Introduction

Chapter 1. Theoretical foundations of tuberculosis

1 General characteristics of tuberculosis

2. Clinical classification of tuberculosis

3 Current trends in the spread of tuberculosis in Russia

Chapter 2. Measures to prevent tuberculosis

1 Social orientation of tuberculosis prevention

2 Specific prevention of tuberculosis

3 Chemoprophylaxis and examination

4 Anti-epidemic measures to improve tuberculosis foci

Conclusion

Introduction

Relevance of the research topic. Tuberculosis is still one of the most common and dangerous diseases in the world. According to the World Health Organization, at the end of 2008, more than 12 million cases of tuberculosis were reported worldwide.

Over three million of them died. Russia's contribution to world statistics is 75 percent of tuberculosis cases. And this is a country that has a powerful TB service, in which victory over the insidious disease was almost officially declared. There is a real tuberculosis epidemic going on in Russia. Moreover, the infection increasingly began to manifest itself in such severe forms as polycavernous lesions of the lungs, damage to the intestines, larynx and other internal organs. In other words, these are forms of infection that have not been registered in Russia for 30 years.

The revival of tuberculosis at the end of the 20th century as a widespread disease causing heavy damage to humanity requires the combined efforts of everyone, not just doctors. This is the only way to do something.

The problem of eliminating this disease can be solved with the help of tuberculosis prevention, aimed at freeing the younger generation from the pathogen through vaccinations, complete cure of patients, and also stimulation of biological recovery of previously infected adults. The immediate and main goal of national health programs in many countries around the world is the prevention of tuberculosis, which is the main way to reduce the prevalence of this disease by interrupting the process of transmission of the pathogen from sick people to healthy people.

Preventive measures available to the entire population should be recognized as specific methods: vaccination and revaccination with the BCG vaccine in newborns, at 7 years, 14 years and every 7 years until the age of 30, and chemoprophylaxis of “threatened groups”: from contact foci of tuberculosis, “viral” , "hyperergics". Chemoprophylaxis is prescribed with drugs from the GINK group (isoniazid 10 mg/kg body weight or ftivazid 30 mg/kg if isoniazid is contraindicated) for 3 months of daily use with vitamin B6 to prevent side effects of the drugs.

In addition to specific means of preventing tuberculosis, one should remember about non-specific prevention; rational nutrition is of primary importance for preventing tuberculosis.

Anti-tuberculosis care is provided to the population by all treatment and preventive institutions of the general medical network, anti-tuberculosis dispensaries, sanatoriums, hospitals, departments and offices, and centers of the state sanitary and epidemiological surveillance service.

The object of the study is tuberculosis as one of the most common and dangerous diseases in the world.

The subject of the study is measures to prevent tuberculosis.

The purpose of the study is to study the problem of tuberculosis prevention.

In connection with the purpose of the study, the following problems were put forward and solved:

Give a general description of tuberculosis,

Consider the clinical classification of tuberculosis,

To characterize current trends in the spread of tuberculosis in Russia,

Study measures to prevent tuberculosis.

The structure of the work includes an introduction, two chapters, a conclusion and a list of references.

Chapter 1. Theoretical foundations of tuberculosis

1 General characteristics of tuberculosis

Tuberculosis is the most common infection in the world. Every year, more than 20 million people fall ill with tuberculosis and about 4 million die. In Russia, 350 thousand patients with tuberculosis are registered, and, probably, even more are not known to the anti-tuberculosis service, since “socially defective” groups of the population (homeless people, illegal migrants, alcoholics, drug addicts, etc.) are practically inaccessible to timely detection of tuberculosis.

Since the nineties of the 20th century, the epidemiological situation regarding tuberculosis in our country has sharply worsened due to economic and environmental problems, migration processes and the impoverishment of a significant part of the population. Tuberculosis today is becoming a national disaster, reaching epidemic proportions in a number of territories. Late detection of tuberculosis in sick people, insufficient isolation of patients from healthy people, poor nutrition and a decrease in the effectiveness of treatment due to the emergence of drug resistance of the pathogen led to an unprecedented prevalence of infection among the population (90-100%); Infection and morbidity among children increased sharply.

Late detection of tuberculosis is associated with the characteristics of its clinical manifestations. Tuberculosis does not have a “personality of its own” and occurs under the “masks” of various diseases, while the well-being of patients hardly suffers. The toxins of the causative agent of tuberculosis, acting on the central nervous system of the patient, cause some excitement - euphoria, and therefore the patient’s well-being usually does not reflect the disease process: a patient with tuberculosis does not consider himself sick. Most often, tuberculosis, especially its uncomplicated forms, is detected during routine examinations: in adults - fluorographically, in children - during X-ray examination after tuberculin diagnostics.

Mycobacterium tuberculosis was discovered 100 years ago by R. Koch. Subsequently, it turned out that a person becomes infected with two of its species - human and bovine, which cause similar diseases. The bovine type pathogen infects dairy cattle, and infection usually occurs through consumption of milk from a sick cow. Strict veterinary supervision contributed to the disappearance of forms of the disease caused by this type of pathogen.

Every third inhabitant of the Earth carries a tuberculosis bacillus. No single infection kills as many people as tuberculosis. In Russia, over the last decade, tuberculosis has become an epidemic, which is associated with economic cataclysms in the country. Of course, the highest incidence of tuberculosis is observed among prisoners, homeless people, drug addicts, prostitutes, and migrants, but now quite prosperous sections of the population become infected and fall ill with tuberculosis. First of all, people who are forced to communicate with tuberculosis patients suffer - medical workers, shelter employees, prison staff, church workers and, of course, family members who have constant contact with tuberculosis patients.

The causative agents of tuberculosis are very variable and quickly become resistant to drugs; they are difficult not only to destroy with drugs, but also to detect. Tuberculosis affects not only people, but also animals, which can be a source of infection. The tuberculosis bacillus is most often transmitted by airborne droplets. Not only cough and sputum are dangerous, but also dust. In humid places without access to the sun, the causative agent of tuberculosis lives for months. Rarely, tuberculosis is acquired through food (milk or meat), water (if water bodies are contaminated with wastewater from tuberculosis hospitals or farms with sick livestock), or in utero. Sometimes tuberculosis becomes infected through wounds on the skin of people who autopsy corpses or cut up meat carcasses.

The morphological manifestation of tuberculosis is a tuberculous tubercle (granuloma). It has now been proven that granuloma is the body’s reaction to the introduction of an infection (antigen-antibody). When the antigen predominates in the tubercle, necrosis develops, and when antibodies predominate, a benign productive reaction develops. Depending on the reactivity of the body, the tubercles can be of a different nature, from exudative to necrotic - caseous. In addition to specific ones, in tuberculosis there are various paraspecific reactions, clinically manifested by different “masks” of tuberculosis depending on their predominant location in a particular organ.

Infection with tuberculosis is very often observed in childhood and adolescence. Not everyone infected with tuberculosis will get sick. The occurrence of tuberculosis depends on the weakening of the body, living conditions, nutrition, smoking, alcoholism and other harmful factors. If a person is healthy, lives in a normal home, eats well, his immune system copes with tuberculosis bacilli.

2 Clinical classification of tuberculosis

The clinical classification of tuberculosis used in our country was adopted in 1938 and revised several times taking into account scientific achievements and practical requirements: it identifies the main clinical forms of tuberculosis, characteristics of the tuberculosis process (localization and extent, bacterial excretion phase), complications and residual changes after tuberculosis.

A. Main clinical forms

Tuberculosis intoxication in children and adolescents

Respiratory tuberculosis

Primary tuberculosis complex

Tuberculosis of intrathoracic lymph nodes

Disseminated pulmonary tuberculosis

Focal pulmonary tuberculosis

Infiltrative pulmonary tuberculosis

Pulmonary tuberculoma

Cavernous pulmonary tuberculosis

Fibrous-cavernous pulmonary tuberculosis

Cirrhotic pulmonary tuberculosis

Tuberculous pleurisy (including pleural empyema)

Tuberculosis of the bronchi, trachea, larynx, upper respiratory tract

Respiratory tuberculosis combined with dust occupational lung diseases (coniotuberculosis)

Tuberculosis of other organs and systems

Tuberculosis of the meninges and central nervous system

Tuberculosis of the intestines, peritoneum and mesenteric lymph nodes

Tuberculosis of bones and joints

Tuberculosis of the urinary and genital organs

Lupus

Tuberculosis of peripheral lymph nodes

Tuberculosis of the eye

Tuberculosis of other organs

B. Characteristics of the tuberculosis process.

Localization and extent (in the lungs by lobes and segments).

a) infiltration, decay, contamination;

Bacterial excretion:

a) with the isolation of Mycobacterium tuberculosis (BK+);

b) without isolating Mycobacterium tuberculosis (BK-)

B. Complications: hemoptysis and pulmonary hemorrhage, spontaneous pneumothorax, pulmonary heart failure, pulmonary atelectasis, amyloidosis, renal failure, fistulas (bronchial, thoracic, etc.).

D. Residual changes after cured tuberculosis

Residual changes in the respiratory organs: fibrous, fibrous-focal, bullous changes, calcifications in the lungs and lymph nodes, pleuropneumosclerosis, cirrhosis of the lungs, bronchiectasis, condition after surgery, etc.

Residual changes in other organs: scar changes and their consequences, calcification, condition after surgical interventions.

Based on the requirements of medical statistics, the clinical classification of tuberculosis is brought into line with the International Classification of Diseases. In addition to the clinical classification of tuberculosis used to formulate a diagnosis, there is also a dispensary grouping of tuberculosis patients, which meets the practical goals of dispensary work.

3 Current trends in the spread of tuberculosis in Russia

Currently, there is an increase in the incidence of tuberculosis and mortality from it, especially in Eastern European countries, including Russia. The increase in incidence is due to a large reservoir of infection and untimely identification of bacillary patients disseminating tuberculosis infection. Endogenous reactivation is also of great importance, especially in risk groups. Late detection of advanced forms, acutely progressive processes, especially those caused by drug-resistant mycobacteria, are the cause of high mortality. A program of modern, controlled chemotherapy of shortened duration is of paramount importance to stop the spread of tuberculosis infection and reduce mortality from tuberculosis.

Over the past decades, major changes have occurred in the epidemiology of tuberculosis, which are reflected in changes in statistical indicators of the prevalence of tuberculosis.
The epidemiology of tuberculosis has a number of features due to both the infectious and social nature of the disease.
The results of the fight against tuberculosis are associated not only with the use of effective treatment methods, but also with the organization of anti-tuberculosis work among the population. The most characteristic feature of anti-tuberculosis measures is their mass nature, carried out among large groups of the population.

Epidemiological surveillance of tuberculosis in WHO is carried out from 3 positions:

systematic accumulation of data from epidemiological studies;

regular synthesis and evaluation of the data obtained;

rapid dissemination of epidemiological assessment results among specialists.

The main epidemiological indicators of the prevalence of tuberculosis are:

• infection rate - the number of persons reacting positively to intradermal injection of tuberculin;
• morbidity - the number of cases of tuberculosis during a calendar year;
• prevalence (morbidity) - the number of known patients with active tuberculosis who are registered,
• mortality - the number of deaths from tuberculosis during a calendar year.

Epidemiological indicators are calculated per 10 or 100 thousand population. This makes it possible to compare the prevalence of tuberculosis in different countries or different regions of the same country.
The most objective and reliable criteria for the epidemiological situation regarding tuberculosis are morbidity and mortality.
In international practice, among patients with tuberculosis, it is customary to distinguish patients in whom mycobacteria were found in sputum or other material (by microscopy, culture on nutrient media, culture on liquid enriched nutrient media, Baktek, PCR, etc.), as well as a group of abacillary patients.
The morbidity indicator (patient populations) is in the most direct connection with morbidity, completeness of detection, as well as the accuracy of the work of anti-tuberculosis institutions in registering those sick and deregistering those who have recovered from tuberculosis. The reliability of epidemiological indicators depends on the quality of the organization of medical statistics.
The most essential information for any infectious disease is information about the size of the reservoir of infection, characteristic trends and ways of its dispersion.

The main reservoir of tuberculosis infection consists of patients with pulmonary tuberculosis, who secrete Mycobacterium tuberculosis in large quantities, which can be relatively easily detected in sputum by direct microscopy. The vast majority of patients who secrete mycobacteria and pose an epidemiological danger have a destructive tuberculosis process in the lungs.

Patients who constitute the reservoir of infection can be divided into two main groups: those newly identified during the current year and those identified earlier with chronic forms of tuberculosis.

