Evidence-based practice involves the use of literature in identifying the recent treatment
strategies that are used in the treatment of the said disease. Treatment for diseases are
continuously sorted and the later treatment strategy is normally better compared to the latter.
The treatment stages that are developed at a later stage are always an improvement of the
ones that were being used currently. Multidrug-resistant tuberculosis (MDR-TB) is the type
of TB that is resistant to the drugs that are normally used in the treatment of TB. The most
popular drugs that are used in the treatment of the TB include isoniazid and rifampicin. A
multi-drug resistant TB is referred to as the type of TB that is resistant to isoniazid and
rifampicin as well as other two powerful anti-TB drugs. In the current case study, Maria has
developed a multi-drug resistant TB that does not respond the medication that she is given.
The pathophysiology of Mycobacterium tuberculosis
Mycobacterium tuberculosis is airborne meaning that a healthy individual may be infected by
the bacteria by inhaling contaminated air. The infectious droplets settle in in the airways after
being inhaled. Majority of the bacilli are trapped within the mucus that lines the airways. The
mucus traps foreign objects within the airways then they are moved out of the airways by
cilia then taken out of the body as sputum. The mucus, therefore, provides the initial defense
mechanism that prevents the body from the infectious agents that get into the body through
the airways. The Mycobacterium tuberculosis trapped in the droplets then bypass the
mucociliary system then get into the alveoli where the alveolar macrophages engulf them.
The complement system also plays a role in the phagocytosis of the bacteria. The
complement protein C3 binds to the cell wall of the bacteria, which enhances the ability of
the macro-phages to identify the mycobacteria. The subsequent phagocytosis may lead to the
containment of the disease, or it may not depend on the strength of the immune system. The
Mycobacterium tuberculosis defeats the host defense systems in the immunocompromised
individuals. The mycobacteria continue to multiply slowly even after being engulfed by the
macrophages. The macrophages then secrete enzymes and cytokines in an attempt to
eliminate the mycobacteria. T lymphocytes to the site by the released cytokines. The next
defensive step is the formation of granulomas around the M tuberculosis organisms is the
next line of defense. For people with intact cell-mediated immunity, granulomas will
combine with the T lymphocytes and macrophages to create an environment that will limit
the growth of the bacteria. In the immunocompromised individuals, the granuloma will be
formed but will be unsuccessful in the elimination of the bacteria.
There are various stages of TB, namely latency, primary disease, primary progressive disease,
and extra pulmonary disease. Each stage of the disease has its clinical manifestations. In the
early infection, the infection generally proceeds with no signs and symptoms. The patients
may have various signs and symptoms that include fever, paratracheal lymphadenopathy, or
dyspnea. In the early primary progressive stage, the patient may feel inflation in the tissues;
the patients may also have non-specified signs and symptoms such as weight loss, fatigue,
and fever. The patient also develops a nonproductive cough. It is difficult to diagnose TBB at
the early primary progressive stage. At the late primary progressive stage, the cough
becomes productive; there are more signs and symptoms as the disease progresses. The
patient may also experience progressive rales, anemia, and weight loss. The diagnosis can be
done through sputum culture. In the latent tuberculosis stage, the mycobacteria persist in the
body, and the signs and symptoms are clearly shown. In both latent and active TB it is
important to look at the following symptoms namely: Coughing that lasts three or more
weeks, coughing up blood, chest pain, or pain with breathing or coughing, unintentional
weight loss, fatigue, fever, night sweats, chills and loss of appetite.
Primary medical concerns of the patients
Most cases of latent tuberculosis occur in immunocompromised individuals; hence, it is
important to assess what is causing immuno-compromisation in the patients. The other
diagnoses will have to be done so that the problems will be dealt with together for once. The
tuberculosis is also multidrug resistant meaning that the patient will have to be placed in a
more stringent and serious medical program that may take a year as a way of treating the
disease failure to which the condition may worsen, and the patient may die. As it is, there is
no need to take chances, and she may have to be quarantined as a way of protecting her
children and the general population from the disease.
Psychosocial concerns in the treatment of tuberculosis
The patient may be quarantined as a way of protecting other people from the disease. Patient
isolation is also important because it makes it enables the doctor to ensure that the patient is
adhering to all the medications that have been prescribed. Prolonged hospitalization leads to
a significant psychosocial burden for the MDR-TB patient, according to Ribón, (2018). Maria
is used to her kids; hence isolating her will have a toll on her hence affecting them
Implications of the treatment regimen and the likelihood of compliance with the
Tuberculosis is treatable if the patients are treated with effective uninterrupted anti-
tuberculosis therapy. Adherence to treatment is important for the treatment of the disease,
controlling the spread of the infection as well as dealing with the drug resistance. The side
effects of the drug may make the patient not to comply with the medication. Management of
drug-resistant TB can be difficult and may necessitate the use of second-line
drugs and surgical resection. Management of such patients is very challenging; hence, it
should be carried out by the professionals that are experienced in the area and the context of
supportive public health infrastructure. Maria will have to go through resection of the lung
lesions as a treatment strategy. The surgery has to be done by a professional to ensure that
there are no complications afterward. In the use of medication, the patients may face some
instances of side effects. The treatment of tuberculosis comprises of medication whereas the
treatment of drug-resistant tuberculosis is much more complicated and may have great
implication on the life of the patient including the side effects and the other complications
(Huai et al., 2019).
