University of Pangasinan

College of Nursing
Dagupan City, Philippines

Prepared by:

Paul Christian P. Santos

Kaethleen G. Sangcap

3-11 MT/W BFD-GH San Carlos City

Submitted to:

Ms. Beatrice Bautista, RN

Pulmonary Tuberculosis
Definition:

Pulmonary Tuberculosis is a chronic, sub-acute or acute respiratory disease commonly affecting the
lungs characterized by the formation of lesions (tubercles) in the tissues which tend to undergo
caseation (tissue changes into a dry, cheeselike substance) necrosis and calcification (D. Navales,
2008)

Tuberculosis can also affect the central nervous system, the lymphatic system, the circulatory
system, the genitourinary system, the gastrointestinal system, bones, joints, and even the skin.

Etiologic Agent:

Mycobacterium bovis,
Mycobacterium africanum,
Mycobacterium canetti
Mycobacterium microti

Incubation Period:
2-10 weeks

Period of communicability:
Highly communicable during active phase and all through-out if untreated.
Primary complex in children in not contagious
NOT CONTAGIOUS- 2-4 weeks after the initiation of treatment

Mode of Transmission:

Airborne Droplet
Inhalation of contaminated air
Coughing, Sneezing, Coughing, Kissing
Eating and drinking utencils

Source of Infection:
Sputum
Hemoptysis
Nasal Discharge
Saliva

Prevention:

BCG (Bacillus Calmette-Guerin) Vaccination of NB, Infants, and Schoolers

Best given at birth
If planning to give at 12months do PPD (tuberculin test) if (-) give BCG

Diagnostic Procedure:

Sputum smear – detection of the acid fast bacilli in stained smears is the first
bacteriologic clue of TB. Obtain first morning sputum on 3 consecutive days.

Sputum culture - a positive culture for M. tuberculosis confirms a diagnosis of TB.

Chest X-ray – to determine presence and extent of disease.

Tuberculin skin test (purified protein derivative or Mantoux test) – inoculation of

tubercle bacillus extract (tuberculin) into the intradermal layer of the inner aspect of the
forearm. Detects the presence of antibodies
Results read within 48-72 hours from skin testing
(+) if 10mm or more
If <5y/o and already received BCG = 10mm is (+)
If <5y/o and didn’t received any BCG = 5mm is (+)

Nonspecific screening test – such as multiple puncture tests (tine test), should not be
used to determine if a person is infected.
Anatomy and Physiology

Respiration- refers to the act of breathing, or inhaling and exhaling.

- the uptake of oxygen by an organism, its use in the tissues, and the release of carbon
dioxide.
- two main functions: to supply the cells of the body with the oxygen needed for
metabolism and to remove carbon dioxide formed as a waste product from
metabolism.
- One of the features of both the upper and lower respiratory tracts is the mucociliary
apparatus that protects the airways from irritating substances, and is composed of the
ciliated cells and mucus-producing glands in the nasal epithelium. The glands produce
a layer of mucus that traps unwanted particles as they are inhaled. These are swept
toward the posterior pharynx, from where they are swallowed, spat out, sneezed, or
blown out.

UPPER RESPIRATORY TRACT

 nasal cavity
 mouth
 pharynx
 epiglottis
 larynx
 upper trachea

Nasal and Oral Cavity

- the entry point of air
- the nasal cavity filters, warms, and humidifies air.

Pharynx
-or throat is a tube like structure that connects the back of the nasal cavity and mouth to
the larynx, a passageway for air, and the esophagus, a passageway for food.

-serves as a common hallway for the respiratory and digestive tracts, allowing both air and
food to pass through before entering the appropriate passageways.

- Pharynx contains a specialized flap-like structure called the epiglottis that lowers over the
larynx to prevent the inhalation of food and liquid into the lower respiratory tract.

Larynx, or voice box,

 - contains the vocal cords, which are essential for human speech. Small and triangular in
shape, the larynx extends from the epiglottis to the trachea.
- control movement of the epiglottis, has specialized muscular folds that close it off and
also prevent food, foreign objects, and secretions such as saliva from entering the
lower respiratory tract.

LOWER RESPIRATORY TRACT

The lower respiratory tract begins with the

trachea, which is just below the larynx.

trachea, or windpipe,
- is a hollow, flexible, but sturdy air tube that contains C-shaped cartilage in its walls. - the
inner portion of the trachea is called the lumen.

