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International Council of Nurses TB GUIDELINES for Nurses in the Care and Control of Tuberculosis and Multi-Drug Resistant Tuberculosis 3Rd Edition

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International Council of Nurses TB GUIDELINES for Nurses in the Care and Control of Tuberculosis and Multi-Drug Resistant Tuberculosis 3Rd Edition International Council of Nurses TB GUIDELINES for Nurses in the Care and Control of Tuberculosis and Multi-drug Resistant Tuberculosis 3rd Edition All rights, including translation into other languages, reserved. No part of this publication may be reproduced in print, by photo static means or in any other manner, or stored in a retrieval system, or transmitted in any form without the express written permission of the International Council of Nurses. Short excerpts (under 300 words) may be reproduced without authorisation, on condition that the source is indicated. Copyright © 2015 by ICN - International Council of Nurses, 3, place Jean-Marteau, 1201 Geneva (Switzerland) ISBN: 978-92-95099-31-9 International Council of Nurses TB GUIDELINES for Nurses in the Care and Control of Tuberculosis and Multidrug-Resistant Tuberculosis 3rd Edition Table of Contents Preface........................................................................................................................ 1 Introduction ................................................................................................................ 2 Chapter 1: Tuberculosis: the Clinical Context ........................................................ 3 History of tuberculosis ................................................................................................. 3 Epidemiology of tuberculosis ....................................................................................... 4 Pathology..................................................................................................................... 6 Pulmonary TB .............................................................................................................. 7 Extrapulmonary TB ...................................................................................................... 8 Signs and symptoms of pulmonary and extrapulmonary TB ....................................... 8 Risk factors for TB ....................................................................................................... 9 Managing and preventing risks .................................................................................... 9 TB and HIV ................................................................................................................ 12 Isoniazid preventive therapy ...................................................................................... 14 Co-trimoxazole prophylaxis therapy ......................................................................... 14 TB and diabetes ........................................................................................................ 15 TB in children ............................................................................................................. 15 TB in women .............................................................................................................. 16 Drug-resistant tuberculosis ........................................................................................ 16 Chapter 2: Global Measures for Tuberculosis Control......................................... 21 The End TB Strategy (Post-2015 Global Tuberculosis Strategy) ............................... 21 The Stop TB strategy (2006 – 2015) ......................................................................... 23 The DOTS strategy (1995 – 2005) ............................................................................ 24 Chapter 3: Diagnosis of Tuberculosis ................................................................... 29 Screening tests for TB ............................................................................................... 29 Diagnosis of pulmonary TB........................................................................................ 30 Diagnosis of extrapulmonary TB ................................................................................ 32 Diagnosis of drug-resistant TB .................................................................................. 32 Diagnosis of TB in children ........................................................................................ 34 Contact investigation ................................................................................................. 35 TB Classification ........................................................................................................ 35 Chapter 4: Treatment of Tuberculosis ................................................................... 40 TB treatment: Essential drugs against TB ................................................................. 40 TB treatment regimens for children ........................................................................... 44 Treatment of MDR-TB ............................................................................................... 45 New drugs to treat drug-resistant TB ......................................................................... 49 Monitoring TB treatment ............................................................................................ 50 Treatment outcome definitions .................................................................................. 50 Medication adverse effects ........................................................................................ 52 Treatment Adherence ................................................................................................ 53 Chapter 5: Guidelines for Patient Care: Nursing Principles and Processes ...... 55 Role of Nurses in TB Care and Management ............................................................ 55 Patient-centred approach to TB control and care ...................................................... 56 DOTS strategy ........................................................................................................... 57 ii Patient-centred care and treatment adherence ......................................................... 60 Chapter 6: Organisational and Workforce Issues ................................................. 63 Organisational issues ................................................................................................ 63 Workforce issues ....................................................................................................... 63 Infection prevention and control ................................................................................. 64 Maintaining a healthy workforce ................................................................................ 66 Social mobilisation and advocacy .............................................................................. 70 DOT treatment support .............................................................................................. 72 Conclusion ................................................................................................................. 73 ANNEXES ................................................................................................................. 74 Annex 1: Algorithm for Screening for TB among Adults and Adolescents ................ 75 Annex 2: TB Symptom Screening Tool Sample ........................................................ 76 Annex 3: Algorithm for Diagnosing TB in Children .................................................... 77 Annex 4: TB Drugs used for MDR-TB in Five Groups .............................................. 78 Annex 5: Adverse Effects, Suspected Agents and Management Strategies in MDR-TB Treatment ............................................................................... 80 Annex 6: Factors Affecting Adherence ..................................................................... 90 References ............................................................................................................... 91 iii List of Tables Table 1.1: Differences between latent TB infection and TB disease ............................ 7 Table 1.2: Signs and symptoms of TB ......................................................................... 9 Table 1.3: Causes of inadequate anti-tuberculosis treatment .................................... 18 Table 2.1 The WHO End TB strategy indicators and selected targets ....................... 23 Table 3.1: TB Diagnostic tests and procedures ......................................................... 32 Table 3.2: Definitions of TB case classifications ........................................................ 38 Table 4.1: Essential first-line anti-TB drugs and recommended doses ...................... 40 Table 4.2: Fixed-dose combination of first-line drugs ................................................ 41 Table 4.3: Recommended treatment regimens for new and presumed TB patients .. 42 Table 4.4: TB treatment regimens for previously treated patients based on availability of access to DST ..................................................................... 44 Table 4.5: Recommended treatment regimens for new paediatric patients in HIV endemic settings ....................................................................................... 45 Table 4.6: Recommended doses according to weight for children ............................ 45 Table 4.7: Conventional groups of second-line anti-tuberculosis agents used to treat MDR-TB............................................................................................ 47 Table 4.8. Updated anti-TB medications for the treatment of RR-TB and MDR-TB ... 48 Table 4.9: Monitoring of TB treatment by smear microscopy for new pulmonary TB patients ..............................................................................................
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