CHAPTER I
ANTECEDENT
1.1
Background
Most people know tuberculosis (TB) as a
disease of the lungs. However, not all TB disease is in the lungs. Around 40%
of TB disease occurs in another part of the body. This happens when the
bacteria spread outside of the lungs. In these cases, TB is more difficult to
diagnose since the patient does not have the normal signs and symptoms
associated with pulmonary TB. TB disease can also occur in the lymph glands,
brain, spine, kidneys, or other organs.
Tuberculosis is a
respiratory disease that is passed to other people through coughing and
sneezing over a period of time and where there is little ventilation to prevent
it from spreading. At this point the bacteria enter their respiratory system
and can spread to other organs if it is not suppressed by the person’s immune
system. If the person who is exposed to TB is healthy, their immune system is
then able to contain the bacteria and the person then has what is called Latent
TB, which may become active if their immune system is somehow impaired, either
by age or other diseases such as AIDS. When the person’s immune system takes
over it is able to contain the bacteria in small sacs or tubercles in the
lungs, thus preventing the bacteria from spreading to other parts of the body
where it can cause much damage and even death. If for some reason the body
isn’t able to stop the spreading of the disease then the bacteria would be
spread through the blood to other parts of the body such as the spine, kidneys,
and female reproductive organs. In addition a mother is able to spread it to
her unborn child.
Once TB is spread
through the body to other organs the bacteria are attacked by the immune system
and a minor "war" is started and both sides lose
"warriors." The bacteria die and also healthy tissues die and turn
into growths that are called granulomas. The bacteria are able to live within
these granulomas. However, they do cease growing.
It must be stated
also that even though this disease is contagious, it is only the person’s
respiratory system that is the method contagion; a person cannot get TB from
touching the person or their bedding or clothing. So, while proper ventilation
is quite necessary, avoiding touching the person or their clothing is not
necessary at all. Touch remains a very healthy and necessary part of life and
can sometimes assist in providing a person with emotional encouragement and
peace in this and any other illness.
Left untreated,
each person with active TB disease will infect on average between 10 and 15
people every year. But people infected with TB bacilli will not necessarily
become sick with the disease. The immune system "walls off" the TB
bacilli which, protected by a thick waxy coat, can lie dormant for years. When
someone's immune system is weakened, the chances of becoming sick are greater.
-
Someone in
the world is newly infected with TB bacilli every second.
-
Overall,
one-third of the world's population is currently infected with the TB bacillus.
-
5-10% of
people who are infected with TB bacilli (but who are not infected with HIV)
become sick or infectious at some time during their life. People with HIV and
TB infection are much more likely to develop TB.
When a person’s
immune system is weakened and they are exposed to TB or have Latent TB then the
disease becomes active. The bacteria then begin to war against the body, and
destruction can be rather severe depending both on the level of the person’s
immune system and the location of the bacteria. The respiratory system is the
most common place where the bacteria grow. Respiratory symptoms may include
horrible coughing that extends longer than three weeks, chest pains, blood or
sputum when coughing. Other symptoms include extreme fatigue, reduced weight,
loss of appetite, high fever, chills, night sweats.
Important nurse so central in TBC patient healing.
Specially in medication, nurse as gift execution medicinize also the
observation take medicine for the TBC patient. While family of playing a part
in of progress from medication result and have to give motivation to family
member incured by TBC in order to they the confidence will heal until the
complete medication. Nurse of playing a part in to breathe life into at patient
especially coming from it self family or through source or people trusted have
influence to healing process and also own role in security requirement
accomplishment earn the sharing directly and also indirectly. Directly the
nurse can do conduct treatment upbringing of at client experiencing of related
problem by not fullfiled is security requirement. As for nurse role in security
requirement accomplishment is as direct treatment giver, educator that is give
health education to family and client in order to the family and client do
conduct related family health upbringing program with security requirement
self-supportingly, and hold responsible to family security problem., health
supervisor, consultant, kolaborasi, fasilitator, inventor problem, and the
environmental modification ( Medical.Blogspot )
Pursuant to above background, hence the writer
interested to do conduct research with an eye to can know about TBC desease,
prevention and also medication and role of nurse in RS XX.
