Tuberculosis PPT

1. Tuberculosis
Mrs. Mahima paul Ali

2. Pathophysiology
 Due to etiological factors
 Individual inhale TB bacteria
 Entered bacteria first passed down to Airway system and get implant
 The usual site of initial bacterial implantation is lower part of the lungs
 After implantation, the bacilli multiply with no initial resistance from the host.
Body’s immune system starts to work

3.  The immune system surrounds the infected area in the lungs with Neutrophil
and then with alveolar macrophages
 Macrophage indulge the bacteria
 If the individual’s immune system is capable and strong
 Bacteria inside the Macrophage die or become inactive
 If the individual’s immune system is weak then bacteria inside the
macrophage become again active
 Starts multiply with the macrophage
 Active disease occur or put individual to high risk for clinical disease

4. Clinical Manifestation
 Easy fatigability
 Anorexia or loss of appetite
 Weight loss and body wasting
 Persistent, long term low- grade fever
 Chills and night sweats
 Persistent, progressive cough which may be non-productive at first but may
produce purulent sputum in the long term (2 weeks or more)
 Non-resolving bronchopneumonia
 Dull or pleuritic chest pains
 Dyspnea
 Hemoptysis
 Anemia in some

5. Diagnostic Evaluation
 ABG
the characteristics of arterial
blood gas and electrolytes in
patients with severe pulmonary
tuberculosis with respiratory
failure. Analysis of arterial blood
gas and electrolytes may help
monitor the progression of severe
pulmonary tuberculosis and
provides valuable information for
implementing treatment and
making prognostic decisions.

6.  Mantoux test
The Mantoux test is a widely used test
for latent TB. It involves injecting a
small amount of a substance called
PPD tuberculin into the skin of your
forearm. It's also called the tuberculin
skin test (TST).
 Sputum test
Checking sputum is the best way to
find out if patient is suffering from
TB.

7.  Chest X-ray
The best method for TB screening is
both symptom inquiry and chest
radiograph (CXR), which depends on
resource availability, cost and the
expected yield.
 CT or MRI scan: Determines degree
of lung damage and may confirm a
difficult diagnosis

8.  Histologic or tissue cultures
(including gastric
washings; urine and cerebrospina
l fluid [CSF]; skin biopsy): Positive
for Mycobacterium
tuberculosis and may indicate
extrapulmonary involvement.
 Pulmonary function
studies: Decreased vital capacity,
increased dead space, increased
ratio of residual air to total lung
capacity, and decreased oxygen
saturation are secondary to
parenchymal infiltration/fibrosis,
loss of lung tissue, and pleural
disease (extensive chronic
pulmonary TB).

9. Complications
 Pleurisy
Pleurisy is inflammation of the sheet-
like layers that cover the lungs (the
pleura). The most common symptom
of pleurisy is a sharp chest pain when
breathing deeply. Sometimes the pain
is also felt in the shoulder.
 Pericarditis
Pericarditis is swelling and irritation of
the thin, saclike tissue surrounding
the heart (pericardium). Pericarditis
often causes sharp chest pain. The
chest pain occurs when the irritated
layers of the pericardium rub against
each other.

10.  Peritonitis
Peritonitis is a serious condition that
starts in the abdomen. That's the area
of the body between the chest and
the pelvis. Peritonitis happens when
the thin layer of tissue inside the
abdomen becomes inflamed.
 Meningitis
Meningitis is an inflammation
(swelling) of the protective
membranes covering the brain and
spinal cord. A bacterial or viral
infection of the fluid surrounding the
brain and spinal cord usually causes
the swelling.

11.  Bone and joint Infections
 Genitourinary infection
A urinary tract infection (UTI) is an
infection in any part of the urinary
system. The urinary system includes
the kidneys, ureters, bladder and
urethra. Most infections involve the
lower urinary tract — the bladder and
the urethra.

12. Management
Medical Management
1. Preventive measures
As with all health conditions, prevention of TB is always better
than a cure. Although there is no sure-fire way to completely
prevent the spread of TB at this point in time, there are a number
of measures that can be put in place to reduce the spread of the
illness.
 The BCG vaccination : The BCG (Bacille Calmette-Guérin) is a
live vaccine against tuberculosis.
 Early diagnosis : Early diagnosis and treatment is the most
effective way to prevent the spread of tuberculosis.
A person with infectious tuberculosis can infect up to 10–15 other
people per year. But once diagnosed with TB, and started on
treatment, the majority of patients are no longer infectious after
just two weeks of taking the medication.

13.  Case finding
Limiting the spread of TB depends on successfully finding
and treating people with the illness, to prevent them from
passing it on to others.
This can be done through raising awareness of TB, so people
with TB symptoms know to seek help. Outreach workers and
volunteers also work within communities with high rates of
TB to find people with symptoms and refer them for testing.
When someone is diagnosed with infectious TB, their close
contacts are screened for the illness — this is known as
contact tracing.

14.  Managing your environment
As TB is an airborne infection, TB bacteria are released into
the air when someone with infectious TB coughs or sneezes.
The risk of infection can be reduced by using a few simple
precautions:
 good ventilation: as TB can remain suspended in the air
for several hours with no ventilation
 natural light: UV light kills off TB bacteria
 good hygiene: covering the mouth and nose when
coughing or sneezing reduces the spread of TB bacteria.

