This document provides an overview of pulmonary tuberculosis, including its definition, classification, types, incidence, risk factors, pathophysiology, signs and symptoms, diagnosis, treatment, nursing management, and complications. It classifies TB based on anatomical site, previous treatment history, and drug resistance. Key points include that TB is caused by the bacterium Mycobacterium tuberculosis and spreads through airborne droplets. Diagnosis involves chest x-rays, sputum smears and cultures, tuberculin skin tests, and interferon-gamma blood tests.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Ong Hang Cheng, Infectious Disease Physician at University Malaya Medical Center
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
1. The document discusses skeletal manifestations in HIV infected patients, including reactive arthritis, Reiter's syndrome, psoriatic arthritis, septic arthritis, HIV-associated arthropathy, and painful articular syndrome.
2. It covers the classification and definition of HIV/AIDS according to the CDC and WHO, including disease progression, opportunistic infections, and CD4 cell counts.
3. The epidemiology of HIV is examined, including transmission routes between people of different ages, from mother to child, and occupational transmission among healthcare workers.
The document provides an overview of the COVID-19 pandemic, discussing the epidemiology, aetiology, clinical features, diagnosis, treatment, and prevention of the disease. It notes that COVID-19 is caused by the SARS-CoV-2 virus, first identified in Wuhan, China in late 2019. As of the date of writing, over 10 million cases and 500,000 deaths had been reported worldwide. The main symptoms are fever, dry cough and tiredness, and diagnosis is via RT-PCR testing of respiratory samples. Current treatment is supportive and focuses on symptom management, while prevention emphasizes good hand hygiene, social distancing and use of masks.
This presentation provides an overview of COVID-19 and was given by Team-D from the Department of Family Medicine at University of Uyo Teaching Hospital. It discusses the history, epidemiology, pathophysiology, clinical features, treatment, prevention and the role of family physicians in addressing the COVID-19 pandemic. Key points include that COVID-19 is caused by the SARS-CoV-2 virus, over 404 million confirmed cases worldwide as of February 2022, and prevention strategies involve vaccination, personal protective measures, and infection control in healthcare settings. The family physician plays an important role in identifying and managing potential COVID-19 cases at the primary care level.
They are members of the family Coronaviridae, enveloped and positive stranded RNA viruses. The virions are typically decorated with large, club-or petal-shaped surface projections (spikes) which in electron micrographs of spherical particles create an image reminiscent of the solar corona.
Pathogenesis and Clinical manifestation
COVID-19 has 5 clinical variants based on severity;
• Asymptomatic form – in this form, one gets infected without manifesting any symptom whatsoever. The person thus ends up just as a mere carrier, spreading the infection to others.
• Mild disease –this affects the upper respiratory tract producing symptoms such as sneezing, mild fever, cough, malaise, etc; The infected individual recovers rapidly, with or without any supportive treatment.
• Moderate disease –this is a lower respiratory tract infection, which may present as pneumonia and would need some supportive treatment, but may not be sick enough to need oxygen therapy.
• Severe disease – this group develop severe pneumonia and get so sick that they need oxygen therapy.
• Critical disease – this group of patients get so bad and develop acute respiratory disease syndrome and ventilator respiratory failure, so much that they would need a ventilator to survive.
This document provides information about Coronavirus Disease 2019 (COVID-19). It discusses the epidemiology, causes, signs and symptoms, diagnosis, management, and preventive measures of COVID-19. The objectives are to introduce COVID-19, discuss its transmission, clinical presentation, testing and treatment approaches, complications, and prevention. Key points covered include that COVID-19 is caused by a novel coronavirus, spreads through respiratory droplets, and can cause pneumonia, respiratory failure, and multi-organ dysfunction in severe cases. Diagnosis is via PCR testing of respiratory samples and management focuses on supportive care. Prevention emphasizes hand hygiene, surface disinfection, and use of personal protective equipment during patient care activities.
Infectious Diseases Associated with Fever part II.pptx12koshi
Severe acute respiratory syndrome (SARS) is a rapidly spreading, potentially fatal infectious viral disease.
