Tuberculosis Study Guide - M. M. Savula 2002

Care. Treatment
Regimen, care, nutrition

Treatment of tuberculosis patients encompasses:

♦ regimen, balanced Nutrition, and care;

♦ antituberculosis Chemotherapy;

♦ Non-specific therapies;

♦ Surgical treatment.

Patient care aims to promote successful treatment outcomes and alleviate suffering. It involves assisting the patient with basic daily needs, maintaining personal hygiene, adhering to sanitary-hygienic and infection control protocols, monitoring Changes in the patient's condition, and providing timely pre-physician care.

Upon admission to the hospital, a physician assistant or nurse examines the patient and assesses their general and hygienic condition. If necessary, the on-duty physician is called to provide emergency care. When needed, patients are offered a shower or hygienic bath and clean clothes. For patients in critical condition, care is limited to bed baths. If pediculosis is detected, sanitization is performed according to instructions.

After completing the cover sheet of the inpatient medical record, which includes personal details, height, and weight, the patient is briefed on the hospital rules and regimen. Sputum-positive patients (those with Mycobacterium tuberculosis detected in their sputum) are instructed that they must not leave the hospital or go home until they achieve sputum conversion (non-infectious status), especially if there are children in the family. Children are also strictly prohibited from visiting patients in the tuberculosis facility. If family members need or wish to stay by the bedside of a critically ill patient, only adults are permitted to do so, and under no circumstances teenagers.

In the hospital ward, the patient is assigned a bed with clean linen and an individual spittoon, which is changed daily.

In a tuberculosis hospital, a strict Sanitary and hygienic regimen must be maintained to prevent nosocomial (hospital-acquired) infection and the spread of mycobacteria outside the facility. Upon arrival at the hospital, the nurse or physician assistant changes into work clothes, footwear, a medical gown, and a cap. After their shift, they take a shower and change back. Personal and work clothes are stored in separate lockers.

For more details on the specific sanitary and hygienic regimen in a tuberculosis hospital, as well as in a tuberculosis outbreak focus, see the section "Sanitary Prevention".

In tuberculosis, the risk of developing the disease increases significantly with repeated massive exposure, which typically occurs in active TB foci and tuberculosis facilities, especially those treating patients with chronic destructive Pulmonary Tuberculosis. Therefore, it is undesirable for young individuals who are not infected with Mycobacterium tuberculosis (which can be determined via tuberculin Skin testing) to work in TB facilities. New employees at a TB dispensary undergo chest photofluorography and a Mantoux test with 2 TU. Non-infected individuals (those with a negative Mantoux test) receive BCG revaccination and are allowed to work only after 6-8 weeks (once anti-tuberculosis Immunity has developed). Regardless of this, medical staff must strictly adhere to hygiene rules: handle infectious material wearing rubber gloves, wash hands after every contact with a patient or infectious material, and eat only in designated areas after removing their medical gown.

Junior medical staff should approach patients with patience and tact, listen to their Complaints, explain the necessity of following all doctor's recommendations, and monitor the intake of prescribed medications. Tuberculosis patients require long-term treatment, and the nurse must explain to them that feeling well does not mean they are cured, and treatment must continue. Ongoing health education is essential: patients must be taught to cover their coughs during direct contact with others (at the table, during conversation) and to expectorate sputum only into a special individual lidded spittoon filled to 1/3 with a 0.5 % chloramine solution. If a patient cannot suppress a cough, they must cover their Mouth with a handkerchief or an individual tissue to prevent sputum droplets from reaching others. Healthcare workers themselves should avoid standing directly in front of a patient who has an uncontrollable cough.

The risk of transmission from patients with extrapulmonary forms of tuberculosis is significantly lower.

The regimen for tuberculosis patients depends on their general condition. Patients with early, minor forms of tuberculosis or those in the final stages of successful therapy can be treated on an outpatient basis, in a day hospital, or in a sanatorium. Key Components of their regimen include adequate Sleep and rest, balanced nutrition, and a strict ban on smoking and alcohol consumption. Drinking alcohol is particularly dangerous during treatment with anti-tuberculosis drugs due to the high risk of hepatotoxicity (toxic Liver damage). The nurse must explain to patients that compliance with the regimen is a vital component of their treatment.

Patients with severe forms of tuberculosis, who are emaciated and have a high fever, must adhere to bed rest and require attentive care until they regain strength and their Temperature subsides. Chills followed by a sharp rise in body temperature can be particularly exhausting for patients with Caseous Pneumonia or acute exacerbations of chronic destructive pulmonary tuberculosis. When a patient feels chilly, they should be well covered, have a heating pad applied to their feet, and be given hot tea to drink.

At high body temperatures, patients are encouraged to drink frequently (tea, rosehip decoction, alkaline mineral Water), a cold compress is applied to the forehead, and 2 ml of a 50 % analgin solution is administered intramuscularly. Food is given in small, frequent portions. Inpatients with high fevers are fed by the nurse.

A sudden drop in body temperature may be accompanied by acute vascular insufficiency—sometimes presenting with cyanosis, cold sweat, a rapid, weak pulse, and a sharp drop in Blood pressure (pulse and blood pressure must be monitored regularly). In this case, the physician assistant or nurse must notify the doctor, lower the HEAD of the bed or remove the pillow, apply a heating pad to the feet, and administer 1 ml of a 10 % sodium caffeine benzoate solution subcutaneously.

Tuberculosis intoxication is often accompanied by increased sweating, sometimes profuse night sweats. Such patients need to be wiped dry with a towel and have their linen changed. To reduce sweating, the skin can be sponged with a warm, weak vinegar solution (1 tablespoon per 1 l of water).