In recent years, there has been an increase in the incidence of tuberculosis among people in contact with tuberculosis patients who secrete Mycobacterium tuberculosis. When examining persons who are in contact with patients with epidemiologically dangerous forms of tuberculosis, tuberculosis disease is often detected, the occurrence of which can be associated with re-infection. Superinfection often occurs when mycobacteria that are resistant to anti-tuberculosis drugs enter the respiratory tract, causing so-called drug-resistant tuberculosis. The source of such infection are patients who have been ineffectively treated with chemotherapy.

In recent years, an increase in incidence and mortality from tuberculosis has been noted throughout the world. This trend is most pronounced in the countries of Central and Eastern Europe, Russia, as well as in countries that were formerly part of the USSR. In Russia, the tuberculosis incidence rate in 2008 reached 67 cases per 100 thousand population. This increase in the incidence of tuberculosis is primarily associated with a large reservoir of tuberculosis infection, which maintains a high level of infection, as well as endemic outbreaks of secondary tuberculosis due to superinfection.

Due to the still frequent detection of advanced and acutely progressive forms of tuberculosis, the mortality rate has increased, the level of which reached 17.5 cases per 100 thousand population in 2008. The increase in mortality from tuberculosis indicates the insufficient effectiveness of treatment (primarily chemotherapy), as well as the frequent late detection of patients with incurable forms of the disease.

focus of tuberculosis chemoprophylaxis examination

Chapter 2. Measures to prevent tuberculosis

1 Social orientation of tuberculosis prevention

Prevention of tuberculosis has a social orientation, which consists in carrying out measures of an economic and sanitary nature on a state scale. Such events include:

· improving the living conditions of the population;

· optimization of working conditions, prevention of occupational lung diseases;

· improvement of the environment, including the fight against pollution of atmospheric air, water bodies, soil, landscaping, compliance with sanitary requirements of industrial hygiene;

· improving the quality of nutrition;

· fight against alcoholism, drug addiction, substance abuse, smoking;

· development of physical culture and sports, cultivation of a healthy lifestyle;

· expansion of the network of children's health and health resort institutions;

· carrying out social and sanitary-veterinary measures in places of industrial production of animals and birds.

It is important for tuberculosis patients, the state and the employer to know and remember:

1. Every patient with tuberculosis has the right to a separate living space
2. right to sick leave for 10-12 months
3. all tuberculosis patients had the right to vacation only in the summer
4. all patients with tuberculosis at work have the right to free dietary meals
5. every sick person who has recovered from illness and his relatives have the right to free sanatorium treatment for 2-3 months

Sanitary propaganda: the authorities should deal with it - printed leaflets about the disease in public places, etc., television, radio.

Thus, social prevention of tuberculosis is only now acquiring civilized forms. This is due to the fact that only relatively recently the attention of persons belonging to the social risk group for tuberculosis was drawn, which, as we have already said, includes: children from socially disadvantaged families, street children, orphans and children left behind. without parental care. It is important that social prevention of childhood tuberculosis can only be effective by reducing the number of socially maladjusted children, and this is possible by increasing the standard of living of the entire society.

2 Specific prevention of tuberculosis

The main goal of specific prevention of tuberculosis (vaccinations against tuberculosis) is the development of specific individual and collective immunity in children and adults under 30 years of age. Vaccination and revaccination are carried out with the BCG vaccine. It is a live dried culture of a weakened strain of Mycobacterium tuberculosis that has lost its virulence, but has retained its immunogenicity (i.e., the ability to stimulate the development of anti-tuberculosis immunity). The biological activity (immunogenicity) of the BCG vaccine is associated with the ability to take root in the body of those vaccinated, multiply at the site of vaccination and give a specific response, accompanied by an allergic restructuring of the body, which makes it possible to use it for the prevention of tuberculosis.

Vaccination is carried out on newborns on the 4-7th day of life. After a few years, in order to prevent tuberculosis, revaccination is carried out. In Russia, it is performed on clinically healthy children 7 years old (1st grade students), 12 years old (5th grade), adolescents 16-17 years old (10th grade), and then every 5-7 years until 30 years old age in the presence of appropriate indications (contact with a patient with tuberculosis or absence of infection according to the results of a tuberculin test).

Prevention of tuberculosis involves selecting candidates for revaccination using the Mantoux test. Only those individuals who have a negative Mantoux test are revaccinated. Revaccination is contraindicated: persons infected with tuberculosis of any age, those who have had tuberculosis in the past, patients with all acute infectious diseases, skin and allergic diseases, including rheumatism, exudative diathesis, and epilepsy.

An analysis of a number of studies assessing the effectiveness of vaccinations against tuberculosis shows that BCG vaccination reduces the risk of developing the disease by 50%. Prevention of tuberculosis by vaccination is most effective in conditions of high risk of infection, which occurs in tropical countries. The higher the vaccination coverage, the lower the incidence of tuberculosis. Prevention of tuberculosis through vaccination leads to a decrease in infection rates, a sharp decrease in the incidence of tuberculous meningitis and mortality.

Vaccinations are carried out only in special rooms of clinics, outpatient clinics, health centers, medical units and anti-tuberculosis dispensaries (treatment rooms, vaccination rooms) on days that do not coincide with the Mantoux test and other preventive vaccinations.

The BCG vaccine is produced in ampoules containing 1 mg of BCG, which is 20 doses of 0.05 mg. The ampoule labels indicate the batch number, expiration date and the name of the manufacturing institute. The vaccine should be stored in a dark place at a temperature no higher than +8 "C (preferably in the refrigerator on a separate shelf). Its shelf life is 12 months from the date of release.

The vaccine is unsuitable for use if its expiration date has expired, the integrity of the ampoule is damaged, or the label is missing or incorrectly filled out. It is unusable if its dilution produces an unbreakable suspension or foreign impurities.

For vaccinations at any age, a single dose is used - 0.05 mg of BCG suspended in 0.1 ml of saline. The dry vaccine ampoule comes with an ampoule containing 2 ml of saline solution. The diluted vaccine must be used immediately or no later than 3 hours later, while maintaining the strictest sterility and protecting the solution from light. Unused vaccine should be destroyed.

More pronounced reactions with correct vaccination technique and correct selection for revaccination are rare. In these cases, it is necessary to consult a phthisiatrician who will conduct a full examination of the vaccinated person and decide on local treatment.

3 Chemoprophylaxis and examination

Chemoprophylaxis and mass fluorographic and allergological examinations play a special role in the prevention of tuberculosis.

Chemoprophylaxis is an effective method of preventing tuberculosis in individuals at increased risk of developing infection. Prevention of tuberculosis through chemoprophylaxis can be primary, when carried out in healthy individuals who are not infected with MTB, but who are in contact with patients with tuberculosis, and secondary - in people infected with MBT or who have been ill in the past.

Chemoprophylaxis is carried out with isoniazid at a dose of 10 mg per kg of weight, carried out in the spring-autumn period for a period of 2-3 months.

Prevention of tuberculosis through primary chemoprophylaxis not only reduces the incidence, but also the infection rate, suppressing tuberculosis infection in the incubation period; secondary prevention prevents exogenous superinfection and activation of endogenous tuberculosis infection.

Chemoprophylaxis is necessary:

· all healthy persons (children, adolescents, adults) who are in family, household and professional contact with bacteria-releasing agents;

· children and adolescents with a tuberculin test;

· children and adolescents infected with tuberculosis in whom the normal tuberculin reaction has turned hyperergic;

· persons with post-tuberculosis changes in the lungs who are receiving steroid hormones for another disease;

· patients with silicosis, diabetes mellitus, mental illness, drug addiction, alcoholism, gastric ulcer of the duodenum, chronic inflammatory diseases of the respiratory system in the presence of post-tuberculosis changes in the lungs, HIV-infected;

· adults with post-tuberculosis changes in the lungs and in the presence of hyperergic reactions.

For all of these categories of people, tuberculosis prevention through chemoprophylaxis is carried out in the spring-autumn period (March-April and September-October) or at other times of the year, depending on the “seasonality” of the manifestations of the infection and its relapses. A necessary condition is control over its implementation by a medical professional when drugs are given to patients for use at home.

Mass fluorographic examinations of the adult population are highly effective for the prevention of tuberculosis. An annual examination helps to identify people with tuberculosis in a timely manner. Fluorography in the system of tuberculosis prevention allows you to start treatment in the early stages of the disease, which is an important condition for its success. Depending on the specific conditions, material and technical equipment of health authorities in different countries, in order to prevent tuberculosis, either a complete or a random survey of the population is carried out. During a random survey, groups of people at high risk of infection and development of secondary tuberculosis should be monitored.

The process of diagnosing respiratory tuberculosis includes several stages. The first is the identification of persons with various lung diseases suspicious for tuberculosis. This stage occurs, as a rule, in clinics and hospitals of the general network.

For many years, the basis for detecting respiratory tuberculosis in adults was the x-ray method. Early detection of tuberculosis was carried out using fluorography, which was performed on all those who applied to clinics and were not examined by X-ray this year, as well as persons included in high-risk groups for tuberculosis (patients with diabetes, patients receiving corticosteroid drugs, radiation therapy, etc. .). Fluorography was also carried out annually mandatory contingents , subject to examination for tuberculosis (employees of children's and municipal institutions, catering establishments, grocery stores, public transport, etc.). Mass fluorographic examinations of adolescents and adults, carried out once every 2 years, covered the majority of the population and made it possible to identify patients with respiratory tuberculosis at relatively early stages of its development. Using the fluorographic research method, patients were identified and selected mainly with limited local processes in the form of focal tuberculosis, limited infiltrates, disseminations and tuberculomas. Clinical manifestations of diseases in such patients were mild or absent. Those examined with such forms of the disease often did not feel sick and remained able to work. In the process of further examination, first of all, radiography of the respiratory organs was performed to clarify the changes identified during fluorography.

In recent years, preventive fluorographic studies of the population have been significantly reduced, which has led to a very significant decrease in the number of identified tuberculosis patients. Under the current conditions, identifying patients with respiratory tuberculosis among those who sought medical help has acquired particular importance.

The primary task remains to identify patients with bacillary tuberculosis of the respiratory system, since such patients, as a rule, have a progressive tuberculosis process, and they pose a great epidemiological danger to others. Cure of identified bacillary patients has both clinical and epidemiological significance, since it allows not only to prevent death from the progression of tuberculosis, but also to stop the spread of mycobacteria, to avoid the development of a chronic process with constant or periodic release of mycobacteria. Due to the reduction in fluorographic studies, the role of correct assessment of the patient’s clinical symptoms and microscopic examination of sputum for Mycobacterium tuberculosis is increasing. Diagnosis of bacillary tuberculosis should be carried out primarily in patients with manifestations of inflammatory intoxication who produce sputum.

All research methods for diagnosing tuberculosis can be divided into 3 groups: mandatory diagnostic minimum (MDM), additional research methods of a non-invasive (DMI-1) and invasive (DMI-2) nature, and, finally, optional methods.

ODM includes the study of anamnesis, complaints, clinical symptoms, physical examination, x-ray of the chest organs in frontal and lateral projections, microscopy and sputum culture to detect Mycobacterium tuberculosis, Mantoux test with 2 TU, clinical blood and urine tests.

DMI-1 includes tomography and zonography of the lungs and mediastinum, including computed tomography, ultrasound examination for pleurisy and subpleurally located round formations; repeated examination of sputum and bronchial washings for Mycobacterium tuberculosis using flotation and polymerase chain reaction methods; determination of drug sensitivity of mycobacteria; sputum culture for nonspecific microflora and fungi; in-depth tuberculin diagnostics.

DMI-2 include bronchoscopy with biopsy and bronchoalveolar lavage; puncture of the pleural cavity and pleurobiopsy; transthoracic lung biopsy; thoracoscopy, mediastinoscopy and, finally, open lung biopsy with subsequent cytological, histological and microbiological studies of the obtained material.

Optional methods are very numerous and are aimed not so much at diagnosing tuberculosis, but at determining the functional state of various internal organs and metabolic processes. These are studies of blood glucose levels, liver function, cardiovascular system, external respiration function, blood gas composition, pulmonary blood flow, etc.

Anti-epidemic measures to improve the health of tuberculosis foci are important for the prevention of tuberculosis<#"justify">1.Foci with a high degree of epidemiological danger (burdened foci), where patients live with massive bacterial excretion or meager excretion of MBT, but in the presence of children, adolescents and pregnant women in the outbreak.

2.Epidemiologically less dangerous foci in which patients with scanty secretion of MBT live, there are no children, adolescents and pregnant women; This also includes pockets of “conditional” bacterial excretors, even in the presence of children and adolescents in their environment.