Etiology
SARS-associated coronavirus (SARS-CoV)
Incubation Period
2-7 days
But may be as long as 10 days
Air way droplets containing living Virus
SARS-CoV spreads from one person to another mainly through close contact with someone who is infected with SARS.
When a person with SARS coughs or sneezes without covering his or her mouth, respiratory droplets containing living virus can spray up to 3 feet and invade the mucous membranes of another person.
It is not known whether SARS can spread more broadly through the air.
Initial tests in patients suspected of having SARS include the following:
Pulse oximetry
Blood cultures
Sputum Gram stain and culture
Viral respiratory pathogen tests, notably influenza A and B viruses and respiratory syncytial virus
HRCT(High-resolution computed tomography)
This document provides information on the management of CoViD 19. It discusses the virology of SARS-CoV-2, symptoms of CoViD 19, transmission routes, diagnosis methods including RT-PCR testing and CT scans, treatment approaches based on illness severity from mild to severe pneumonia and ARDS, and those at high risk of severe illness such as older patients and those with underlying medical conditions. Pathology findings include diffuse alveolar damage and lymphocytic infiltrates in severe cases.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Ong Hang Cheng, Infectious Disease Physician at University Malaya Medical Center
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
1. The document discusses skeletal manifestations in HIV infected patients, including reactive arthritis, Reiter's syndrome, psoriatic arthritis, septic arthritis, HIV-associated arthropathy, and painful articular syndrome.
2. It covers the classification and definition of HIV/AIDS according to the CDC and WHO, including disease progression, opportunistic infections, and CD4 cell counts.
3. The epidemiology of HIV is examined, including transmission routes between people of different ages, from mother to child, and occupational transmission among healthcare workers.
The document provides an overview of the COVID-19 pandemic, discussing the epidemiology, aetiology, clinical features, diagnosis, treatment, and prevention of the disease. It notes that COVID-19 is caused by the SARS-CoV-2 virus, first identified in Wuhan, China in late 2019. As of the date of writing, over 10 million cases and 500,000 deaths had been reported worldwide. The main symptoms are fever, dry cough and tiredness, and diagnosis is via RT-PCR testing of respiratory samples. Current treatment is supportive and focuses on symptom management, while prevention emphasizes good hand hygiene, social distancing and use of masks.
This presentation provides an overview of COVID-19 and was given by Team-D from the Department of Family Medicine at University of Uyo Teaching Hospital. It discusses the history, epidemiology, pathophysiology, clinical features, treatment, prevention and the role of family physicians in addressing the COVID-19 pandemic. Key points include that COVID-19 is caused by the SARS-CoV-2 virus, over 404 million confirmed cases worldwide as of February 2022, and prevention strategies involve vaccination, personal protective measures, and infection control in healthcare settings. The family physician plays an important role in identifying and managing potential COVID-19 cases at the primary care level.
They are members of the family Coronaviridae, enveloped and positive stranded RNA viruses. The virions are typically decorated with large, club-or petal-shaped surface projections (spikes) which in electron micrographs of spherical particles create an image reminiscent of the solar corona.
Pathogenesis and Clinical manifestation
COVID-19 has 5 clinical variants based on severity;
• Asymptomatic form – in this form, one gets infected without manifesting any symptom whatsoever. The person thus ends up just as a mere carrier, spreading the infection to others.
• Mild disease –this affects the upper respiratory tract producing symptoms such as sneezing, mild fever, cough, malaise, etc; The infected individual recovers rapidly, with or without any supportive treatment.
• Moderate disease –this is a lower respiratory tract infection, which may present as pneumonia and would need some supportive treatment, but may not be sick enough to need oxygen therapy.
• Severe disease – this group develop severe pneumonia and get so sick that they need oxygen therapy.
• Critical disease – this group of patients get so bad and develop acute respiratory disease syndrome and ventilator respiratory failure, so much that they would need a ventilator to survive.
