care of the TB patients must wear disposable masks that are capable of filtering the tubercle bacillus particles. TB patients must remain in isolation until their tested sputum smear results are negative for three consecutive determinations. That is also between 2-4 weeks of TB treatment (Herchline et al., 2018). Lastly, proper disinfection measures should be observed by all nurses leaving the TB quarantine zones to avoid new transmissions of the ailment.

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Drug Therapy

The empiric treatment for patients with TB entails the use of a four-drug regimen, which includes isoniazid, pyrazinamide, rifampin as well as ethambutol or streptomycin. When the TB isolate has been determined as fully susceptible, ethambutol or streptomycin can be discontinued (Herchline et al., 2018). TB patients attaining pyrazinamide must have a baseline as well as a periodic visual acuity test. After 2 months of four-drug therapy, pyrazinamide can be discontinued (Herchline et al., 2018). In its place, Isoniazid and rifampin are then continued for the TB treatment daily for 4 more months (Herchline et al., 2018).

Treatment in Children

Most children that have TB should be treated using both isoniazid and rifampin for at least six months (Assefa et al., 2018). Additionally, such children should be given pyrazinamide for the first two months. In postnatal TB cases, the treatment should be increased for up to 9-12 months (Herchline et al., 2018). That is due to the possibility of a declined immune system for children aged less than 12 months. Lastly, for infants in the United States, the Bacillus Calmette-Guerin (BCG) vaccination is not recommended (Herchline et al., 2018). However, BCG is used commonly in other regions around the world.

Treatment for TB Patients with HIV

Treatments regimens for persons with active or latent TB infected with HIV are similar to those offered to people that are HIV negative (World Health Organization, 2014). However, adjustment in the TB-regimens' dosage levels may be essential. Also, HIV patients on protease inhibitors should not be offered rifampin but instead, they can be treated with rifabutin. HIV TB patients may acquire a paradoxical response, which is also called an Immune Reconstitution Inflammatory Syndrome (IRIS) when they start their antiretroviral therapy. That is due to the patients' strong immune response towards the Mycobacterium tuberculosis (M. tuberculosis) and as such, their TB treatment should be well monitored.

Nursing Implications

Correct treatment of tuberculosis may lead to an increase in the rate of positive healthcare outcomes for patients being treated for TB by nursing practitioners. Also, it can aid the nursing fraternity in reducing the mortality rates of people at risk of TB especially those diagnosed with HIV. Lastly, it is possible for nursing practitioners to identify new traits of TB resistance from the patients being treated due to the close monitoring of the health progress of such patients in medical facilities. Subsequently, modification or alternative treatment interventions can be adopted by the nursing practitioners in treating and managing new strains of TB infection among patients.

References

BIBLIOGRAPHY Assefa, Y., Assefa, Y., Woldeyohannes, S., Hamada, Y., & Getahun, H. (2018). 3-month daily rifampicin and isoniazid compared to 6- or 9-month isoniazid for treating latent tuberculosis infection in children and adolescents less than 15 years of age: an updated systematic review. European Respiratory Journal , 52, 1-4. doi: 10.1183/13993003.00395-2018

Herchline, T. E., Amorosa, J. K., & Amorosa, J. K. (2018). Tuberculosis (TB) Treatment & Management. Retrieved from Medscape: Thomas E Herchline

World Health Organization. (2014). Rapid Advice: Treatment of Tuberculosis in Children. Herndon: Stylus Pub Llc.