In case of a debilitating cough, In addition to the doctor's prescriptions, the patient can be given warm milk with honey or sodium bicarbonate (baking soda—1/4 teaspoon per cup). If the patient coughs up a large amount of sputum, they should be assisted in finding a body position that facilitates its easiest expectoration. If blood appears in the sputum or the patient coughs up pure blood, they must be kept relatively still, sudden movements must be prohibited, a semi-sitting position should be provided, and the doctor must be notified immediately. Such patients are given warm (neither cold nor hot) food of a pureed consistency.

For chest pain, an iodine grid applied to the skin or a half-alcohol compress can be used as a counterirritant. A sharp, sudden chest pain accompanied by breathing difficulties may indicate Spontaneous pneumothorax, requiring immediate notification of the doctor. In cases of severe dyspnea, the patient is placed in a semi-sitting position by raising the head of the bed or adding an extra pillow. If necessary, humidified oxygen is administered.

Care for a tuberculosis patient presenting with Heart Failure does not differ from the care provided to patients with this complication in other diseases.

Severely weakened patients must be fed in bed by medical staff, who should also monitor their bowel function and skin cleanliness.

A special regimen and care are required for patients with Tuberculous meningitis. For the first 1.5-2 months, the patient must strictly adhere to bed rest. After improvement in their general condition and CEREBROSPINAL FLUID parameters, the patient is allowed to sit up, and after 3-4 months, to walk. Subsequently, physical activity is gradually increased, but on days when a follow-up lumbar puncture is performed, the patient must remain recumbent. Tuberculous meningitis is often accompanied by constipation and sometimes urinary retention. In these cases, medical staff must administer cleansing enemas or perform catheterization. Patients with impaired swallowing are fed via a nasogastric tube. Maintaining skin cleanliness and preventing pressure ulcers is crucial (see also the section "Tuberculosis of the Meninges and Central Nervous system").

Special attention from medical staff is required for patients with Bone and joint Tuberculosis treated with immobilization (plaster cast, plaster bed). If a patient complains of discomfort while lying in a plaster bed or tightness from a plaster cast, this may indicate improper fitting, and the doctor must be notified.

Feeding patients with Osteoarticular Tuberculosis must be carried out in a way that does not disturb the forced therapeutic position they are required to maintain. Patients are assisted with washing, and provided with bedpans and urinals. A patient in a plaster bed is removed daily for skin hygiene. For patients undergoing immobilization therapy, massage and prescribed, graduated physical exercises are of great importance.

For the successful treatment of all forms of tuberculosis without exception, clean air is of great importance, as this disease causes chronic oxygen deprivation (Hypoxia). Before the Introduction of modern antituberculosis drugs, some patients could only be cured by spending as much time as possible outdoors in a coastal or mountain climate, combined with a nutritious diet.

In tuberculosis sanatoriums, patients spend almost 24 hours a day and sleep in semi-open pavilions and on verandas. Regular airing of rooms and wards is also mandatory in hospital and home settings. As the patient's condition improves, outdoor walks are beneficial, and during the recovery stage, graduated physical activity is recommended.

Patients with active pulmonary tuberculosis, especially those prone to hemoptysis, must be cautioned against excessive exposure to direct sunlight and sunbathing during the hot season. This can trigger disease exacerbation and hemoptysis. In some extrapulmonary forms of tuberculosis (particularly osteoarticular), especially during the remission stage, controlled sun exposure is used in combination with other treatment Methods.

A complete, balanced diet, along with fresh air, promotes recovery. In tuberculosis, metabolic processes are disrupted due to intoxication and oxygen deprivation. Tuberculosis patients are often malnourished and sometimes emaciated. Long-term antibacterial treatment leads to impaired synthesis of many Vitamins, which are essential for energy and certain enzymatic processes.

In tuberculosis, Protein METABOLISM is significantly altered, so patients must receive an adequate amount of easily digestible Proteins (milk, cottage cheese, eggs, meat, fish, etc.), especially during disease exacerbations when the body's Energy Expenditure increases. The daily diet should contain 100-150 g of protein.

The fat and carbohydrate content is the same as for healthy individuals. The total ENERGY VALUE OF food is 2800-3500 kcal (11723-14656 kJ) per day.

There is a popular misconception among some people and patients that tuberculosis patients require a high-fat diet. Following the advice of acquaintances or "folk healers," patients sometimes consume dog, badger, or bear fat. Excessive fat intake causes dysfunction of The Stomach, intestines, and liver, and generally has a negative impact on the patient's health. Therefore, 80-100 g of fat per day is sufficient to meet the body's needs. The majority of animal fats should come from butter, sour cream, and eggs. Vegetable fats rich in Unsaturated Fatty acids are also beneficial.

The total amount of CARBOHYDRATES should not exceed 500-550 g per day. Their sources include cereal and flour products. Easily digestible vegetables and fruits are beneficial, as they are rich in vitamins, mineral salts, and dietary fiber, which regulates bowel function. Tuberculosis patients do not require excessive consumption of confectionery and sugar, which should be replaced with honey when possible.

Mineral salts and vitamins, found in wholesome foods, are an important component of a tuberculosis patient's diet. Rose hips are an excellent source of VITAMINS AND MINERALS. They also have a beneficial effect on liver function, so rose hip decoction is useful to systematically include in the diet of tuberculosis patients. However, natural sources do not always supply the body with enough vitamins, the deficiency of which in tuberculosis is caused by intoxication and long-term use of chemotherapy drugs. Thus, there is a need for their additional administration in the form of various pharmaceutical preparations.

Meals in tuberculosis facilities are served 4-5 times a day. Diet No. 11, used in Tuberculosis Treatment, meets all the aforementioned requirements. Patients with tuberculosis and comorbidities (Kidney or liver disease, Diabetes Mellitus, etc.) are prescribed an appropriate diet.