Tuberculosis

On the job exposure to infectious diseases has long been one of the hazards associated with the nursing profession. In recent years, such exposure has become especially dangerous. Nurses need to be aware of the risks. Without precautions, diseases such as AIDS and drugresistant tuberculosis might prove deadly.

Tuberculosis (TB) has been one of the leading causes of death in human populations throughout much of recorded history. Hippocrates described clinically active pulmonary tuberculosis 2,300 years ago as "the most considerable of the disease which then prevailed" and "the only one which proved fatal to many persons" (Ismeurt & Long, 1993, p. 16). The Greeks and Romans called it consumption or phthisis; TB is even described in the Bible.

In the 1940s, antibiotics that cured illness became widely available (Madsen, 1990, p. 44). From about the 1950s to the mid1980s, the TB's incidence steadily declined in industrialized countries at a rate of about 6% per year (Boutotte, 1993, p. 42). This great progress may have prompted an announcement made by the U.S. Secretary of the Department of Health and Human Services, Dr. Louis Sullivan, in 1989. Sullivan endorsed a plan which called for the elimination of T.B. in the U.S. by the year 2010 (Ismeurt & Long, 1993, p. 16). While at the time, such a plan may have seemed feasible, it appears less so today.

From 1985 to 1991, the number of reported TB cases increased 18.4% (Boutotte, 1993, p. 42). In addit

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tion in excess of 15 mg/day. Also at risk are patients with insulindependent diabetes, chronic renal failure, and lungs scarred by silicosis (Madsen, 1990, p. 46). In addition, certain ethnic groups may have a higher risk of contracting TB. For example, Hispanics, American Indians, blacks, and Asians account for approximately twothirds of TB in the U.S. Finally, the disease can also be a problem when large groups of persons must live together under crowded conditions. Numerous studies have shown that a widespread excess risk for TB exists in nursing homes and correctional facilities (Hutton et al., 1993, p. 305). In fact, the case rate of TB for people age 65 and over is higher than that for any other age group. For example, Stead (1989) measured rates of 150 to 200 per 100,000 among the elderly, as compared with 4 to 6 per 100,000 in adults age 15 to 44. The symptoms of TB include a persistent cough, hemoptysis, hoarseness, fever, chills, night sweats, anorexia, and unexplained weight loss. TB might also present with fatigability and dull chest pain. In addition, erythema nodosum (painful nodules) and lymphadenopathy can occur (Ismeurt & Long, 1993, p. 18). On examination, the patient may have fine crackles in t

Category: Medical - T