.“Safe” foci of tuberculosis infection, formed by “conditional” bacterial excretors in the absence of children, adolescents, and other aggravating factors. This group also includes private farms in rural areas where livestock with tuberculosis have been identified.

Persons at increased risk of developing tuberculosis include healthy persons with radiological signs of cured tuberculosis and persons recovering from tuberculosis.

Additional risk factors for these patients are alcoholism, drug addiction, and social factors (low income, vagrancy, poor living conditions). In recent years, people whose immediate relatives have had or are sick with tuberculosis have been classified as a risk group. These groups of people should be covered by preventive measures (periodic medical examinations, chemoprophylaxis).

Clinical observation of risk groups includes:

1. obtaining accurate information about people at risk
2. periodic medical examinations
3. recreational activities, rational employment, sanatorium-climatic treatment
4. treatment of acute and chronic diseases of internal organs
5. carrying out specific (preventive) chemoprophylaxis with tubazid (0.45 - 0.6 g per day) or tubazid and ethambutol or pyrazinamide, or PAS. Duration - 3-6 months. The drugs are used daily, once a day.

According to WHO, under the influence of chemoprophylaxis, the incidence of tuberculosis decreased by 70% within 2 years.

Much attention must be paid to preventive measures in foci of tuberculosis infection, taking into account the nature of contact, the degree of infectiousness of the patient, and the susceptibility of contacts to tuberculosis.

Preventive measures are carried out in all outbreaks, but first of all in the most dangerous ones.

Prevention of tuberculosis in tuberculosis foci includes:

· hospitalization of patients with tuberculosis and especially obvious MBT excretors immediately after diagnosis;

· carrying out final and subsequently ongoing disinfection;

· systematic, long-term examination of persons in contact with patients;

· vaccination, revaccination and isolation of contact persons for the period of development of immunity;

· chemoprophylaxis for contact persons;

· training in sanitary and hygienic skills for the patient and surrounding people;

· improving the living conditions of the patient’s family.

Along with anti-epidemic and preventive measures in outbreaks at the place of residence of patients, the prevention of tuberculosis in production conditions is essential in the fight against tuberculosis.

Conclusion

At the end of the twentieth century, after a long period of relative prosperity, the incidence of tuberculosis increased significantly, and acutely progressive forms of it appeared, reminiscent of transient consumption . This trend is observed both in Russia and in many economically developed countries of Eastern and Western Europe, and the USA and indicates the low effectiveness of anti-tuberculosis measures. In the course of their daily work, doctors often lose their alertness to tuberculosis, mistakenly consider it a rare disease and do not use diagnostic methods aimed at identifying tuberculosis even in patients with characteristic clinical manifestations.

Based on the work done, we can conclude that prevention at all stages of the fight against tuberculosis was one of the main anti-tuberculosis measures. Depending on the object of preventive measures and the scale, they can be divided into 3 large groups:

Activities carried out among the entire population (vaccination and revaccination with BCG, sanitary measures to protect the most endangered populations from infection and superinfection).

Activities carried out in population groups with an increased risk of developing tuberculosis (registration, clinical observation, health improvement, chemoprophylaxis).

Measures taken in outbreaks of infection (remediation of the outbreak, disinfection, isolation of the patient, monitoring of contacts).

If the first principle of the fight against tuberculosis in our country is its state nature, then the second can be called treatment and prophylactic, the third principle is the organization of anti-tuberculosis work by specialized institutions, the broad participation of all health care facilities in this work.

The comprehensive plan to combat tuberculosis includes the following sections: strengthening the material and technical base, incl. equipping healthcare facilities, providing the necessary personnel and improving their qualifications, carrying out measures aimed at reducing the reservoir of tuberculosis infection and preventing its spread among the healthy population, identifying patients and treating them.

It must be remembered that tuberculosis is controlled, i.e. controllable, infectious diseases and the implementation of clear and timely measures to prevent tuberculosis can achieve a significant reduction in the prevalence of this dangerous disease.

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On April 25, 2018, in the conference hall of the St. Petersburg state budgetary healthcare institution “Interdistrict Petrograd-Primorsky Anti-TB Dispensary No. 3” (hereinafter referred to as St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3) the Interdistrict Conference “The Role of the Nurse in the Prevention and Treatment of Tuberculosis” (hereinafter referred to as – Conference). The conference was organized by the Professional Regional Public Organization “Medical Workers of St. Petersburg” together with the St. Petersburg State Budgetary Institution of Healthcare of the Moscow Region No. 3. The purpose of the Conference is the exchange of modern scientific information and generalization of existing theoretical and practical experience in the field of prevention and treatment of tuberculosis, as well as joint discussion of key problems , trends, achievements and future prospects in the “Phthisiology” profile. The conference was attended by heads of nursing services, paramedics, laboratory assistants, nurses from the anti-tuberculosis service and the general medical network of the region. The total number of conference participants was 75 people. Before the start of the conference, the President of the Professional Regional Public Organization “Medical Workers of St. Petersburg”, Associate Professor of the Department of Geriatrics, Propaedeutics and Nursing Management of the North-Western State Medical University named after A. I.I. Mechnikova, Ph.D. G.M. Podoprigora and the chief physician of the St. Petersburg State Budgetary Institution of Public Health Institution No. 3 V.V. Kozlov. The report “Results of the medical activities of the St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3 for 2017” was presented by the Deputy Chief Physician for outpatient medical care of the St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3 D.Yu. Alekseev. Dmitry Yuryevich informed about the clinical structure of primary tuberculosis patients in the Petrograd and Primorsky districts in 2017. In the Petrograd region, infiltrative tuberculosis was 37.1%, disseminated - 29.6%, focal - 3.7%, tuberculosis of the intrathoracic lymph nodes - 25.9%, miliary tuberculosis - 3.7%. In the Primorsky district, infiltrative tuberculosis amounted to 54.9%, disseminated tuberculosis - 18.6%, focal - 13.7%, tuberculosis of the intrathoracic lymph nodes - 8.8%, miliary tuberculosis - 4.0%. The speaker spoke about the proportion of newly diagnosed patients who were not examined by fluorography for more than two years. In the Petrograd region in 2017, 54.5% of people were regularly examined, and 45.5% were not examined for more than two years. In the Primorsky district in 2017, 55.6% of people were regularly examined, and 44.4% were not examined for more than two years. The speaker spoke about the social composition of primary tuberculosis patients in 2017: working citizens made up 33.9%, non-working citizens - 46.0%, pensioners - 13.7%, disabled people - 3.2%, students - 3.2%. The speaker emphasized that tuberculosis requires long-term treatment associated with isolation, adherence to the regime and many months of antibacterial therapy. A nurse needs knowledge of ethics, deontology, epidemiology; she must know the clinic and diagnosis of forms of tuberculosis, modern methods of treatment and types of prevention of tuberculosis. The chief nurse of the St. Petersburg State Budgetary Healthcare Institution V.N. made a report on the topic “The main performance indicators of nursing staff for 2017 in St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3.” Dovbash. Valentina Nikolaevna voiced the main sections of the Federal Law of June 18, 2001. No. 77 “On preventing the spread of tuberculosis in the Russian Federation” and the order of the Ministry of Health of the Russian Federation dated November 15, 2012. No. 932n “On approval of the procedure for providing medical care to patients with tuberculosis.” The speaker said that the main tasks of the St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3 are: planning and organizing the fight against tuberculosis in the service area; organization and implementation of preventive measures; identification of patients with tuberculosis, registration and accounting of all patients with tuberculosis, as well as all persons belonging to groups at increased risk of its development; implementation of dispensary observation of all contingents registered at the dispensary; organization of treatment of tuberculosis patients, including outpatient chemotherapy. The speaker emphasized that a nurse must have three types of qualifications: scientific - to understand the disease, cardiac - to understand the patient and technical - to care for the sick. A nurse should be distinguished by mercy and compassion, be a psychologist and teacher, teach patients generally accepted norms and rules of behavior, and set the patient up for a speedy recovery. “Epidemiological situation in the Petrograd and Primorsky regions. Organization of work in the outbreaks” - this topic was revealed in his speech by the epidemiologist of the St. Petersburg State Budgetary Institution of Healthcare of the MPPPTD No. 3 I.E. Plakhin. Ivan Evgenievich informed that the work of the TB service in an epidemic outbreak of tuberculosis infection includes: epidemiological examination of the outbreak, assessment of the risk of infection, development of an action plan; hospitalization, isolation of the patient within the outbreak and his treatment; isolation of children; organization of current and final disinfection; initial examination of contact persons, dynamic monitoring of contact persons; carrying out preventive treatment; training patients and contact persons in hygiene skills; determining the conditions for removing an outbreak from epidemiological registration; maintaining an epidemiological map reflecting the characteristics of the outbreak and the activities carried out in it. The speaker said that anti-epidemic measures in educational institutions include: determining the boundaries of the outbreak (can be extensive due to several buildings and buildings occupied by the institution); identification of contact persons; checking the results of fluorographic examination of employees and students for the previous and current year; carrying out final disinfection. Anti-epidemic measures in medical organizations include: a set of primary anti-epidemic measures; transfer of the patient to a tuberculosis hospital; determining the circle of contact employees and patients; transfer of contact data to the TB dispensary at the place of residence; organization of current and final disinfection. The speaker emphasized that the situation with tuberculosis is stable, there is a gradual decrease in incidence, prevalence and mortality. However, one of the most pressing threats is the rising incidence of drug resistance. It is necessary to coordinate the work of phthisiatric and somatic outpatient services for the early detection of tuberculosis. With a report on the topic “Organization of the work of a local nurse. Work in outbreaks with contact persons” was presented by the district nurse of department No. 2 T.A. Suderevskaya. Tatyana Aleksandrovna informed that during the appointment, the local nurse reports to the doctor about the work done, receives new tasks and appointments, and schedules priority visits to the site, taking into account joint visits to the source of tuberculosis infection with the TB specialist and epidemiologist. The dispensary specifically allocates time for systematic work with a card index compiled for all contingents of the serviced area. This is done to attract patients for the necessary follow-up examination, sanatorium, preventive and anti-relapse treatment. When working with a card index, patients and contacts who did not show up for examination and treatment within the time limits established for each group are identified. At strictly fixed hours, the district nurse works with the nurse in the children's department to clarify the composition of children and adolescents in the outbreaks and attract them to the dispensary. The nurse regulates the reception, calling to the doctor first of all patients with fever, complaints of pain, hemoptysis, shortness of breath or poor health, with a certificate of incapacity on their hands, and elderly patients. As prescribed by the doctor, the nurse fills out directions for tests, tuberculin tests, x-ray examinations, prepares prescriptions, writes certificates and directions. The speaker noted that the nurse requires a lot of tact and patience not only in conducting conversations, but also in instilling hygienic skills and rules of behavior in the patient. The patient secretes especially a lot of mycobacteria with tiny droplets of sputum when sneezing and coughing and less when talking. It is necessary that when sneezing and coughing, the patient turns his face away from nearby people, covers his nose and mouth with a handkerchief or the back of his left hand, since the right hand will remain clean when the patient greets with a handshake. The patient should wash his hands more often, change handkerchiefs more often, which are most infected. The speaker emphasized that the patient should not spit on the floor, on the ground, in the sink or in a handkerchief. The patient uses a disposable spittoon to collect sputum. The collection, disinfection and removal of sputum is carried out by the patient himself. The patient should have separate utensils and ensure that they are stored separately and not used by others. Clothes and bedding should be stored separately. A separate box or bag must be allocated for collecting dirty laundry. The patient should also have other items (books, notebooks, etc.) for individual use. The report “The role of the nurse in organizing specific prevention and treatment of tuberculosis” was presented by treatment nurse L.V. Guskova. Larisa Valentinovna said that people with a weakened immune system (with HIV, malnutrition, diabetes) are at a higher risk of contracting tuberculosis; having chronic obstructive pulmonary diseases; living in poor material and living conditions. The speaker noted that tuberculosis infection is relevant for people of any age. All people, starting from 15 years old, undergo fluorography at least once a year, according to regulatory documents. The speaker informed about measures to prevent tuberculosis: a healthy lifestyle (proper nutrition, regular physical activity, proper rest, quitting smoking, alcohol, drugs); compliance with personal hygiene rules (washing hands, washing dishes using detergents and running water, wet cleaning and ventilation of residential premises, mandatory heat treatment of meat and milk, use of personal hygiene products and utensils); mandatory BCG vaccination at birth and revaccination at 7-14 years of age; timely diagnosis of tuberculosis and completion of the full course of treatment. The speaker emphasized that when the first signs of the disease appear, you cannot self-medicate and you should consult a doctor as soon as possible. “Training of vaccinators for medical institutions in the Petrograd and Primorsky districts. Technique for performing the Mantoux reaction (RM) and Diaskintest (DT)” – this topic was discussed in her report by the district nurse of department No. 1 E.V. Malova. Elena Vladimirovna said that, based on the results of immunodiagnostics, for further examination in order to exclude tuberculosis, within six days from the moment the Mantoux test is performed, children are sent for consultation with a phthisiatrician: with a newly detected positive reaction to tuberculin (papule 5 mm or more), not related to the previous one immunization against tuberculosis; with a long-lasting (four years) reaction to tuberculin (with an infiltrate of 12 mm or more); with an increase in the reaction by less than 6 mm, but with the formation of an infiltrate measuring 12 mm. and more; with a hyperergic reaction to tuberculin – infiltrate 17 mm. and more, with vesicular-necrotic reactions; with questionable or positive reactions to recombinant tuberculosis allergen (ATR). The speaker informed about contraindications to intradermal tests: skin diseases; acute, chronic infectious and somatic diseases during exacerbation; allergic diseases during exacerbation; quarantine for childhood infections in children's institutions (until quarantine is lifted); individual intolerance to tuberculin or ATP. The speaker talked about the assessment of the Mantoux test: negative – in the complete absence of infiltration or the presence of a prick reaction of up to 1 mm; doubtful – with an infiltrate of 2-4 mm. or only hyperemia of any size without infiltration; positive – with an infiltrate of 5 mm. and more; weakly positive – with an infiltrate size of 5-9 mm. in diameter; medium intensity – infiltrate size – 10-14 mm; pronounced intensity – 15-16 mm. in diameter; hyperergic – with an infiltrate of 17 mm. or more in children and adolescents and 20 mm. and more in adults. The speaker noted the main medical advantages of the drug Diaskintest: it allows you to clearly differentiate different types of allergic reactions (post-vaccination, infectious and nonspecific, caused by non-tuberculous mycobacteria); has high sensitivity and specificity with a minimal frequency of excessively strong reactions; does not cause the immune reaction associated with BCG vaccination; the test is simple to perform (identical to the Mantoux test technique). At the end of the event, the chief physician of the St. Petersburg State Budgetary Healthcare Institution MPPPTD No. 3 V.V. Kozlov acquainted the Conference participants with the order of the institution on organizational events dedicated to the International Nurses Day. Authors I.A. LEVINA, President of the Union of Medical Professional Organizations, Chief Freelance Specialist in Nursing Management of the Ministry of Health of the Russian Federation in the Ural Federal District and the Ministry of Health of the Sverdlovsk Region, Director of the Sverdlovsk Regional Medical College, G.M. PODOPRIGORA, Ph.D. honey. Sciences, President of the Professional Regional Public Organization "Medical Workers of St. Petersburg", Associate Professor of the Department of Geriatrics, Propaedeutics and Management in Nursing, North-Western State Medical University. I.I. Mechnikova, A.V. AVERIN, manager of the Union of Medical Professional Organizations

