Healthcare

1. PREPARED BY:
REYMART B. BOLAGAO, MAN, RN
Infectious Diseases

2. NATIONAL
TUBERCULOSIS
CONTROL PROGRAM

3. TUBERCULOSIS
• Extra-pulmonary form is
generally non-
communicable, even with
draining sinus.
• Primary complex is generally
non-communicable.

4. TUBERCULOSIS CATEGORIES
CATEGORY I
• Smear (+), New Case
• Smear (-), CXR with
extensive parenchymal
lesions
• Extra-pulmonary
• HIV (+) Patients

5. TUBERCULOSIS CATEGORIES
CATEGORY II
• Relapse, Treatment Failure

6. TUBERCULOSIS CATEGORIES
CATEGORY III
• Smear (-), CXR with minimal
lesions

7. TUBERCULOSIS CATEGORIES
CATEGORY IV
• Chronic

8. CAUSATIVE AGENT
MYCOBACT
ERIUM
TUBERCULO
SIS

9. MODE OF TRANSMISSION
•Airborne,
Droplet; Direct
Invasion (Rare)

10. DIAGNOSTICS
1.Direct Sputum Smear Microscopy
(DSSM)
*If with hemoptysis, control first!
2.Chest X-Ray (CXR)
3.Sputum Culture
*If negative to DSSM for 3 times
4.Purified Protein Derivative (PPD)
*To confirm exposure to
Mycobacterium Tuberculosis

11. SIGNS AND SYMPTOMS
• Cough (2 or more weeks)
• Fever
• Chest and back pain not
musculosketal in origin.
• Hemoptysis / Recurrent Blood
Streaked Sputum.
• Significant Weight Loss

12. SIGNS AND SYMPTOMS ON CHILDREN (3
SIGNS) - SUSPECTED
• Cough or Wheezing (2
or more weeks)
• Unexplained Fever for
2 or more weeks
• Loss of appetite and
weight or failure to gain
weight

13. SIGNS AND SYMPTOMS ON CHILDREN (3
SIGNS) - SUSPECTED
• Failure to respond to
antibiotic therapy for lower
respiratory tract infection
in 2 weeks.
• Failure to regain previous
state of health after two
weeks of viral infection.

14. COMMUNICABILITY
• Factors affecting
communicability:
1.Number of bacilli discharge
2.Bacilli Virulence
3.Adequate Ventilation
4.Exposure to bacilli to sun,
UV light.

15. TREATMENT MODALITIES
•BCG(Bacille
Calmette Guarine)
Vaccine for Prevention

16. TREATMENT MODALITIES – MULTI DRUG
THERAPY
Rifampicin
• Orange discoloration of secretion and
urine.
• Best taken on EMPTY STOMACH but
causes GASTRIC IRRITATION hence
could be taken with food (also at bed
time).
• Protect drug from light.

17. TREATMENT MODALITIES – MULTI DRUG
THERAPY
Isoniazid (INH)
• Could cause hepatic enzyme
elevation, peripheral neuropathy (as it
competes with absorption of Vitamin
B6 or pyridoxine).
• Take BEFORE MEALS
• 10-50mg Pyridoxine as prophylaxis,
50-100mg as treatment

18. TREATMENT MODALITIES – MULTI DRUG
THERAPY
Pyrazinamide
(PZA)
• Rapidly bacteriostatic and slowly
bactericidal.
• Hepatotoxic, ototoxic, nephrotoxic, GI
upset
• May lead to hyperuricemia; arthralgia
(shoulder)

19. TREATMENT MODALITIES – MULTI DRUG
THERAPY
Ethambutol
• Leads to optic neuritis (Affect the red
green discrimination), Skin rash
• Not given to children 6 years or
younger because they can not reliably
monitor vision

20. TREATMENT MODALITIES – MULTI DRUG
THERAPY
Streptomycin
• Renal impairment, tinnitus and
auditory impairment

21. TREATMENT MODALITIES
TWO FORMULATION OF ANTI-TB DRUGS
1. Fixed Dose
Combination (FDC)
•Two or more 1st line anti
TB drugs are combined
in one tablet (2, 3, or 4
drug fixed dose)

22. TREATMENT MODALITIES
TWO FORMULATION OF ANTI-TB DRUGS
2. Single Dose
Formulation (SDF)
•Each drug prepared
individually.

23. TUBERCULOSIS CATEGORICAL TREATMENT
CATEGORY I
•4 Months – HRZE
•2 Months - HR

24. TUBERCULOSIS CATEGORICAL TREATMENT
CATEGORY II
•1 Month - HRZE
•2 Months -
HRZES
•4 Months - HRE

25. TUBERCULOSIS CATEGORICAL TREATMENT
CATEGORY III
•2 Months - HR
•4 Months - HRZE

26. TUBERCULOSIS CATEGORICAL TREATMENT
CATEGORY IV
•Refer

27. •The END!!!!

28. TRUE OR FALSE

29. 1. HEMOPTYSIS IS VOMITING
OF BLOOD THAT IS COMMON
IN ACTIVE TUBERCULOSIS.

30. 2. RUBOR MEANS HOTNESS

31. 3. ETHAMBUTOL CAUSES RED
ORANGE URINE IN ANTI TB
TREATMENTS

32. 4. ANTI SEPTIC IS CHEMICAL
USED IN NON LIVING THINGS

33. 5. AIRBORNE PRECAUTION
CAN BE TRANSMITTED IF
WITHIN 3 FEET AWAY.

34. 6. GLOVES IS REMOVE FIRST
BEFORE GOWN

35. 7. MASK IS REMOVE FIRST
BEFORE GOWN

36. 8. IF PPD IS GIVEN ON
THURSDAY, NEXT FOLLOW
VISIT WILL BE ON SATURDAY
MORNING.

37. 10. PRIMARY COMPLEX IS TB
INFECTION ACQUIRED IN
ELDERLY

38. 11. PYRAZINAMIDE CAUSE EYE
BLINDNESS

39. 12. FLUOR MEANS DRAINAGE
IN INFLAMMATORY PROCESS.

40. 13. CONTACT PRECAUTION
MUST BE OBSERVE WHEN
MANAGING TB PATIENTS.

41. 14. DOTS HELP CLIENT TO
COMPLY ON TB MANAGEMENT.

42. 15. BACTERICIDAL Prevents
bacterial multiplication but does
not kill it.

43. 16. GLOVES IN NEEDED TO
WEAR WHERE HANDLING
DROPLET PRECAUTION.

44. 17. WBC OF 16,000 INDICATES
INFECTION.

45. 18. Wear gown or apron during
procedures that are likely to
generate splashing of blood or
body fluids.

46. 19. FAILURE TO WEIGHT GAIN
INDICATES PROGRESSING
TUBERCULOSIS.

47. 20. POSITIVE PPD TEST
INDICATES TB INFECTION.