Pulmonary tuberculosis is caused by Mycobacterium tuberculosis and primarily affects the lungs. It spreads through airborne droplets when an infected person coughs or sneezes. Common symptoms include chronic cough, sputum production, weight loss, fever, and night sweats. Diagnosis involves sputum testing, chest x-rays, and culture. Treatment consists of a multi-drug regimen over 6-9 months. Nursing care focuses on preventing infection spread, promoting airway clearance and nutrition, managing activity intolerance, and ensuring patient understanding to support adherence to the treatment plan.

1. PULMONATY TUBERCLOSIS (PTB)
DR EVA VELIKOSHI-INDONGO
(DIP NURSING/MIDWIFERY, RN/RM/RT, BNSc (HSM), NED
(NDP), MNSc, DNSc (UNAM), MBChB, ZAMBIA)
26/02/2020
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2. Overview
 Introduction
 Epidemiology
 Risk factors
 Pathophysiology
 Clinical manifestation
 Diagnosis
 Management
 Complications
 Nursing care plan
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1. Introduction
Anatomy review

4. Definition of TB
 Tuberculosis is a chronic communicable, infectious disease caused
by Mycobacterium tuberculosis
 Primarily affects the lung parenchyma.
 Characterized by pulmonary infiltrates, formation of granulomas with
caseation, fibrosis, and cavitation.
 Commonly spread via droplets when person infected with TB coughs or
sneezes i.e. it is airborne
 Usually involves the lungs but may affect any organ in the body (kidneys,
brain, abdomen, bones, skin)
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5. 2. Epidemiology
Global TB:
-9 million new and relapsed cases of TB worldwide in 2010
- incidence increasing by around 1% per year to a peak in 2005, but since
then the global incidence has declined slowly.
-The majority of cases (around 65%) are seen in Africa and India
-Namibia 9th in top ten countries in the world (MOHSS, 2019)
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6. 3. Risk factors
 TB contact
 Immunocompromise
 Institutionalization
 Over-crowdingness and substandard housing (i.e. with poor ventilation)
 Being a health worker
 Comorbidities (presence of other medical conditions such as Diabetes
Mellitus)
 Malnutrition
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7. 4. Pathophysiology
 Inhalation- susceptible person inhales mycobacteria and becomes infected.
 Transmission: The bacteria transmitted through the airways to the alveoli, if
not contained in lung, spread to other parts of body via lymph system and
bloodstream
 Defense:
- The body’s immune system mounts an immune response  inflammatory
reaction and phagocytes engulf many of the bacteria, and lymphocyte lyse/destroy
the bacilli.
- Granuloma formation: masses of live and dead bacilli, surrounded by
macrophages, which form a protective wall.
- They are then transformed to a fibrous tissue mass, the central portion of which is
called a Ghon tubercle.
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8. • Dormancy. At this point, the bacteria become dormant, and there is no further
progression of active disease (Latent TB).
• Activation. After initial exposure and infection, active disease may develop
because of a compromised or inadequate immune system response (Active TB).
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10. 5. Clinical Manifestations
1) chronic cough
2) sputum production
3) anorexia
4) weight loss
5) Fever
6) night sweats
7) Hemoptysis
8) Chest pain
9) Reduced breath sounds
10)Shortness of breath
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11. 6. Diagnosis making
6.1. Assessment
History of signs and symptoms
-Determine if patient has cough: productive/non-productive, duration, association
with chest pain, shortness of breath
-Sputum: color (yellowish, bloody etc), amount
-weight loss: duration, how much lost, nausea/vomiting, food intake
- presence of night sweats- duration, soaked sheets, how often
- Past illnesses history: previous TB treatment, drugs, duration and outcome
- Co-morbidities: HIV status, DM, liver disease
- Risk factors
- Level of activity- fatigue, weakness
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12. Physical examination:
- Diminished breathing sound bilaterally or unilaterally (pleural
effusion or pneumothorax)
- Increased fremitus
-bronchial breath sounds -crackles
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13. 6.2) Diagnosis
Sputum Laboratory studies
- Sputum culture: Positive for Mycobacterium tuberculosis
- Ziehl-Neelsen (acid-fast staining in liquid medium) Positive for acid-
fast bacilli (AFB).
- Gene Xpert: Resistance to Isoniazid and Rifampicin
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14. 6.3. Imaging
- Chest X-ray : May show small, patchy apical infiltrations, calcium
deposits of healed primary lesions, pleural effusion, cavitation, scar
tissue/fibrotic areas.
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15. 6.5. Others:
-Skin tests (purified protein derivative (PPD)/Mantoux test
0.1 mls administered by intradermal injection and read after 48-72 hours
Positive :
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16. •Pleural biopsy: Positive for granulomas of TB
• Western Blot ELISA test- HIV co-infection
•Bloods: FBC  leucocytosis, increased ESR
•Polymerase Chain Reaction (PCR)- Mycobactium DNA
•Pleural fluid aspiration studies (MCS)
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17. 7. Medical Management
- Pulmonary TB: Antituberculosis agents for 6-9 months (see next table for
doses)
•First line treatment. First-line agents for the treatment of tuberculosis are
Rifampin (RIF), Isoniazid (INH), Ethambutol (EMB), and Pyrazinamide (PZA)
Initial phase: administration of all four drugs daily for 2 months
Continuation phase of 4 months INH and RIF.
•DOT (Directly observed therapy) may be selected, wherein an assigned
caregiver directly observes the administration of the drug
•Prophylactic isoniazid. Prophylactic INH treatment involves taking daily
doses for 9 months.
•Vit B6 (Pyridoxine) added
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19. 2nd line therapy:
INH & RIF plus injectables (Capreomycin, Kanamycin, Paraaminosalicylate
(PAS), Amoxicillin/Clavulanic acid, Levofloxacin for Multi-drug resistance
(MDR) and extensively Drug resistance TB (XDT).
Extrapulmonary TB treatment:
-Excluding CNS: Abdominal, military, bone, kidney, skin  6 months (May
extend to 9 months)Abdominal
2HRZE + 4HR
-CNS TB: 12 months (2HRZE + 10HR Plus Prednisolone)
**E-Ethambutol; H- Isoniazid; R-Rifampicin; Z-Pyrazinamide
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20. Other Terms related to TB:
1. Multidrug-resistant tuberculosis (MDR-TB): TB resistant to INH and RIF
i. Primary MDR: caused by person-to-person transmission of a drug-resistant
organism
ii. Secondary MDR: usually the result of non-adherence to therapy or
inappropriate treatment
2. Extensively Drug resistant TB (XDT TB): TB resistant to at least one of the
injectables(Capreomycin, Kanamicin) and any floroquinolone, i.e. resistance to
those some of the drugs in the second line of treatment.
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8. Complication
•Respiratory failure
•Pleural effusion
•Pneumothorax
•Pneumonia

