In the late 1980s, the global tuberculosis epidemic made a comeback, and tuberculosis once again became a serious public health problem and a worldwide concern. Therefore, proper health education and management of patients is crucial.
The following is a brief discussion of health education for patients in terms of the transmission route of tuberculosis, diet, oral medication, psychological factors, sputum supervision and sterilization and isolation.
I. Infectious route of tuberculosis
The main infectious agent of tuberculosis is a patient with bacillary tuberculosis (Mycobacterium tuberculosis is detected in the sputum). That is, patients with active tuberculosis at the peak of infection unknowingly spread the tuberculosis bacteria to the surrounding population, increasing the incidence.
Coughing is the main transmission route for spreading TB. When coughing, sneezing or spitting on the ground, droplets and sputum with TB bacilli are sprayed out and inhaled by susceptible people to cause disease.
Therefore, patients should be educated not to spit anywhere, cover their mouth and nose lightly when coughing or sneezing, and develop good hygienic living habits.
II. Dietary and behavioral guidance
Tuberculosis is a chronic wasting disease, so we must pay attention to nutrition, not only to maintain the nutrition needed for normal life, but also to make up for the needs of disease consumption and repair of damaged tissues. There are no other contraindications except for the combination of other diseases such as hypertension, hyperlipidemia and diabetes.
The nutrients needed by human body, such as protein, carbohydrate, fat, vitamins, minerals, etc., are all needed by TB patients. In particular, protein can improve the body’s resistance to disease and has the effect of proliferation and cell repair. It is advisable to eat more fish, lean meat, eggs, milk, soy products and other high-protein foods.
Diet should pay attention to.
(1) Tuberculosis patients should reduce spicy, overly salty and stimulating foods to reduce respiratory tract stimulation and prevent induced coughing.
(2) Patients with high fever in tuberculosis should be encouraged to drink more water and given a high-calorie semi-fluid or liquid diet.
(3) Patients with tuberculosis combined with pleurisy should be given a high-protein, high-calorie diet.
(4) Patients with tuberculosis combined with hemoptysis should pay attention to the temperature of drinking water and diet should not be too high.
Rest should be noted.
(1) Rest is one of the methods of treating tuberculosis. Before the introduction of anti-tuberculosis drugs, many patients with tuberculosis were cured of tuberculosis by getting sufficient rest.
(2) Rest reduces physical exertion, slows down blood circulation, eases breathing, and reduces pulmonary activity, which helps prolong the time of drug retention in the lesion site to facilitate the repair of focal tissues and promote disease cure.
(3) The degree of rest depends on the condition. In the case of acute progression, obvious symptoms of poisoning or combined hemoptysis, absolute bed rest should be taken; when the condition is light and the symptoms are few, attention should also be paid to rest.
(4) General principle: regular rest, moderate activity, not excessive activity.
Behavioral life should pay attention to.
(1) During the period of bed rest, it is not advisable to read the newspaper too much to reduce brain consumption; after the symptoms are reduced, you can get up and move around appropriately; after the symptoms disappear and the condition improves significantly, you can do indoor activities and take a walk appropriately, gradually and not too fast.
(2) Pay attention to weather changes in outdoor activities and keep warm in winter to prevent colds.
(3) Always open the windows of the living room for ventilation and change underwear regularly. The patient’s bedding and other items should be exposed to the sun.
(4) Do not go to crowded, crowded, dusty and exhausted public places to prevent irritation of the respiratory tract and aggravate symptoms or cause respiratory complications.
(5) TB patients are strictly prohibited from smoking. Smoke entering the lungs can directly cause lung damage, inhibit lung defense functions, and can lead to respiratory infections. Smoke can inhibit alveolar bactericidal ability, inhibit phagocyte protein synthesis, affect the role of macrophages, so that macrophages to reduce the phagocytosis of tuberculosis bacteria, affecting the cure of tuberculosis, so that the course of the disease is delayed.
(6) Avoid drinking alcohol. Alcohol can aggravate the drug damage to the liver, dilate blood vessels, and may induce hemoptysis.
(7) Coughing and sneezing should be covered with a handkerchief or hand over the nose and mouth, and do not sleep with infants and children side by side.
(8) Pay attention to the hygiene of tableware and disinfect it frequently. It is best to implement a meal sharing system, dedicated to each person.
Third, treatment and medication guidance
1, according to medical advice to adhere to the full course of treatment (generally need 9 months) regular medication. When to stop the drug should be determined by the doctor according to the condition, chest X-ray, sputum bacteria examination results.
2. Except pyrazinamide, which is taken orally three times a day, all other drugs should be taken once a day; rifampicin is best taken in the early morning on an empty stomach, while rifapentine should be taken after meals, usually twice a week.
3.The age of patients treated with quinolone should be above 18 years old.
4.Patients with tracheobronchial tuberculosis should be actively treated with tracheoscopic intervention.