This document provides information about Coronavirus Disease 2019 (COVID-19). It discusses the epidemiology, causes, signs and symptoms, diagnosis, management, and preventive measures of COVID-19. The objectives are to introduce COVID-19, discuss its transmission, clinical presentation, testing and treatment approaches, complications, and prevention. Key points covered include that COVID-19 is caused by a novel coronavirus, spreads through respiratory droplets, and can cause pneumonia, respiratory failure, and multi-organ dysfunction in severe cases. Diagnosis is via PCR testing of respiratory samples and management focuses on supportive care. Prevention emphasizes hand hygiene, surface disinfection, and use of personal protective equipment during patient care activities.
Infectious Diseases Associated with Fever part II.pptx12koshi
Severe acute respiratory syndrome (SARS) is a rapidly spreading, potentially fatal infectious viral disease.
Etiology
SARS-associated coronavirus (SARS-CoV)
Incubation Period
2-7 days
But may be as long as 10 days
Air way droplets containing living Virus
SARS-CoV spreads from one person to another mainly through close contact with someone who is infected with SARS.
When a person with SARS coughs or sneezes without covering his or her mouth, respiratory droplets containing living virus can spray up to 3 feet and invade the mucous membranes of another person.
It is not known whether SARS can spread more broadly through the air.
Initial tests in patients suspected of having SARS include the following:
Pulse oximetry
Blood cultures
Sputum Gram stain and culture
Viral respiratory pathogen tests, notably influenza A and B viruses and respiratory syncytial virus
HRCT(High-resolution computed tomography)
This document provides information on the management of CoViD 19. It discusses the virology of SARS-CoV-2, symptoms of CoViD 19, transmission routes, diagnosis methods including RT-PCR testing and CT scans, treatment approaches based on illness severity from mild to severe pneumonia and ARDS, and those at high risk of severe illness such as older patients and those with underlying medical conditions. Pathology findings include diffuse alveolar damage and lymphocytic infiltrates in severe cases.
Mucormycosis and how it is related to Covid 19 disease - department seminar ...RubinaSubhani
Mucormycosis, also known as black fungus, is a serious fungal infection caused by a group of molds called mucormycetes. It affects people with health problems or those taking medications that lower the body's ability to fight germs and sickness. The infection is seen in some COVID-19 patients as well, likely due to them having diabetes, being on steroids, or having low immunity from the virus. Symptoms depend on the infected area but can include sinus congestion, black lesions, fever and breathing issues. Treatment requires antifungal medicines and sometimes surgery. People with diabetes should keep their blood sugar under control to reduce mucormycosis risk.
Bronchiectasis is a chronic lung disease characterized by irreversible dilation of the bronchi. It results from damage to the airways due to infection or inflammation that impairs mucus clearance. Common symptoms include chronic cough with sputum production. Diagnosis involves chest imaging and sputum culture. Treatment aims to clear secretions, treat infections, and manage symptoms. Nursing care focuses on airway clearance techniques, breathing exercises, infection control, nutrition support, and health education.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
Dr. Suseela Prabhakaran was inaugurated as the new chair. Dr. Devin Prabhakar spoke on mucormycosis, also known as black fungus, which has afflicted many recovering from COVID-19. It invades the sinus and can be fatal if not treated early. Those with reduced immunity due to conditions like COVID-19, diabetes, or steroid use are susceptible. Rhino-orbital mucormycosis is the most common form and can spread to the brain. Aggressive surgery, antifungal therapy, and controlling underlying risks are needed for improved survival rates, though mortality remains high without early diagnosis and treatment.
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptxBibekananda shah
This document provides an overview of COVID-19, including its history, epidemiology, transmission, clinical presentation, investigations, treatment, and complications. It describes the SARS-CoV-2 virus morphology and genome. Key variants discussed are Delta and Omicron. Prevention methods covered include handwashing, social distancing, and vaccinations. Oral manifestations associated with COVID-19 and post-COVID fungal infections like mucormycosis are also reviewed.
Mucormycosis, also known as black fungus, is a serious fungal infection caused by mold of the Mucorales order. It has been increasingly reported in COVID-19 patients, especially in India. Key risk factors include diabetes, steroid therapy for COVID-19, and immunosuppression. Common symptoms include sinusitis, facial swelling and numbness. Diagnosis involves fungal culture, histopathology and imaging. Prognosis is poor if left untreated, with mortality rates reaching 90% for invasive forms. Treatment requires antifungal therapy and surgery.
