NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay

NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay
Introduction
Infectious diseases for a long time have plagued society and effecting people globally.  These are communicable diseases that have the potential of being transmitted from one person to the next either directly or indirectly via vector.  Upon transmission from one person to another, the disease takes over the body’s natural defense mechanisms by discharging toxins throughout the body. The professional community health nurse must understand the different aspects of a disease when working and serving a community. The nurse needs to know how the disease progresses, as well as the effects of the communicable disease if it’s not managed accordingly. Nurses are one of many mandated reporters of communicable diseases and should know and recognize the signs and symptoms of approximately 80 communicable diseases that is currently known to exists (ACPHD, 2013). Tuberculosis (TB), has been known as a communicable disease that is global concern and has also been recognized as the leading cause of death among underprivileged populations. NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay. Keeping a watchful eye is an important part of a plan to maintaining control of TB. The purpose of this paper is to discuss the pathophysiology, development, and transmission of TB.  In addition, the epidemiology triangle, the role of the professional nurse, and issues surrounding TB will be addressed.
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Description and Pathophysiology of Tuberculosis
Mycobacterium tuberculosis (Mtb) is known as a pathogenic and highly infectious bacterium that comes in different strains, which can potentially influence how the disease takes its course.  The virus attacks individuals with weakened immune system making them susceptible to being infected with the tuberculosis virus.  As soon as the individual becomes infected with Mtb, they instantaneously convert to a host or reservoir of TB.  The primary transmission mode of TB is through the air; however, there are possibilities of the virus being transmitted after an individual coughs, sneezes, or spits via droplets.  The droplets linger in the air and an uninfected person breathes in the bacterium into their lungs and then becomes infected. TB infection requires a favorable environment like closed rooms or spaces or prison to cause an infection.  Climate affects the survival and transmission of the virus, meaning everything such temperature of the environment, ventilation, and humidity level, etc. NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay.
(ALA, 2014) postulated that, an individual who has acquired the tuberculin infection may not show symptoms.  According to the Center for Disease Control and Prevention (CDC, 2014), The following signs and symptoms are known to be indicative of possible TB virus: coughing that typically lasts longer than two weeks along bloody sputum, unexplained fatigue, unintentional weight loss, fever, chills night sweat, and difficulty breathing (Center for Disease Control and Prevention, CDC, 2014.  In order to test and confirm active infection of the TB virus a medical professional will do a purified protein derivative (PPD) skin test, chest x-ray, and/or CT scan. Another method of testing for TB is through a serum test called the interferon-gamma release assays (IGRAs). NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay.
Globally, it is estimated that one third of the world’s population has been impacted by the tuberculin virus. According to the CDC (2014), there were nearly 3.2 TB reported cases in every 100,000 in the United States alone in 2103.  Without a doubt, the tuberculin virus poses as a direct threat to individuals with the HIV/AIDS infections, the homeless, incarcerated, healthcare employees, and individuals living in deplorable communities, placing them at greater risk of infection.  Infection by Mtb is a complex and multistage process proceeding from the initial encounter with the pathogen.
 