1.2 Problem
formulation
From above background hence
formula of problem of this research is
not yet been known by the TBC desease prevention.
1.3 Research Target
How to prevention of TBC disease and role of nurse of
patient of TBC in RS. XX ?
1.4
Research
Benefit
1.4.1
Common Target
To know
prevention and role of nurse [of] [at] patient tbc
1.4.2 Special Target
1. To know TBC
desease prevention
2. To know
role of nurse of p
CHAPTER II
EVALUATE BOOK
2.1
Definition
Tuberculosis Disease (TB) is a very
contagious disease of the respiratory system. It is a bacterial infection that
begins in the lungs and is able to spread by the circulatory system to other
parts of the body, such as the Meninges (the tissue covering the brain), spine,
kidneys, and other abdominal organs and may be fatal. Tuberculosis symptoms are
loss of appetite and weight, sweating at night, and fever.
Tuberculosis or TB is a common and
often deadly infectious disease caused by various strains of mycobacteria,
usually Mycobacterium tuberculosis in humans.Tuberculosis usually
attacks the lungs but can also affect other parts of the body. It is spread
through the air, when people who have the disease cough, sneeze, or spit.Most
infections in humans result in an asymptomatic, latent infection, and about one
in ten latent infections eventually progresses to active disease, which, if
left untreated, kills more than 50% of its victims.
Tuberculosis is a respiratory disease
that is passed to other people through coughing and sneezing over a period of
time and where there is little ventilation to prevent it from spreading. At
this point the bacteria enter their respiratory system and can spread to other
organs if it is not suppressed by the person’s immune system. If the person who
is exposed to TB is healthy, their immune system is then able to contain the
bacteria and the person then has what is called Latent TB, which may become
active if their immune system is somehow impaired, either by age or other
diseases such as AIDS. When the person’s immune system takes over it is able to
contain the bacteria in small sacs or tubercles in the lungs, thus preventing
the bacteria from spreading to other parts of the body where it can cause much
damage and even death. If for some reason the body isn’t able to stop the
spreading of the disease then the bacteria would be spread through the blood to
other parts of the body such as the spine, kidneys, and female reproductive
organs. In addition a mother is able to spread it to her unborn child. Once TB
is spread through the body to other organs the bacteria are attacked by the
immune system and a minor "war" is started and both sides lose
"warriors." The bacteria die and also healthy tissues die and turn
into growths that are called granulomas. The bacteria are able to live within
these granulomas. However, they do cease growing. It must be stated also that
even though this disease is contagious, it is only the person’s respiratory
system that is the method contagion; a person cannot get TB from touching the
person or their bedding or clothing. So, while proper ventilation is quite
necessary, avoiding touching the person or their clothing is not necessary at
all. Touch remains a very healthy and necessary part of life and can sometimes
assist in providing a person with emotional encouragement and peace in this and
any other illness. Someone Latent TB is not contagious, asymptomatic (having no
symptoms), feel healthy, however they do have a positive skin test and the
tuberculosis get active without treatment for the Latent TB. In most cases this
person never gets TB, the bacterium remaining inactive through the rest of
their life.
2.2 Classification
The current clinical classification system for
tuberculosis (TB) is based on the pathogenesis of the disease.
|
Classification System
for TB
|
||
|
Class
|
Type
|
Description
|
|
0
|
No TB exposure
Not infected |
No history of exposure
Negative reaction to tuberculin skin test |
|
1
|
TB exposure
No evidence of infection |
History of exposure
Negative reaction to tuberculin skin test |
|
2
|
TB infection
No disease |
Positive reaction to tuberculin skin test
Negative bacteriologic studies No clinical, bacteriologic, or radiographic evidence of TB |
|
3
|
TB, clinically active
|
M. tuberculosis cultured (if done)
Clinical, bacteriologic, or radiographic evidence of current disease |
|
4
|
TB
Not clinically active |
History of episode of TB or
Abnormal but stable radiographic findings Positive reaction to the tuberculin skin test Negative bacteriologic studies and No clinical or radiographic evidence of current disease |
|
5
|
TB suspect
|
Diagnosis pending
TB disease should be ruled in or out within 3 months |
2.3 Signs and symptoms
When the disease becomes active, 75% of the cases are pulmonary TB,
that is, TB in the lungs. Symptoms include chest pain , coughing up blood, and
a productive, prolonged cough for more than three weeks. Systemic symptoms
include fever, chills, night sweats, appetite loss, weight loss, pallor, and
often a tendency to fatigue very easily. In the other 25% of active cases, the
infection moves from the lungs, causing other kinds of TB, collectively denoted
extrapulmonary tuberculosis.This occurs more commonly in immunosuppressed
persons and young children. Extrapulmonary infection sites include the pleura
in tuberculosis pleurisy, the central nervous system in meningitis, the
lymphatic system in scrofula of the neck, the genitourinary system in
urogenital tuberculosis, and bones and joints in Pott’s disease of the spine.
