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Course: Pediatric Nursing

Topic: Pediatric Tuberculosis

The Nurses International Community

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Module Goals

Learners will be able to:

Explain causes and risk factors for pediatric tuberculosis
Describe clinical manifestations and complications of pediatric tuberculosis
Identify common diagnostic tests for pediatric tuberculosis
Identify preventive measures for pediatric tuberculosis
Discuss the nursing management of a child with pediatric tuberculosis

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Pediatric Tuberculosis (TB)

A chronic infectious disease which may involve many organs of the body, but most often affects the lungs

Other organs such as the kidneys, spine, or brain may be affected

TB disease in children under 15 years of age (also called pediatric tuberculosis)

CDC, 2021

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Pediatric Tuberculosis (TB): Causes

Caused by a bacterium called Mycobacterium tuberculosis.

Airborn: Spreads from individual to individual through the air.

TB bacteria enter the air when an individual with TB disease of the lungs or throat coughs, speaks, or sings.

People nearby may breathe in these bacteria and become infected.

CDC, 2021

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Pediatric Tuberculosis (TB): Risk Factors

Infants, young children
Immunocompromised children (HIV) are at the highest risk of TB meningitis or disseminated TB disease
Living with someone who has TB
A child with Diabetes
Homeless children
Are from a country where TB is common
Common in unsanitary or crowded conditions

CDC, 2021

University of Rochester, 2022

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Pediatric Tuberculosis (TB): Conditions

Exposed:

In contact with an individual with TB, but has a negative TB test and no symptoms.

Latent TB Infection:

Positive TB skin test or blood test
Have TB bacteria that are not active
Not sick with no symptoms
Cannot spread bacteria to others
Often given medicine to prevent from developing the TB disease

CDC, 2021

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Discuss the difference between an active and a latent TB infection.

Why is close observation of clients with latent TB necessary?

What kind of education would you provide to clients with latent TB infection?

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People with latent TB do not have any symptoms and cannot spread TB. If they do not get treatment, however, they may develop active TB disease in the future, spread the disease to others, and feel quite ill. People with active TB disease can be treated and cured if they get medical help

Directly Observed Therapy Most TB patients start feeling well after only a few weeks of treatment but the TB germs are still alive in the body It is very dangerous for a TB patient to stop taking medicine early or not to take it regularly. The TB germs begin to grow again and patients may become infectious and remain sick much longer. Stopping treatment too early or taking treatment irregularly could cause the TB germs to become resistant to the TB medicine. If this happens, new and different medicines will be needed to kill the TB germs. These new medicines have to be taken for a longer time and usually have more serious side effects. DOT helps prevent these problems by making sure that treatment is complete.

Limit alcohol use when taking TB medication. Combining alcohol and TB medicine can cause liver damage. Tell the nurse if other medications are being taken. TB medication can interfere with certain prescription drugs. Report any complaints to the nurse.

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Pediatric Tuberculosis (TB): Conditions

TB Disease:

TB bacteria becomes active and the individual becomes sick

A positive skin test or blood test indicating TB infection
Symptoms of TB disease present
Can spread the disease if the infection is in the lungs and it is untreated
Must be given medicine to treat disease

CDC, 2021

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Pediatric Tuberculosis (TB): Sign and Symptoms

Cough
Feelings of sickness or weakness
Lethargy, or reduced playfulness
Weight loss
Failure to thrive
Fever
Night sweats

CDC, 2021

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Pediatric Tuberculosis (TB): Signs and Symptoms

In older children:

Cough that lasts longer than 3 weeks
Pain in the chest
Blood in sputum
Swollen glands (some may begin to drain fluid through the skin)
Weight loss, Weakness
Decrease in appetite
Fever
Sweating at night
Chills

University of Rochester, 2022

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Pediatric Tuberculosis (TB): Diagnosis

History
Physical examination
Test for TB infections:

Mantoux tuberculin skin test (TST):

Injecting a small amount of fluid tuberculin into the skin in the lower part of the arm
The test is read within 48 to 72 hours

TB blood test: immune system reaction to M. tuberculosis

CDC, 2016

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Pediatric Tuberculosis (TB): Diagnosis

The diagnosis of TB disease in children often based on:

Clinical signs and symptoms associated with TB disease
Positive tuberculin skin test (TST)
Positive TB blood test (IGRA),
Chest x-ray patterns typically associated with TB disease
History of contact with an individual with infectious TB disease

CDC, 2021

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

What signs would you expect to see in the older child who has TB?

