Group 1

Tuberculosis

• Andika Hemawan
• Eti rahmawati
• Risma Defriyanti
• Siska Juliati
• Widya Akmalia A
 A. Definition
Tuberculosis (TB) is a disease caused by systemic
mycobacterium tuberculosis bacteria that can affect all
the organs of the body with the most sites in the lungs
which is usually the location of primary infections I
(Arif mansjoer 2000)

Tuberculosis (TB) is an infectious disease that

primarily affects the lung parenchyma. Tuberculosis can
also be transmitted to other body parts, especially the
meninges, kidneys, bones, and lymph nodes (Suzanne and
Brenda, 2001)
 B. Etiology
The main infectious agents, mycobakterium aerobic
rod-resistant tuberculosis is a slow-growing acid and
sensitive to heat and ultra-violet rays, with a length of 1-4/
um thick 0, 3 - 0,6 / um. The classified germs of complex
mycobacterium tuberculosis
are:
1. Mycobacterium tuberculosis
2. The asian variant
3. African variant I
4. Asfrican II variant
5. Mycobakterium bovis
 The group of mycobacterium tuberculosis and
mycobakterial othetan Tb (mott, atipyeal)
bacteria are:
1. Mycobacterium cansasli
2. Mycobacterium avium
3. Mycobacterium intra celulase
4. Mycobacterium scrofulaceum
5. Mycobacterium malma cerse
6. Mycobacterium xenopi
Presdisposing Factor
1. Those who are in close contact with someone who
has active TB.
2. Immunosuppressive individuals (Including elderly,
patients with cancer, those in corticosteroid therapy
or HIV-infected brand A).
3. Users of IV medicines and alcoholics.
4. Any individual without adequate health care
(homeless, prisoners , ethnic and racial minorities
especially children under 15 years of age or young
adults between 15-44 years old).
5. Any individual with pre-existing medical disorders
(eg diabetes, chronic renal failure, silicosis,
nutritional aberrations, yeyunoileal gastectomy
bypass).
7 . Immigrants from countries with high
TB ​incidents (southeast Asia, Africa, Latin
America, the Caribbean)
8 . Individual who live in slum substandart
housing area.
9 . Health workers
 C . Classification
Pulmonary tuberculosis in humans can be found in
2 forms:
1. Primary Tuberculosis
When the disease occurs in the first infection
2. Post-primary tuberculosis
When the disease develops after a period of time
a person has primary infection heal and is the
most important form because it is the most
common form and with the presence of germs in
sputum which is the source of transmission.
 D . Clincal Manifestatios
1 . Systemic / general symtomps, among others,
are as follows :
a. Fever is not too high that lasts long, usually
felt at night with night sweats. Sometimes
fever attacks such as inflde nza and are
disappearing arise.
b. Decreased appetite and weight.
c. Cough for more than 3 weeks (may be
accompanied by blood).
d. Feeling uneasy (malaise), weak.
2. Specific symptoms , among others, as follows:

a. Depending on which organs are affected, if there is a

partial blockage of the bronchus (the channel leading
to the lungs) due to enlarged lymph node suppression,
will cause voice "wheeze", the sound of weak breath
accompanied by shortness. If there is liquid
dironggapleur a (wrapping the lungs), can be
accompanied by chest pain complaints.
b. When it comes to bone, there will be symptoms such
as bone infection that at one time can form a channel
and empty into the skin above it, in this aura will
come out of pus fluid.
c. In children can affect the brain (the layer of the brain
wrap) and called sebagaim eningitis (inflammation of
the lining of the brain), the symptoms are high fever,
the decrease in consciousness and convulsions.
 E . Pathophysiology
Transmission of pulmonary tuberculosis occurs
because the germ is smoothed or coughed out into
droplet nuclei in the air. These infectious particles
can settle in free air for 1-2 hours, depending on the
presence or absence of ultraviolet light, poor
ventilation and moisture. In a humid and dark
atmosphere germs can hold for days for months. If
the particles of this infection are sucked by healthy
people will stick to the airway or lungs.
 After being in an alveolar room usually at the
bottom of the upper lobe of the lung or at the
top of the lower lobe, this tuberkel bacillus
generates an inflammatory reaction.
Polymorphonuclear leukocytes appear in these
areas and bacterial phagocytes but do not kill
these organisms. After the first days the
leukocytes will be replaced by macrophages. The
affected alveoli will be consolidated and
symptoms of acute pneumonia develop.
 Macrophages that infiltrate become longer
and partially unite to form epithelioid tubercle
Cellssurrounded by lymphocytes. This reaction
Takes10-20 days. The disease can spread
Through lymph or blood vessels. Organisms that
Escapefrom the lymph nodes will reach the
bloodstream in small amounts, sometimes can
cause lesions in other organs.
 F . Diasnotic Examination
1. Sputum Culture
2. Ziehl Neelsen (Acid-fast Staind applied to smear of
body fluid )
3. Skin Test (PPD, Mantoux, Tine, Vollmer Patch )
4. Chest X-Ray
5. Histology or Culture of tissue (including stomach,
urine and CSF, skin biopsy )
6. Needle Biopsy of Lung Tissue
7. Electrolytes: may be abnormal depending on location
and severity of infection
8. ABGs
9. Bronchography
10. Blood
11. Lung Function Test
 G . Management of Tuberculosis
Treatment of TB there are 2 stages according to
DEPKES.2000 namely:
1 . INTENSIVE STAGE
Patients receive daily medication and are directly
supervised to prevent immunity from rifampicin.
When the intensive time is given properly, the
infectious patient becomes not infectious within 2
weeks. Most people with smear positive TB
become negative (conversion) at the end of
intensive treatment. Strict supervision in the
intensive stage is very important to prevent the
occurrence of drug resistance.
2 . Advanced stage
In the later stages of the patient get longer drug
duration and fewer drugs to prevent recurrence.
The advanced stage is important for killing
persistent bacteria (dormant) to prevent
recurrence.

