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PULMONARY TUBERCULOSISPULMONARY TUBERCULOSIS

Infectious disease primarilyInfectious disease primarilyaffecting the lung parenchymaaffecting the lung parenchyma

Commonly caused byCommonly caused by

Mycobacterium tuberculosisMycobacterium tuberculosis Infects 1/3 of the worlds populationInfects 1/3 of the worlds population

Leading cause of death from infectiousLeading cause of death from infectiousdisease worldwidedisease worldwide

Closely associated with poverty,Closely associated with poverty,malnutrition and overcrowdingmalnutrition and overcrowding

Transmission: airborneTransmission: airborne

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PathophysiologyPathophysiology

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Clinical manifestations:Clinical manifestations:

insidious in onsetinsidious in onset

Low grade feverLow grade fever

CoughCough HemoptysisHemoptysis

Night sweatsNight sweats

FatigueFatigue

AnorexiaAnorexia

Weight lossWeight loss

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Assessment and DiagnosticAssessment and Diagnostic

FindingsFindings

History and PEHistory and PE

Tuberculin skin testTuberculin skin test Chest X rayChest X ray

AFB smearAFB smear

Sputum cultureSputum culture

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Classification of TBClassification of TB

Class 0Class 0 no exposure, no infectionno exposure, no infection Class 1Class 1 (+) exposure, no(+) exposure, no

evidence of infectionevidence of infection

Class 2Class 2 latent infection, nolatent infection, nodiseasedisease Class 3Class 3 (+) disease, clinically active(+) disease, clinically active Class 4Class 4 (+) disease, not clinically(+) disease, not clinically

activeactive Class 5Class 5 suspect, diagnosis pendingsuspect, diagnosis pending

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Medical Management:Medical Management:

Chemotherapeutic agents for 6Chemotherapeutic agents for 6--12 months12 months To ensure eradication and preventTo ensure eradication and prevent

relapserelapse

Multidrug treatment: to preventMultidrug treatment: to preventdevelopment of resistant strainsdevelopment of resistant strains

Considered nonConsidered non--infectious afterinfectious after22--3 weeks of therapy3 weeks of therapy

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Medical Management:Medical Management:

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TB DOTSTB DOTSCategorCategoryy

Type of TBType of TB IntensiveIntensive MaintenancMaintenancee

II New Smear (+)New Smear (+)

ExtensiveExtensiveParenchymal LesionsParenchymal Lesions

2 HRZE2 HRZE 4 HR4 HR

IIII Treatment FailureTreatment FailureRelapseRelapse

2 HRZES2 HRZES 5 HRE5 HRE

IIIIII Smear (Smear (--) with) withminimal parenchymalminimal parenchymallesionlesion

2 HRZE2 HRZE 4 HR4 HR

IVIV Chronic (still smearChronic (still smear(+) after supervised(+) after supervised

re treatmentre treatment

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Preventive MeasuresPreventive Measures

Prompt diagnosis and treatment ofPrompt diagnosis and treatment ofinfectious casesinfectious cases

BCG vaccination of newborn, infantsBCG vaccination of newborn, infantsand grade 1 (school entrants)and grade 1 (school entrants)

Educate the public in mode of spreadEducate the public in mode of spreadand methods of control and theand methods of control and the

importance of early diagnosisimportance of early diagnosis Provide public Health nursing andProvide public Health nursing and

outreach services for homeoutreach services for homesupervisionsupervision

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Nursing InterventionNursing Intervention

1. Promoting Airway clearance1. Promoting Airway clearance oofluid intakefluid intake postural drainagepostural drainage

2. Advocating adherence to treatment2. Advocating adherence to treatmentregimenregimen inform client about the drugs, schedule,inform client about the drugs, schedule,

side effectsside effects prevention of transmissionprevention of transmission

covering the mouth and nose during coughingcovering the mouth and nose during coughingand sneezingand sneezing proper disposal of tissuesproper disposal of tissues hand hygienehand hygiene

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Nursing InterventionNursing Intervention 3. Promoting activity and adequate3. Promoting activity and adequate

nutritionnutrition progressive activityprogressive activity small frequent meals and liquidsmall frequent meals and liquid

nutritional supplementsnutritional supplements 4. Monitoring and Managing Potential4. Monitoring and Managing Potential

ComplicationsComplications a. Malnutrition: collaborate with thea. Malnutrition: collaborate with the

dietician, physician, patient anddietician, physician, patient andfamilyfamily provide high calorie nutritionalprovide high calorie nutritional

supplementsupplement b. Side effects of medicationb. Side effects of medication

assess for side effectsassess for side effects take medicines before meals or 1take medicines before meals or 1

hour after mealshour after meals c. Multidrug resistancec. Multidrug resistance

monitor vital signs and observe formonitor vital signs and observe forchanges in clinical statuschanges in clinical status

d. Spread ofTB infectiond. Spread ofTB infection monitor vital signs and observe formonitor vital signs and observe for