Pulmonary Tuberculosis (Phthisis, Kochs disease, Consumption disease) Definition Infectious disease Primarily affects the lung parenchyma

ma May be transmitted to other parts of the body including meninges, kidneys ,bones and lymph nodes World deadliest disease Remains as a major public health problem in Philippines Synonymously to the word Infectious Agent: Mycobacterium Tuberculosis and Mycobacterium Africanium Primary infectious agent Acid fast aerobic rod bacilli that grows slowly and its sensitive to heat and UV.

Clinical Manifestation: Low grade afternoon fever Cough- productive and/or non-productive Night sweating Chest or back pains not referable to any musculoskeletal disorders Fatigue Significant weight loss Hemoptysis- may also occur Risk Factors: Close contacts with someone has active TB. Inhalation of airborne nuclei from an infected person is proportional to the amount of time spent in the same airspace, and proximity of the person, and the degree of ventilation. Immunocompromised status- HIV infection, cancer, transplanted organs, prolonged high-dose corticosteroid therapy.

Mycobacterium bovis and Mycobacterium avium Have rarely been associated with the development of a TB infectious. Inadequate health care- homeless, impoverished, minorities, particularly children under age 15 year old and young adults between (15 and 44 year old) Mode of transmission: Airborne droplet method through coughing, sneezing, signing, talking Smaller than 5 microns and more than 5 feet Pre-existing medical conditions or special treatment (eg. diabetes, chronic renal failure, malnourishment, selected malignancies, haemodialysis

Immigration from countries with a high prevalence of Direct invasion Through mucous membranes or breaks in the skin may TB (South Eastern Asia, Africa, Latin, America, occur but it is extremely rare. Caribbean) Unpasteurized milk or dairy products From cattle that has m-bovis. Primary TB Secondary TB Form of disease that Pattern of disease that arise develops in a in a previously sensitized previously unexposed host & unsensitized person Reinfection of dormant primary lesions when host resistance is weakened Source of organism Source of organism Exogenous Endogenous Exogenous Living in overcrowded, substandard housing Occupation (health care provider) Smoking- prolonged used of cigarettes. Incubation Period From 2 to 10 weeks Period of Communicability The patients are capable of discharging the organism all throughout his/her life if he/she remains untreated. The disease is highly communicable during its active phase. Pathophysiology Infection of lungs caused by Mycobacterium tuberculosis, an acid-fast bacterium. Causes tubercles, fibrosis, and calcification within the lungs. Tubercle bacillus may be communicated to others by means of drop formation (inhalation), ingestion, or inoculation. Predisposing factors include debilitating diseases such as alcoholism, cardiovascular disease, HIV infection,

diabetes mellitus, and cirrhosis, as well as poor nutrition and crowded living conditions. The emergence of multi-drug-resistant tuberculosis has complicated management of the disease. Chronic, progressive, and reinfection phase is most frequently encountered in adults and involves progression or reactivation of primary lesions after months or years of latency. Swallowing infected sputum may lead to laryngeal, oropharyngeal, and intestinal tuberculosis.

: Isoniazid is given with vitamin B to prevent isoniazid associated- peripheral neuropathy Common Nursing Diagnosis:

