Name: Maejan Anoba

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may
spread to other organs.

Causes

Pulmonary TB is caused by the bacterium Mycobacterium tuberculosis (M tuberculosis). TB is

contagious. This means the bacteria is easily spread from an infected person to someone else.
You can get TB by breathing in air droplets from a cough or sneeze of an infected person. The
resulting lung infection is called primary TB.

Most people recover from primary TB infection without further evidence of the disease. The
infection may stay inactive (dormant) for years. In some people, it becomes active again
(reactivates).

Most people who develop symptoms of a TB infection first became infected in the past. In some
cases, the disease becomes active within weeks after the primary infection.

Types of Pulmonary Tuberculosis Disease (TB):

There are two types of pulmonary tuberculosis disease (TB), which are discussed in the
following:

1. Latent TB:

A tuberculosis bacterium presents in the body but cannot make/arise symptom due to active
immune system. Immune systems are keeping it from turning into active TB and the disease goes
to sleep is called Latent TB.

2. Active TB:

The bacterial grow fast and create symptoms against immune systems.

Causative Organism:

The bacteria of Tuberculosis are Mycobacterium Tuberculosis (TB).

The following people are at high risk of active TB or reactivation of TB:

 Older adults
 Infants
 People with weakened immune systems, for example due to HIV/AIDS, chemotherapy,
diabetes, or medicines that weaken the immune system
 Your risk of catching TB increases if you:
 Are around people who have TB
 Live in crowded or unclean living conditions
 Have poor nutrition
Name: Maejan Anoba

The following factors can increase the rate of TB infection in a population:

 Increase in HIV infections

 Increase in number of homeless people (poor environment and nutrition)
 Drug-resistant strains of TB

Prognosis

Tuberculosis is a curable disease. Progress of tuberculosis from infection to frank illness

involves overcoming of the immune system defences by the bacteria. As the bacteria start to
multiply, it affects the immune system and finally overwhelms it to cause the disease.

Once diagnosed, with effective, adequate and appropriate therapy with anti tubercular drugs,
treatment is possible and so is cure.

In primary tuberculosis, that forms around 1 to 5% of all cases, the progression of the infection
to frank disease occurs soon after infection. In many, the initial infection is latent tuberculosis.
The disease may remain dormant within the body with the immune system capable of containing
the infection.

When the immune system weakens for some reason (e.g. HIV infection, diabetes, renal disease
etc.) there is reactivation of the infection. The risk of this reactivation rises when immunity is
suppressed. For example, those with concomitant HIV infection have an increased risk of
reactivation of tuberculosis of 10% each year of infection.

Signs and Symptoms

The primary stage of TB does not cause symptoms. When symptoms of pulmonary TB occur,
they can include:

 Breathing difficulty
 Chest pain
 Cough (usually with mucus)
 Coughing up blood
 Excessive sweating, especially at night
 Fatigue
 Fever
 Weight loss
 Wheezing

Mode of Transmission:

TB bacteria can be transmitted through cough, sneeze, and spit of infected person.
Name: Maejan Anoba

TB is an air bone disease (Droplet).

A single sneeze can release up to 40000 droplets and each droplet can transmitted into disease.

TB bacteria can be live 6-7 hours in the air.

Exams and Tests

Exams and Tests has been expanded.

The health care provider will perform a physical exam. This may show:

 Clubbing of the fingers or toes (in people with advanced disease)

 Swollen or tender lymph nodes in the neck or other areas
 Fluid around a lung (pleural effusion)
 Unusual breath sounds (crackles)

Tests that may be ordered include:

 Bronchoscopy (test that uses a scope to view the airways)

 Chest CT scan
 Chest x-ray
 Interferon-gamma release blood test, such as the QFT-Gold test to test for TB infection
(active or infection in the past)
 Sputum examination and cultures
 Thoracentesis (procedure to remove fluid from the space between the lining of the
outside of the lungs and the wall of the chest)
 Tuberculin skin test (also called a PPD test)
 Biopsy of the affected tissue (done rarely)

Possible Complications

Possible Complications has been expanded.

Pulmonary TB can cause permanent lung damage if not treated early. It can also spread to other
parts of the body.

Medicines used to treat TB may cause side effects, including:

 Changes in vision
 Orange- or brown-colored tears and urine
 Rash
 Liver inflammation
 A vision test may be done before treatment so your provider can monitor any changes in
the health of your eyes.

Prevention
Name: Maejan Anoba

 Prevention has been expanded.