An especially serious form is disseminated TB, more commonly known as ,military
tuberculosis. Extrapulmonary TB may co-exist with pulmonary TB as well.
2.4 Causes Tuberculosis
When a person’s immune system is weakened and they are exposed to TB
or have Latent TB then the disease becomes active. The bacteria then begin to
war against the body, and destruction can be rather severe depending both on
the level of the person’s immune system and the location of the bacteria. The respiratory
system is the most common place where the bacteria grow.
Respiratory symptoms may include horrible coughing that extends
longer than three weeks, chest pains, blood or sputum when coughing. Other
symptoms include extreme fatigue, reduced weight, loss of appetite, high fever,
chills, night sweats. In addition, TB results in abnormal chest x-rays and lab
results. It also must be remembered that a person with active TB can spread it
easily to others nearby. Adequate ventilation is a must. Also caution by those
attending to or visiting the patient must be taken.
2.5 Risk Faktor
Persons with silicosis have an approximately 30-fold greater risk for developing TB. Silica particles
irritate the respiratory system, causing immunogenic responses such as phagocytosis
which consequently results in high lymphatic vessel deposits. It is this
interference and blockage of macrophage function which increases the risk of
tuberculosis. Persons with chronic renal failure who are on hemodialysis also
have an increased risk: 10—25 times greater than the general population.
Persons with diabetes mellitus have a risk for developing active TB that is two
to four times greater than persons without diabetes mellitus, and this risk is
likely greater in persons with insulin-dependent or poorly controlled diabetes.
Other clinical conditions that have been associated with active TB include
gastrectomy with attendant weight loss and malabsorption, jejunoileal bypass,
renal and cardiac transplantation, carcinoma of the head or neck, and other
neoplasms (e.g., lung cancer, lymphoma, and leukemia).
Given that silicosis greatly increases the risk of tuberculosis,
more research about the effect of various indoor or outdoor air pollutants on
the disease would be necessary. Some possible indoor source of silica includes
paint, concrete and Portland
cement. Crystalline silica is found in concrete, masonry, sandstone, rock,
paint, and other abrasives. The cutting, breaking, crushing, drilling,
grinding, or abrasive blasting of these materials may produce fine silica dust.
It can also be in soil, mortar, plaster, and shingles. When you wear dusty
clothing at home or in your car, you may be carrying silica dust that your
family will breathe.
Low body weight is associated with risk of tuberculosis as well. A
body mass index (BMI) below 18.5 increases the risk by 2—3 times. On the other
hand, an increase in body weight lowers the risk. Patients with
diabetes mellitus are at increased risk of contracting tuberculosis, and they
have a poorer response to treatment, possibly due to poorer drug absorption
Some drugs, including rheumatoid arthritis drugs that work by
blocking tumor necrosis factor-alpha (an inflammation-causing cytokine), raise
the risk of activating a latent infection due to the importance of this
cytokine in the immune defense against TB.
2.6 Prevention
TB prevention and control takes two parallel approaches. In the
first, people with TB and their contacts are identified and then treated.
Identification of infections often involves testing high-risk groups for TB. In
the second approach, children are vaccinated to protect them from TB. No
vaccine is available that provides reliable protection for adults. However, in
tropical areas where the levels of other species of mycobacteria are high,
exposure to nontubercolous mycobacteria gives some protection against TB.
