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SAN LAZARO HOSPITAL

PULMONARY TUBERCULOSIS
(Kochs Disease/Phthisis/Consumption Disease)

Submitted by:
Minerva Malinis
BSN-III

Submitted to:
Mrs. Memory Saramosing
Clinical Instructor
DEFINITION:
-Is an infectious disease that primarily affects the lung parenchyma. May be transmitted to other parts of the
body including the meninges, kidneys bones and lymph nodes.
-Is a chronic, subacute or acute respiratory disease commonly affects the lungs, characterized by tubercle
bacilli which tends to undergo necrosis and calcification.
CAUSATIVE AGENT:
Mycobacterium tuberculosis, are acid-fast aerobic rod that grows slowly and is sensitive to heat and ultraviolet
light. M. Africanum in human and M. bovis in cattle.
SOURCES OF INFECTION:
Sputum, blood from hemoptysis, nasal discharges and saliva. TB spreads from person to person by airborne
transmission. An infected person releases droplet nuclei (usually particles 1 to 5 um in diameter) through
talking, coughing, sneezing, laughing, or singing.
MODE OF TRANSMISSION:
1. Transmitted through of organisms directly into the lungs from contaminated air.
2. Direct or indirect contact with infected persons usually from respiratory tract by means of coughing, sneezing
or kissing.
3. Transmitted through contact with contaminated eating or drinking utensils.
INCUBATION PERIOD:
Is from two to ten weeks.
PERIOD OF COMMUNICABILITY:
The patient is capable if discharging the organismal throughout his/her life if he/she remains untreated. The
disease is highly communicable during its active phase.
Active phase:
 The tuberculin test is positive.
 X-ray of the chest is generally progressive.

CINICAL MANIFESTATIONS:
 Afternoon rise in temperature
 Night sweating Body malaise and weight loss
 Occasional chest pain
 Dry to productive cough
 Dsypnea and hoarseness of voice
 Hemoptysis (pathognomonic of the disease)
 Sputum positive for AFB

DIAGNOSTIC TEST:
1. Sputum analysis (confirmatory test)
2. Chest x-ray
3. Tuberculin test
a. Mantaux test (PPD)
b. Tine test
c. Heaf test

MODALITIES OF TREATMENT:
1. Short-course chemotherapy consisting of INH, rifampicin, pyrazinamide and ethambutol may be given
for a period of six months.
2. Patients with drug resistance nay be given second-line drugs such as capreomycin, streptomycin,
cycloserine, amikacin and quinolone.
3. WHO recommends DOTS to prevent non-compliance.
4. Relapsing patients usually becomes resistant to individual drugs (INH, rifampicin, ethambutol and PZA.)

NURSING INTERVENTIONS:
 Monitor temperature as indicated.
 Emphasized the importance of uninterrupted drug therapy/
 Assess respiratory function, such as breath sounds, rate, rhythm, and depth and use of accessory
muscles
 Place client in a semi or high fowlers position.

NURSING MANAGEMENT:
 Maintain respiratory isolation until patient respond to treatment or until he/she is no longer contagious.
 Always check the sputum for blood or purulent secretions.
 If patient is receiving ethambutol, watch out for optic neuritis.
 If patient is receiving rifampicin, watch out for hepatits and purpura.
 Advise patient to get plenty of rest and nutrition.

PATHOPHYSIOLOGY
Modifiable factors Non-modifiable factor
Age History of PTB
Gender
Poverty
Malnutrition
Overcrowding
Inadequate heath care

Person inhales mycobacteria

Transmitted througn airways to the alveoli

Bacilli are transported via lymph system and blood stream

Immune sysytem iniates inflammatory reaction

Tissue reaction results in the accumulation of exudate in the alveoli causing brochopneumonia

Granulomas are surrounded by macrophage. form a protective layer.

Transformed toba fibroud tissue mass. Called Ghon tubercle

Bacteria becomes dormant

Active disease develop because of compromised or inadequate immune system

Cause the infected lung to become inflamed resulting in bronchopneumonia and tubercle formation.