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NRS 428 Assignment: Epidemiology Paper

NRS 428 Assignment Epidemiology Paper

Introduction

Tuberculosis (TB) refers to a variety of clinical illnesses caused by Mycobacterium tuberculosis complex. Tuberculosis is a multisystemic disease that can affect every organ, with the most affected being the lungs where there is granuloma formation. TB is primarily classified into two pulmonary TB (PTB) and Extrapulmonary TB (EPTB). PTB is defined as a case of TB that involves the lung parenchyma, while EPTB affects other organs apart from the lungs such as the lymph nodes, pleura, skin, gastrointestinal tract, bones, joints, and meninges (Sharma & Mohan, 2019). This essay aims at describing the epidemiology of Tuberculosis and the role of the community health nurse and national agency in addressing TB.

Causes: The primary infectious agent of TB is Mycobacterium tuberculosis, which is an acid-fast aerobic rod that has slow growth and is sensitive to heat and ultraviolet light.

Other species include Mycobacterium africanum and Mycobacterium Canetti, which are rare causes of tuberculosis in Africa

Symptoms: The typical clinical features of active pulmonary TB include cough, anorexia, weight loss, fever, night sweats, chest pain, hemoptysis, and fatigue. Symptoms of Tuberculosis meningitis include an intermittent or persistent headache that lasts for 2-3 weeks, subtle mental status changes that may result in coma over days to weeks, and low-grade fever. Skeletal TB presents with back stiffness or pain, paralysis of the lower extremities, and arthritis, which involves only one joint, mostly the hip or knee joint (Sharma & Mohan, 2019). Genitourinary TB manifests with flank pain, urinary frequency, dysuria, painful scrotal mass, or epididymitis in males and symptoms mimicking Pelvic inflammatory disease in females (Sharma & Mohan, 2019). Symptoms of gastrointestinal (GI) TB depend on the infected site and may include, non-healing ulcers in the mouth or anus, swallowing difficulties with esophageal infection, abdominal pain with duodenal or gastric infection, malabsorption with small intestine infection, and pain, diarrhea or pain during defecation with colon infection (Sharma & Mohan, 2019).

Mode of Transmission: Mycobacterium tuberculosis is transmitted from one person to another through airborne transmission. Infected persons release droplets containing Mycobacterium nuclei, which are usually particles 1-5 um in diameter when coughing, sneezing, or talking (Koch & Mizrahi, 2018). The large droplets settle while small droplets are suspended in the air and get inhaled by susceptible individuals. The bacteria are transmitted via the airways to the lungs and deposited the alveoli where they multiply. The bacilli are also transported via the bloodstream and the lymphatic system to other body organs such as the cerebral cortex, bones, and kidneys, and other parts of the lungs such as the upper lobes (Koch & Mizrahi, 2018).

Complications: Complications of TB are usually a result of the disease process or from antimicrobial therapy. The most common late complication of PTB is hemoptysis, which refers to bleeding from submucosal bronchial veins. Other PTB complications include Broncholithiasis, which results from spontaneous migration of lymph nodes into the bronchial tree and Fibrothorax. Bronchiectasis, Aspergilloma, chronic obstructive pulmonary disease, and carcinoma of the lung tissue and relapse are late complications that develop after completion of drug therapy. Extrapulmonary complications following antimicrobial therapy include hepatitis, peripheral neuropathy, and Retrobulbar optic neuropathy.

Treatment: Pharmacologic treatment of is divided into first-line and second-line agents.

The first-line treatment consists of a 4-drug regimen, namely, Isoniazid (H), Rifampin (R), Pyrazinamide (Z), and Ethambutol (E). Isoniazid is the cornerstone of treatment and should be included in all therapies unless in cases where there is a high degree of Isoniazid resistance. Rifampin is the second major Anti-TB agent (Sotgiu et al., 2015).

The intensive phase lasts for two months, and the drugs used include Isoniazid, Rifampin, Pyrazinamide, and Ethambutol. The continuation phase lasts for four months, and the drugs used are Rifampicin and Isoniazid. Pyridoxine is administered daily with Isoniazid to prevent peripheral neuropathy, and Vitamin A is administered as a STAT dose when treatment is initiated (Sotgiu et al., 2015).

Treatment for defaulters, relapsed, or failed TB cases entail Intensive therapy for one month with Streptomycin, Isoniazid, Rifampin, Pyrazinamide, and Ethambutol and Continuation phase with Rifampin, Isoniazid, and Ethambutol for five months (Sotgiu et al., 2015).

Demographic of interest: Globally, TB is the leading cause of mortality from a single infectious agent and the leading cause of mortality among people with HIV infection and accounts for about 40% of death in HIV-infected persons.  As per the World Health Organization (WHO) 2019 TB report, approximately 10 million individuals got infected with TB in 2018. The burden of the disease varies significantly among countries from less than five to greater than 500 new cases annually, and the global average of new TB infected cases was 130. In 2018, approximately 1.2 million TB deaths were reported among HIV-negative persons and an estimated 251000 deaths among HIV positive persons (WHO, 2018). TB affects individuals of both sexes in all age groups, but the highest-burden is in males above the age of 15 years. In 2018, this population accounted for 57% of all TB cases, while women and children below 15 years accounted for 32% and 11%, respectively (WHO, 2018). Besides, 8.6% of all TB cases in 2018 were people infected with HIV.