Vaccination is key to controlling the COVID-19 pandemic. The document discusses SARS-CoV-2, the virus that causes COVID-19, explaining its structure and how it transmits through respiratory droplets. It also summarizes COVID-19 symptoms from mild to severe, complications, and the need for vaccines to be safely and effectively delivered to as many eligible people as possible to control the pandemic.
The document discusses surgical problems in HIV positive patients. It covers the epidemiology of HIV/AIDS, how HIV affects the body's immune system, common clinical manifestations including opportunistic infections, diagnostic tests for HIV, and various surgical presentations and considerations for HIV positive patients. Key points are that surgeons must take universal precautions for all patients, opportunistic infections can mimic surgical conditions, and HIV patients require careful pre-operative screening, intra-operative protocols, and post-operative management to prevent complications and transmission.
This document provides information on COVID-19 including its structural characteristics, epidemiology, case definition, diagnosis, and care of healthcare workers. It describes COVID-19 as a respiratory illness caused by a novel coronavirus (SARS-CoV-2) that ranges from mild to severe symptoms. Key points include modes of transmission, risk factors like age and pre-existing conditions, stages of illness, global and local case statistics, and steps healthcare workers should take like using proper PPE, hand hygiene, and isolation protocols to care for patients and protect themselves.
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
1. The document discusses SARS-CoV-2, the virus that causes COVID-19, including its transmission, clinical manifestations, risk factors, investigations, and management guidelines.
2. Key points include that SARS-CoV-2 is transmitted via droplets or contact and may cause asymptomatic to critical illness. Common symptoms include fever, cough and shortness of breath.
3. Older adults and those with pre-existing medical conditions are at higher risk for severe illness. Diagnosis is confirmed via RT-PCR testing of respiratory samples, while chest imaging may show pneumonia.
This document summarizes the pathogenesis and morphological features of SARS-CoV-2 in various organs. It begins with an introduction and timeline of the virus. It then discusses the mode of transmission and laboratory handling guidelines. The pathogenesis involves the virus binding to ACE2 receptors in lungs and other organs. This causes cytokine release syndrome and acute respiratory distress syndrome seen in lungs. Effects in other organs like heart, gastrointestinal tract, and kidney are also discussed based on autopsy findings like thrombi, inflammation and necrosis. Long term sequelae could include altered lipid metabolism and cardiovascular complications.
This document provides an overview of pulmonary tuberculosis (TB). It defines TB as an infectious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs. TB is spread through airborne droplets when an infected person coughs or sneezes. The document discusses the pathogenesis, stages, risk factors, signs and symptoms, diagnostic tests, medical management including drug therapy, and nursing care of patients with pulmonary TB. It also covers complications, education on respiratory hygiene and home care considerations for patients.
Mr. D.T., a 54-year-old hypertensive nurse, was admitted to the hospital with cough, fever, difficulty breathing, and diarrhea after returning from India. On examination, he had a fever, rapid breathing, fast heart rate, high blood pressure, and low oxygen levels. Tests showed positive for COVID-19 and images of his lungs showed signs of the infection. He was given treatments like oxygen, fluids, and medicines to fight the virus.
This document provides an overview of tuberculosis (TB), including its causative agent, epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment. It describes Mycobacterium tuberculosis as the typical bacteria that causes TB. It outlines the differences between TB infection and active disease, and lists risk factors for developing active TB. Key topics covered include pulmonary and extrapulmonary TB symptoms and presentations, as well as considerations for HIV-associated TB and drug-resistant TB.
The document provides information about COVID-19 and the NSW Health response. It defines SARS-CoV-2, the virus that causes COVID-19, and details the timeline of the outbreak worldwide and in Australia. It describes NSW Health's response, which includes establishing clinical councils, providing advice to healthcare workers, developing diagnostic tests, managing cases through infection control and public health measures, and regular public updates. It provides guidance on case definitions, testing criteria, and infection prevention and control strategies to prevent transmission, including the use of personal protective equipment and isolation for suspected or confirmed cases.