The role of a nurse in the process of treating a patient is difficult to overestimate; this person knows all the nuances of the course of the disease, spends the most time with the patient and controls the progress of many medical procedures. Let's consider what the nursing process for tuberculosis is, what its features and stages are.

Tuberculosis is an infectious disease that affects organs and tissues of the body. Koch's bacillus can enter the ENT organs through the upper respiratory tract, mucous membranes and damaged skin. And thus cause tuberculosis of the nose, larynx, ear or pharynx. But most often in medical practice pulmonary tuberculosis occurs. This disease is characterized by respiratory disorders, coughing, and destruction of lung tissue.

The complex of actions of medical personnel directly depends on the form, stage of the disease, group of patients and the individual nature of the pathology.

The nurse has the role of mediator between the patient and the attending physician; she must provide moral support, explain the principles and monitor the implementation of treatment.

First of all, we highlight the main stages of the nursing process:

• Nursing examination. Collection of information about the patient, complaints, registration of personal data. At this stage, the nurse establishes psychological contact with the patient.
• Identifying patient needs.
• Drawing up a patient care plan. In each case, the care process will be individual, as the needs of patients may differ.
• Direct implementation of care.
• Evaluating your actions.

The nursing process can occur in both inpatient and outpatient settings.

Necessary knowledge and skills of a nurse

The work of a nurse involves great responsibility, so the level of professionalism and competence must be high. To carry out the process of nursing care for tuberculosis, you must have a number of knowledge and be able to apply them in practice. Among the main ones are the following knowledge:

• Factors that contribute to the occurrence of the disease.
• Ways to prevent the disease.
• Symptoms of the disease.
• Types of pathology.
• Manifestation of complications.
• Duties of a nurse.

In addition to knowledge, you need to be able to carry out all the necessary manipulations and care for a patient with tuberculosis.

The nurse must be able to:

• Conduct patient needs assessment.
• Plan your work correctly.
• Provide emergency first aid.
• Prepare the patient for diagnostic and therapeutic procedures.
• Carry out vaccination and revaccination.
• Carry out anti-epidemic actions in the ward, ensuring the safety of both patients and medical staff.
• Carry out all nursing procedures.
• Carry out medication therapy (as directed by your doctor).

The process and outcome of patient treatment depends on the performance of all the duties of a nurse. Therefore, the work of nursing staff should be based on a responsible approach, competence and humanity.

Actions of a nurse when diagnosing an illness

Already at the diagnostic stage, the nursing process begins. The nurse is actively involved in work during research. To make a diagnosis, as a rule, the doctor prescribes a Mantoux test, X-ray examination, culture and microscopic analysis of pathological mucus from the lungs, PCR. At this stage, the nurse must accompany the patient to procedures, take tests, send them and assist the doctor in every possible way.

In order to take a sputum sample for research, the nurse does:

• Preparing the spittoon.
• Explains how to properly collect sputum, since this is done exclusively for involuntary coughing.
• Informs about the need for personal hygiene both before and after collecting secretions from the lungs.
• Directly collects sputum.
• Writes a referral and sends the analysis to the laboratory.

During the diagnosis, the nurse explains the essence and significance of the procedures, the purpose for which they are carried out, answers all the patient’s questions, monitors the examination process and provides moral support, if necessary.

Treatment in a hospital setting

In a hospital setting, the nurse is responsible for the safety of the patient and the medical staff, because there are patients with an open form of the disease, so the function of monitoring all procedures is a priority.

In the nursing process for pulmonary tuberculosis, nursing staff carries out:

1. Distribution of medications. In addition, the nurse monitors their intake and explains how certain medications work.
2. Monitoring compliance with instructions regarding the patient’s diet and rules of stay in a medical institution. Depending on the form and stage of the disease, each patient’s stay in the hospital may differ.
3. Monitoring compliance with hygiene rules. To do this, the nurse must explain the rules for using spittoons and focus on performing daily hygienic actions, since the health of both the patient and surrounding staff and patients depends on this.
4. Performing manipulations. The nurse puts in IVs, gives injections to the patient, applies bandages, and performs gastric and intestinal lavage. General nursing care is also the direct responsibility of the employee. The main rule when performing manipulations and other contact with patients with open tuberculosis is the use of a respirator, gloves and other protective equipment.
5. Ensuring a safe epidemic situation in the ward. The nurse monitors the disinfection of the room, thermally or chemically disinfects the spittoons. Ensures that junior medical staff disinfects the issued utensils and bed linen. Mycobacterium tuberculosis may be present in urine and excrement, so they are also disinfected. Regarding pillows, blankets and mattresses, they are processed in disinfection chambers.
6. Informing the doctor about any changes in the patient’s condition for the worse. The nurse should be attentive to patient complaints, since depending on them, the doctor may adjust treatment regimens.

The nurse's performance of each of the functions described plays a critical role in the therapeutic process. She bears great responsibility for the patient's health.

Actions for complications of tuberculosis

If side effects appear (itching, vomiting, chest pain, fever, rash, weakness, sweating), the nurse should promptly report them to the doctor. Particular attention should be paid to the patient's well-being after taking medications, since some medications can provoke pulmonary hemorrhage.

This is one of the main phenomena that the nurse must promptly record. First of all, the patient turns pale, then blood appears from the mouth and nasal passages, in foamy form.

It is also important to monitor:

• The patient’s cough, its character and duration.
• The appearance of hemoptysis.
• The release or absence of viscous pathological mucus.
• An increase in the patient's temperature.
• The appearance of wheezing.

In the case of hemoptysis, nursing staff are obliged first of all to inform the doctor about the occurrence of complications, inform the patient about the process of hemoptysis, about possible negative manifestations, about the necessary actions in this case, about the need to temporarily exclude hot food from the diet.

If complications or a critical condition of the patient are recorded, the nurse must act in a coordinated manner to help the patient as quickly as possible.

Treatment at home

The nursing process for tuberculosis depends on the group of patients with whom the district nurse works. For each of them, a set of actions is selected separately. Among the groups of patients registered with a phthisiatrician are:

1. Zero group. This includes patients whose diagnosis is still unknown. When there is only an assumption that a person has tuberculosis or it is necessary to clarify the activity of pathological changes. The nurse, when working with this group, must promptly involve patients in examinations in the conditions of an anti-tuberculosis dispensary.
2. Patients with active forms of the disease. They are divided into 2 additional categories: patients in whom the disease manifested itself for the first time, and those in whom tuberculosis relapsed. This group of patients needs to be especially closely monitored and monitored for compliance with all doctor’s prescriptions at home. If pulmonary hemorrhage occurs, the nurse should provide first aid and report this to the doctor.


3. Patients with a chronic form of the disease. They may experience an exacerbation of the disease, so patients in this group should be regularly involved in examinations and follow all doctor’s recommendations. The nurse should monitor this closely.
4. Patients who have recovered from tuberculosis. For them, it is recommended to improve their health in sanatoriums.
5. The last group includes people who are in direct contact with tuberculosis patients. They should be observed while the risk of infection remains high and for another 2 years after contact has ceased.

The nurse should familiarize patients of all groups with preventive measures. First of all, this means regular examination, elimination of bad habits and a balanced diet. It should inform the population about the symptoms of the disease and the need to see a doctor if they are detected.

Caring for a sick child

It should be noted that children who suffer from tuberculosis have additional difficulties. Due to their age, not all children can independently perform all hygiene procedures correctly; their risk of adverse reactions is higher compared to adults. In addition, many children are afraid to undergo certain procedures and stay in hospital settings. Thus, the child’s psychological load increases significantly, so the nurse is also assigned the function of moral and psychological support.

In the hospital, children stay in specialized children's departments, all relatives and visitors are strictly controlled, and nursing staff register them as a risk group. Children who need the care and presence of an adult stay in a medical facility with one of the parents or a guardian.

The duties of a nurse in a children's department (except for general ones) include:

• Take a sick child for walks every day; on average, they should last 2–5 hours a day.
• Conducting preventive conversations about the negative impact of bad habits (for teenagers).
• Monitoring your child's sleep patterns.

If treatment occurs at home, the role of the paramedic is to inform parents about the standards of care for a sick child.

In general, the nursing process for tuberculosis is based on the correct work and individual responsibility of nursing staff.

Characteristics of the main methods and areas of tuberculosis prevention and the role of the nurse in this process. Skills and knowledge that a nurse should have: injection technique, conducting tuberculin tests, providing first aid.
Brief summary of the material:

Posted on

Almaty Medical College

Center for Continuing Graduate Education

Student of the retraining cycle “General Nursing Technologies”

Topic: The role of the nurse in the fight against tuberculosis

Completed by: Kamzina G. G.

Checked by: Ababkova M.A.

Almaty 2011

1. Introduction

2. Prevention

3. Types of prevention:

3.1 Social prevention

3.2 Specific prevention

3.3 Sanitary prevention

4. Preventive work includes several areas

6. Conclusion

7.Source

1. Introduction

Currently, tuberculosis represents one of the most serious threats to health care on a global scale and is a global emergency. To solve it, it is necessary to unite the efforts of healthcare, the state, and society, to direct enormous funds to the fight against tuberculosis, paying special attention to preventive work. The nurse must have knowledge in the field of epidemiology and prevention, clinic and treatment of tuberculosis, organization of timely detection, vaccination and outpatient chemotherapy. The nurse must be able to maintain documentation, master the technique of subcutaneous, intramuscular, and intravenous injections, be able to conduct tuberculin tests, and provide first-aid care, for example, in case of pulmonary hemorrhage.