1. Ineffective Breathing Pattern 2. Ineffective airway clearance 3. Body image disturbance 4. Altered nutrition: less than body requirements 5. Fatigue 6. Self-care deficit Diagnostic Procedures 7. Alteration in comfort 8. Knowledge deficit SPUTUM CULTURE- direct sputum smear microscopy (DSSM) is the most definitive examination 9. Sleep Disturbance for PTB. CHEST X-RAY- the results may reveals lesions on the NURSING CARE upper lobe of the lungs. TUBERCULIN SKIN TEST- (matoux test and PPD) 1.) ISOLATION: the results has induration (hardening) and erythema. The pt is remove from frequently contact w/members of This is also done to know if youve been exposed to the family and public PTB. It serves to prevent the spread of tubercle bacilli Positive Sputum patient should be grouped together and Methods of Control negative sputum patient should be together BCG vaccination after birth and at school entrants for 2.) The TB education program for the patient: the booster dose. Educate the public in the mode of spread and methods The nurse must impress the pt and his family with the of control and the importance of early diagnosis. necessary of controlling the spread of TB Improve social risk condition, such as overcrowding Educate pt regarding personal hygienic but also the Early detection and treatment members of the family about the necessary medical aseptic technique. DRUG OF CHOICE Proper disposal of secretions from mouth and nose should be prioritized in this program. RIFAMPICIN- common side effects are hepatitis and Used of tissue, handkerchief, or towel when coughing febrile reaction. Cause an orange or brown coloration of or sneezing. tears and urine. ISONIAZID- can cause peripheral neuritis PYRAZINAMIDE- hyperuricemia is one of the side References: effects ETHAMBUTOL- can cause optic neuritis or blindness Cuevas, F. P. (2007). Public Health Nursing in the STREPTOMYCIN- only anti-tuberculosis drugs that Philippines. Philippines: Piblications Committee, is injectable National League of Philippines Government Nurses Inc. Initial treatment phase Ferrara G, Losi M, Meacci M, et al.(2005). Routine - It consist of multi-medication regimen of isoniazid, Hospital Use of a New Commercial Whole Blood rifampicin, pyrazinamide, and ethambutol Interferon-(gamma) Assay for the Diagnosis of - It was administered daily for 8 weeks or 2 months Tuberculosis Infection. Am J Respir Crit Care Med. Continuation treatment phase Navales, Dionesia. (2010). Handbook of common - Include isoniazid and rifampicin communicable and infectious disease.3rd ed. C&E - It last for 4 to 7 months, which is 4-month period are Publishing, Inc. Phil. used for the large majority of patient and 7-month period are recommended for patient with cavitary PTB http://www.nlm.nih.gov/medlineplus/ency/article/000077. whose sputum culture after initial treatment phase is htm positive. NOTE: People are considered non-infectious after 2 to 3 weeks of CONTINUOUS medication therapy.

Medical Isolation- CLMMRH. Post-Test on PTB General Instructions: Please read the questions carefully. Choose the best answer. Answer in SMALL LETTERS before the number. Good luck. Test I. Multiple Choice 1.) The following are the other names of PTB, except? a. Kochs Disease b. Gohns Tubercles c. Phthisis d. Consumption disease 2.) Agents that primarily can be transmitted from human to human? a.) Mycobacterium bovis b.) Mycobacterium ipratropium c.) Mycobacterium avium d.) Mycobacterium Tuberculosis 3.) The following are modes of transmission of PTB, except? a.) Airborne b.) Direct c.) Droplet d.) Ingestion of cheddar cheese 4.) What event that pose a lesser risk of contracting PTB? a.) Person undergoing haemodialysis b.) A beggar c.) Immigrants from Africa d.) Prolonged use of alcohol 5.) Incubation period of PTB: a.) 2 days to 10 days b.) 2days to 10 weeks c.) 2 weeks to 10 weeks d.) 2 weeks to 10 days 6.) Mr. You asks the nurse what is the ideal diagnostic test to rule out PTB. Your best response would be? a.) Chest x-Ray b.) direct sputum smear microscopy (DSSM) c.) Tuberculin Skin Test d.) Guiac Test for occult microbes in the lungs 7.) Only Anti Tb Drugs that is categorized as bacteriostatic: a.) Rifampicin b.) Isoniazid

c.) Ethambutol d.) Streptomycin 8.) A PTB patient undergoing treatment under DOTS complains to the nurse shouting, Nars Nars! Ga luha ko dugo!. Your best initial action would be: a.) Put direct pressure on the eyes using sterilized gauze b.) Call the physician immediately c.) Tell patient to calm down d.) Monitor for signs of active bleeding 9.) The following are TB education program to the patient, except? a. The nurse must impress the pt and his family with the necessary of controlling the spread of TB b. Educate pt regarding personal hygienic but also the members of the family about the necessary medical aseptic technique. c. Proper disposal of secretions from mouth and anus should be prioritized in this program. d. Covering using your inner clothing when sneezing or coughing. 10.) People are considered non-infectious after how many weeks of CONTINUOUS medication therapy? a.) 2 to 3 weeks b.) 3-6 weeks c.) 1-2 weeks d.) 1-3 weeks II. Enumeration 1.) Give (5) signs and symptoms of PTB. 5 points 2.) List the (3) most common diagnostic test of PTB. 3 points 3.) Formulate (4) nursing diagnosis in clients with PTB. 4 points 4.) With the formulated nursing diagnosis, outline (2) nursing interventions each. 8 points. -------------Bright Future MI nurses!-----------------------

Prepared By: Rene John Francisco BN4-A PCI