Tuberculosis

PULMONARY TUBERCULOSIS • Infectious disease primarily affecting the lung parenchyma • Commonly caused by Mycobacterium tuberculosis Infects 1/3 of the world’s population  Leading cause of death from infectious disease worldwide 

• Closely associated with poverty, malnutrition and overcrowding 

Transmission: airborne

Pathophysiology

Clinical manifestations: insidious in onset       

Low grade fever Cough Hemoptysis Night sweats Fatigue Anorexia Weight loss

Assessment and Diagnostic Findings     

History and PE Tuberculin skin test Chest X ray AFB smear Sputum culture

Tuberculin skin test / Mantoux test 

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Determine if the person has been infected PPD: injected intradermal Area of induration is read at 48-72 hours Interpretation:

• 0-4mm - not significant ∀ > or = to 5mm - significant for individuals at risk (HIV) • > or= to 10 mm- significant in normal individuals

Classification of TB  

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Class 0 no exposure, no infection Class 1 (+) exposure, no evidence of infection Class 2 latent infection, no disease Class 3 (+) disease, clinically active Class 4 (+) disease, not clinically active Class 5 suspect, diagnosis pending

Medical Management: 

Chemotherapeutic agents for 612 months • To ensure eradication and prevent relapse

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Multidrug treatment: to prevent development of resistant strains Considered non-infectious after 2-3 weeks of therapy

Medical Management:

Categor y

I

II III

IV

TB DOTS

Type of TB

New Smear (+) Extensive Parenchymal Lesions Treatment Failure Relapse Smear (-) with minimal parenchymal lesion Chronic (still smear (+) after supervised re treatment

Intensive

Maintenanc e

2 HRZE

4 HR

2 HRZES

5 HRE

2 HRZE

4 HR

Preventive Measures 

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Prompt diagnosis and treatment of infectious cases BCG vaccination of newborn, infants and grade 1 (school entrants) Educate the public in mode of spread and methods of control and the importance of early diagnosis Provide public Health nursing and outreach services for home supervision

Nursing Intervention 

1. Promoting Airway clearance ∀ ↑ fluid intake • postural drainage

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2. Advocating adherence to treatment regimen • inform client about the drugs, schedule, side effects • prevention of transmission 

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covering the mouth and nose during coughing and sneezing proper disposal of tissues hand hygiene

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Nursing Intervention

3. Promoting activity and adequate nutrition • progressive activity • small frequent meals and liquid nutritional supplements 4. Monitoring and Managing Potential Complications • a. Malnutrition: collaborate with the dietician, physician, patient and family  provide high calorie nutritional supplement • b. Side effects of medication  assess for side effects  take medicines before meals or 1 hour after meals • c. Multidrug resistance  monitor vital signs and observe for changes in clinical status • d. Spread of TB infection  monitor vital signs and observe for