 
Epidemiology Triangle
The study of epidemiology is to study the process of a disease and gaining an understanding of why they happen.  In order for a disease or injury to occur, a sufficient mode of transmittance ought to be present.  When a disease begins to spread either locally, nationally, or globally it is considered an epidemic. Epidemiologist gathers data to understand the source of the disease and take action to halt the spread of the disease.  In epidemiology, consists of investigative methods with steps to presenting a solution to a problem. These investigative methods are known as descriptive, analytic, as well as, experimental. The descriptive aspects of epidemiology collect data pertaining to the time of occurrence, the individual it affects, the place, and how the disease affects and influence the level of the body’s immune system.
Epidemiology triangle describes the chain of infection showing the events that takes place when an infection is spread from one source to the next.  When a disease agents such as bacteria, fungi, parasites, and virus come around carrying infections spreading the disease through means of contact, the air, touch, etc, that is considered a communicable diseases. For the agent to survive and have the ability to spread the infection, it needs a host with a portal of entry and environment conducive to survival. As previously mentioned, TB is an infectious disease caused by Mycobacterium tuberculosis (CDC, 2014). The lungs are usually primary organ that is attacked by the TB bacterium; but the virus can also attack other parts of the human body.  For instance, it can attack the kidneys, central nervous system, as well as the lymphatic system affecting their normal functions. The TB bacteria can become fatal very fast if it is not treated accordingly.  There are a number of situations that can take place when the bacteria enter the body. The body can fight it off naturally with its defense mechanisms; the bacteria can become dormant in the body waiting for the perfect opportunity to take over the body’s defense mechanisms.  To clarify further, as the bacteria enter the latent stage, it is unable to spread the infection to others.  NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay. The host stays asymptomatic. Furthermore, bacteria have the ability to take over prone immune systems and as a result, the host is now ill. The ailing individual can spread the TB virus through the air by simply coughing.
Evidence Based Practice & Role of the Professional Nurse
According to Varaei, et al (2013) “Evidence-based Nursing (EBN) is based on the integration of the best research evidence with clinical expertise and patient values to facilitate clinical decision-making, and it may become a vital part of quality improvement in nursing practice” (p. 251). The role of the professional nurse is paramount in implementing EBP. The nurse can help prevent a varying complications associated with TB and providing education patients.  The goal is to provide the best nursing care possible.
In any aspect of patient care, the professional nurses should be well aware of a disease and competent to care for the patient including the patient with tuberculosis.   The nurse must first fully comprehend the process of the infectious diseases such as TB. As the bacterium gets in the lungs, it reproduces very fast causing the lungs to become inflamed. “The flamed tissues form tubercles causing tissue necrosis at the center of a lesion called caseation necrosis as inflamed tissues are surrounded by collagen, fibroblasts and lymphocytes. These tubercles can become calcified or liquefied” (CD, 2014, para 5).  The solidified tubercles can be seen on a chest x-ray exam.  The nodular lesions in the lungs liquefy have the possibility of leaking into any of the air passages of the lungs, for instance the trachea that leads to the lungs causing an infection.  At first, the infection in the lungs may not be specific and body’s immune system may respond by producing specific antibodies.  That is to say, if the body’s immune system is healthy and strong, it can fight off the infection on its own and nothing else needs to be done.  Cell mediated immunity, which is an immune response that excludes the use of antibodies, but involves activating antigen-specific cytotoxic T-lymphocytes with various cytokines released to fight off an antigen (ALA, 2014). This can grow in 2 to 10 weeks after the sign of first infection. Interestingly enough, some people may be immune to the TB virus; but they will have positive test result for the PPD skin test; however, can test negative on chest x-ray because they are no tubercles yet formed. Typically, the initial onset of TB is slow; however, in the case of someone with a weak immune system, it can advance very rapidly.  In some case, the progression of the TB virus can take place prior to showing any signs and symptoms. If an individual with TB in the latent stage, they become immune-compromised. TB then can become active. “The symptoms of active TB are cough, chest pain, and bloody mucus. If it is not treated, TB can be fatal. But TB can almost always be treated and cured if you take medicine as directed by your healthcare provider” (ALA, 2014, p. 3).
There a very few commonly used drugs to treat the TB virus.  Antibiotics such as isoniazid (INH) can be given combined with other drugs like rifampin, pyrazinamide, and ethambutol.  In case of complicated Tb, the drug called Streptomycin may be prescribed to it.  NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay. As short as a few weeks of receiving treatment, a person infected with the TB virus will no longer be contagious to spread the virus to others. The average duration of TB treatment is between six to 12 months.  There are complications that can become a problem during treatment because the bacterium could potentially become resistant to the drugs resulting in the need for multiple drugs to be used to successfully treat the TB virus. After treatment is over, there is a possibility of  necrotized tissues left in the lungs, but can be removed with surgery. Lack of compliance due to adherence to medication can also cause some serious complications (ALA, 2014).
Social Determinants of Health
There are several factors that take part in the social determinants of health are when it comes to the to the populations that the tuberculosis infections impact. “Socioeconomic equalities, rapid urbanization, rapid increase in population have caused the unequal rise and distribution of the social determinants of TB” (WHO, 2014, para 6).  For example,

Age and sex
Behaviors: smoking, drugs & alcohol use, and practicing safe sex
Income, social class status
Malnutrition from lack of food supply,
Living in crowding or enclosed conditions,
Financial instability, and cultural barriers to access health care as need, just to                              name a few.                                                                                                                                     As a result, these social determinants regulate how the TB virus is spread amongst certain populations, result in exposure to the virus, and how the disease progresses. TB disease has become a worldwide issue in the healthcare realm.