The nurse provides very valuable assistance to the doctor in organizing the reception of patients: before the appointment begins, she selects the relevant medical histories, selects radiographs for them, and pastes up the test results after the doctor has reviewed them. She regulates the appointment, calling to the doctor first of all patients with fever, complaints of pain, hemoptysis, shortness of breath or poor health, with sick leave in hand, the weak and elderly, who have come for a consultation from afar. As directed by the doctor, she fills out referrals and certificates, prescriptions, statistical accounting forms and other documentation. In the treatment room, she checks the regularity of visits to assigned patients, identifies those who have separated and identifies the causes of the separation, and, if necessary, calls these patients to the doctor; works with the control file, notes the dates of arrival and re-arranges the patient’s appearance, enters diagnoses, registration group, data on inpatient, sanatorium and outpatient treatment, changes in the work activity of patients, their place of residence, identifies persons who did not appear at the dispensary within the control period; works with the district nurse’s card (registration form 93), enters the date of visit to the outbreak, notes its sanitary condition, the patient’s behavior, implementation of the outbreak’s recovery plan, and the content of the conversation. The district nurse works together with the nurse of the children's department to identify children in contact with tuberculosis patients. She assists the medical statistician in collecting material for the preparation of the annual report.

2. Prevention

Prevention of this socially significant disease is a very important and responsible part of the work of nursing staff.

The main task of the anti-tuberculosis institution is the prevention, treatment and rehabilitation of patients with tuberculosis. However, the priority is to reduce the incidence rate. In this regard, the prevention of tuberculosis, aimed at the early identification of people infected with the tuberculosis bacillus and their adequate treatment, as well as at preventing the disease, reducing the risk of transmission of infection from a sick person to a healthy one, is of great importance.

Prevention is the fight against the disease and prevention of infection with tuberculosis.

Organization of tuberculosis prevention is one of the main sections of anti-tuberculosis work.

3. Types of prevention

1. social

2. specific

3. sanitary

3.1 Social prevention

The totality of improvements in the health of the population:

Labor legislation

Protection of motherhood and childhood

Housing construction and improvement of populated areas

Improving material living conditions

Improving general culture and introducing sanitary knowledge

Wide development of physical culture and sports

All this can reduce the incidence of tuberculosis

3.2 Specific prevention

Patient care and education at the dispensary

Observation groups at the dispensary

At-risk groups

Patient care and education at the dispensary

3.3 Sanitary prevention

Aimed at preventing tuberculosis infection in healthy people and organizing anti-tuberculosis measures. The main task of sanitary prevention is to limit and, if possible, make safe the contact of a patient with tuberculosis, primarily a bacteria excretor, with healthy people around him at home, at work, and in public places.

Preventive measures include:

Compliance with sanitary and hygienic standards;

Increased immunity;

Maintaining a healthy lifestyle.

Important sections of preventive work are:

Early detection of the disease; respiratory isolation;

Complete cure of tuberculosis patients, especially with the BC+ form (an open form in which the tuberculosis pathogen is released into the external environment when coughing, sneezing, or talking).

4. Preventative workincludes several directions

nurse prevention tuberculosis disease

First direction- the work of chief and senior nurses in training nursing staff. Heads of nursing services are taught to determine priorities in preventive work, conduct classes with patients, select topics, forms of such classes (lectures, conversations); acquaint nurses with new information that needs to be conveyed to the patient (new treatment methods, statistical data on the results of treatment, epidemiological situation in the city, region, country, world).

An important part of this work is the fight against prejudice and prejudice among mid-level medical personnel. Nurses should not be allowed to perceive all patients with tuberculosis as socially maladjusted people who use health services as an excuse to avoid work.

Improving the knowledge and skills of mid-level professionals increases the effectiveness of efforts aimed at combating tuberculosis.

Second direction- work with tuberculosis patients.

At first glance, it seems illogical to carry out preventive work with a person who is already sick. However, this activity is very important, and the more competently and responsibly one approaches this work, the more noticeable the results will be.

It is easier to fight a disease if the patient has complete information about it. In the treatment of tuberculosis, the patient’s position and his motivation for cure are very important, since for many patients the diagnosis of tuberculosis is associated with an incurable disease. Developing and strengthening motivation for recovery is one of the tasks of preventive work with the patient. A well-informed, educated patient becomes an ally of medical professionals, fulfilling all requirements and recommendations. Patients with low trust are difficult to persuade. You have to have conversations with them, sometimes multiple times, trying to find an approach using various methods of persuasion

Preventive work is carried out both in the dispensary, to which a patient with tuberculosis first turns, and in the department where he is hospitalized for treatment.

At the first visit to the dispensary, the district nurses of the outpatient department introduce the patient to precautionary measures in the family (the presence of separate dishes, individual bed linen, towels, a container for spitting and disinfecting sputum, mandatory disinfection and ventilation) and in public places (covering the mouth when coughing and sneezing, etc.). This work is carried out in the form of conversations with each patient and his relatives with whom he is in contact. The local nurse provides additional information when visiting the site of the disease (the place where the patient with tuberculosis lives).

In inpatient departments, such work is carried out by ward nurses. Usually, as patients are admitted to the hospital, groups of 3-4 people are formed, with whom classes are held in the form of lectures and conversations. Required topics include information about the disease; behavior of tuberculosis patients in hospital; medications for the treatment of tuberculosis, side effects; information when drinking...

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KOHTLA-JÄRVE MEDITSIINIKOOL

ÕE PÕHIKOOLITUS

TROFIMOVA JULIA

ÕE ROLL ELANIKKONNA TUBERKULOOSI HAIGESTUMISE PROFÜLAKTIKAS

Diplomitöö juhendaja:

KOHTLA - JÄRVE 2002

Õe roll elanikkonna tuberkuloosi haigestumise profülaktikas

Töö maht on 67 lehekülge, 15 graafikut ja 2 lisa.

Töös on kasutatud 16 erinevat kirjandusteost ja allkat: meditsiinialane kirjandus, õpikud ja artiklid ajakirjandusest.

Töö on kirjutatud vene keeles.

Võtmesõnad: tuberkuloos, informatsioon, röntgen, kopsud, mükobakterid, batsill, bakterid, profülaktika,

Uurimise objektikstiks oli 80 erinevat inimest:

· 20 õpilast üldhariduskoolist;

· 20 õmblusvabriku tõõtajat;

· 20 hoolduskodu elanikku;

· 20 prügila elanikku.

Uurimise metoodiks olid anketeerimine.

Uurimise tulemused on järgmused:

· kõige enam on tuberkuloosi olemusest informeritud asotsiaalide grupp;

· peaaegu täiesti puudub informeeritus üldhariduskooli õpilastel;

· õmblusvabriku töötajad ja hooldekodu elanikud on tuberkuloosist hästi informeeritud.

Uurimistöö järeldused on järgmised:

· õde peab koolis tutvustama tuberkuloosi haigestumise põhjusi ja vältimise võimalusi;

· õde peab perioodiliselt suunama õpilasi kopsude uuringutele ja informeerima riskigruppi;

· koolis pööratakse liiga vähe tähelepanu riskigruppidele.
CONTENT:

INTRODUCTION 4-5

1. THEORETICAL PART OF THE WORK

1.1. Historical information 6-7

1.2. Tuberculosis. Etiology 8-9

1.3. Classification 10-11

1.4. Clinic 12-19

2. RESEARCH PART OF THE WORK

2.1. Characteristics of objective research 20-23

2.2. Research result 24-30

2.3 Comparative analysis of results in 4 groups 31-42

3 CONCLUSIONS AND SUGGESTIONS 43-44

3.1 The role of the nurse in the prevention of tuberculosis among

population 44-51

CONCLUSION 52

USED ​​LITERATURE 53-54

APPENDIX 1 55-58

APPENDIX 2 59-66

APPENDIX 3 67-68
INTRODUCTION

Tuberculosis is one of the oldest diseases, known back to ancient Egypt. This is a life-threatening disease. Not so long ago, tuberculosis killed up to 3 million people every year. This is more than from malaria and tropical infections combined. The situation was aggravated by the fact that society did not know how to properly use the means at its disposal in the fight against that epidemic.

Recently, society has had the opportunity to free itself from the eternal fear of this disease. Since 1994, 5 very effective anti-tuberculosis drugs have been discovered. In Tazania, a new strategy was developed in 1977, showing that even poor countries could overcome the disease. WHO declared 1993 a dangerous year for tuberculosis and began mobilizing efforts against this epidemic.

In Narva in 1999, there were 25 tuberculosis patients and 2 relapses; in 2000, 35 patients and 6 relapses were registered; in 2001, this figure decreased slightly: 34 patients and 5 relapses. Over the past 3 years, there have been 5 cases of secondary outbreaks of tuberculosis, which led to tuberculosis of the kidney and knee joint. Tuberculosis patients are most often unemployed, social workers and alcoholics.

Tuberculosis is a social disease, the causes of which are: insufficient nutrition, chronic malnutrition, poor sanitary and hygienic working and living conditions, unhygienic overcrowded gray dwellings.

PURPOSE OF THE DIPLOMA THESIS

· Show the role of the sister in preventing tuberculosis among the population.

To achieve the goal, the following tasks must be completed:

1. Conduct an analysis of the literature on this disease.

2. Conduct a practical study in 4 groups.

3. Conduct a comparative analysis of the study results for 4 groups.

4. The role of the nurse in the prevention of tuberculosis among people at risk and suffering from tuberculosis.

1. THEORETICAL PART OF THE WORK

1.1. HISTORICAL INFORMATION

Tuberculosis was known in ancient times: it is mentioned in the code of laws of Hammurat (Babylonia 2000 BC), in the sacred books of the Hindus "Rivegra" (1500 BC), in the works of Homer.

Pathomorphological changes of a tuberculous nature were discovered during archaeological excavations in the bone remains of Stone Age people and mummies of Egypt. Doctors of antiquity described a certain symptom complex of tuberculosis, characterized by the presence of a severe cough with the release of macrophages, frequent hemoptysis and fever, which led to the rapid exhaustion of the patient. This is where the names “consumption” (from the word “waste away”) and “phthisis” came from, which means “exhaustion” or “destruction” in translation from Greek (phthitisis).

At that time, the idea of ​​​​the contagiousness of tuberculosis and a hereditary predisposition to it had already arisen. To prevent the spread of the disease in Persia, tuberculosis patients were isolated along with leprosy patients, and in India, marriages with tuberculosis patients and their relatives were prohibited.

The first description of the disease, which we call tuberculosis, can be found in the writings of Hippocrates (460-377 BC). Hippocrates outlined the symptoms of the disease, characterized its course and proposed some therapeutic methods and remedies.

The ideas of Hippocrates, and later of the ancient Roman physician Galen, were the basis for the further development of ideas about tuberculosis.

The Italian scientist Frocastro spoke about the contagiousness of tuberculosis in 1546.

A more detailed description of the clinical and pathological changes in tuberculosis was made by the French scientist Laennec (1781 - 1826); He was the first to introduce the term tuberculosis.

In 1882, Koch isolated the tuberculosis bacillus from the macrota of a patient and on March 24 of the same year, in a report to the Physiological Society in Berlin, presented convincing data on his discovery of the causative agent of tuberculosis.

1.2. ETIOLOGY

Mycobacterium tuberculosis is very resistant to various environmental factors. Cold, even very low temperatures, do not change their biological properties. At the boiling point of water and direct sunlight, they quickly die. In liquid, sputum and in a dried state, mycobacteria remain viable. Over the course of several months and if it enters a person, they can cause illness.

The main reservoir and source of tuberculosis infection are people and cattle, less often cats, dogs and wild animals. Mycobacterium tuberculosis can be found in reservoirs and rivers if insufficiently disinfected wastewater from tuberculosis hospitals and sanatoriums gets into them. Water consumed from such reservoirs, even for economic purposes, significantly increases the infection rate and incidence of tuberculosis in the population.

The source of tuberculosis infection is mainly a person with tuberculosis and the excretion of tubercle bacilli in the sputum; When coughing, macrota splashes and settles on various objects. The viability of the microbe when dried, especially in dimly lit places, remains for a long time. Infection with tuberculosis occurs through inhalation of tiny dust particles or macroscopic spray suspended in the air. Another source of infection is food containing tuberculosis microbacteria, dishes infected with them, as well as common household items (the patient’s handkerchiefs, as well as his bed linen, etc.). With insufficient veterinary supervision, the consumption of milk from cows with tuberculosis is of significant epidemiological significance. Other methods of infection are rare. Science denies the hereditary transmission of tuberculosis. Intrauterine infection of the fetus of a mother with tuberculosis is extremely rare; As a rule, children of even sick parents are born healthy.

