Tuberculosis is an infectious disease primarily affecting the lung parenchyma caused by Mycobacterium tuberculosis. Risk factors include age, immune status, living conditions, and country of origin. It spreads through airborne droplets from coughing, sneezing, etc. Symptoms may include cough, fever, weight loss, and night sweats. Diagnosis involves chest x-ray, sputum smear, tuberculin skin test, and culture. Treatment involves a combination of antibiotic medications over several months. Patient education focuses on medication compliance, prevention of spread, signs of treatment failure, and lifestyle modifications.

1. Pulmonary Tuberculosis
Shyambhatewara
Lecturer
Indexnursing college

2. Tuberculosis
Tuberculosis (TB) is an infectious disease that
primarily affects the lung parenchyma. It also may be
transmitted to other parts of the body, including the
meninges, kidneys , bones, and lymph nodes.

3. Etiological factors
The primary infectious agent, M.
tuberculosis is an acid-fast aerobic
rod that grows slowly and is
sensitive to heat and ultraviolet
light.
Mycobacterium bovis and
Mycobacterium avium have rarely
been associated with the
development of a TB infection.

4. Associated risk fctors
Child younger than 5 years of age
Drinking unpasteurized milk if the cow is infected with
bovine tuberculosis
Homeless individuals or those from a lower socioeco-
nomic group, minority group, or refugee group
Individuals in constant, frequent contactwithanuntreated or
undiagnosed individual
Individuals living in crowded areas, such as long-term
care facilities, prisons, and mental health facilities

5. Associated risk factors
Older client
Individuals with malnutrition, infection, immune
dysfunction, or human immunodeficiency virus infection;
or immunosuppressed as a result of medication therapy
Individuals who abuse alcohol or are intravenous drug
users

6. Transmission
Via the airborne route by droplet infection.
When an infected individual coughs, laughs, sneezes, or
sings, droplet nuclei containing tuberculosis bacteria enter
the air and may be inhaled by others.

7. Pathophysiology
T.B. bacilli enter the lung through the inhalation
T.B. bacilli settle at the apex of the lung due to high concentration
of O2 at apex of the lungs
Here bacilli multiply & induce antigen-antibody reaction
Macrophages, lymphocyte cells surround the bacilli
Macrophages phagocyte the bacilli & some of them destroy &
travel to the lymph node & riches the mediastinum lymph node

8. It will leads to lymph node enlargement with necrosis
If immune system of host is good If immune system of host is
than region is healed by fibrosis compromised
T.B. bacilli spread through
heamatogenous route
If heamatogenous route T.B. bacilli is reach different organs of body
than it is called milliary T.B.

9. Clinical manifestations
May be asymptomatic in
primary infection
Fatigue
Lethargy
Anorexia
Weight loss
Low-grade fever
Chills
Night sweats
Persistent cough and the
production of mucoid and
mucopurulent sputum,
which is occasion- ally
streaked with blood
Chest tightness and a dull,
aching chest pain may
accompany the cough.

11. Diagnostic evaluation
Detailed history collection
Physical examination
Chest X- ray
Sputum microscopy (AFB)
Tuberculin skin test (Montox test)
QuantiFERON-TB Gold test
Bronchoscopy
Blood test
Spo2

12. Induration5 -5 or >5 mm
Considered Positive in:
Positive in:
Induration5 -10 or >10 mm
Considered Positive in:
Induration5 -15or >15 mm
Considered Positive in:
 HIV-infected persons
 Recent contact of a person with
TB disease
 Persons with fibrotic changes on
chest x-ray consistent with prior
TB
 Clients with organ transplants
Persons immunosuppressed for
other reasons
 Recent immigrants from high-
prevalence countries Injection drug
users
 Residents and employees in high-risk
congregate settings
 Mycobacteriology laboratory
personnel Persons with clinical
conditions that place them at high risk
 Children <4 years of age Infants,
children, and adolescents exposed to
adults in high-risk categories
 Any person including
persons with no known
risk factors for TB
Tuberculin skin test

14. Management
First-Line Agents Second line Agents
 Isoniazid
 Rifampin
 Ethambutol
 Pyrazinamide
 Amikacin
 Capreomycin sulfate
 Cycloserine
 Ethionamide
 Levofloxacin
 Moxifloxacin
 p-Aminosalicylic acid
 Rifabutin
 Rifapentine
 Streptomyci

15. Symptomatic management
Analgesics for the pain
Antipyretic for the fever- PCM
Cough suppressant for the excessive cough-Bromocriptin
O2 therapy
Bronchodilator- Thiophylline

16. DOTS: Directly Observed Therapy,
Short-course
DOTS stands for Directly Observed Therapy, Short-course.
It is also known as TB-DOTS. It refers to a strategy that aims
to cure the tuberculosis (TB) and reduce the number of
tuberculosis cases.
In this strategy, a health care worker or any other designated
person (excluding the family members) provides the
prescribed TB drugs to the TB patients and makes sure that
the patient swallows every dose.

17. Importance of DOTS
 It prevents TB from spreading to others.
 It decreases the chances of treatment failure.
 It helps patents finish their TB treatment as quickly as possible and without any
gap.
 It decreases the risk of drug-resistance TB which results from the incomplete
treatment.
 We cannot be sure that the patient will take medication as directed; people may
forget or have problems taking medication correctly. This problem can be solved
with DOTS.

18. Client Education
Provide the client and family with information about
tuberculosis and alway concerns about the contagious
aspect of the infection. Instruct the client to follow the
medication regimen exactly as prescribed and always to
have a supply of the medication on hand.
Advise the client that the medication regimen is continued
up to 12 months depending on the situation.
Advise the client of the side and adverse effects of the
medication and ways of minimizing them to ensure
compliance.

19. Client Education
Reassure the client that after 2 to 3 weeks of medication
therapy, it is unlikely that the client will infect anyone.
Advise the client to resume activities gradually.
Instruct the client about the well-balanced diet (foods rich
in iron, protein, and vitamin C) to promote healing and to
prevent recurrence of the infection.
Inform the client and family that respiratory isolation is
not necessary because family members already have been
exposed.

20. Client Education
Instruct the client to cover the mouth and nose when
coughing or sneezing and to put used tissues into plastic
bags.
Instruct the client and family about thorough hand
washing. Inform the client that a sputum culture is needed
every 2 to 4 weeks once medication therapy is initiated.
Inform the client that when the results of 3 sputum
cultures are negative, the client is no longer considered
infectious and usually can return to former employment.

21. Client Education
Advise the client to avoid excessive exposure to silicone
or dust because these substances can cause further lung
damage.
Instruct the client regarding the importance of compliance
with treatment, follow-up care, and sputum cultures, as
prescribed