Bronchus
- contains substantial amounts of cartilage that help keep the airway open.
- each bronchus enters a lung at a site called the hilum. The bronchi branch sequentially
into secondary bronchi and tertiary bronchi followed by bronchioles until they arrive at
the terminal bronchioles, each of which subsequently branches into two or more
respiratory bronchioles.
Bronchiole
- leads into alveolar ducts and alveoli.

Alveoli
-are bubble-like, elastic, thin-walled structures that are responsible for the lungs’ most
vital function: the exchange of oxygen and carbon dioxide.

Each structure of the lower respiratory tract, beginning with the trachea, divides into smaller
branches. This branching pattern occurs multiple times, creating multiple branches. In this way, the
lower respiratory tract resembles an “upside-down” tree that begins with one trachea “trunk” and ends
with more than 250 million alveoli “leaves”. Because of this resemblance, the lower respiratory tract is
often referred to as the respiratory tree.

In descending order, these generations of branches include:

 Trachea
 Right bronchus and left bronchus
 Secondary bronchi
 Tertiary bronchi
 Bronchioles
 Terminal bronchioles
 Respiratory bronchioles
 Alveoli

THE LUNGS
The thoracic cage, or ribs, and the diaphragm
bound the thoracic cavity. There are two lungs
that occupy a significant portion of this cavity.
>diaphragm is a broad, dome-shaped muscle
that separates the thoracic and abdominal
cavities and generates most of the work of
breathing.
>The inter-costal muscles, located between the
ribs, also aid in respiration. The internal
intercostal muscles lie close to the lungs and are
covered by the external intercostal muscles.
>The lungs are cone-shaped organs that are
soft, spongy and normally pink. The lungs cannot
expand or contract on their own, but their
softness allows them to change shape in
response to breathing. The lungs rely on
expansion and contraction of the thoracic cavity
to actually generate inhalation and exhalation.
This process requires contraction of the
diaphragm.
To facilitate the movements associated with respiration, each lung is enclosed by the pleura, a
membrane consisting of two layers, the parietal pleura and the visceral pleura.
The parietal pleura comprise the outer layer and are attached to the chest wall. The visceral pleura are
directly attached to the outer surface of each lung. The two pleural layers are separated by a normally
tiny space called the pleural cavity. A thin film of serous or watery fluid called pleural fluid lines and
lubricates the pleural cavity. This fluid prevents friction and holds the pleural surfaces together during
inhalation and exhalation.

Pathophysiology:

>Granuloma leads to necrosis, then liquefication,

sloughing & cavitation
>May Progress to extra Pulmonary Tuberculosis

Clinical Manifestation:
Fatigue
Weight Loss
Persistent low grade Fever in the
afternoon
Night sweats and chills,
Hemoptysis,
Productive Cough
Pleuritic Chest Pain.

Classifications:

Class 0 Class III (Disease)

No exposure (+) History
Not Infected (+) S/Sx
(+) Sputum
(+) PPD test
(+) X-ray

Class I (Exposure) Class IV (Inactive)

(+) Exposure (+) PPD test
(-) S/Sx (+) X-ray
healed
(-) test results (-) S/Sx
(-) Smear

Class II (Infection)
(+/-) exposure
(+) PPD test
(-) S/Sx
(-) X-ray

Pharmacological Considerations:
Rifampicin
Orange discoloration of secretions and Urine
Best taken on Empty Stomach
Maybe taken with food (Gastric Irritant)
Protect Drug from light
Isoniazid (INH)
Hepatic Enzyme elevation
It Competes with the absorption of B6 (Pyridoxine) causing Peripheral neuropathy
Take before Meals
10-50 mg as Prophylaxis
50-100 mg as Treatment dose
Pyrazinamide
Hepatoxic
Ototoxic
Nephrotoxic
GI upset
May lead to Hyperurecemia
May lead to Shoulder Arthralgia
Light Sensitive

Ethambutol
 Leads to Optic Neuritis ( Impaired red and green discrimination)
Skin rash
Not for 6 years old and below (Difficult to assess color discrimination)
Discontinue Drug:
Jaundice (All)
Visual Impairment (Ethambutol)
Tinnitus and Hearing Impairement ( Streptomycin)
Oliguria and Albuminuria ( Streptomycin and Rifampicin)
Psychosis and convulsion (INH)
Thrombocytopenia & anemia ( Rifampicin)