1.3. CLASSIFICATION

Respiratory tuberculosis:

· Focal pulmonary tuberculosis

· Tuberculosis of intrathoracic lymph nodes

· Pulmonary tuberculoma

Tuberculosis intoxication

Infiltrative pulmonary tuberculosis

Cavernous pulmonary tuberculosis

Pulmonary tuberculosis fibrous-cavernous

· Cirrhotic pulmonary tuberculosis

· Tuberculosis of the upper respiratory tract, trochea, bronchi.

Respiratory tuberculosis combined with dust occupational lung diseases.

Tuberculosis of the lymph nodes:

Tuberculosis of peripheral lymph nodes

· Tuberculosis of mesenteric lymph nodes

Osteoarticular tuberculosis:

Shoulder joint

· Elbow joint

· Hip joint

Knee joint

Brain tuberculosis

Tuberculosis of the eye

Tuberculosis of the larynx

Tuberculosis of the ureter and genital organs

Adrenal tuberculosis

Intestinal tuberculosis

Lupus

1.4. CLINIC

· Primary tuberculosis.

Primary tuberculosis develops after contact of mycoorganisms with Mycobacterium tuberculosis. This is mainly pulmonary tuberculosis.

· Secondary tuberculosis.

Secondary tuberculosis, i.e. Tuberculosis disease in persons who have had primary tuberculosis in the past can occur both edogenically and as a result of repeated (exogenous) infection of the body.

Respiratory tuberculosis:

Focal pulmonary tuberculosis

It is characterized by limited distribution of lesions in the form of foci of no more than one cm in diameter. It occurs in the form of fresh focal lesions and long-standing firous-focal processes. Focal pulmonary tuberculosis often does not cause disturbances in the patient’s well-being, and therefore patients with this form of tuberculosis are usually identified using a fluorographic examination.

Tuberculosis of intrathoracic lymph nodes

Tuberculosis of the intrathoracic lymph nodes is a particular form of primary tuberculosis. The affected lymph nodes increase from slight hyperplasia (minor form) to significant hyperplasia, clearly visible on radiographs.

Pulmonary tuberculoma

It is an isolated encapsulated casual focus with a diameter of more than 1 cm. It arises from the infiltrate, when it regresses against the background of anti-tuberculosis therapy, or from the focus as a result of multiple perifocal inflammatory reactions.

Tuberculosis intoxication

Tuberculosis intoxication is a complex of functional disorders that arise during the period of the tuberculin reaction, i.e. at the first registration of a positive tuberculin reaction.

Infiltrative pulmonary tuberculosis

It is an area of ​​specific inflammation with a diameter of more than 1 cm, consisting of a focus of caseosis with perifocal inflammation of a predominantly exudative nature.

The infiltrate can occupy a lobe of the lung, a subsegment, or a lobe. When the infiltrate disintegrates, occurring in the form of caseous pneumonia, the process can spread to the entire lobe and move to another lung. Infiltrative tuberculosis can occur asymptomatically and is recognized by radiographic examination.

Pulmonary tuberculosis fibrous-cavernous

It is formed from cavernous, infiltrative and disseminated forms of the tuberculosis process with a progressive course of the disease. The cavity acquires a wide fibrous wall; pronounced fibrous changes and foci of bronchogenic contamination appear around the cavity. The lesion occupies a significant area of ​​the lung, can be unilateral or bilateral with the presence of one or several cavities.

Cirrhotic pulmonary tuberculosis

It is characterized by the growth of connective tissue in the lungs as a result of the involution of fibro-cavernous, infiltrative and other forms of intrathoracic tuberculosis. Tuberculous changes that persist among fibrous tissue, represented by foci, calcified lymph nodes, and sometimes slit-like cavities.

Tuberculosis of the upper respiratory tract, trochea, bronchi.

It is a complication of pulmonary tuberculosis. When tuberculosis of the respiratory tract occurs, patients develop a sore throat and a change in voice. When tuberculosis spreads hematogenously, other organs may also be affected.

· Tuberculosis of the respiratory system, combined with dust occupational lung diseases.

Among pneumoconeosis, tuberculosis most often occurs in patients with silicosis. The more severe the silicosis, the more often it is complicated by tuberculosis. As a result of the combination of these diseases, a pathological process unique in mythology and clinical picture is formed - silicotuberculosis.

· Tuberculosis of lymph nodes

Tuberculosis of peripheral lymph nodes.

In most cases, it refers to the primary period of the disease, and is associated with the glandular component of the primary complex, but there may also be post-primary lymphadenitis.

Infection of peripheral lymph nodes by tuberculosis is more often observed in children and adolescents, less often in adults and the elderly (extremely rare). In children, tuberculosis often affects several groups of peripheral lymph nodes.

Tuberculosis of mesenteric lymph nodes (mesadenitis).

Tuberculosis of the mesenteric lymph nodes can develop in both primary and secondary tuberculosis.

Secondary tuberculous mesadenitis is observed only with a sharp decrease in the body's defenses caused by a severe progressive course of pulmonary or extrapulmonary tuberculosis; More often, the occurrence of mesadenitis can be associated with the primary form of tuberculosis.

· Osteoarticular tuberculosis

One of the manifestations of common tuberculosis infection is observed in 10% of tuberculosis patients. The process affects the ends of long tubular bones, as well as the vertebrae. The resulting tuberculosis foci lead to bone destruction, the process entering the joint and deforming it. This tuberculosis most often affects children. Damage to the spine – from 2-3 years; upper limb joint 15-20 years; hip joint 3-6 years. The spine is most often affected (40%), in 2nd and 3rd place are the hip and knee joints (together 40%), then the ankle joint and foot (7%), the joints of the upper extremities account for 5% of all tuberculous lesions of the joints , everything else – 8%.

Osteoarticular lesions are secondary focal lesions resulting from dissemination.

The development of the disease is determined not only by the active excitation of tuberculosis, but also by an increase in the reactivity of the body and local tissue reaction. At first, the disease occurs as an isolated bone lesion, which, when spreading to the joint, leads to inflammation and subsequent destruction. The course of osteoarticular tuberculosis is cyclical and, in the absence of proper treatment, leads to deformity, for example, a hump.

Tuberculosis of the shoulder joint.

Tuberculosis of the shoulder joint is relatively rare. The focus of tuberculosis occurs in the head of the humerus, located throughout the entire joint with incomplete destruction of the head, ankylosis. Sometimes “dry” bone destruction occurs - without an abscess and fistulas.

Tuberculosis of the elbow joint.

It occurs more often in childhood than tuberculosis of the shoulder joint. Secondary infection. With a long process, the muscles of the limb atrophy. Tuberculosis spreads to the synovial membrane, destroying the articular ends of the bones and the capsule.

Tuberculosis of the hip joint.

It occurs much more often than lesions of other joints. Muscle atrophy, fistulas from which purulent contents are released, bone sequesters. There is a change in the shape of the pelvis.

Tuberculosis of the knee joint.

In terms of frequency, it is in 2nd place after the hip. When the articular surfaces and capsule are destroyed, posterior subluxation of the tibia may occur. When inflammation subsides, ankylosis of the joint often forms.

· Tuberculosis of the brain

Damage to the meninges, meningitis, is the secondary and most severe manifestation of tuberculosis. In the majority of cases (90-95%), meningitis occurs when there is an active pulmonary or extrapulmonary tuberculosis process in the body. In children, meningitis can develop against the background of a primary complex or bronchoadenitis. In a small number of cases (about 5%), meningitis occurs in the absence of visible tuberculous changes in the lungs or other organs.

· Eye tuberculosis

Ocular tuberculosis develops as a result of predominantly hematogenous spread of Mycobacterium tuberculosis. Only sometimes eye damage is a consequence of further widespread inflammation in tuberculosis of the skin of the face and eyelids.

Laryngeal tuberculosis

Laryngeal tuberculosis is a complication of the lungs and occurs mainly in men aged 20 to 40 years. Potological changes are characterized by the formation of epithelioid tubercles. With the development of infiltrates and cheesy disintegration of tubercles, ulcers occur. When the tuberculous process spreads deeper, the perichondrium and cartilage are affected.

· Tuberculosis of the ureter

With tuberculosis affecting the ureter, specific ulcers appear on its mucous membrane, which tend to quickly scar, which leads to a persistent narrowing of the lumen of the ureter.

Tuberculosis of the genital organs

Tuberculosis of the genital organs is secondary. Mycobacterium tuberculosis enters the genitals mainly through the hematogenous route (most often from the lungs, intestines, and peritoneum). They occur more often in young women (20-30 years old), but are also observed in children, young and old people. The fallopian tubes (85-90%), uterus (32-40%), and less commonly the ovaries (15-20%) are most often affected by tuberculosis. Tuberculous lesions of the cervix and vagina are very rare.

Adrenal tuberculosis

Tuberculosis damage to the adrenal cortex causes chronic failure of these glands with a set of characteristic symptoms known as Addison's disease (Morbus Addisoni) after the author who described it. The disease is relatively rare and is observed mainly in people aged 20 to 40 years; Addison's disease occurs more often in men than in women.

Intestinal tuberculosis

The appearance of persistent diarrhea in tuberculosis patients in the 18th and 19th centuries

were considered by doctors as a fatal sign of consumption.

The tuberculous process in the intestine can occur through sputogenic, lymphogenous and contact routes. Pathomorphological changes in intestinal tuberculosis can be in the form of scattered foci. Most often, tuberculosis is localized in the ileocecal region of the small and large intestines, as well as the rectum.

Skin tuberculosis

Skin tuberculosis is a group of diseases caused by the penetration of Mycobacterium tuberculosis into the skin or subcutaneous tissue. In almost all cases, tuberculous skin lesions are secondary (the pathogen is introduced into the skin by the lymphatic route from lesions of other organs). Recently, skin tuberculosis is rare.

2. RESEARCH PART OF THE WORK.

Table No. 1.

Statistics on BCG at the Soldinovskaya gymnasium in Narva.

Purpose of the study:

To identify awareness of tuberculosis among different groups of the population.

To achieve the given goal, you need to complete the following tasks:

1. identify awareness of the causes of tuberculosis;

2. identify awareness of the routes of transmission of infection;

3. identify awareness of prevention methods.

2.1. Characteristics of objective research

The research method is questionnaires.

A questionnaire was compiled, including 20 questions (See Appendix 1). Respondents answered questions anonymously, voluntarily and independently.

Characteristics of the research object.

80 people took part in the study. All subjects are from different groups, 20 people each, in accordance with age and social status.

Table 2.

Group number		Social Status
		Schoolchildren
		Work. People
		Pensioners
		Associates

The study sites were:

2. Sewing enterprise

3. House of Veterans

4. City dump

Narva Gymnasium “Soldino”, where 1,148 children are currently studying.

20 students were interviewed

· three from 9th grade

· ten from 10th grade

· seven from 11th grade

Girls (11) took a more active part: they took part in the conversation and asked questions. Young people (9) were more reserved, although they were also interested in the research.

2. Sewing company A/S “JUNONA”

20 people were interviewed:

· 12 men: riveters, cutters, loaders, foreman, watchman, director (they were less busy than women).

· 8 women: seamstresses, packers, foreman, technologist.

The company employs 90 people.

3. Veterans' House in Narva-Jõesuu.

Women predominate in numbers. 15 women responded to the survey, 12 of whom can move independently. The remaining women were interviewed in their rooms. Men (5) all move independently. Everyone answered eagerly, the men joked and were interested in the research work and tuberculosis itself as a pulmonary disease.

267 people live in the Veterans' House.

4. City dump.

20 people were interviewed.

Here, as in the sewing enterprise, the majority of people (16) are men. Two of the men answered questions quickly - mechanically. The rest took the survey seriously. While filling out the questionnaire, women (4) shared their opinions on any of the questions asked. They rarely made their own decisions.

In the group of respondents, the ages were very different: from 37 to 70 years. More than 30 people live there, their own separate town has been created, with its own laws and with its own elder – the “head”. All people are divided into 4 groups:

· Do not leave the area - security;

· They walk around the city collecting bottles and then handing them over;

· Look through trash containers for things, bottles, etc.;

· Without leaving the landfill, they sort the garbage and get food;

2.2. Research results:

2. Do you think this disease is dangerous for humans?

3. Is it easy to get infected?

Social status
Associate
Alcoholic
Child under 6 years old
Smoker
Schoolboy
Elderly man
Working man
A person with reduced nutrition
Unemployed man

7. Do you often get colds?

8. Have you been vaccinated against tuberculosis?

9. Do you know what vaccinations you have received?

10. Do you know how long the tuberculosis bacillus lasts and what causes it to die?

11. Does anyone in your family suffer from chronic lung diseases?

12. Do you smoke?

14. Do you smoke in your family?

	1 time per year	2 times a year	Once every two years

19. What topics did you give lectures on?

20. How many people do you think suffer from tuberculosis in Narva?

			Person 20

2.3. Comparative analysis of results in 4 groups

In the comparative results of the study for all 4 groups, there is a difference in the responses of groups of schoolchildren and associations from groups of pensioners and working people. The tables and graphs show the comparative differences between these groups.

