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PULMONARY TUBERCULOSIS (TB) Although many still believe it to be a problem of the past, pulmonary tuberculosis (TB) is on the rise. Most frequently seen as a pulmonary disease, TB can be extrapulmonary and affect organs and tissues other than the lungs. In the United States, incidence is higher among the homeless, drug-addicted, and impoverished populations, as well as among immigrants from or visitors to countries in which TB is endemic. In addition, persons at highest risk include those who may have been exposed to the bacillus in the past and those who are debilitated or have lowered immunity because of chronic conditions such as AIDS, cancer, advanced age, and malnutrition. When the immune system weakens, dormant TB organisms can reactivate and multiply. When this latent infection develops into active disease, it is known as reactivation TB, which is often drug resistant. Multidrug-resistant tuberculosis (MDR-TB) is also on the rise, especially in large cities, in those previously treated with antitubercular drugs, or in those who failed to follow or complete a drug regimen. It can progress from diagnosis to death in as little as 4–6 weeks. MDR tuberculosis can be primary or secondary. Primary is caused by person-to-person transmission of a drug-resistant organism; secondary is usually the result of nonadherence to therapy or inappropriate treatment. CARE SETTING Most patients are treated as outpatients, but may be hospitalized for diagnostic evaluation/initiation of therapy, adverse drug reactions, or severe illness/debilitation. RELATED CONCERNS Extended care Pneumonia: microbial Psychosocial aspects of care Patient Assessment Database Data depend on stage of disease and degree of involvement. ACTIVITY/REST May report: Generalized weakness and fatigue Shortness of breath with exertion Difficulty sleeping, with evening or night fever, chills, and/or sweats Nightmares May exhibit: Tachycardia, tachypnea/dyspnea on exertion Muscle wasting, pain, and stiffness (advanced stages) EGO INTEGRITY May report: Recent/long-standing stress factors Financial concerns, poverty Feelings of helplessness/hopelessness Cultural/ethnic populations: Native-American or recent immigrants from Central America, Southeast Asia, Indian subcontinent May exhibit: Denial (especially during early stages) Anxiety, apprehension, irritability FOOD/FLUID May report: Loss of appetite Indigestion Weight loss May exhibit: Poor skin turgor, dry/flaky skin Muscle wasting/loss of subcutaneous fat PAIN/DISCOMFORT May report: Chest pain aggravated by recurrent cough
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May exhibit: Guarding of affected area Distraction behaviors, restlessness RESPIRATION May report: Cough, productive or nonproductive Shortness of breath History of tuberculosis/exposure to infected individual May exhibit: Increased respiratory rate (extensive disease or fibrosis of the lung parenchyma and pleura) Asymmetry in respiratory excursion (pleural effusion) Dullness to percussion and decreased fremitus (pleural fluid or pleural thickening) Breath sounds diminished/absent
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