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Uncomplicated Pediatric (TB): Treatment

The four commonly used anti-tuberculous drugs used to treat drug-susceptible TB in childhood are:

Isoniazid (INH)
Rifampicin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB)

Treatment usually lasts six months

Better Care, 2021

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Uncomplicated Vs Complicated (TB)

Uncomplicated TB:

Milder forms of tuberculosis in HIV uninfected children
Mild forms of pulmonary tuberculosis and less severe forms of extrapulmonary tuberculosis

Complicated TB includes:

HIV-infected children with any form of pulmonary or extrapulmonary TB except for TB meningitis and miliary TB

Better Care, 2021

Contact info: info@nursesinternational.org

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Uncomplicated (TB): Treatment

For children less than 8 years of age and under 30 kg:

The intensive phase (first 2 months):

Three drugs used: Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA)

Followed by a continuation phase (last 4 months):

Two drugs (INH and RIF)

Treatment usually lasts six months

Better Care, 2021

Contact info: info@nursesinternational.org

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Complicated (TB): Treatment

For children less than 8 years and under 30 kg:

The intensive phase (first 2 months)

Four drugs are used: INH, RIF, PZA and EMB

Followed by a continuation phase (last 4 months)

Two drugs INH and RIF

The total duration of treatment usually lasts six months

Better Care, 2021

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

A parent comes to the clinic and says that her child is taking TB medication but seem to be well now.

The parent says that she has little money to pay for medication and wants to stop the medication at this time.

How should the nurse respond?

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Pediatric Tuberculosis (TB): Prevention

BCG immunization
Avoiding exposure to adolescents and adults with tuberculosis
TB prophylaxis in children
Reporting and effectively treating cases of tuberculosis
Educating the community about tuberculosis
Controlling the spread of HIV

Better Care, 2021

Contact info: info@nursesinternational.org

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Pediatric Tuberculosis (TB): Nurse Role

Address body temperature:

Warm water compress (not more than 15 minutes) and antipyretic
May sweat excessively, avoid exposing to wet clothes and linens

Address tissue perfusion:

Maintain a well-ventilated room
May need oxygen supplement

Address fluid volume:

Encourage plenty of fluids (fluid loss through sweat)
Administer parenteral fluids as ordered

Belleza, 2021

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Pediatric Tuberculosis (TB): Nurse Role

Provide education:

About tuberculosis and its transmission
Immunization
Medication administration and side effects
Plan for child’s emotional, educational, social, and activity needs

Emotional support

Provide play and diversional activities as appropriate
Provide child with age appropriate information

Providing directly observed therapy (DOT)
Creating a plan for treatment considering child/family values, needs, culture, and beliefs
Appropriately using available resources, including enablers and incentives, to help client complete treatment

Wisconsin Department of Health Sciences

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References:

Better Care. (2021). Childhood TB. https://bettercare.co.za/learn/childhood-tb/text/0-3-contents.html

Belleza, M. (2021). Malaria. https://nurseslabs.com/malaria/

CDC.C(2021 October 19). TB and Children. https://www.cdc.gov/tb/topic/populations/tbinchildren/default.htm

CDC. (2016). Diagnosis of Tuberculosis Disease. https://www.cdc.gov/tb/publications/factsheets/testing/diagnosis.htm

University of Rochester. (2022). Tuberculosis (TB) in Children. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02548#:~:text=A%20child%20can%20be%20infected%20with%20TB%20bacteria%20and%20not,medicines%20for%20a%20few%20months

Wisconsin Department of Health Services. (n.d). TB Nurse Care Management. https://www.dhs.wisconsin.gov/tb/nurse-care-management.htm

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