Angeles University Foundation

Tuberculosis
Dela Pena, Joyce S., Group 12

Tuberculosis

Also known as Kochs Disease, Phthisis, and Consumption Disease Sub-acute/acute respiratory disease commonly affecting the lungs Characterized by formation of tubercles in the tissues which tend to undergo ceseation, necrosis and calcification

Etiologic Agent

Causative agent: Rod shaped organism, Mycobacterium tuberculosis, M. africanum from humans and M. bovis from cattle.

Incubation Period

2-10 weeks

Period of Communicability

All throughout life if remains untreated Highly communicable during its active phase

Mode of Transmission

Transmitted by deliberate inoculation of microorganism or by droplet:

Inhalation directly into lungs from air Direct/indirect contact with infected people(usually by discharges from

respiratory tract by means of coughing, sneezing or kissing)

Contact with contaminated eating utensils Rarely: through skin lesions

Sources of Infection

Sputum Blood from hemoptysis Nasal discharge Saliva

Quantitative Classification
1. Minimal

Characterized by slight lesions without demonstrable excavation Confined to a small part of one or both lungs

2. Moderately Advanced

One or both lungs involved Volume affected should not extend to one lobe Total diameter of the cavity should not exceed four centimeters

3. Far Advanced

Lesions are more extensive than moderate

Clinical Classification
1. Inactive TB

S/sx are absent Sputum is absent for tubercle bacilli after repeated exam. No evidence of cavity on chest x-ray

2. Active

Tuberculin test is (+) X-ray of the chest is generally progressive S/sx due to lesions are usually present Sputum and gastric are (+) for tubercle bacilli

Clinical Manifestations

Afternoon rise of temperature Night sweating Body malaise Weight loss Cough, dry to productive Dyspnea hoarseness of voice Hemoptysis considered pathognomonic to disease Chest pain Sputum(+) for AFB

Diagnostic Procedures

Sputum analysis for AFB confirmatory Chest X-ray Tuberculin testing

a) Mantaux test(PPD) b) Tine test(OT) c) Heaf test(LT)

Pathophysiology of Kochs Disease (Tuberculosis)

Predisposing Factors:

Precipitating Factors: - Occupation (e.g Health Workers) - Repeated close contact w/ infected - Indefinite substance abuse via IV - recurrence of infection

Age Immunosuppression persons o Prolonged corticosteroid therapy

Systemic Infection:

o o
o

Diabetes Mellitus End-stage Renal Disease HIV or AIDS infection

Exposure or inhalation of infected Aerosol through droplet nuclei (exposure to infected clients by coughing, sneezing, talking)

Tubercle bacilli invasion in the apices of the Lungs or near the pleurae of the lower lobes

Bronchopneumonia develops in the lung tissue (Phagocytosed tubercle bacilli are ingested by macrophages) bacterial cell wall binds with macrophages

arrest of a phagosome which results to bacilli replication

Necrotic Degeneration occurs (production of cavities filled with cheese-like mass of tubercle bacilli, dead WBCs, necrotic lung tissue)

drainage of necrotic materials into the tracheobronchial tree (eruption of coughing, formation of lesions) PRIMARY INFECTION

Lesions may calcify (Ghons Complex) and form scars and may heal over a period of time

Tubercle bacilli immunity develops (2 to 6 weeks after infection) (maintains in the body as long as living bacilli remains in the body)

Acquired immunity leads to further growth Of bacilli and development of ACTIVE INFECTION

SIGNS AND SYMPTOMS

Pulmonary Symptoms: Dyspnea Non-productive or productive cough Hemoptysis (blood tinge sputum) Chest pain that may be pleuritic or dull and Chest tightness Crackles may be present on auscultation

General Symptoms: - Fatigue - anorexia - Weight loss - low grade fever with chills sweats (often at night)

With Medical Intervention

Without Medical intervention

Early detection/ diagnosis of the dse Multi-antibacterial therapy Fixed- dose therapy TB DOTS (Direct Observed Therapy) BCG vaccination