This document provides an overview of COVID-19 including its history, current global situation, transmission factors, clinical presentation, case definitions, laboratory diagnosis, management, and infection prevention strategies. It discusses how the virus was first detected in China in late 2019 and has since spread globally. Key points covered include the virus's pathogenesis, symptoms that can include fever and respiratory issues, diagnostic testing through samples like sputum, and treatment involving isolation, supportive care, and infection control measures.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
This document discusses COVID-19 in immunocompromised patients. It notes that while immunocompromised patients are at higher risk of severe COVID-19 due to an impaired immune response, the suppression of inflammation may also be protective. The effects of various immunocompromising conditions like HIV, cancer, transplant recipients, and primary immunodeficiencies on COVID-19 outcomes are reviewed. Management strategies like antiviral therapy and immunoglobulin replacement are also discussed. More research is still needed to understand how immunocompromise impacts COVID-19 severity.
UNIT 5.2 PHYSIOLOGICAL CONCEPTS AND PHYSICAL CHARACTERISTICS: Estrogens replacement therapy is commenced on the basis of dependent or previously estrogen sensitive women.
Low dose estrogens for short period to improve metabolic state. Estrogens therapy relieves unpleasant symptoms such as hot flashes and vaginal dryness and also appeared to protect against postmenopausal conditions such as osteoporosis and heart disease
A wound is a break or cut in the continuity of any body structure, internal or external caused by physical means.
A wound is a type of injury which happens relatively quickly in which skin is torn, cut, or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound).
Mucormycosis and how it is related to Covid 19 disease - department seminar ...RubinaSubhani
Mucormycosis, also known as black fungus, is a serious fungal infection caused by a group of molds called mucormycetes. It affects people with health problems or those taking medications that lower the body's ability to fight germs and sickness. The infection is seen in some COVID-19 patients as well, likely due to them having diabetes, being on steroids, or having low immunity from the virus. Symptoms depend on the infected area but can include sinus congestion, black lesions, fever and breathing issues. Treatment requires antifungal medicines and sometimes surgery. People with diabetes should keep their blood sugar under control to reduce mucormycosis risk.
Bronchiectasis is a chronic lung disease characterized by irreversible dilation of the bronchi. It results from damage to the airways due to infection or inflammation that impairs mucus clearance. Common symptoms include chronic cough with sputum production. Diagnosis involves chest imaging and sputum culture. Treatment aims to clear secretions, treat infections, and manage symptoms. Nursing care focuses on airway clearance techniques, breathing exercises, infection control, nutrition support, and health education.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
Dr. Suseela Prabhakaran was inaugurated as the new chair. Dr. Devin Prabhakar spoke on mucormycosis, also known as black fungus, which has afflicted many recovering from COVID-19. It invades the sinus and can be fatal if not treated early. Those with reduced immunity due to conditions like COVID-19, diabetes, or steroid use are susceptible. Rhino-orbital mucormycosis is the most common form and can spread to the brain. Aggressive surgery, antifungal therapy, and controlling underlying risks are needed for improved survival rates, though mortality remains high without early diagnosis and treatment.
COVID-19 (NOVEL CORONA VIRUS DISEASE PANDEMIC ).pptxBibekananda shah
This document provides an overview of COVID-19, including its history, epidemiology, transmission, clinical presentation, investigations, treatment, and complications. It describes the SARS-CoV-2 virus morphology and genome. Key variants discussed are Delta and Omicron. Prevention methods covered include handwashing, social distancing, and vaccinations. Oral manifestations associated with COVID-19 and post-COVID fungal infections like mucormycosis are also reviewed.
Mucormycosis, also known as black fungus, is a serious fungal infection caused by mold of the Mucorales order. It has been increasingly reported in COVID-19 patients, especially in India. Key risk factors include diabetes, steroid therapy for COVID-19, and immunosuppression. Common symptoms include sinusitis, facial swelling and numbness. Diagnosis involves fungal culture, histopathology and imaging. Prognosis is poor if left untreated, with mortality rates reaching 90% for invasive forms. Treatment requires antifungal therapy and surgery.