 TB is preventable, even in those who have been exposed to an infected person. Skin
testing for TB is used in high risk populations or in people who may have been exposed
to TB, such as health care workers.
 People who have been exposed to TB should have a skin test as soon as possible and have
a follow-up test at a later date, if the first test is negative.
 A positive skin test means you have come into contact with the TB bacteria. It does not
mean that you have active TB or are contagious. Talk to your provider about how to
prevent getting TB.
 Prompt treatment is very important in preventing the spread of TB from those who have
active TB to those who have never been infected with TB.
 Some countries with a high incidence of TB give people a vaccine called BCG to prevent
TB. But, the effectiveness of this vaccine is limited and it is not usually used in the
United States.
 People who have had BCG may still be skin tested for TB. Discuss the test results (if
positive) with your provider.
Treatment for Pulmonary Tuberculosis Disease (TB):
Various treatment ways for pulmonary tuberculosis disease (TB) are discussed in the
following:
Treatment for Latent TB:
 In latent TB one antibiotic can use to kill the bacteria and prevent active TB.
 Isoniazid is a standard treatment for latent TB and need to continue for 9 momths.
 For people who cannot take Isoniazid for 9 months, sometimes a 6 month programme
is done.
 Rifampicin for 4 months is another acceptable treatment where Isoniazid exposed to
bacteria resistant.
Sometimes two antibiotics used to treat latent TB. Treatment plan two antibiotics must be
taken once a week for 12 weeks. The antibiotic combination includes Isoniazid and
Refapentine or Isoniazid and Refampin.
Treatment for Active TB:
 Anti- TB drug:
 Rifampicin,
 Isoniazid,
 Pyrazinamide,
 Ethambutal.

Prevention for Pulmonary Tuberculosis Disease (TB):

There are different ways of prevention for pulmonary tuberculosis disease (TB), those are
mentioned in the below:

 Avoid spend long periods of time in enclosed rooms with anyone who has active TB until
that person has been treated for at least 2 weeks.
 Use protective measures and cover face with n-95 mask.
Name: Maejan Anoba

 Avoid direct face to face contact and maintain a safe distance.

 Carefully dispose infected person sputum in a covered bin.
 Maintain standard hand hygiene after any work of the TB patient.
 Avoid sharing personal belongings with infected person.
 Use negative pressure room where infected air out those rooms regularly.
 If someone lives with active TB patient, help and encourage the person to follow
treatment instructions.
 People who have been exposed to TB should have a skin test as soon as possible and have
a follow-up test at a later date, if the first test is negative.
 BCG vaccination to prevent TB. But, the effectiveness of this vaccine is limited.

Complication of Pulmonary Tuberculosis Disease (TB):

 Aspergilloma,
 Arterial pseudoaneurysms,
 ARDS (Acute Respiratory Disease Syndrome),
 Bronchiectasis,
 Bronchopleural fistula Haemoptysis,
 Pneumothorax or Fibrothorax,
 Pleurisy,
 Pleural effusion,
 Empyema,
 Extensive lung destruction,
 Endobronchitis,
 Cor pulmonale,
 Ca bronchus,
 Immune Reconstitution Inflammatory Syndrome (IRIS),
 Laryngitis,
 Miliary Tuberculosis,
 HIV related opportunistic infections.

Nursing Intervention for Pulmonary Tuberculosis Disease (TB):

1. Place the patient in a negative pressure room

2. Always keep the door of the patient’s room shut and place an isolation sign at a visible
location.
3. Monitor negative pressure is maintaining – 2mmhg.
4. Use standard precautions and wear gloves, gowns when providing direct care to the
patient.
5. Maintain effective hand wash after giving care to patient.
6. Nurse and visitors must wear an N-95 mask while entering the patient room.
7. Dispose all PPE (Personal Protective Equipment) carefully in different colored bin.
8. Provide isolation care until the patient is no longer contagious.
9. Check vital sign regularly.
10. Assess dyspnoea, tachypnea, and abnormal respiratory sounds.
Name: Maejan Anoba

11. Always check sputum for blood or purulent expects ration.

12. Encourage patient to expectorate mucus and cough effectively.
13. Keep patient in high semi fowler’s position.
14. If patient cannot expectorate, give suction to clear airway.
15. Administer oxygen if needed and as ordered by a physician.
16. Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs.
17. Instruct patient to give up smoking.
18. Provide balanced and vitamin containing diets as prescribed.
19. Maintain fluid intake at least 2500ml per day unless indicated.
20. Ensure plenty of rest.
21. Administer all medication as ordered in exact time in empty stomach.
22. Explain patient about doses of medicine, frequency of administration, expected action
and outcome, and the reasons for long treatment period.
23. Explain patient about the side effect of TB drug (High color urine).
24. Carefully monitor any complications or adverse effects of drug.
25. Refer patients having a hard time sticking to their drug therapy for direct observation
therapy, where someone will watch them take their medication as they should.
26. Encourage patient to stay out of work place, school and public place until the physician
declared that it is now safe and not spread to others.
27. Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply
tissue instead of their bare hands, washing their hands after this and disposing of the
tissue into a closed plastic bag.
28. Teach the tuberculosis patient to stay in well ventilated areas and limit contact to other
people to avoid spread the infection.
29. Encourage clients to accommodate their sputum when coughing to prevent transmission
of infection.
30. Monitor the patient’s weight daily.