Tuberculosis

Overview of Tuberculosis

Tuberculosis is an infectious disease that affects the lungs and can spread to the lymph nodes and other organs. It is caused by the mycobacterium tuberculosis, which creates necrotic granulomas in the parenchyma of the lungs. The tissues of the lungs control these organisms by forming a tubercle around the infection. Individuals with this condition usually are asymptomatic until they become debilitated due to another illness that results in a depressed immune system. The infection then spreads through the lobes of the lungs and becomes systemic through the lymph nodes. Clients exhibit a chronic productive cough, crackles (formerly called rales), and bronchial breath sounds, with fever, weight loss, and malaise. They have signs of excessive inflammation and exudates from their lungs that make breathing difficult. The infection can spread to numerous other tissues (including bone), resulting in their destruction. Clients with the spread of infection into connective tissues experience limited mobility and pain. Clients with an active tuberculosis episode have limited endurance due to their inflammatory lung condition.

Comorbidities to Consider

• Clients whose status is post-tuberculosis have lung damage that creates a restrictive lung disease and possibly a chronic obstructive pulmonary disease.¹

Client Examination

Keys to Examination of Clients

• The tuberculin skin test and QuantiFERON-TB blood tests are used to diagnose this condition, and a chest radiograph is taken for the location and size of the tubercle.

• Clients in a post-tuberculosis state have restricted lung capacities and may have altered trunk postures, muscle weakness, and breathing patterns that affect their tolerance to endurance activities.²

• Assessment of rib cage and extremity mobility help determine the types of interventions that are most appropriate.

Recommended Baseline Testing of Fitness Levels

• A 6-minute walk test is recommended before starting a pulmonary rehabilitation program.

• Clients whose status is post-tuberculosis should be assessed for dyspnea and lung function testing.

Exercise Prescription

Type: Walking, stationary cycling, and weight training

Intensity: Low intensities

Duration: 20–30 minutes

Frequency: 5–6 days per week

Getting Started

Exercises can include endurance activities, strength training for proximal upper and lower extremity muscles, and diaphragmatic breathing exercises. Supervised endurance activities of walking or treadmill walking and stationary bicycling are appropriate for beginning the exercise program. Exercise intensity is best assessed by the client's perceived exertion levels and by ratings of dyspnea. For strength training, use a circuit of free weights and pulley exercises at low intensities, with 12 to 20 repetitions for up to 30 minutes. Diaphragmatic breathing training can be performed in supine and sitting positions with an emphasis on rib cage expansion and controlled expirations with pursed lip breathing.² Clients can be ...