Vaccination is key to controlling the COVID-19 pandemic. The document discusses SARS-CoV-2, the virus that causes COVID-19, explaining its structure and how it transmits through respiratory droplets. It also summarizes COVID-19 symptoms from mild to severe, complications, and the need for vaccines to be safely and effectively delivered to as many eligible people as possible to control the pandemic.
The document discusses surgical problems in HIV positive patients. It covers the epidemiology of HIV/AIDS, how HIV affects the body's immune system, common clinical manifestations including opportunistic infections, diagnostic tests for HIV, and various surgical presentations and considerations for HIV positive patients. Key points are that surgeons must take universal precautions for all patients, opportunistic infections can mimic surgical conditions, and HIV patients require careful pre-operative screening, intra-operative protocols, and post-operative management to prevent complications and transmission.
This document provides information on COVID-19 including its structural characteristics, epidemiology, case definition, diagnosis, and care of healthcare workers. It describes COVID-19 as a respiratory illness caused by a novel coronavirus (SARS-CoV-2) that ranges from mild to severe symptoms. Key points include modes of transmission, risk factors like age and pre-existing conditions, stages of illness, global and local case statistics, and steps healthcare workers should take like using proper PPE, hand hygiene, and isolation protocols to care for patients and protect themselves.
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
1. The document discusses SARS-CoV-2, the virus that causes COVID-19, including its transmission, clinical manifestations, risk factors, investigations, and management guidelines.
2. Key points include that SARS-CoV-2 is transmitted via droplets or contact and may cause asymptomatic to critical illness. Common symptoms include fever, cough and shortness of breath.
3. Older adults and those with pre-existing medical conditions are at higher risk for severe illness. Diagnosis is confirmed via RT-PCR testing of respiratory samples, while chest imaging may show pneumonia.
This document summarizes the pathogenesis and morphological features of SARS-CoV-2 in various organs. It begins with an introduction and timeline of the virus. It then discusses the mode of transmission and laboratory handling guidelines. The pathogenesis involves the virus binding to ACE2 receptors in lungs and other organs. This causes cytokine release syndrome and acute respiratory distress syndrome seen in lungs. Effects in other organs like heart, gastrointestinal tract, and kidney are also discussed based on autopsy findings like thrombi, inflammation and necrosis. Long term sequelae could include altered lipid metabolism and cardiovascular complications.
This document provides an overview of pulmonary tuberculosis (TB). It defines TB as an infectious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs. TB is spread through airborne droplets when an infected person coughs or sneezes. The document discusses the pathogenesis, stages, risk factors, signs and symptoms, diagnostic tests, medical management including drug therapy, and nursing care of patients with pulmonary TB. It also covers complications, education on respiratory hygiene and home care considerations for patients.
Mr. D.T., a 54-year-old hypertensive nurse, was admitted to the hospital with cough, fever, difficulty breathing, and diarrhea after returning from India. On examination, he had a fever, rapid breathing, fast heart rate, high blood pressure, and low oxygen levels. Tests showed positive for COVID-19 and images of his lungs showed signs of the infection. He was given treatments like oxygen, fluids, and medicines to fight the virus.
This document provides an overview of tuberculosis (TB), including its causative agent, epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment. It describes Mycobacterium tuberculosis as the typical bacteria that causes TB. It outlines the differences between TB infection and active disease, and lists risk factors for developing active TB. Key topics covered include pulmonary and extrapulmonary TB symptoms and presentations, as well as considerations for HIV-associated TB and drug-resistant TB.
The document provides information about COVID-19 and the NSW Health response. It defines SARS-CoV-2, the virus that causes COVID-19, and details the timeline of the outbreak worldwide and in Australia. It describes NSW Health's response, which includes establishing clinical councils, providing advice to healthcare workers, developing diagnostic tests, managing cases through infection control and public health measures, and regular public updates. It provides guidance on case definitions, testing criteria, and infection prevention and control strategies to prevent transmission, including the use of personal protective equipment and isolation for suspected or confirmed cases.