A majority of TB cases in 2018 were in the geographic regions of South-East Asia with a prevalence of 44%, Africa with 24%, and

NRS 428 Assignment Epidemiology Paper

NRS 428 Assignment Epidemiology Paper

Western Pacific with 18% (WHO, 2018). The lowest prevalence was in the Eastern Mediterranean with 8%, America with 3%, and Europe with 3%. Furthermore, eight countries accounted for two-thirds of the global total TB cases, and these were India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa (WHO, 2018).

In the United States (US), TB infection was more prevalent in Asians, with 30% followed by Hispanics with 29% and African Americans/ Non-Hispanic blacks with 23% (Schmit et al., 2017). The least affected ethnic groups were American Indians/ Native Alaskans and Native Hawaiians and Pacific Islanders with a prevalence of 1%. More than 60% of TB infections in the US occur in individuals aged 25-64 years; however, the risk is highest in individuals above 65 years (Schmit et al., 2017). TB is less prevalent in children between 5-15 years.

Reporting of TB Cases: TB is a notifiable disease, and countries have different TB reporting laws. The recommended timeframe to report suspected or confirmed cases of TB in the USA is within 24 hours (Thombley & Stier, (2016). The general requirement is that any individual having knowledge of the disease or has reason to believe that an individual has TB should report to facts to the local health department. Healthcare providers licensed under state licensure code, include the list of specific persons required to notify the TB program in the state department of new TB cases within 24 hours (Thombley & Stier, (2016). Upon receiving the notice, the TB Program should notify the local board of health in the community where the TB case resides within 24 hours.

Laboratories are required to report to the local or state health department of health the identification of or any laboratory findings indicating the presence of microscopical, immunological, cultural, serological, or other evidence of TB (Thombley & Stier, (2016).

The report should contain information about the individual, and this includes the individual’s name, address, and county, and if the individual is homeless. The telephone number, date of birth, sex, race, ethnic origin, occupation, and country of origin, including the month and year the person arrived in the US, should be indicated (Thombley & Stier, (2016). In addition, the site of infection, chest radiography date and results, lab results, tuberculin skin test history, HIV status, alcohol, and drug use history, initial drug regimen, whether the individual is a resident of a long-term or correctional facility, signature of the person reporting and date of report submission should be included.

Social determinants of health

Healthy People 2020 define social determinants of health (SDOH) as the conditions in the environment in which individuals are born, live, work, play, and age (People, 2017). The conditions affect health, functioning, and quality of life outcomes and risk in various ways. Factors that improve the quality of life significantly influence population health outcomes, and they include safe and affordable housing, public safety, availability of nutritious food, access to education, accessibility to local health services, and an environment free of toxins (People, 2017). Examples of SDOH include social norms and attitudes, socioeconomic conditions, availability of resources to meet day-to-day needs, access to education, access to healthcare services, residential segregation, and social support.

The risk factors for TB transmission include persons without adequate health care, immigration from countries with a high prevalence of TB, institutionalization, living in substandard, and overcrowded housing. Consequently, people who live in crowded neighborhoods and substandard housing are at a high risk of being infected with TB. For instance, people living in slums where the environment has toxins, including TB aerosol droplets,  have the highest risk of TB infection with TB (People, 2017). Besides, TB infected people with no access to healthcare are likely to transmit the disease to other individuals due to the lack of appropriate treatment (People, 2017).  Furthermore, individuals with no access to education are at a high risk of TB infection since they are less informed of the prevalence and complications of TB as well as how to prevent and control TB, especially when living with TB infected people.

Transportation options also contribute to the transmission of TB when people use public transportation. Transmission takes place as people interact and move using public transport facilities such as buses and trains where individuals inhale contaminated aerosol droplets in the environment. Moreover, people living in overcrowded confined spaces such as prisons have an increased likelihood of TB transmission.

Epidemiological Triangle

Host: Humans are the only known reservoirs for Mycobacterium tuberculosis through various animals that are susceptible to infection. The likelihood of a person developing active TB depends on the intensity and duration of exposure to infected aerosol droplets. Individuals with intense exposure have the highest risk of infection and also for the development of TB (Koch & Mizrahi, 2018). Factors that make an individual susceptible to TB infection include alcoholism, malnutrition, immunocompromised status, history of substance abuse, and preexisting medical conditions.

Agent Factors: Mycobacterium tuberculosis is an aerobic, non–spore-forming, nonmotile bacillus with a high cell wall content of high-molecular-weight lipids. It has slow growth and has a generation time of 24-30 hours (Koch & Mizrahi, 2018).

Environmental Factors: Mycobacterium tuberculosis is resistant to desiccation, and this makes it remain viable as droplet nuclei when suspended in a room for about 30 minutes. However, the aerobic rode is sensitive to heat and ultraviolet light. An infected person can transmit the organism to numerous persons in an exposed group when there is no appropriate isolation (Koch & Mizrahi, 2018).