5.It is normal to have orange-colored urine after taking rifampicin. If nausea, vomiting, loss of appetite, discomfort in liver area, tinnitus, heavy hearing, perioral numbness, abnormal vision, etc. occur, the doctor should be informed promptly.
6, the side effects of anti-tuberculosis drugs: kanamycin, streptomycin, capreomycin, etc. have certain toxicity to hearing, vestibular function and kidney; isoniazid, rifampin, prothiocin, pyrazinamide, para-aminosalicylic acid, etc. have certain toxicity to the liver; pyrazinamide can cause arthralgia; ethambutol can cause visual impairment; rifampin can also appear when using larger doses of intermittent method, flu syndrome, purple scar, abdominal pain and Asthma and other immune reactions.
7. Most of the side effects of anti-tuberculosis drugs are safe and have little effect on the body when used under the guidance of a doctor. However, there are individual cases that are more serious, so you should work closely with your doctor, reflect the situation in a timely manner, and deal with the side effects in a timely and effective manner according to your doctor’s opinion to ensure that the treatment is completed and the cure is achieved. Do not stop the drug or change the dosage at will.
8.Tuberculosis chemotherapy principles: “early, combination, appropriate amount, regular, the whole”.
Education of isolation knowledge
Do not visit each other’s wards during the period when the patient’s symptoms are not controlled, and try not to go out to public places. Tell patients that tuberculosis is respiratory transmitted, open windows and doors for ventilation 2~3 times a day for 30 min each time to keep indoor air fresh. Patients should be told not to spit, and bedding should be frequently exposed to the sun because TB bacilli can be killed by sunlight for 2 to 4 hours.
Patients with positive sputum for tuberculosis should be equipped with special utensils and disinfected regularly. Patients should be allowed to live alone, and those who are not in a position to do so should be separated from each other and forbidden to share a bed, and children under 15 years of age and elderly people over 70 years of age should live in separate rooms with patients.
As far as possible, patients should not share meals with family members. The patient’s caregiver should wear a mask, and the mask needs to be soaked and disinfected daily, and regular chest x-ray examinations should be performed. Promptly seek medical attention if the patient develops afternoon hypothermia, peripheral weakness, chest tightness, cough, loss of appetite, night sweats, and wasting.
Educate the patient about the importance of sputum for this disease. First, instruct them to properly retain sputum specimens, which should be retained in the morning after waking up by rinsing the mouth and then breathing deeply and coughing hard to cough up the sputum deep in the airway without mixing saliva, mouthwash, etc.
When sputum is sticky and not easy to cough out, hold a hollow fist in your hand and pat your back from the bottom up and from the outside in or give drugs such as chymotrypsin, mucosolvan, and amiloride for nebulized inhalation.
As a patient, more knowledge and good hygiene habits to reduce social transmission will play a positive role in controlling the tuberculosis epidemic, reducing the infection rate and improving the overall health of the nation.
V. Psychological guidance
With the progress of modern medicine and the continuous introduction of effective drugs, tuberculosis is a completely curable disease, and the era of the so-called “nine deaths from ten consumptions” and “incurable diseases” has long since disappeared, so we should abandon the stereotypes and cooperate with medical personnel to accept modern chemotherapy methods. Establish confidence in the cure.
It is important to overcome all difficulties, adhere to regular medication and complete the full course of treatment. Do not listen to social rumors and look for “partial prescriptions or experimental prescriptions”, which may cause a delay in treatment.
Tuberculosis is a contagious disease, after suffering from tuberculosis, colleagues around often adopt an avoidant attitude, coupled with the long duration of the disease, the long course of treatment, easy to relapse, resulting in patients lonely pessimism and suspicious sensitive psychology, nurses should promptly understand the patient’s psychological state, help patients understand the occurrence of tuberculosis, development, treatment prognosis and how to cooperate in all aspects, the correct understanding of the disease, treat the disease, eliminate adverse psychological reactions, release The nurse should help the patient understand the occurrence, development, treatment prognosis and how to cooperate in the process of TB treatment.
We also tell patients that prolonged psychological stress will affect the immunity of the body and is not conducive to the recovery of the disease. With the development of medical science and the continuous improvement of the medical level, as long as the treatment is in accordance with the medical prescriptions, it can definitely be cured.
At the same time, patients who have recovered from the disease can be taught by themselves. Tuberculosis can be cured in the first attack, and more than 90% of patients with relapse can be controlled.
Education on first aid
Tell the patient to take a semi-recumbent position immediately if there is difficulty in breathing and chest tightness, and to inhale oxygen immediately when there is oxygen at the bedside. When hemoptysis, take the head low and foot high position, cough out the accumulated blood as gently as possible, do not hold your breath to keep the airway open, and immediately call the medical personnel with the bedside pager. Instruct the patient to keep the stool unobstructed. For patients with spontaneous pneumothorax, hemoptysis and heart disease, force is prohibited during stooling to avoid hemoptysis or sudden cardiac death, etc.