This document provides an overview of COVID-19 including its history, current global situation, transmission factors, clinical presentation, case definitions, laboratory diagnosis, management, and infection prevention strategies. It discusses how the virus was first detected in China in late 2019 and has since spread globally. Key points covered include the virus's pathogenesis, symptoms that can include fever and respiratory issues, diagnostic testing through samples like sputum, and treatment involving isolation, supportive care, and infection control measures.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
This document discusses COVID-19 in immunocompromised patients. It notes that while immunocompromised patients are at higher risk of severe COVID-19 due to an impaired immune response, the suppression of inflammation may also be protective. The effects of various immunocompromising conditions like HIV, cancer, transplant recipients, and primary immunodeficiencies on COVID-19 outcomes are reviewed. Management strategies like antiviral therapy and immunoglobulin replacement are also discussed. More research is still needed to understand how immunocompromise impacts COVID-19 severity.
UNIT 5.2 PHYSIOLOGICAL CONCEPTS AND PHYSICAL CHARACTERISTICS: Estrogens replacement therapy is commenced on the basis of dependent or previously estrogen sensitive women.
Low dose estrogens for short period to improve metabolic state. Estrogens therapy relieves unpleasant symptoms such as hot flashes and vaginal dryness and also appeared to protect against postmenopausal conditions such as osteoporosis and heart disease
A wound is a break or cut in the continuity of any body structure, internal or external caused by physical means.
A wound is a type of injury which happens relatively quickly in which skin is torn, cut, or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound).
“Trauma” = Injury of one or more systems,that results in excessive bleeding and mayaffect the normal body functioning.
Defined as cellular disruption caused by anexchange with environmental energy that isbeyond the body's resilience.
This document discusses substance abuse, focusing on alcohol overdose and cannabis intoxication. It defines substance abuse and lists the most common substances abused, including alcohol and cannabis. For alcohol overdose, it describes the lethal dose, signs and symptoms, diagnosis involving breathalyzer or blood tests, and emergency management following CAB principles. For cannabis intoxication, it discusses lethal doses, causes of dependency and overdose, signs of dependency and overdose, diagnosis using urine tests, and general emergency management involving supportive care.
Poisoning is injury or death due to swallowing, inhalation, touching or injecting various drugs, chemical, venoms or gases.
Many substances such as drugs, carbon monoxide, food poisoning, organo-phosphorus are poison.
Poisoning can be an accident or a planned action.
Organophosphate poisoning is poisoning due to organophosphates (OPs). Organophosphates are used as insecticides, medications, and nerve agents.
Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion.
Other names: Organophosphate toxicity
Causes: organophosphates
Hypovolemic shock is a life-threatening emergency in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Hypovolemic shock is a dangerous condition that happens when suddenly lose a lot of blood or fluids from body. This drops blood volume, the amount of blood circulating in body. That’s why it’s also known as low-volume shock.
Heat stroke a core temperature ≥40°C accompanied by CNS dysfunction in patients with environmental heat exposure. This condition represents a failure of the body's ability to maintain thermoregulatory homeostasis.
Hemorrhage is the loss of blood escaping from the circulatory system.
Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally either through a natural opening such as mouth, nose, ear, urethra or anus or through a break in the skin.
Uncontrolled bleeding can rapidly lead to shock and death.
Excessive or uncontrollable bleeding, often caused by trauma, surgical or obstetrical complications, or the advanced stages of certain illnesses such as cirrhosis and peptic ulcer disease.
An airway obstruction is a blockage in any part of the airway.
The airway is a complex system of tubes that conveys inhaled air from nose and mouth into the lungs.
An obstruction may partially or totally prevent air from getting into lungs.
Acute upper airway obstruction is a life-threatening medical emergency.
This document provides information on emergency care and triage. It discusses the principles of emergency care which include providing care without delay and using triage to prioritize patients. Triage involves sorting patients into categories of emergent, urgent, and non-urgent based on the seriousness of their conditions. The document then describes the triage process in more detail, including the different color codes used to categorize patients and the criteria for each category. It also discusses the roles of triage team members and how to set up an effective triage system.
Emergency nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury.
While this is common to many nursing specialties, the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known.