The WHO declared TB a global health emergency in 1993, and the Stop
TB Partnership developed a Global Plan to Stop Tubercolusis that aims to save
14 million lives between 2006 and 2015. Since humans are the only
host of Mycobacterium tuberculosis,
eradication would be possible. This goal would be helped greatly by an
effective vaccine.
2.7 Treatment
Treatment for TB uses antibiotics to kill the bacteria. Effective TB
treatment is difficult, due to the unusual structure and chemical composition
of the mycobacterial cell wall, which makes many antibiotics ineffective and
hinders the entry of drugs. The two antibiotics most commonly used are
rifampicin and isoniazid. However, instead of the short course of antibiotics
typically used to cure other bacterial infections, TB requires much longer
periods of treatment (around 6 to 24 months) to entirely eliminate mycobacteria
from the body. Latent TB treatment usually uses a single antibiotic, while
active TB disease is best treated with combinations of several antibiotics, to
reduce the risk of the bacteria developing antibiotic resistance. People with
latent infections are treated to prevent them from progressing to active TB
disease later in life.
Drug resistant tuberculosis is transmitted in the same way as
regular TB. Primary resistance occurs in persons who are infected with a
resistant strain of TB. A patient with fully susceptible TB develops secondary
resistance (acquired resistance) during TB therapy because of inadequate
treatment, not taking the prescribed regimen appropriately, or using low
quality medication.Drug-resistant TB is a public health issue in many
developing countries, as treatment is longer and requires more expensive drugs.
Multi-drug-resistant tuberculosis (MDR-TB) is defined as resistance to the two
most effective first-line TB drugs: rifampicin and isoniazid. Extesively
drug-resistant TB (XDR-TB) is also resistant to three or more of the six
classes of second-line drugs. The DOTS (Directly Observed Treatment
Short-course) strategy of tuberculosis treatment recommended by WHO was based
on clinical trials done in the 1970s by Tuberculosis Research Centre, Chennai,
India. The country in which a person with TB lives can determine what treatment
they receive. This is because multidrug-resistant tuberculosis is resistant to
most first-line medications, the use second-line antituberculosis medications
is necessary to cure the patient. However, the price of these medications is high;
thus poor people in the developing world have no or limited access to these
treatments.
2.8
Role of family
and nurse
Specially in
medication, nurse as gift execution medicinize also the observation take
medicine for the TBC patient. While family of playing a part in of progress
from medication result and have to give motivation to family member incured by
TBC in order to they the confidence will heal until the complete medication.
Nurse of playing a part in to breathe life into at patient especially coming from
it self family or through source or people trusted have influence to healing
process and also own role in security requirement accomplishment earn the
sharing directly and also indirectly. Directly the nurse can do conduct
treatment upbringing of at client experiencing of related problem by not
fullfiled is security requirement. As for nurse role in security requirement
accomplishment is as direct treatment giver, educator that is give health
education to family and client in order to the family and client do conduct
related family health upbringing program with security requirement
self-supportingly, and hold responsible to family security problem., health
supervisor, consultant, kolaborasi, fasilitator, inventor problem, and the
environmental modification.
CHAPTER
IV
CLOSING
Tuberculosis Disease (TB) is a very contagious disease
of the respiratory system. It is a bacterial infection that begins in the lungs
and is able to spread by the circulatory system to other parts of the body,
such as the Meninges (the tissue covering the brain), spine, kidneys, and other
abdominal organs and may be fatal. Tuberculosis symptoms are loss of appetite
and weight, sweating at night, and fever.
TB prevention and control takes two parallel approaches. In the
first, people with TB and their contacts are identified and then treated.
Identification of infections often involves testing high-risk groups for TB. In
the second approach, children are vaccinated to protect them from TB. No
vaccine is available that provides reliable protection for adults. However, in
tropical areas where the levels of other species of mycobacteria are high,
exposure to nontubercolous mycobacteria gives some protection against TB.
Important
nurse so central in TBC patient healing. Specially in medication, nurse as gift
execution medicinize also the observation take medicine for the TBC patient.
Muttaqin, A. 2008. Asuhan Keperawatan dengan
Gangguan Pernapasan. Jakarta:
Salemba Medika
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