Do you know what tuberculosis is?

No

According to the data presented, schoolchildren are poorly informed about tuberculosis. Their percentage is only 5% - this is one person, the remaining 19 do not know what tuberculosis is. 50% more students know associates. Working people know much better about tuberculosis - 75% and older people - 95%.

In your opinion, who is more likely to become infected with tuberculosis?

Social status
Associate
Alcoholic
Child under 6 years old
Smoker
Schoolboy
Elderly man
Working man
A person with reduced nutrition
Unemployed man

They understand the risk of people being infected with tuberculosis a little better than other social groups; working people are in second place, and the elderly are in third place. Schoolchildren have insufficient understanding of risk groups.

Do you know how this disease is transmitted?

Group 4

Looking at the graph, the following picture appears: the second, third and fourth groups hardly differ in results. Of these, only 25% - 5 out of 60 people do not know how tuberculosis is transmitted. For students, the picture is completely different: 85% know nothing about the routes of transmission of tuberculosis.

Do you have friends who suffer from tuberculosis?

There are no acquaintances in the first and third groups. Who suffer from tuberculosis. In the second group, 5% - this is one person - suffers from tuberculosis. And in the group of associates, among their acquaintances, three people are sick - 15%.

Have you been vaccinated against tuberculosis?

95% of working people and pensioners know that they have been vaccinated against tuberculosis. Of the associations, only 15% know this, and only 10% of schoolchildren - two out of twenty people. Of the associates, one person was not vaccinated against tuberculosis. But 90% of schoolchildren, 80% of social workers and only 5% of elderly people do not remember this.

Do you know what vaccinations you have received?

Group 4

According to the data received, working people and pensioners responded equally: 35%, social workers 15%, and schoolchildren know nothing about vaccinations.

Do you smoke?

Group 4

A lot of schoolchildren smoke, 90% of them, although more girls were interviewed.

In second place are working people 70%, 30% of respondents are men, the remaining percentage goes to women - 50%.

The third place is occupied by the associations.

Of the elderly, 35% smoke, 25% are men, and 10% are women.

In your opinion, does smoking contribute to the development of tuberculosis?

Group 4

Of the second group, 60% think “YES”.

The third group is slightly behind - 55% of respondents.

The fourth group answered “YES” - 50%.

Only 35% of schoolchildren responded positively.

Have you had an X-ray of your lungs?

All working people and pensioners underwent lung x-rays. Of the associations, 80% attended. Of the schoolchildren, 85% went for an x-ray of their lungs. Almost all of the respondents underwent chest X-rays.

Who sent you for an x-ray of your lungs?

Let's go ourselves

In all groups, most often the family doctor sent for an x-ray of the lungs. After the family doctor come:

surgeon – 35%,

traumatologist – 20%.

The school nurse sends the least number of people for lung x-rays – 10%.

How many times a year do you think lung x-rays should be taken?

	1 time per year	2 times a year	1 time every 2 years
Group 3

Many people believe that X-rays of the lungs should be done 2 times a year.

much less believe that it is necessary to have an X-ray of the lungs once every 2 years: schoolchildren (20%), social workers (15%), working people (40%) and only elderly people - 95%;

to the answer option: 5% answered once a year - schoolchildren and elderly people,

35% are associates.

Where did you get information about diseases?

Basically, all four groups listened to lectures at school.

What topics did you give lectures on?

Pensioners and associates all took a first aid course about certain diseases. Working people also took a first aid course, but they were also given lectures on personal hygiene and sexual development. Schoolchildren are given a lot of material about AIDS, drug addiction and sexuality, but not a single lecture is given on the prevention of tuberculosis.

How many people do you think suffer from tuberculosis in Narva?

			Person 20

Associates have a very good idea of ​​the number of tuberculosis patients - 80%. For the rest of the answers they have 5%.

In second place are schoolchildren, 25% of whom know how many people suffer from tuberculosis, but 30% believe that not very many. 25% of schoolchildren believe that about 20 people in Narva have tuberculosis. Only 5% don't know.

In third place are older people: 15% know how many people have tuberculosis; and 65% are not sure about this.

In turn, working people are 80% unsure of the exact number of tuberculosis patients. The rest of the answers are 5%.

3. CONCLUSIONS AND SUGGESTIONS

As a result of the study, the following conclusions can be drawn:

· Pupils of general education schools are almost not informed about tuberculosis.

· The group of social workers is not well informed about tuberculosis.

· Garment factory workers and elderly people from the Veterans' Home are well informed about tuberculosis.

For greater awareness and health improvement:

· The nurse should actively involve in periodic examination and inform risk groups.

· The family nurse should remind about the benefits of maintaining sanitary and hygienic conditions at home and at work, as well as the dangers of poor nutrition and irregular diet.

· The dispensary nurse must:

Teach the patient to take care of his health (take medications carefully, follow the regimen, quit smoking and alcoholic beverages),

Explain and help relatives in creating the atmosphere of a home sanatorium,

Explain to the patient the need to protect family members from infection.

· The school nurse should conduct lectures and classes about the disease and the causes of tuberculosis.

During the internship, I had conversations with students of the Soldino gymnasium on the topic “Tuberculosis is a contagious disease”

As a result, I felt the students’ interest in this topic and revealed almost complete ignorance about tuberculosis.

(See Appendix 2)

3.1 PREVENTION OF NURSING AMONG THE POPULATION.

Prevention is the fight against the disease and prevention of infection with tuberculosis.

Organization of tuberculosis prevention is one of the main sections of anti-tuberculosis work.

One of the central tasks of the sister is to implement a system of measures aimed at preventing the infection of healthy people with tuberculosis, to combat tuberculosis as an infectious disease. The scientific basis for the prevention of infection is tuberculosis infection, the doctrine of anti-tuberculosis immunity, i.e. about the disease itself and its prevention.

In her work, the sister proceeds from the fact that the main source of tuberculosis infection is the patient’s discharge, mainly sputum during coughing.

Among the main tasks of tuberculosis prevention is the desire to limit, if possible, and make safe the contact of tuberculosis patients who are capable of infecting others (especially bacilli-whitening people) with the healthy population.

The focus of tuberculosis infection is the home of a patient with an open form of tuberculosis (bacteria). Bacterial excretion is of greatest epidemiological significance in pulmonary tuberculosis.

Types of prevention:

1. social

2. specific

3. sanitary

1. Social prevention

The totality of improvements in the health of the population:

– Labor legislation

– Protection of motherhood and childhood

– Housing construction and improvement of populated areas

– Improving material living conditions

– Improving general culture and introducing sanitary knowledge

– Wide development of physical culture and sports

All this can reduce the incidence of tuberculosis.

2. Specific prevention:

– Patient care and education at the dispensary

– Observation groups at the dispensary

- At-risk groups

Patient care and education at the dispensary

We should not forget the peculiarities of the patient’s psyche and his reaction to the information communicated to him about tuberculosis. A patient with tuberculosis is a special kind of listener and reader, very sensitive to everything that has to do with his illness. If the lecturer is careless, if, for example, he dwells in detail on pathological changes and various complications, the patient may develop pneo-hymeotic ideas and a skeptical attitude towards the benefits of the relationship between the regimen and treatment. Emotional patients may develop hypochondria. Therefore, it should be explained to the patient that even advanced forms of tuberculosis are curable. With this tactic, the lecture becomes an effective psychotherapeutic event.

It is necessary to convince the patient to stop drinking alcohol - this is an important element of the hygienic regime. At the same time, along with a statement of the dangers that drunkenness and alcoholism pose, the harm of alcohol for a patient with tuberculosis should be especially emphasized. Educating tuberculosis patients about the dangers of smoking is also of great importance.

The sister teaches the patient to take care of his health (carefully take medications, follow a regimen, quit smoking and alcoholic beverages), explains and helps relatives in creating the environment of a home sanatorium, explains to the patient about the need to protect family members from infection. The sister’s conversation with the family and the patient consists of explaining:

1. a hygienic regime, including adherence to a diet, is the basis for the treatment of tuberculosis.

2. personal hygiene of the patient, routine disinfection

3. nutrition of a patient with tuberculosis

4. fight against alcohol consumption and smoking

5. Regular use of chemotherapy drugs

6. protecting others from infection (visitors).

The most dangerous in terms of infecting others is macrota. The nurse should teach the patient to observe cough hygiene and proper collection of macrota. When coughing and sneezing, it is necessary to cover your mouth and nose with the back of your left hand, turning away from your neighbor or interlocutor - this is a principle that the nurse should explain to the patient.

The nurse should teach the patient how to use a pocket spittoon and ensure that he uses it everywhere, storing it in specially sewn bags that are easy to disinfect.

The sister should also explain to relatives the correct behavior with the patient.

Observation groups at the dispensary:

Group 0 - adults, adolescents and children who need to clarify the activity of tuberculous changes in the lungs, as well as children and adolescents who need differential diagnosis of pulmonary and extrapulmonary pathology suspicious for tuberculosis, clarification of the nature of the tuberculin reaction, the etiology of intoxication.

Group 1 - newly diagnosed patients, as well as patients with chronic active respiratory tuberculosis with and without bacterial excretion, who need a complex of therapeutic anti-epidemic and social measures.

Group 2 - patients with active subsiding tuberculosis, transferred from group 1.

Group 3 - persons who completed observations in the 1st and 2nd registration groups and who achieved clinical cure of pulmonary tuberculosis, as well as children and adolescents newly diagnosed with residual changes in tuberculosis in the absence of symptoms and intoxication and process activity, infected from the 4th registration group.

Group 4 - adults who are in family and related contact, as well as children who are in family and residential contact with a bacterial excretor, children and adolescents - in contact with a patient with active tuberculosis without bacterial excretion.

Group 5 - patients with extrapulmonary tuberculosis and persons cured of it.

Group 6 - children and adolescents with primary infection, as well as those unvaccinated with BCG during the neonatal period and children with post-vaccination complications.

Group 7 - adults with residual tuberculous changes.

Group 8 - patients with sarcoidosis of any localization and persons cured of it.

At-risk groups:

Persons who frequently suffer from lung diseases

· Patients with repeated, atypical or slowly resolving pneumonia

· Patients with chronic lung diseases (not exacerbation)

Persons who have had exudative pleurisy or suffer from recurrent pleurisy

· Patients with occupational lung diseases

· Patients with peptic ulcer and duodenal ulcer

· Patients with diabetes

· Women in the postpartum period

· Young people

· Patients who are prescribed long-term hormonal or radiation therapy

· Persons suffering from chronic alcoholism and drug addiction

· Persons who have recently moved from rural areas

3. Sanitary prevention:

· Vaccination and revaccination

Chemoprophylaxis of tuberculosis

Anti-tuberculosis vaccination and revaccination

For vaccination and revaccination, the intradermal method of vaccine administration is used, which has a series of vaccine dosages that achieves immunological restructuring of the body in a shorter period of time, as well as provide more stable and long-lasting immunity. All newborn healthy children are vaccinated with BCG on days 4-7 of life. The vaccination is carried out in the maternity hospital, where the doctor, under whose supervision the newborn is, prescribes vaccination, taking into account contraindications to it. Contraindications include an increase in temperature above 37.5C, dyspeptic disorders, clinical symptoms of birth trauma, Rh conflict in the presence of clinical manifestations, diseases that affect the general condition of the child (pyodermitis, pemphigus, skin abscess, etc.),

In children vaccinated at birth using the intradermal method, immunity remains for 7-10 years. Hence the need for revaccination after a certain period after vaccination arises. Currently, repeated vaccinations are given to uninfected children and adolescents within the prescribed time limits:

– first revaccination with BCG (BCG Bacilles Calmette-Guerin) at 6-7 years of age (upon entry to school)

– second - at 11-12 years old (5th grade)

– third - at 16-17 years old (10th grade)

Subsequent revaccinations are carried out at intervals of 5-7

(See Appendix 3.)