The role of the community clinic in assisting patients in covering the cost of TB
Healthcare in the United States of America is funded by healthcare insurance sponsored by
the government. The government of the United States sponsors the healthcare of TB patients
through community clinics. The community clinics, therefore, receive funding then they give
the healthcare to the people in the society. The community health centers also provide data to
the government so that the latter can comfortably cover healthcare in the country. The
government will therefore understand that a given disease requires more attention compared
to the other. The resource for the treatment of Tuberculosis in the United States of America
includes training literature that teaches the people on what they are supposed to do in case
they are infected with the bacteria or what they are supposed to do to prevent the cases of
infection. The other resource is the presence of the drugs and the professionals that will help
in the treatment of the patients in the United States of America. The cost of subsidized
treatment is significantly lower than the cost of unsubsidized treatment because in the former
the government takes some of the costs that are incurred by the patients hence leaving them
with a lighter financial burden.
What are the implications of TB for critical care and advanced practice nurses?
Advanced practice nurses have a critical role in supporting patients in TB treatment process.
The roles of the advanced practice nurse is to make sure that there are no interruptions in
treatment, the side effects of the drugs are easily identified and monitor the improvement of
the patients even though the process is gradual. The advanced practice nurse are highly
trained in the provision of care and that enables them to protect themselves better as they
take good care of the patients. They are provided with the correct gear that they use to protect
themselves from the disease since it is airborne. TB is prevalent in many areas in the United
States of America. The advanced practice nurses have a role to play to ensure that the patients
are well taken care of. TB makes some of the nurses to have the passion for taking care of the
The recent treatment techniques that are used in the treatment of TB
Huai et al. (2019) note that TB is one of the most prevalent infections in the world. The
study conducted by Grobbelaar et al. (2019) shows the improvements that have been made
with regards to treating the people using rifampicin since the time it was improved in the year
1965. The drug derives its value from the fact that it sterilizes and can shorten treatment.
Rifampicin has been tested both invitro and invivo respectively, and it has been proven to be
one of the most important drugs that is used in the treatment of Tuberculosis. According to
Grobbelaar et al., (2019), there are studies that are being carried to assess whether the higher
doses of the drug could shorten the time that is used in the treatment of TB. The study notes
that currently, a high dose of the drug are used in the treatment of high risk patients.
Li et al. (2019) conducted a study where they noted the possibility of Biapenem in the
treatment of Mycobacterium tuberculosis. They concluded that the drug could become a
better option in the clinical treatment of MDR tuberculosis. Li et al. (2019) assessed the
susceptibility of Mycobacterium tuberculosis to Biapenem. The experiment was conducted
using mice as specimens. More tests may lead to the approval of the drug as one of the
options for the treatment of MDR tuberculosis. MDR-TB requires a new drug since the
bacteria has proved to be resistant to the drugs that have been approved for the treatment of
the disease. Maria had the signs and symptoms of latent tuberculosis.
Carlsson, M., Johansson, S., Eale, R. B., & Kaboru, B. B. (2014). Nurses’ Roles and
Experiences with Enhancing Adherence to Tuberculosis Treatment among Patients in
Burundi: A Qualitative Study. Tuberculosis Research and Treatment, 2014, 1-9.
Grobbelaar, M., Louw, G. E., Sampson, S. L., Van Helden, P. D., Donald, P. R., &
Warren, R. M. (2019). Evolution of rifampicin treatment for tuberculosis. Infect
Genet Evol., 74. doi:10.1016/j.meegid.2019.103937
Heemskerk, D., Caws, M., Marais, B., & Farrar, J. (2015). Tuberculosis in Adults and
Children. Basingstoke, England: Springer.
Huai, C., Wei, Y., Li, M., Zhang, X., Wu, H., Qiu, X., Shen, L., Chen, L., Zhou, W.,
Zhang, N., Zhu, G., Zhang, Y., Zhang, Z., He, L., & Qin, S. (2019). Genome-Wide
Analysis of DNA Methylation and Anti-Tuberculosis Drug-Induced Liver Injury in
Han Chinese Population. Clinical Pharmacology & Therapeutics.