Reactivation of the tubercle bacilli (Due to repeated exposure to infected Individuals, Immunosuppression) SECONDARY INFECTION

Severe occurrence of lesions in the lungs No Recurrence Recurrence

Cavitation in the lungs occurs Good Prognosis Bad Prognosis

Active infection is spread throughout the body systems (infiltration of tubercle bacilli in other organs) TB of the Bones Potts Disease Renal TB

INFECTION

SEVERE OCCURRENCE OF Client becomes clinically ill

BAD PROGNOSIS

DEATH

Modalities of Treatment a) Short Term Course Chemotherapy(6 months): Isoniazid(INH), Rifampicin, Pyrazinamide(PZA) and Ethambutol. b) Patients with drug resistance(second lined drugs) such as: capreomycin, streptomycin, cycloserine, amikacin and quinolone drugs. c) Direct Observed Therapy is high recommended to prevent noncompliance d) The medicine shouldn't be taking incorrectly because it will make the treatment harder the second time around because the patient will become resistant to the drug. e) Patients who get need to take the drug again are given different combinations of other drugs(INH, Refampicin, Ethambutol, PZA) rather than just using one.

Other diseases/Problems Associated with PTB

The aging population Diabetes mellitus Chronic Alcoholism Psychiatric Patient Hematologic Disorder HIV

Nursing Management

1. Maintain respiratory isolation until patient responds to treatment or until the patient is no longer contagious. 2. Administer medicines as ordered. 3. Always check sputum for blood purulent expectoration. 4. Encourage questions and conversation so that the patient can air his or her feelings. 5. Teach or educate the patient all about the PTB 6. Encourage the patient to stop smoking. 7. Teach the patient to cough or sneeze into the tissue paper and dispose secretions properly. 8. Advise patient to have plenty of rest and eat balanced meals. 9. Be alert for signs of drug reaction. 10. If the patient is taking ethambutol, watch for optic neuritis. If it develops, discontinue the drug. 11. If patient recieves rifampicin (Rifampin), watch for hepatitis and purpura. Also observe the patient for other complications like hemoptyis. 12. Emphasize the importance of regular follow-up examinations and instruct the patient and his family about the signs and symptoms of recurring TB.

ELEMENTS OF DOTS 1. Political commitment with increased and sustained financing it is needed to foster national and international partnership correct funding is needed to keep health care workers working hard

2. Case detection through quality-assured bacteriology it is to ensure accurate diagnosis and ensured proper testings 3. Standardize treatment with supervision and patient support it is a system needed because it standardizes the treatment of TB in all aspects Short Course Chemotherapy(SCC) and Fixed Dose Combination(FDC) are examples of standardized treatments to this disease to prevent risk of developing drug resistance Supervised treatment(Directly Observed Treatment) is needed so that the patient will be watched over with the schedule of their needed care(ie: drug dosage, time of taking the drug, etc) 4. An effective drug supply and management system it is needed so that the anti-TB drugs will be available to everyone, whether rich or poor it is needed so that the treatment of the drugs will be monitored, properly dosed and used it is also needed so that it can improve drug administration, promote adherence to treatment and prevent development of drug resistance 5. Monitoring and evaluation system and impact measurement it is needed so that there will be a system that will have all the patients data and information of what the patience needs to help treat and monitor the disease the system needs: a) in a district level, it is needed so that we can identify local problems and treat them right away. b) on a national level to ensure consistently high quality TB control. c) nationally and internationally evaluate the performance of each country.
d) regular programmed supervision should be carried out to see

the quality of information and to address performance problems.

Common Nursing Diagnosis Sleep pattern disturbance Body image disturbance Altered nutrition: Less than body Requirement Fatigue

Self-care deficit Alteration in comfort Knowledge deficit Ineffective airway clearance

Prevention and Control

Submit all babies for BCG immunization Avoid overcrowding Improve nutrition and health Advise people previously exposed to TB infected individuals to undergo diagnostic procedures and prophylactic isoniazid