TUBERCULOSIS

Koch’s Disease, Phthisis,

Consumption Disease,
Wasting Disease, White, Plague, Scrofula,
Tabes Mesenterica,Lupus Vulgaris

REMEMBER!!!!
TUBERCULOSIS IS INITIALLY ASYMPTOMATIC

• A chronic disease that usually

• Causative agent:
involves the lungs Mycobacterium tuberculosis
• may disseminate in any other Mycobacterium bovis
parts of the body A rod shape, gram positive
• characterized by formation organism
of tubercles which tend to undergo • Incubation period is from 2-10
caseation necrosis or fibrosis and calcification. weeks

EPIDEMIOLOGY
• According to the World Health Organization (WHO), nearly 2 billion people—one third of
the world's population—have been exposed to the tuberculosis pathogen.
• annually, 8 million people become ill with tuberculosis, and 2 million people die from the
disease worldwide
• Tuberculosis is the world's greatest infectious killer of women of reproductive age and the
leading cause of death among people with HIV/AIDS
Etiology
-poverty and overcrowding
-energy-protein malnutrition
-multivitamin deficiency vit A, D and C
-presence of debilitating diseases
-
CHILDREN BELOW 5 YEARS OLD- due to inadequate level of immunity

Pathophysiology of Tuberculosis
Precipitating Factors:
Predisposing Factors:
• Age
- Occupation (e.g Health Workers)
• Immunosuppression - Repeated close contact w/ infected persons
• Prolonged corticosteroid therapy - Indefinite substance abuse via IV
• Systemic Infection:
• - recurrence of infectio
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 (Ghon’s Complex/Ghon’s tubercle)
and form scars and may heal over a period of time

SIGNS AND SYMPTOMS

Pulmonary Symptoms: General Symptoms:

Dyspnea - Fatigue
• Non-productive or productive cough - anorexia
• Hemoptysis (blood tinge sputum) - Weight loss
• Chest pain that may be pleuritic or dull - low grade fever with chills and
• Chest tightness sweats (often at night)

Crackles may be present on auscultation

With Medical Intervention Without Medical intervention

• Early detection/ diagnosis
of the disease • Reactivation of the tubercle
bacilli (Due to repeated
exposure to infected
Multi-antibacterial therapy individuals, Immunosuppression)
Fixed- dose therapy
TB DOTS (Direct Observed Therapy) Severe occurrence of lesions
BCG vaccination 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, Lupus Vulgaris
• Pott’s Disease, Miliary tb, etc.

SEVERE OCCURRENCE OF INFECTION

(client becomes clinically ill)

Bad Prognosis

DEATH
Mode of transmission
• Direct or indirect contact with infected persons usually by respiratory discharges
• Use of contaminated utensils
• Direct inoculation of the pathogen
• Rarely, through skin lesions
• Drinking cow’s milk containing Mycobacterium bovis
Sources of infection:
• SPUTUM of persons with TB is the usual source of the microorganism
• Blood
• Saliva
Quantitative Classification of TB
• Minimal
• Moderately Advanced
• Far Advance classifications Minimal
• Moderately Advanced
• Far Advance classifications
Clinical Classification
▪ Inactive TB
-symptoms of tuberculosis are absent
-sputum negative
-no evidence of cavity on x-ray
• Active
-Tuberculin test is positive
-x-ray on chest is progressive
-symptoms due to lesions are present
-sputum and gastric contents are positive
• Activity not determined
-no suitable period of observation
-no lab data

Clinical Manifestations
• Afternoon rise of temperature
• Night sweating
• Malaise and weight loss
• Cough, dry to productive
• Dyspnea, hoarseness of voice
• Occasional chest pain
• Sputum positive for AFB
•
HEMOPTYSIS
►SPITTING OF BLOOD OR BLOOD STAINED SPUTUM
►PATHOGNOMONIC SIGN OF TUBERCULOSIS

DIAGNOSTIC PROCEDURES
• SPUTUM ANALYSIS FOR AFB -(CONFIRMATORY)
PURPOSE:
To determine the presence of microorganism

NURSING KEYPOINTS:
• 10-15 ml
• A.M.
• Gargle with water
• Instruct patient to take several deep breaths and then cough deeply

DIAGNOSTIC PROCEDURES
a. CHEST X-RAY
b. Mantoux test (Tubirculin Test)
• Screening test for TB
• Indicator for (+) exposure to TB pathogen
• (+) interpretation parameters:
5mm induration 10mm induration 15mm induration
(+) HIV, AIDS patients (+) immigrants and pediatric (+) general population
patients