15. DOTS therapy
The full form of DOTS is Directly Observed Therapy. It is also known as
TB – DOTS. It refers to a strategy aimed at curing and reducing the risk of
TB (tuberculosis) cases. In this technique, a healthcare practitioner or
other suitable representative provides the recommended TB medications
to tuberculosis patients and ensures that the patient takes every dose. If
the patient is left alone, they may fail to take any of the doses, which
can spread drug-resistant tuberculosis. DOTS involved treatment with a
four drug regimen. These were isoniazid (INH), Rifampicin (Rif),
Prazinamide (PZA) and Ethambutol (EMB) for 6-9 months.

16. Main actions of DOTS
 Supplying the drug prescribed in the DOTS
 Checking for medication-related side effects
 To ensure that the patient swallows the drug,
 Detailing the visit
 Answering TB & DOTS relevant queries

17. Significance of DOTS
 DOTS avoids the transition of TB to others.
 DOTS reduces the probability of a treatment error.
 DOTS allows patients to complete their treatment of tuberculosis as
quickly and without interruption.
 The probability of drug-resistance tuberculosis resulting from
ineffective therapy is decreased.
 Under DOTS, as reported, 85-90 per cent of tuberculosis patients
administered their medications correctly, compared with 62 per cent
of TB patients who were on self-administered therapy.
 We can not be sure that the patient will take the drug as guided;
individuals can fail or have difficulty appropriately taking pills.
Through DOTS, this problem can be overcome.

18. The first line antituberculosis medications
include:•
 Isoniazid (INH). INH is a bactericidal agent that is used as prophylaxis
for neuritis, and has side effects of peripheral neuritis, hepatic
enzyme elevation, hepatitis, and hypersensitivity.
 Rifampin (Rifadin). Rifampin is a bactericidal agent that turns the
urine and other body secretions into orange or red, and has common
side effects of hepatitis, febrile reaction, purpura, nausea,
and vomiting.
 Pyrazinamide. Pyrazinamide is a bactericidal agent which increases
the uric acid in the blood and has common side effects of
hyperuricemia, hepatotoxicity, skin rash, arthralgias, and GI distress.
 Ethambutol (Myambutol). Ethambutol is a bacteriostatic agent that
should be used with caution with renal disease, and has common side
effects of optic neuritis and skin rash.

19. Nursing Management
Nursing management includes the following:
Nursing Assessment-
The nurse may assess the following:
 Complete history: Past and present medical history is assessed as well
as both of the parents’ histories.
 Physical examination: A TB patient loses weight dramatically and may
show the loss in physical appearance.
 Ask the patient about a pervious history of TB, Chronic illness or any
immunosuppressive medication obtain a social and occupational
history
 to determine risk factors for transmission o TB

20.  Assess for symptoms of active disease
Productive cough, night sweats, afternoon temperature elevation,
unintentional weight loss, pleuritic chest pain.
 Auscultate lungs for crackles
 During drug therapy, assess for dysfunction.
Question the pt. about loss of appetite, fatigue, joint pain, fever,
tenderness in liver region, clay –colored stool, dark urine.
Monitor for fever, abdominal tenderness, nausea, vomiting.

21. Nursing Diagnosis
Based on the assessment data, the major nursing diagnoses for the patient
include:
 Risk for infection related to inadequate primary defenses and lowered
resistance.
 Ineffective airway clearance related to thick, viscous, or bloody secretions.
 Risk for impaired gas exchange related to decrease in effective lung surface.
 Activity intolerance related to imbalance between oxygen supply and
demand.
 Imbalanced nutrition: less than body requirements related to inability to
ingest adequate nutrients.

22. Nursing Care Planning & Goals
 The major goals for the patient include:
 Promote airway clearance.
 Adhere to treatment regimen.
 Promote activity and adequate nutrition.
 Prevent spread of tuberculosis infection.

23. Nursing Interventions
 Nursing interventions for the patient include:
 Promoting airway clearance. The nurse instructs the patient
about correct positioning to facilitate drainage and to increase fluid
intake to promote systemic hydration.
 Adherence to the treatment regimen. The nurse should teach the
patient that TB is a communicable disease and taking medications is
the most effective means of preventing transmission.
 Promoting activity and adequate nutrition. The nurse plans
a progressive activity schedule that focuses on increasing activity
tolerance and muscle strength and a nutritional plan that allows for
small, frequent meals.
 Preventing spreading of tuberculosis infection. The nurse carefully
instructs the patient about important hygienic
measures including mouth care, covering the mouth and nose when
coughing and sneezing, proper disposal of tissues, and handwashing.

24.  Acid-fast bacillus isolation. Initiate AFB isolation immediately,
including the use of a private room with negative pressure in relation
to surrounding areas and a minimum of six air changes per hour.
 Disposal. Place a covered trash can nearby or tape a lined bag to the
side of the bed to dispose of used tissues.
 Monitor adverse effects. Be alert for adverse effects of medications

25. Evaluation
 Expected patient outcomes include:
 Promoted airway clearance.
 Adhered to treatment regimen.
 Promoted activity and adequate nutrition.
 Prevented spread of tuberculosis infection.

26. Health Education
 Disposal of secretions. Cough and sneeze into tissues and to dispose of all
secretions in a separate trash can.
 Isolation. Wear a mask when going outside of the room.
 Activity and nutrition. Remind the patient to take a lot of rest and to eat
balanced meals to aid recovery.
 Adverse effects. Advise the patient to watch out for adverse effects of
medications and to report them to the physician immediately.