Chemoprophylaxis of tuberculosis

The sister monitors the use of chemotherapy drugs, not only for the treatment of patients with tuberculosis, but also for the purpose of preventing this disease in practically healthy people. Chemoprophylaxis is used for certain strictly limited indications. There is no reason to consider primary chemoprophylaxis as a broad measure to prevent infection. Only BCG vaccination is a reliable method of preventing tuberculosis in uninfected people. Prescribing chemoprophylaxis to an unidentified person is permissible for a limited period if vaccination is for some reason impossible or if there is a high risk of infection.

Essential conditions for achieving the effectiveness of chemoprophylaxis are the correct and reasonable selection of the appropriate contingent and the nurse must carefully monitor the daily intake of drugs during the entire course of chemoprophylaxis.

CONCLUSION:

Tuberculosis is a disease that still affects vulnerable populations.

During the practical research, the following conclusions were made:

· Pupils of general education schools are almost not informed about tuberculosis. (90%)

· The group of social workers is not well informed about tuberculosis. (75%)

· Garment factory workers and elderly people from the Veterans' Home are sufficiently informed about tuberculosis. (80-95%)

The nurse’s task is to prevent tuberculosis and carry out serious preventive work with people at risk.

· The school nurse should conduct lectures and classes about the disease and the causes of tuberculosis, and methods of prevention.

· The nurse should actively involve people at risk in periodic examination and inform them.

With the help of literature, knowledge gained in medical school and consultations with specialists on this disease, I hope to use the data obtained and the experience of writing a thesis in the nursing profession in further practical work with patients in the prevention of diseases

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“Tervisedrend” – magazine 1999/5

Internet use:

“Õendus alused” Roper, Logen, Tierney Elmatar Tartu 1999 a

“Tervisedendus and tervisekaavatus” Lemon-5 Tallinn 1997 a .

“Õendusprotsess ja selle dokumenteerimine” Lemon-4

APPENDIX 1

1. Do you know what tuberculosis is?

3. Do you think this disease is dangerous for humans?

4. Is it easy to get infected?

4. In your opinion, who is more likely to become infected with tuberculosis?

Associate

Alcoholic

Child under 6 years old

Smoker

Schoolboy

old man

Working man

A person with reduced nutrition

Unemployed man

5. Do you know how this disease is transmitted?

6. Do you have friends who suffer from tuberculosis?

8. Do you often get colds?

9. Have you been vaccinated against tuberculosis?

10. Do you know what vaccinations you have received?

11. Do you know how long the tuberculosis bacillus lasts and what causes it to die?

12. Does anyone in your family suffer from chronic lung diseases?

12. Do you smoke?

13. In your opinion, does smoking contribute to the development of tuberculosis?

14. Do you smoke in your family?

15. Have you had an X-ray examination of your lungs?

16. Who sent you for an x-ray of the lungs?

Family doctor

Traumatologist

School sister

Let's go ourselves

17. How many times a year do you think X-rays of the lungs should be done?

1 time per year

2 times a year

1 time every 2 years

18. Where did you get information about diseases?

19. What topics did you give lectures on?

________________________________________________________________________________________________________________________

20. How many people do you think suffer from tuberculosis in Narva?

Person 20

APPENDIX No. 2

Lecture notes at school.

"Tuberculosis is a contagious disease"

In the world, 8 million people fall ill with tuberculosis every year, and 3 million people die from tuberculosis.

TUBERCULOSIS CHRONIC SOCIALLY DANGEROUS INFECTIOUS DISEASE.

Tuberculosis during the period of maximum spread in Europe (16-19 centuries) was called the “white plague” due to its high mortality rate. The causative agent of tuberculosis in humans is a mycobacterium (mycobakterium tuberculosis), discovered by Robert Koch in 1982, which is also called Koch's bacillus because of its rod-shaped shape. Its positive finding in the investigated material is indicated by the symbol “VK+”.

Tuberculosis is a disease of the whole body that can affect every organ and every tissue. But in 90-95% of cases it manifests itself as pulmonary tuberculosis - the most infectious form of tuberculosis. The most life-threatening form of tuberculosis is tuberculous inflammation of the meninges and brain (meningitis, meningoencinphalit).

The causative agent of livestock tuberculosis (mykobakterium bovis) is also infectious to humans. People most often develop extrapulmonary forms of tuberculosis after infection with this pathogen (tuberculosis of the lymph glands, kidneys, bones, joints, etc.). In Estonia, no livestock tuberculosis has been registered in the last 20 years. Many cases of this infection have occurred in several CIS countries. Today, Estonian veterinarians are concerned that people suffering from tuberculosis can also infect cows, because Mycobacterium tuberculosis is infectious and dangerous for livestock

The causative agent of tuberculosis releases macrota into the external environment, a patient with pulmonary tuberculosis, sprayed into the air with tiny, invisible droplets (droplet infection): when coughing, sneezing and talking, urine of a patient with kidney tuberculosis, feces of a patient with intestinal tuberculosis, pus from fistulas with tuberculosis of the lymph glands or bones and joints, menstrual blood of a patient with tuberculosis, uterus and ovaries, milk of cows with tuberculosis, etc.

TUBERCULOSIS CAPACITIES RETAIN THE ABILITY TO INFECT

Droplets of air, spread over a distance of up to 5 meters and persist for up to five hours;

In dried secretions in the dark for up to 1 year;

There are 3 months in the pages of books;

In street dust for 10 days;

In open reservoirs for 150 days (they were found in the water of the Black Sea, off the southern coast of Crimea, near large tuberculosis sanatoriums and in the water of rivers into which wastewater from tuberculosis hospitals flowed).

In products (when stored in refrigerators) made from contaminated milk (butter, cheese) 260 days

The buried corpses of those who died from tuberculosis lasted for 3 years.

TUBERCULOSIS CAUSES DIE

With intense ultraviolet radiation in 2-3 minutes

Subsolar radiation for 1.5 hours

When pasteurizing milk at 70 degrees for 30 minutes

When dry calcining dried secretions at 100 degrees for 45 minutes

When exposed to disinfectants (phenol and others) within 15 minutes.

THE SPREAD OF TUBERCULOSIS OCCURS:

1. Droplet infection (alcohol in Estonia is an additional factor in the spread of tuberculosis in 1/3 – ½ cases)

2. Dust infection

3. Domestic infection in the family or apartment.

In addition to droplet and dust infections, tuberculosis can be transmitted by household objects contaminated with the tuberculosis pathogen (dishes, handkerchiefs, linen, etc.). This type of transmission is especially dangerous while the patient is not aware of his illness.

Tuberculosis often begins without noticeable complaints. The patient may be active, cheerful, and sometimes moody and tired. Night sweats may occur, as well as a slight increase in body temperature after lunch. Sometimes a short-term (about 1 week) febrile illness occurs, which is mistaken for the flu.

TUBERCULOSIS SHOULD BE DETECTED IN CHILDREN AND ADOLESCENTS DURING THE INFECTION PHASE

Detection of tuberculosis in children with an already pronounced disease is late. The reasons for this may not be the consciousness or negligence of the parents.

To detect tuberculosis infection, it is necessary to regularly conduct tuberculin tests in children and adolescents.

IT IS POSSIBLE TO AVOID THE DEVELOPMENT OF TUBERCULOSIS INFECTION INTO DISEASE

To avoid the development of the disease, you must, as prescribed by a phthisiatrician (tuberculosis doctor), take one anti-tuberculosis medicine once a day for 3 months in a dose corresponding to your weight. During this so-called chemoprophylaxis, there are no restrictions in the way of life or work.

Although only every 10 infected people get tuberculosis, unfortunately, there is still no reliable method for separating the lucky 9/10 from the unlucky 1/10, whose disease is very likely without the use of chemoprophylaxis.

PULMONARY TUBERCULOSIS WILL BE DETECTED ON AN X-RAY

To clarify the extent and phase of the disease, a series of x-rays are required in different directions and from different layers of the chest

BEFORE STARTING TREATMENT, THE PATIENT SHOULD BE CAREFULLY EXAMINED.

To do this you need to:

Various general clinical functional and laboratory tests

Bronchoscopy or internal examination of the mucous membrane of the respiratory tract with an appropriate instrument. Samples taken from the lumen of the respiratory tract or from altered mucous membranes provide, after laboratory tests, the opportunity to clarify the essence of the disease. This method can also detect lung cancer, which is curable in the early phase of the disease.

Thoroscopy or examination of the pleural cavity through the chest wall with inserted instruments. The visible picture and data from laboratory studies of the taken material make it possible to clarify the diagnosis

Bacteriological research, which makes it possible to determine the causative agent of the disease and its sensitivity to drugs, thereby providing targeted treatment

Cytological and histological examination, which allows us to determine the cellular structure of the focus of the disease and make the correct diagnosis

Computed tomography, which allows you to accurately determine the spread and localization of the disease

Some studies have to be repeated during treatment. To detect extrapulmonary tuberculosis, a special test is used, depending on the suspected diseased organ.

TUBERCULOSIS IS CURABLE

With moderate development of pulmonary tuberculosis, treatment of the patient lasts 6 months. To prevent tuberculosis pathogens from becoming insensitive to medications, you need to take up to 3 medications at the same time. We need to change our lifestyle - a gentle regime is necessary. In the second half of treatment, to restore working capacity, it is necessary to engage in physical therapy.

COMMON TUBERCULOSIS REQUIRES TREATMENT FOR AT LEAST A YEAR

For treatment, 5 medications must be used simultaneously. Some of them must be administered by injection intramuscularly or through a dropper into a vein. This is advisable for hospital treatment.

Surgical treatment may be necessary - removal of a lobe of the lung or one entire lung.

INCIDENCE OF TUBERCULOSIS PER 100,000 POPULATION

In 1992, there were an average of 152 people in the world

At the same time, in South and East Asia 247

In Africa 227

In Central and South America 127

In Eastern European countries 47

In developed countries 27

In Estonia in other European countries

1953 417.0 Monaco 1990 3.4

1960 227.0 Denmark 1988 5.4

1970 64,9 1990 6,8

1980 33.8 Sweden 1990 6.6

1990 21,0 1991 6,0

1991 21.4 Norway 1988 6.9

1992 21,0 1991 8,5

1993 29.9 Holland 1988 8.0

1994 34,4 1990 9,2

1995 41.5 Finland 1991 15.3

1996 50,7 1994 10,6

Latvia 1991 28.7 1994 44.1

Lithuania 1991 34.4

USSR 1988 45.8

Russian Fed. 1995 57.8

Children sick with tuberculosis in Estonia

ANTI-TUBERCULOSIS VACCINE WITH BCG VACCINE HELP REDUCE INCIDENCE AND AVOID SEVERE LIFE-THREATENING FORMS OF THE DISEASE

Newborns are vaccinated in the maternity hospital

Children are revaccinated before entering school (at 6-7 years of age), if they have not previously been infected with tuberculosis

Vaccinations are given up to 30 years of age.

A healthy lifestyle and hardening reduce the spread of tuberculosis and other diseases.

APPENDIX No. 3

Name of the disease, drugs and components.	Vaccination schedule	Note
Anti-tuberculosis vaccination. One of the main tasks of the sister is anti-tuberculosis vaccination. Vaccination is carried out with the BCG vaccine.
BC vaccine for intradermal use. All children and adults under 30 years of age are subject to vaccinations.	Vaccination is carried out during the newborn period in the absence of contraindications on days 5-7 of life. The vaccine is administered once on the outer surface of the upper arm after treating the skin with 70% alcohol. The vaccine dose (0.05 mg) is diluted with isotic sodium solution	Persons with negative or questionable Rhesus Mantoux with 2 TU are subject to vaccination

Revaccination
It is carried out clinically for healthy people in whom the Mantoux tuberculin test with 2TE purified tuberculin gave a negative result. Persons who have had tuberculosis or are known to be infected with tuberculosis should not be subject to revaccination and should not be examined for the purpose of selection for revaccination against tuberculosis.	Healthy children and adolescents aged 7 years, 11-12 years, 16-17 years, as well as adults aged 22-30 years are subject to revaccination once by intradermal method in a dose of 0.05 mg. In cities and regions where the incidence of tuberculosis in children has been practically eliminated and local forms of the disease are not detected among them. Revaccination is carried out at 7 years and at 14 and 15 years. Subsequent revaccination of persons not infected with tuberculosis is carried out at intervals of 5-7 years until the age of 30.

KOHTLA-JÄRVE MEDITSIINIKOOL ÕE PÕHIKOOLITUS TROFIMOVA JULIA ÕE ROLL ELANIKKONNA TUBERKULOOSI HAIGESTUMISE PROFÜLAKTIKAS DIPLOMITÖÖ Diplomitöö juhendaja: V. SAHAR