Nonpharmacology
1. Dietary modification: eat plenty of nutritious
foods (TKTP diet)
2. Reduces excessive activity
3. Avoid smoking and drinking alcohol
4. If there is congested sitting semifowler and
effective cough exercises
 ASSESSMENT
a . Signs and symptoms
1). Activity
• Symptoms: General fatigue and weakness, shortness of
breath, difficulty sleeping on a night or a fever instead
of a day, chills and or sweats, nightmares.
• Signs: Tachycardia, tachypnea / dyspnea at work,
muscle fatigue, pain, and tightness
2). Integrity of the ego
• Signs: Denying (especially during the early stages),
anxiety
• Symptoms: the presence / old stress factor, home
finance problems. Feeling helpless, hopeless,
population / culture, ethnicity.
3). Food / fluids
• Signs: Bad skin turgor, dry / scaly, lost muscle
/ lost subcutaneous fat
• Symptoms: Loss of appetite, can not digest,
decreased body weight.
4). Pain / comfort
• Signs: Be cautious in areas of illness,
distraction and anxiety behavior
• Symptoms: Chest pain is increased due to
recurrent cough
5). Respiratory
• Signs: Increased respiratory rate, non-
symmetrical breathing development, percussive
percussion and decreased fremitus.
Breath sound : decreased / absent bilterally or
unilaterally (pleural effus / pneumothorac).
Tubular breathing and / or pectoral whispers over
large lesions. Krekels recorded above the lung
apek during rapid inspiration after a short cough
(Krekel Posttussic) characteristic of sputum:
green / purulent, mucoid or spotting carah.
Tracheal deviation (bronchogenic spread), lack of
attention, arousing the real, mental changes.
• Symptoms: Productive or unproductive cough,
shortness of breath, history of TB / exposure to
infected individuals.
6). Security
• Signs: Low fever or acute heat pain
• Symptoms: The presence of immune suppression
conditions
7). Social interaction
• Symptoms: Feelings of isolation / rejection as
contagious, ordinary pattern changes in
responsibility / physical capacity change to
perform role.
8). Counseling / learning
• Symptoms: Family history of TB, general
disability / poor health status, failure to improve /
recurrence of TB, not participating in therapy.
b. Physical examination
1. Signs of extensive or consolidated infiltration,
there is hardened fremitus, dim percussion,
bronchial breath sound with or without ronchi
2. Signs of pulmonary withdrawal, diaphragm,
mediastinum or asymmetric chest pleura, lagging
breathing movements, shifting from the
diaphragm boundaries, heart, breath sounds
weakened with or without ronchi.
3. Signs of cavities associated with bronchus,
amforik sound
4. Distress breath channel: wet / dry ronchi
5. Location of abnormality: although tuberculosis
lesions predilection at the lung peak, but
abnormalities may occur in all parts of the lung.
c. Laboratory examination
a. Anemia especially when the disease runs
chronic
b. Mild leukocytosis with lymphocyte
predomination
c. The rate of sedimentation of the blood (LED)
increases especially in the acute phase and
generally these values ​return to normal at the
healing stage.
d. Abnormalities in peripheral blood are unusual
and insensitive.
d. Radiological examination
• May indicate early infiltration of lesions in
upper lung areas, calcium deposits of primary
cured lesions or fluid effusions. Changes
indicating wider TB can include cavities,
fibrous areas.

e. Sputum bactericidal examination

• Positive for mycobacterium tuberculosis at the
active stage of the disease.
f. Test tuberculin
• A positive reaction (area 10 mm or greater,
occurring 48-72 hours after injection,
intradermal antigen) suggests past infection
and presence of antibodies but does not
significantly indicate active disease.
Significant reactions in patients who are
clinically ill mean that active TB can not be
derived or infection caused by different
mycobacteria.
 Nursing diagnoses
a. The ineffectiveness of airway clearance is
associated with a visceral secret, or secret,
weakness, poor cough and tracheal / pharyngeal
edema.
b . O2 gaseous CO2 gas exchange disturbances are
associated with decreased lung affective surface,
atelectasis, alveolar-capillary membrane damage
and thick, thick secretions.
c . Changes in nutrients are less than necessity
associated with weakness, frequent chough /
sputum productions, dyspnea and anorexia.
 Nursing Intervention
a . The ineffectiveness of airway clearance is
associated with a visceral secret, or secret,
weakness, poor cough and tracheal / pharyngeal
edema.
• Asses respiratory functions such as breathing,
rhytm, depth.
• Record the ability to release sputum and cough
effectively.
• Teach the patient the deep breathing technique
and how to do the effective cough.
• Intruct patient to drink plenty of water 2000-
2500cc.
b. O2 gaseous CO2 gas exchange disturbances are
associated with decreased lung affective surface,
atelectasis, alveolar-capillary membrane damage
and thick, thick secretions.
• Asses dispnea, tachypnea, abnormal respiratory
sound, increased respiration, liited chest
expansion and fatique.
• Evaluate changes In the level of consciousness,
note the signs of cyanosis and skin changes, the
mucous membranes and the color of the nails.
• Suggest for bed rest/ reduce activity
• Collaboration for supplemental oxygen delivery.
c . Changes in nutrients are less than necessity
associated with weakness, frequent chough /
sputum productions, dyspnea and anorexia.
• Asses nutrional status, history of nausea and
vomiting.
• Monitor intake and output periodically.
• Encourage clients to eat less but often by
eating high-protein carbohydrates.
FINISH