TUBERCULOSIS (PHTHISIS/CONSUMPTION/KOCH’S)

Main Problem: causative agent Mycobacterium tuberculosis

⮚ Mode of transmission: droplet
Incubation Period: 2-10 weeks from infection
Clinical Manifestation:
Primary complex (TB in children)
⮚ Non-contagious because children swallow phlegm
⮚ Fever
⮚ Cough
⮚ Anorexia and loss of weight
⮚ Easy fatigability
Adult
⮚ Afternoon fever
⮚ Night sweats
⮚ Fatigability
⮚ Back pain
⮚ Chest pain
⮚ Dry cough - greenish sputum
⮚ Hemoptysis
Milliary TB: very ill e.g. Pot’s disease
Diagnostic test:
⮚ Sputum exam: specimen taken early morning, 5-10 ml
⮚ Chest X-ray: cavitation of the lungs
⮚ Tuberculin test: to determine the exposure to the tuberculli
⮚ Mantoux text
Involves 0.1 cc injection of PPD and 48-72 hours reading
Check for induration/elevation: 2mm or larger in diameter: positive
Nursing diagnosis: pain, impaired gaseous exchange
Intervention:
⮚ Directly-Observed Treatment Shortcourse (DOTS)
The patient is required to take his medications in the presence of a health
cases provider to ensure compliance to treatment regimen category I, II, III
Treatment category Type of patient Regimen Duration in
months
Category I ⮚ New sputum 2 (RIPE) 6
smear-positive 4 (RI)
PTB
⮚ Seriously ill
sputum smear-
negative PTB
⮚ Seriously ill
extrapulmonary
tubercolosis
(EPTB)
Category II ⮚ Sputum smear- 2 (RIPES) 8
positive relapse 1 (RIPE)
⮚ Sputum smear- 5 (RIE)
positive treatment
failure
⮚ Sputum smear-
 positive treatment
after default
Category III ⮚ Sputum smear- 2 (RIPE)
negative and 4 (RI)
EPTB not serious
ill

Pointers: side effects and adverse reactions

⮚ Rifampicin
Body fluid discoloration
Hepatotoxic (metabolism)
Nephrotoxic (elimination)
Permanent discoloration of contact lenses
⮚ Isoniazid
Peripheral neuropathy
Avoid alcohol
Hepatotoxic
Nephrotoxic
⮚ Pyrazinamide
Monitor s/sx of liver impairment
Liver function studies
⮚ Ethambutol
Report visual disturbances
Hepatotoxic
Not recommended for children
⮚ Streptomycin
Report oliguria
Nephrotoxic
Ototoxic
Neurotoxic
⮚ Diet; high CHON, Vit A and C
⮚ Promote rest
⮚ Strict isolation/precaution

TYPHOID FEVER
Main Problem: Enteric fever, Typhus abdominalis caused by salmonella typhi,
typhoid bacillus, salmonella typhosa
Mode of transmission: fecal-oral
Incubation Period: 1-2 weeks
Clinical Manifestation:
⮚ Involves ulceration of the peyer’s patches
⮚ Cardinal signs: rose spots, ladderlike fever, spleenomegaly
Diagnostic test: widal test or blood agglutination test; usually becomes positive by the
end of the 2nd week.
Nursing diagnosis: altered body temperature
Intervention:
⮚ Antibiotics (Amoxicillin, Chloramphenicol)
⮚ Promote bed rest
⮚ Fluid and electrolyte replacement
SYSTEMIC LUPUS ERYTHEMATOUS
Main Problem: chronic autoimmune multi-system disorder with periods of
exacerbation and remission and increased production of antibodies to cellular DNA,
results in inflammatory process involving veins and arteries causing pain swelling and
tissue damage.
Clinical Manifestation:
⮚ Pancytopenia and butterfly rash on the face
⮚ Palmar erythema
⮚ Psychosis and impaired cognitive function migratory pain and swelling
⮚ Hypertension
⮚ Carditis
Diagnostic test: positive rheumatoid factor and ANA test positive, ESR elevated and
serum globulins elevated, urine chemistry - proteinuria and hematuria
Nursing diagnosis: high risk for injury
Intervention:
⮚ Diet high in iron, CHON, vit C
⮚ Hemodialysis and kidney transplant if renal failure occurs
⮚ Increase rest and sleep
⮚ Monitor musculoskeletal, renal and cardiopulmonary status
⮚ Administer antiemetics and antidiarrheals
⮚ Encourage expression of body image change
⮚ Avoid infection, sunlight exposure, OTC meds, oral contraceptives, hair spray
and color
⮚ Give medications as ordered - analgesics, antiemetics, anti-rheumatics, cytotoxic
drugs, steroids and NSAIDS