Question

Joshua is a 7 years old class 2 student who lives with his parents and his 4 siblings in a rural settlement and has been diagnosed with a CHRONIC ILLNESS of TUBERCULOSIS

that will require frequent admission or visits to the hospital. His father is a security officer and his mother stays home and is a house wife.   

TUBERCULOSIS

1. overview and Etiology of the chronic illness you have chosen.

2. Discuss the significance of the pathophysiology and clinical manifestations of the chronic illness that is affecting Joshua with reference to the literature.

3. Using the development theory, discuss the impacts of the chronic illness on Joshua's growth and development with reference to the literature.

4. Discuss the emotional impact of the chronic illness on the young client.

5. Describe the impact of the child's chronic illness on the family.

6. Explain the five (5) ways parents can assist the child cope with the illness to develop social skills, as well as increase her self-esteem and confidence with the justification of their actions and reference to the professional literature.

7. Discuss the significant role you play as a Paediatrics nurse caring for the client and discuss ways that you will help support this family, with the justification of your actions and reference to the professional literature.

8. You will also need to develop critical thinking, reflective thinking, problem-solving decision making, communication and writing abilities

Answer 1

1. TUBERCULOSIS

Tuberculosis (TB) is a contagious infection that usually attacks your lungs. It can also spread to other parts of your body, like your brain and spine. A type of bacteria called Mycobacterium tuberculosis causes it.

. There are two forms of the disease:

• Latent TB. You have the germs in your body, but your immune system keeps them from spreading. You don’t have any symptoms, and you’re not contagious. But the infection is still alive and can one day become active. If you’re at high risk for re-activation -- for instance, if you have HIV, you had an infection in the past 2 years, your chest X-ray is unusual, or your immune system is weakened -- your doctor will give you medications to prevent active TB.  
• Active TB. The germs multiply and make you sick. You can spread the disease to others. Ninety percent of active cases in adults come from a latent TB infection.

A latent or active TB infection can also be drug-resistant, meaning certain medications don’t work against the bacteria.

ETIOLOGY:

Tuberculosis Causes

Tuberculosis is caused by bacteria that spread through the air, just like a cold or the flu. You can get TB only if you come into contact with people who have it.

Tuberculosis Risk Factors

You could be more likely to get TB if:

• A friend, co-worker, or family member has active TB.
• You live in or have traveled to an area where TB is common, like Russia, Africa, Eastern Europe, Asia, Latin America, and the Caribbean.
• You’re part of a group in which TB is more likely to spread, or you work or live with someone who is. This includes homeless people, people who have HIV, people in jail or prison, and people who inject drugs into their veins.
• You work or live in a hospital or nursing home.
• You’re a health care worker for patients at high risk of TB.
• You’re a smoker.

A healthy immune system fights the TB bacteria. But you might not be able to fend off active TB disease if you have:

• HIV or AIDS
• Diabetes
• Severe kidney disease
• Head and neck cancers
• Cancer treatments such as chemotherapy
• Low body weight and poor nutrition
• Medications for organ transplants
• Certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis

Babies and young children also have higher chances of getting it because their immune systems aren’t fully formed.

2. PATHOPHYSIOLOGY

Infection with M tuberculosis results most commonly through exposure of the lungs or mucous membranes to infected aerosols. Droplets in these aerosols are 1-5 μm in diameter; in a person with active pulmonary TB, a single cough can generate 3000 infective droplets, with as few as 10 bacilli needed to initiate infection.

When inhaled, droplet nuclei are deposited within the terminal airspaces of the lung. The organisms grow for 2-12 weeks, until they reach 1000-10,000 in number, which is sufficient to elicit a cellular immune response that can be detected by a reaction to the tuberculin skin test.

Mycobacteria are highly antigenic, and they promote a vigorous, nonspecific immune response. Their antigenicity is due to multiple cell wall constituents, including glycoproteins, phospholipids, and wax D, which activate Langerhans cells, lymphocytes, and polymorphonuclear leukocytes

When a person is infected with M tuberculosis, the infection can take 1 of a variety of paths, most of which do not lead to actual TB. The infection may be cleared by the host immune system or suppressed into an inactive form called latent tuberculosis infection (LTBI), with resistant hosts controlling mycobacterial growth at distant foci before the development of active disease. Patients with LTBI cannot spread TB.

The lungs are the most common site for the development of TB; 85% of patients with TB present with pulmonary complaints. Extrapulmonary TB can occur as part of a primary or late, generalized infection. An extrapulmonary location may also serve as a reactivation site; extrapulmonary reactivation may coexist with pulmonary reactivation.

The most common sites of extrapulmonary disease are as follows (the pathology of these lesions is similar to that of pulmonary lesions):

• Mediastinal, retroperitoneal, and cervical (scrofula) lymph nodes - The most common site of tuberculous lymphadenitis (scrofula) is in the neck, along the sternocleidomastoid muscle; it is usually unilateral and causes little or no pain; advanced cases of tuberculous lymphadenitis may suppurate and form a draining sinus

• Vertebral bodies

• Adrenals

• Meninges

• GI tract

Infected end organs typically have high regional oxygen tension (as in the kidneys, bones, meninges, eyes, and choroids, and in the apices of the lungs). The principal cause of tissue destruction from M tuberculosis infection is related to the organism's ability to incite intense host immune reactions to antigenic cell wall proteins.

Uveitis caused by TB is the local inflammatory manifestation of a previously acquired primary systemic tubercular infection. There is some debate with regard to whether molecular mimicry, as well as a nonspecific response to noninfectious tubercular antigens, provides a mechanism for active ocular inflammation in the absence of bacterial replication.

Tuberculosis Signs and Symptoms

Latent TB doesn’t have symptoms. A skin or blood test can tell if you have it.

Signs of active TB disease include:

• A cough that lasts more than 3 weeks
• Chest pain
• Coughing up blood
• Feeling tired all the time
• Night sweats
• Chills
• Fever
• Loss of appetite
• Weight loss