Respond in the following ways: (POSITIVE COMMENT)

Share insights on how the factor you selected( THE FACTOR I SELECTED IS ATTACHED BELLOW IN A DOCUMENT) impacts the pathophysiology of the disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

                                                     Main Post

Factors that Influence Disease

Scenario: A 23-year-old male presents to the emergency department with suicidal ideation and requesting detox from heroin. He has been homeless for the last four years, reports that he has many sexual partners, does not use contraceptives, uses heroin IV, and recently spent three months in jail for a drug-related offense. The patient complains of generalized fatigue and night sweats — the nurse practitioner orders several tests, including a sexually transmitted disease (STD) panel and a chest x-ray. The nurse practitioner suspects tuberculosis (TB), so the patient is moved to a negative pressure room. His results are positive for TB and human immunodeficiency virus (HIV).

The factor that I selected was the patient behavior. The patient was a high risk for STDs because he was using drugs IV and not engaging in safe sex practices. According to the World Health Organization (2018), people with HIV are 20-30 times more likely to develop active TB. Furthermore, he was recently in jail. This crowded institutionalized setting is known to increase the risk of contracting TB. The Centers for Disease Control and Prevention (n.d) lists coughing, pain in the chest, coughing up blood or sputum, weakness, weight loss, no appetite, chills, fever, and night sweats as symptoms. The patient complained of fatigue and night sweats. 

TB is caused by an acid-fast bacillus that typically targets the lungs but can spread to other body systems. TB spreads via airborne droplets. Proximity to someone with active TB who is speaking, coughing, or singing can spread the disease very quickly. Once inhaled, the bacilli lodge in the upper lobe and cause localized inflammation (Huether, & McCance, 2017). The immune system attempts to kill the bacteria via engulfment by macrophages, but this is unsuccessful because the bacilli can resist the toxins released by the macrophages. The bacilli then replicate inside the macrophage, causing the formation of a tubercle. Tissues within the tubercle die, forming a cheesy material called caseation necrosis. This formation promotes the growth of scar tissue around the tubercle, isolating the bacteria from the host’s defenses. TB can remain in this state for long periods, also known as latent TB. Once the immune system is impaired, the TB can reactivate and even spread throughout the body.        

Usually, the immune system is very good at identifying invading organisms and destroying them via phagocytosis. Unfortunately, TB is resistant to natural bodily defenses, which makes it a significant health care concern.

References

Centers for Disease Control and Prevention. (n.d.). Signs & Symptoms. Retrieved from https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

World Health Organization. (2018, September 18). Tuberculosis (TB). Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/tuberculosis