Community health nurses can make an impact by helping stop the spread of TB when the reinforce the importance of following the treatment plan for TB and teaching the public how the disease takes its course of action to those who are already infected.  Federal law states that all healthcare providers, including nurses, are mandated reporters for all TB cases that they encounter.  These cases have to be reported to the local health department to be recorded.  It’s a community health nurse’s duty and responsibility to educate local communities everything that they need to know about tuberculosis.  They have to educate and stress the importance of completing TB treatment to patients.  Failure to complete treatment can cause significant damage to the lungs and other organs in the body and most definitely reinfection of TB.  When someone is re-infected with the TB bacterium, they can become resistant to drug therapy. Once TB bacterium becomes resistant, it’s hard and very expensive to treat and manage.  If a patient has positive infection, patient’s family should be tested and educated about maintaining isolation precaution.  Many of the organizations like World Health Organization (WHO) are joined to work in different counties in the fight against TB.
                                                            Supportive Agencies
The Division of Tuberculosis Elimination has been recognized as the chief agency for having the best resources relating to TB (CDC, 2014).  They further explained that, management in preventing, controlling, and potentially eliminating TB in the United          States, through collaboration with other agencies at the community, state, and         international levels. This can be accomplished as DTBE takes on the following             functions: developing and advocating for effective and appropriate TB prevention and            control policies; supporting a nationwide framework for monitoring TB morbidity and             mortality; detects and investigates TB outbreaks; conducts clinical, epidemiological,          behavioral, and operational research to enhance TB prevention and control efforts; evaluates prevention effectiveness; provides funding and technical help to state and local             health departments; and provides training, education, and technical information services             to state and local health departments (CDC, 2015, para. 13) NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay.
Conclusion
Tuberculosis (TB) is one the deadliest and highly contagious diseases around the world, in which millions of lives have succumb to this epidemic lingering around for centuries.  As professional nurses, it’s our duty to effectively educate the public about this communicable disease. Individuals who lack knowledge of the spread and management of TB are urged to seek information to truly understand the severity of this disease.  Most importantly, persons infected with the TB virus need to understand the importance of starting treatment early and completing the course of the treatment to avoid irreversible complications. As healthcare providers, we all need to work together to help with diagnosis, reporting, and follow up care of individual with TB.  As long as of health care providers are making collaborative efforts and continuing to educate the public about the treatment and prevention of tuberculosis, this will help to reduce the number cases of TB and possibly some day eradicate this disease for good NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay.
References
Communicable Disease. (n.d.). – ACPHD. Retrieved from http://www.acphd.org/communicable-  disease.
Communicable disease. (n.d.). Merriam-Webster. Retrieved from http://www.merriam-            webster.com/medical/communicable%20disease
Medical News Today. (2014). What is tuberculosis? What causes tuberculosis? Retrieved from http://www.medicalnewstoday.com/articles/8856.php
Symptoms, Diagnosis and Treatment (ALA, 2014). (n.d.). American Lung Association. Retrieved             from http://www.lung.org/lung-disease/tuberculosis/symptoms-diagnosis.html
. Centers for Disease Control and Prevention (CDC).  (2014). TB Retrieved from http://www.cdc.gov/TB/
Varaei, S., Salsali, M., Cheraghi, M.,Tehrani, MRM., & Heshman, R. (2013).
Education and implementing evidence‑based nursing. Iranian Journal of Nursing and
Midwifery Research, 18(3), 251-257.
World Health Organization. (2014). The stop TB strategy. Retrieved from http://www.who.int/tb/strategy/en NRS-427VN Concepts in Community and Public Health -Tuberculosis EPIDEMIOLOGY essay
 
 

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