TUBERCULOSIS

Introduction:

What is tuberculosis?

It is primarily a respiratory disease but

can also affect other organs of the body.
About 2 billion people are infected with
tuberculosis worldwide. It is considered world
deadliest disease and remained a major
public health problem in the Philippines.

 TB is common among malnourished individuals living

crowded areas. However, all age groups are at risk. Over 95%
of cases and deaths are in developing countries.
In 1993, TB was declared as global emergency by the
WHO because of the resurgence of TB in many part of the
world.
In the Philippines, TB ranks 6th in the leading cause
morbidity (2002) and mortality (2002).The country ranks 9th
among the 22 high burdened countries under the WHO watch
list.
There is a treatment for tuberculosis. When treated 90% of
patients who have an active tuberculosis infection survive.

There is common type of tuberculosis:

1. Latent TB Infection they have no symptoms and
their chest X-Ray may be normal. The only
manifestation of this encounter may be reaction to
the tuberculin skin test (TST) of interferon-gamma
release assay (IGRA).
2. Active TB Disease active TB is an illness in which
the TB bacteria are rapidly multiplying and invading
different organs of the body.
3. Miliary TB is a rare form of active disease that
occurs when TB bacteria find their way into the
bloodstream.

Causative Agents

Tuberculosis is an infection caused by a

bacterium called Mycobacterium tuberculosis. The
bacterium is also called tubercle bacillus.
Mycobacterium tuberculosis and M. Africanum
primarily from humans, and M. Bovis primarily from
cattle. Other mycobacteria occasionally produce
disease clinically indistinguishable from
tuberculosis; the etiologic agents can be identified
only by culture of the organisms. At present (year
2000), there are 23 new stains of the TB bacilli
found in the United States. Therefore TB is no
longer considered to be a disease of the past but of
the present.

Risk Factors

Anyone can get tuberculosis, but certain factors

can increase your risk of the disease. These
factors include:
Weakened immune system
Traveling or living in certain areas
Poverty and substance abuse
- Lack of medical care
- Substance abuse
- Tobacco use
Where you work or live
- Health care work.
- Living or working in a residential care facility.
- Living in a refugee camp or shelter.

Mode of transmission

Tuberculosis spreads from person to person

through air as a person with active tuberculosis
cough, sneezes, or expels air.

Signs & Symptoms

 Cough of two weeks or more

Fever
Chest pain back pains not referable to
any musculo-skeletal disorders

 Hemoptysis or recurrent blood-streaked

sputum
Significant weight loss
Other signs and symptoms such as sweating,
fatigue body malaise and shortness of breath
Some patient may have little or no
symptoms with TB.

Pathagnomic Signs

Hemoptysis
is the expectoration (coughingup)
ofbloodor of blood-stainedsputumfrom
the bronchi,larynx,trachea,
orlungs(e.g., in tuberculosis or other
respiratory infections or cardiovascular
pathologies).

Anatomy and Physiology

Respiratory system

A system of organs functioning in respiration and

consisting esp. of the nose, nasal passage,
nasopharynx, larynx, trachea, bronchi, and lungs.
Function of the Respiratory System
The function of the human respiratory system is
to transport air into the lungs and to facilitate the
diffusion of Oxygen into thebloodstream. Its also
receives waste Carbon Dioxide from the blood and
exhales it.

Parts of the Lower Respiratory Tract

Trachea:
Also known as the windpipe
this is the tube which carries
air from the throat into the
lungs. It ranges from 20-25mm
in diameter and 10-16cm in
length. The inner membrane of
the trachea is covered in tiny
hairs called cilia, which catch
particles of dust which we can
then remove through
coughing..

Parts of the Lower Respiratory

Tract

Bronchi:
The trachea divides
into two tubes called
bronchi, one entering
the left and one
entering the right lung.
The left bronchi is
narrower, longer and
more horizontal than
the right. Irregular rings
of cartilage surround
the bronchi, whose
walls also consist
ofsmooth muscle.
Once inside the lung the
bronchi split several
ways, forming tertiary
bronchi.

Parts of the Lower Respiratory Tract

Bronchioles:
Tertiary bronchi
continue to divide and
become bronchioles,
very narrow tubes, less
than 1 millimeter in
diameter. There is no
cartilage within the
bronchioles and they
lead to alveolar sacs.