22. 8. Nursing Care of patient with Pulmonary TB
1. Risk for infection related to inadequate primary defences and lowered
resistance/decreased ciliary action/tissue destruction.
Goal: 1. Reduced risk of infection
- Review necessity of infection control measures
- Put in temporary isolation if indicated.
- Monitor temperature 4hly
- Identify individual risk factors for reactivation of tuberculosis  alcoholism,
malnutrition, use of immunosuppressive drugs, corticosteroids, DM
- Administer Antituberculosis drugs (RIF, INH, Pyrazinamide, Ethambutol,
Pyridoxine)
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2. Ineffective airway clearance related to thick, viscous, or bloody
secretions.
Goal: Promote airway clearance.
- Assess respiratory function noting breath sounds, rate, rhythm, and depth, and
use of accessory muscles
- Assist patient with coughing and deep-breathing exercises
- Nurse in Semi-fowler to facilitate drainage
- Increase fluid intake to promote systemic hydration, liquefy mucous
- Administer humidified oxygen as needed

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3. Risk for impaired gas exchange related to decrease in effective
lung surface.
Goal: Patient reports absence of/decreased dyspnea and has no symptoms of
respiratory distress.
- Assess respiration status tachypnea, abnormal or diminished breath sounds,
increased respiratory effort, reduced chest wall expansion
- Note cyanosis including mucous membranes and nail beds.
- Monitor ABGs and pulse oximetry (% Oxygen sat.)
- Provide oxygen as needed

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4. Imbalanced nutrition: less than body requirements related to
inability to ingest adequate nutrients.
Goal: Promoting adequate nutrition
- Provide small, frequent meals high in protein and carbohydrates
- Provide oral care before and after meals
- Monitor intake and output
- Weight patient regularly.

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5. Activity intolerance related to imbalance between oxygen supply and
demand.
Goal: Promote activity
-Promote activity tolerance and muscle strength  passive exercises, adequate
rest

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6. Deficient Knowledge Absence or deficiency of cognitive information related
to Tuberculosis
Goal #1: prevent transmission of TB infection and Adherence to treatment
regimen
- Provide instruction and specific information (Verbal or written pamphlets)
related to nature of TB
- Provide written information for patient to refer to schedule for medications and
follow-ups
- Review how TB is transmitted (primarily by inhalation of airborne organisms)
- Educate on prevention measures: cover mouth when coughing/sneezing, proper
disposal of tissues, avoid spitting around,
- Encourage patient and family to verbalize fears and concerns
- Answer questions promptly

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Goal#2: Promote Adheherence to treatment regimen
- Teach the patient that TB is a communicable disease
- Emphasise that taking medications is the most effective means of preventing
transmission and curing the disease
- Explain medication dosage, frequency of administration, expected action, and
the reason for long treatment period
- Educate on potential interactions with other drugs and substances e.g. alcohol
and smoking while taking medications
- Inform patient on potential side effects of treatment (dryness of mouth, visual
disturbances, headache, orthostatic hypertension) (see Anti-tuberculosis drug
table).

29. Detailed/extra notes on Nursing care Plan of TB
patient
Risk for Infection (spread/reactivation) related to:
Inadequate primary defences—decreased ciliary action/stasis of body fluids
tissue destruction/suppressed inflammatory response/malnutrition
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37. •Summary
•Anatomy review of resp. system
•TB causative organism and pathophysiology, method of spread
•Clinical manifestations
•Assessment and diagnosis
•Treatment
•Nursing care plan: problems/risks, Goals, interventions.
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38. ………………………………NICE DAY…..........................…………..
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