CARE OF CLIENT

WITH INFECTIOUS
DISEASES:
TUBERCULOSIS
Belencion, Charles
Bordonada, Maria Ave Bernadette
Fayo, Thanya Kaye
Perialde, Chery
Overview of the Disease
• Tuberculosis is a chronic bacterial infection that
usually affects the lung parenchyma or gas
exchange (alveoli). The primary infectious agent
M. tuberculosis is an acid-fast aerobic rod that
grows slowly than the majority of bacteria, this is
why tuberculosis evolution than most other
bacterial infections. It is because M. tuberculosis
lives longer than most other bacteria.
How the TB transmits?
• TB spreads from person to person by airborne
transmission. An infected person releases
droplet nuclei (usually particles 1 to 5 mcm in
diameter) through talking, coughing, sneezing,
laughing, or singing.
Pathophysiology
• TB begins when a susceptible person inhales
mycobacteria and becomes infected. The bacteria are
transmitted through the airways to the alveoli where
they are deposited and begin to multiply. The bacilli
also are transported via lymph system and
bloodstream to other parts of the body (kidneys,
bones, brain). The body's immune system responds by
initiating an inflammatory reaction. Phagocytes engulf
many of the bacteria and TB-specific lymphocytes
destroy the bacilli and normal tissue. The initial
infection usually occurs 2 to 10 weeks after exposure.
• Granulomas, new tissue masses of live and dead bacilli, are
surrounded by macrophages, which form a protective wall.
Then transformed to a fibrous tissue mass called tubercle.
The material becomes necrotic, forming a cheesy mass. At
this point, the bacteria become dormant, and there is no
further progression of active disease. Active disease may
occur with reinfection and activation of dormant bacteria.
Tubercle ulcerates, releasing the cheesy material into the
bronchi. The bacteria then become airborne, resulting in
further spread of disease. If untreated, the tubercles can
enlarge and merge forming clumps of dead tissue filling the
lung cavity.
Clinical Manifestations
Assessment
and Findings
Tuberculin Skin Test
The Mantoux method is used to determine whether a person
has been infected with the TB bacillus and is used widely
in screening. Just small amount of tubercle bacillus extract
(tuberculin) and purified protein derivative (PPD) is
injected intradermal into the left arm creating an elevation
in the skin in a tuberculin syringe with half inch 26-27
gauge needle. The test results is read 48 to 72 after
injection. A reaction occurs with both induration and
erythema are present. Erythema without induration is not
considered significant. The size of the induration
determines the significance of the reaction. A reaction of 5
mm or greater may be significant in people who are
considered to be at risk. A significant reaction indicates
past exposures to M. tuberculosis or vaccination with BCG.
TB Blood Tests
TB blood tests use a blood sample to find
out if you are infected with TB. It is preffered
diagnosic test for patients who have received
BCG vaccine. Two TB blood tests are approved
by the U.S. Food and Drug Administration and
are available in the United States:
• QuantiFERON®-TB Gold Plus (QFT-Plus)
• T-SPOT®.TB test (T-Spot)
Additional Assessment
• Complete history
• Physical Examination
• Chest X-ray
• Drug Susceptibility Testing
Medical Management
The most common medicines used to treat TB
disease are:
• Isoniazid (INH)
• Rifampin (RIF)
• Ethambutol (EMB)
• Pyrazinamide (PZA)
Nursing Management
• Promoting Airway Clearance
• Advocating Adherence to the treatment regimen
• Promoting Activity and Nutrition
• Preventing Transmission
Nursing Care Plan
• Imbalanced nutrition less than body
requirement related to persistent cough as
evidence by altered taste sensation
• Ineffective air way clearance related to thick
viscous secretions as evidence by productive
cough