The community should be notified when they are at risk of transmitting TB and be educated disease prevention strategies against TB infection when interacting with TB infected individuals.

Role of the Community Health Nurse

The role of a community health nurse not only entails management services involved in patient care and treatment but also consists of a range of public health activities that aid in the prevention and control of TB in the community, which is the eventual goal of case management in TB (Chikovani et al., 2019). The community health nurse has the role of conducting an assessment, which involves systematic data collection, monitoring, and giving information on the health status of the community. The nurse has the responsibility of collecting data on the number of TB cases in the community and conducting an analysis to determine the success of the efforts to manage and control the occurrence of new TB infections (Chikovani et al., 2019). Besides community health, nurses are mandated to report suspected or newly diagnosed cases of TB to the local health departments to aid in the follow-up of the patients. They are further required to follow-up TB-infected patients in their residence to monitor drug-adherence and provide health education to their families on how to prevent the transmission of the disease (Chikovani et al., 2019). Demographic data is necessary in the health of the community as it helps in monitoring the success of treatment and identifying the rate of transmission and relapse cases of TB. Besides, the data guides in the allocation of resources needed for TB programs and determining the health status of a community.

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Topic 2 DQ 1

What are social determinants of health?  Explain how social determinants of health contribute to the development of disease.  Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.

Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.

Hi Class,

The social determinants of health are the conditions of birth, development, employment, living, and aging. They include income, education, housing, and work (Social Determinants of Health, 2018). The social determinants of health are linked to health outcomes and health disparities. A growing body of research has shown that addressing the social determinants of health can improve health outcomes and reduce health disparities. There are many ways to address the social determinants of health. Some approaches include policy changes, community-based initiatives, and individual-level interventions. It is important to note that no one method is suitable for everyone and that different approaches may work better in various settings.

There is growing evidence that social determinants of health play a significant role in disease development. For example, studies have shown that factors such as poverty, poor housing, and lack of access to healthcare can lead to a higher incidence of disease (World Health Organization, n.d). In addition, social determinants of health can also affect the course of an illness and make it more challenging to manage. Therefore, it is a crucial issue to consider, as social determinants of health can significantly impact human health and well-being. Thus, ensuring everyone has access to the resources they need to maintain a healthy lifestyle is vital.

The communicable disease chain model illustrates the transmission and control of infectious diseases. The pathogen, reservoir, portal of exit, method of transmission, the portal of entry, and new host are the six different linkages that make up the model. According to Study.com (2019), each link in the chain plays a specific role, and each one can be broken or interrupted in various ways. For example, a nurse might perform multiple actions to break the chain of infectious diseases. Some of the most popular steps a nurse may use include, but are not limited to, adequate hand washing, wearing PPEs, using all necessary safety precautions, and using the proper sterilization and cleaning methods.

In conclusion, social determinants of health significantly impact individuals’ well-being. Therefore, nurses should understand them and incorporate better practices to prevent the spread of diseases.

References

Social Determinants of Health. (November 30, 2018). Social Determinants of Health. Healthy People. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-of-health

Study.com. (2019). Chain of Infection: Definition & Example. Retrieved from https://study.com/academy/lesson/chain-of-infection-definition-example.html

World Health Organization (n.d). Social determinants of health. Retrieved from https://www.who.int/social_determinants/sdh_definition/en/

REPLIES

Social Determinants of health can be political. Our political temperament and governmental structure play heavily into the healthcare resources that are available to the citizen. It was interesting to learn that healthcare for all, in the United States, was proposed as early as 1904, and was for a time pursued by Franklin D. Roosevelt’s administration. When the doctor’s association of the time protested he pulled back to pursue the Social Security Act. Post-WWII Europe embraced healthcare for all as a deterrent to communism, while the United States felt that “socialized” medicine promoted communism. The American Medical Association, comprised of MDs, has continued to lobby and exert political power against healthcare reform, including the ACA. For years it was the pressure that they exerted on Medicare that prevented those in rural communities from being able to seek care from advanced practice nurses and NPs. While at the same time not being able to attract MDs to their rural communities to serve their people. To be more precise Advanced Practice RNs and NPs could provide care Medicare would just not pay them for it. The AMA’s pressure was to protect power and revenue for their constituency, disappointing. In most areas of inequity if you follow the money or the power the true nature of things will be revealed. Thankfully the Affordable Care Act addresses some of these past hurdles.

 

Reference

 

Gilligan, H. (2018, May 23). Socialized medicine was coined in the US, not Europe. Timeline. Retrieved September 10, 2022, from https://timeline.com/socialized-medicine-was-coined-in-the-us-not-europe-30438fad9d69

 

Rangel, C. (2010, March 23). H.R.3590 – 111th Congress (2009–2010): Patient Protection and Affordable Care Act. Congress.Gov | Library of Congress. Retrieved May 26, 2022, from https://www.congress.gov/bill/111th-congress/house-bill/3590

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