REMEMBER!!!!!!!!!!!
• RESULT IS READ 48-72 HRS
• BCG MAY CAUSE FALSE
POSITIVE RESULT
• MANTOUX TEST IS USED TO DETERMINE EXPOSURE TO TB, NOT ACTIVE INFECTION
c. TINE TEST (OT)
• a multiple puncture tuberculin skin test
• This test uses a small "button" that has four to six short needles coated with TB antigens
• The test is read by measuring the size of the largest papule
• A negative result is the presence of no papules
d. HEAF TEST aka 6-prick test (LT)
• diagnostic skin test performed to determine TB exposure
• Given to pedia patients
• After a negative result BCG may be offered
• The test is read between 2 and 7 days later
Result:
Negative - No indurations, maybe 6 minute
puncture scars
Grade 1 - 4-6 papules
(also considered negative)
Grade 2 - Confluent papules form
indurated ring (positive)
Grade 3 - Central filling to form disc (positive)
Grade 4 - Disc >10 mm with or without blistering (strongly positive)

MODALITIES OF TREATMENT
1.Short course chemotherapy may be given through a six-month treatment with Isoniazid(INH),
Rifampicin, Pyrazinamide(PZA), and Ethambutol.

REMEMBER!!!!!!! MASARAP ANG PRUTAS KAPAG ITO AY :

R- RIFAMPICIN
I- IZONIAZID
P- PYRAZINAMIDE (PZA)
E- ETHAMBUTOL
S-STREPTOMYCIN
REMEMBER!!!!!!!
• R- RIFAMPICIN BEFORE MEALS
• I- IZONIAZID

• P- (PZA) AFTER MEALS

• E- ETHAMBUTOL
Side effects:
• R- RIFAMPICIN- Red orange urine,
hepatotoxicity
• I- IZONIAZID- Peripheral Neuritis (provide Vit. B6)
• P- (PZA)- Hepatotoxicity, Hypercalcemia (alkalinize the urine-MILK)
• E- ETHAMBUTOL- Optic Neuritis /Blurring of vision, color difficulty with red and
green. (discontinue drug if s/s appears)
▪ S- STREPTOMYCIN
NEPHROTOXICITY
-monitor intake and output
-monitor creatinine value
OTOTOXICITY
-tinnitus
-vertigo
D.O.C.-ANTIBIOTIC PROPHYLAXIS FOR TB:

ISONIAZID + VITAMIN B6

Category I Category II Category III

ELIGIBLE New cases, sputum positive,

RELAPSES, FAILURESPTB minimal, new cases with
serious cases, sputum
extrapulmonary tb (-)
Treatment: RIPE RIPES-2mos RIP
INTENSIVE 2 MONTHS RIPE-1 mos 2 MONTHS
Treatment: RI RIE RI
MAINTENANCE 4 MONTHS 5 MONTHS 2 MONTHS

TOTAL 6 MONTHS 8 MONTHS 4 MONTHS

REMEMBER!!!!!!!!!
INTAKE OF DRUGS
2-4WEEKS AFTER, THE PATIENT IS NO LONGER CONTAGIOUS

HEALTH EDUCATION EMPHASIS

• TB is infectious
• TB can be cured but cure requires regular drug intake
• Irregular drug intake impedes cure and result in chronic cases
• Anti-TB drugs have side effects
• It is important to follow-up sputum examinations
• Family/treatment partner support is important

MODALITIES OF TREATMENT
1.Short course chemotherapy may be given through a six-month treatment with Isoniazid(INH),
Rifampicin, Pyrazinamide(PZA), and Ethambutol.
2. Patients with drug resistance may be given with second line drugs such as capreomycin, streptomycin,
cycloserin, amikacin, and quinolone drugs
3. WHO recommends “Direct Observed Therapy” (DOT) to prevent noncompliance. The healthworker
insures that the patient takes his/her drugs.
4. If the medicine is taken correctly, the patient becomes resistant to anti-TB drugs and this is very
dangerous because if the disease recurs it becomes hard to treat the second time around.
5. Relapsing patients usually become resistant to individual drugs (INH, Rifampicin, Ethambutol PZA).

Other Diseases/Problems Associated with PTB

1. The aging population
2. Diabetes mellitus
3. Chronic alcoholism
4. Psychiatric patient
5. Hematologic disorder
6. HIV infection
NURSING MANAGEMENT
1. Maintain respiratory isolation until patient responds to treatment or until the patient is no longer
contagious.
2. Administer medicines ordered.
3. Always check sputum for blood or 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 PTB
6. Encourage the patient to stop smoking.
7. Teach the patient to cough or sneeze into 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 receiving ethambutol,
Watch for optic neuritis. If it develops, discontinue the drug
11. If the patient receives rifampicin (Rifampin), watch for hepatitis and pupura. Also observe the
patient for other complications like hemoptysis.
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
2. Case detection through quality-assured bacteriology
3. Standardize treatment with supervision and patient support
4. An effective drug supply and management system
5. Monitoring and evaluation system, and impact measurement.

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
1. Submit all babies for BCG immunization.
2. Avoid overcrowding
3. Improve nutritional and health status.
4. Advise persons who have been exposed to infected persons to receive tuberculin test and, if
necessary, chest x-ray and prophylactic isoniazid.