Parts of the Lower Respiratory Tract

Diaphragm:
The diaphragm is a broad
band of muscle which sits
underneath the lungs,
attaching to the lower
ribs, sternum and lumbar
spine and forming the
base of the thoracic
cavity.

Parts of the Lower Respiratory Tract

Alveoli:
Individual hollow
cavities contained
within alveolar sacs
(or ducts). Alveoli
have very thin walls
which permit
theexchange of
gasesOxygen and
Carbon Dioxide. They
are surrounded by a
network
ofcapillaries, into
which the inspired
gases pass. There are
approximately 3
million alveoli within
an average adult lung.

Pathopysiology

Infected
Person with
TB

Cured

Death

exposure to
the person
with TB

Treatment
of the
disease

Consult the
doctor

Spread to
the other
organs

Inhalation
of bacteria

Bacteria
reach the
lungs

bacteria
multiplies

Resulting in
active TB

Establishing
primary
infection

May heal if
strong immune
system
response

Resulting
in latent
infection

May remain
latent in life

Infected
Person with
TB

Cured

Death

exposure to
the person
with TB

Treatment
of the
disease

Consult the
doctor

Spread to
the other
organs

Inhalation
of bacteria

Bacteria
reach the
lungs

bacteria
multiplies

Resulting in
active TB

Establishing
primary
infection

May heal if
strong immune
system
response

Resulting
in latent
infection

May remain
latent in life

Confirmatory Exam

 Chest Radiology
If a patient has no respiratory symptoms, a normal chest X-ray
almost excludes pulmonary tuberculosis. Chest X-rays are
valuable for detecting pulmonary lesions of tuberculosis,
however activity of disease cannot be judged with certainty

Culture
IdentifyingM. tuberculosisremains the definitive means
for diagnosis of active tuberculosis. Although culture
ofM.tuberculosisfrom a specimen is a sensitive test (75
80%), bacteria can take up to six weeks or more to grow.
CollecAtion of specimens should include three morning
sputa whatever the suspected site of disease, unless chest
X-ray is normal and there are no respiratory symptoms in a
person with localised extrapulmonary disease

Chest radiograph of perosn without TB

Chest radiograph of perosn without TB

 Tuberculin skin testing

This test measures a patient's immune response
toM.tuberculosisantigens (tuberculin). A small amount of
tuberculin is injected intradermally and the skin reaction is
measured two or three days later.

 Sputum collection
Collection of sputum specimens is essential to confirm that TB
disease is present. Sputum is the mucus from deep within the
lung and not saliva. The health worker must assure that mucus is
present in the collection tube
Ideally three sputum specimens will be collected by the patient
on three successive days, usually right after getting up in the
morning

Medical Management

 Assessment and diagnosis of suspect cases of

TB
Report all cases of active and suspect cases of
active TB within 24 hours of making the
diagnosis
Provide treatment and follow-up of cases and
contacts
Identify ineffective drug therapy regimens and
drug toxicities and report

NURSING MANAGEMENT

 Nursing Assessment of Tuberculosis Patients

Nursing Diagnoses For Tuberculosis

Nursing Interventions for Risk for Infection

Nursing Interventions for Ineffective Breathing Pattern
Nursing Interventions to Improve Nutritional Status of TB
Patients
Nursing Interventions to Improve Compliance with
Tuberculosis Drug Regimen

Treatment Regimen

1.Pulmonary TB
Drugs

Daily Dose (mg/kg/body weight)

Duration

INTENSIVE PHASE
Isoniazid 10-15mg/kg body weight
Rifampicin
10-15mg/kg body weight
Pyrazinamide 20-30mg/kg body weight

2 months

CONTINUATION PHASE
Isoniazid
Rifampicin

10-15mg/kg body weight

10-15mg/kg body weight

4 months

2. Extra-pulmonary TB
Drugs

Daily Dose (mg/kg/body weight)

Duration

INTENSIVE PHASE
Isoniazid 10-15mg/kg body weight
Rifampicin
10-15mg/kg body weight
Pyrazinamide 20-30mg/kg body weight

2 months

PLUS
Ethambutol or 15-25mg/kg body weight
Streptomycin 20-30mg/kg body weight
Continuation Phase
Isoniazid
Rifampicin

10-15mg/kg body weight

10-15mg/kg body weight

10 moths

Reported by: aj