Tuberculosis Is an infection caused by Mycobacterium tuberculosis, an acid-fast bacillus that usually affects the lungs but may invade

other systems

Statistics: Globally, there are a total of 8.6 million new cases of tuberculosis and 1.3 million TB deaths as of 2012. (WHO, Global TB Report 2013) In the Philippines, the number of TB cases had been going down from 1990 to 2011. TB deaths went down by 49 percent while the number of Filipinos with TB decreased by 52 percent. (WHO, Global TB Report 2012) TB ranks the 8th of the 10 leading causes of morbidity (incidence of illness) in the Philippines. (DOH, 2009) TB ranks the 6th of the 10 leading causes of mortality (death) in the Philippines. (DOH, 2009) In Davao City, TB ranks the 9th of the 10 leading causes of morbidity (death) and ranks the 8th of the 10 leading causes of mortality (incidence of illness). (CHO, 2011) Mode of Transmission: airborne droplet (coughing, sneezing, talking) Risk Factors: - Close contact with someone who has active TB - Weak immune system (HIV/Aids, Malnutrition, very young or advanced age) - Living in crowded places - Homelessness and low socioeconomic status - Alcohol abuse Types: - Primary: develops in previously unexposed and unsensitized persons - Secondary: reinfection from inhaled droplet nuclei or reactivation of a previously healed primary lesion Classic clinical features associated with active pulmonary TB: - Cough - Weight loss/anorexia - Fever - Night sweats - Hemoptysis - Chest pain - Fatigue Pathophysiology:
Inhaled droplet nuclei

PASS down bronchial tree

Implanted on respiratory bronchiole or alveolus (apex area of lungs)

Bacilli surrounded and engulfed by MACROPHAGES

INFLAMMATION

GHONS FOCUS

Development of SINGLE GRAY WHITE granulomatous lesions

CENTRAL portion of Ghons focus undergoes SOFT, CASEOUS NECROSIS

Tubercle bacilli, free or inside macrophages DRAIN along LYMPH CHANNELS

CALCIFIED

CASEOUS GRANULOMA EXTENSIVE DESTRUCTION/ EROSION

Forming AIR FILLED CAVITY

DESSIMINATION

Diagnostic Exam: - Tuberculin Skin Test Determines whether a person has been exposed to TB bacillus test result is read 48 to 72 hours after injection 5mm or more (+) in patients with HIV 10 mm or more (+) patients with normal immunity A negative skin test DOES NOT exclude TB infection or disease. Patients who are immunosuppressed cannot develop an immune response that is adequate to produce a positive skin test. (ANERGY) - Chest Xray Reveals lesions in the upper lobes - Sputum Exam (AFB) Determines presence of mycobacteria

How to produce quality sputum? Rinse mouth with water Breathe deeply, hold breath, then exhale slowly. Repeat the sequence twice. Cough strongly at the height of deep inspiration after inhaling deeply for the third time, and spit the sputum in the container. Sputum Collection: 1. First spot specimen as client tells that he/she is having S/Sx 2. Early Morning Specimen as soon as the client wakes up ( it does not matter if patient has brushed his/her teeth) 3. Third Specimen / Second Spot specimen as patient brings back the EMS, ask him/her to spit Medical Management Pharmacology RIFAMPICIN ISONIAZID Inhibits RNA synthesis Orange colored secretions Inhibits mycobacterial cell wall Peripheral neuritis, Hepatitis synthesis - Take meds on empty stomach, no ROH while on tx - Monitor AST and ALT Bactericidal and bacteriostatic Hepatoxicity and hyperuricemia - Monitor uric acid, AST, ALT. Inhibit cellular metabolism Optic neuritis (decreased red green color discrimination, decreased visual acuity) - Check for visual acuity, color perception Bactericidal Ototoxicity, Nephrotoxicity - Report for ringing, fullness of ears, dizziness, vertigo

PYRAZINAMIDE ETHAMBUTOL

STREPTOMYCIN

Nursing Management Promoting airway clearance - Increase oral fluid intake to promote systemic hydration and serves as an effective expectorant - Instruct the patient about correct positioning to facilitate airway drainage Advocating Adherence to Treatment Regimen - Teach the client about the importance of the medications, its scheduled time and the side effects TB is a communicable disease and taking of medications is the most effective means of preventing transmission - Instruct the patient to take the medications either on an empty stomach or at least 1 hour before meals food interferes with medication absorption - Patients taking INH (rifampicin, pyrazinamide and ethambutol) should avoid food that contains tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts) eating them while taking INH results in headache, flushing, hypotension, lightheadedness, palpitations and diaphoresis - Monitoring of side effects of anti-TB medications, including hepatitis, neurologic changes (hearing loss, neuritis) and rash.

Liver enzymes, BUN and serum creatinine levels are also monitored. to detect changes in liver and kidney function - Monitor sputum culture results to evaluate the effectiveness of the treatment regimen and adherence of therapy - Instruct the client about the risk of drug resistance if the medication regimen is not strictly and continuously followed. - Monitor vital signs and observe for spikes in temperature or changes in the patients clinical status. Promoting Activity and Adequate Nutrition - Small frequent feeding or liquid nutritional supplements may assist in meeting basic caloric requirements - Plan for a progressive activity schedule Preventing Spreading of Tuberculosis Infection - Instruct the client about the important hygienic measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues and handwashing. to prevent transmission of TB to others -