The document provides information on the care of patients undergoing traction. It defines traction as applying a pulling force to part of the body. Traction is used to provide alignment, reduce muscle spasms, prevent deformities, provide immobilization, and increase space between opposing surfaces. The document outlines different types of traction including skin, skeletal, and manual traction. It discusses nursing responsibilities like ensuring comfort, preventing complications, educating patients, and promoting exercise and mobility.
Rheumatoid arthritis (RA) facts
Rheumatoid arthritis is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.
It can affect people of all ages.
The cause of rheumatoid arthritis is not known.
In rheumatoid arthritis, multiple joints are usually, affected in a symmetrical pattern.
Paget disease is a chronic bone disorder that typically results in enlarged, deformed bones due to excessive breakdown and formation of bone tissue that can cause bones to weaken and may result in bone pain, arthritis deformities or fractures.
Osteomalacia is a bone condition caused by vitamin D deficiency or impaired mineralization. It results in soft, weakened bones due to incomplete mineralization of bone matrix. Symptoms include bone pain, tenderness, fractures, and muscle weakness. Diagnosis involves x-rays showing pseudofractures and bone biopsy showing excess osteoid tissue. Treatment focuses on calcium and vitamin D supplementation to promote bone mineralization. Nursing care includes education on diet, sunlight exposure, pain management, and monitoring for treatment effectiveness.
Osteoporosis is a chronic, progressive disease of multifactorial etiology.
It is most frequently recognized in particularly in elderly people and does occur in sexes, all races, and all age groups.
Osteoporosis is a preventable disease that can result in disturbing physical, psychosocial, and economic consequences.
Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue.
This document provides information about osteomyelitis, including:
1) Osteomyelitis is an inflammation of bone caused by an infecting organism that may remain localized or spread through the bone. Common causes are bacteria or fungi entering through a break in the skin or spreading via blood.
2) It can be classified as acute (less than 2 weeks), subacute (2-6 weeks), or chronic (over 6 weeks) based on duration of symptoms. It can also be classified based on mechanism of infection such as exogenous (from outside trauma/surgery) or hematogenous (from another infectious site).
3) Staphylococcus aureus is the most common pathogen. Risk factors
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are several types of oral cancers, but around 90% are squamous cell carcinomas originating in the tissues that line the mouth and lips.
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The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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6. INTRODUCTION
• Tuberculosis is an infectious bacterial disease
that primarily affects the lung parenchyma but
may spread to other organs.
• It may be transmitted to other parts of the body,
including meninges, kidneys, bones and lymph
nodes.
• PTB can range from small infection of broncho-
pneumonia to diffuse intense inflammation,
necrosis, pleural effusion and extensive fibrosis.
7/24/2022 6
7. CONTD….
• It is characterized by pulmonary infiltrates,
formation of granulomas with casseation,
fibrosis and cavitations.
• The primary infectious agent is
M.tuberculosis, mycobacterium bovis and
mycobacterim avium have rarely been
associated with development of TB infection.
7/24/2022 7
9. TUBERCULOSIS CASE DEFINITION
• A bacteriologically confirmed TB case is one
from whom a specimen is positive by smear
microscopy, culture or WHO-recommended
rapid diagnostics-WRD such as Xpert MTB/RIF.
7/24/2022 9
10. CONTD….
A clinically diagnosed TB case is one who does
not fulfil the criteria for bacteriological
confirmation but has been diagnosed with
active TB by a health worker based on strong
clinical evidence and has decided to give the
patient a full course of TB treatment.
7/24/2022 10
11. Classification based on Anatomical
site of disease
• Pulmonary tuberculosis (PTB) refers to any
bacteriologically confirmed or clinically diagnosed
case of TB involving the lung parenchyma or the
tracheo-bronchial tree.
• Miliary TB is classified as PTB because there are
lesions in the lungs.
7/24/2022 11
12. CONTD….
• Extra-pulmonary tuberculosis (EPTB)
– is any bacteriologically confirmed or clinically
diagnosed case of TB involving organs other than
the lungs, e.g. pleura, lymph nodes, abdomen,
genitourinary tract, skin, joints, bones and
meninges.
– Tuberculous intra-thoracic lymphadenopathy
(mediastinal and/or hilar) or tuberculous pleural
effusion, without radiographic abnormalities in
the lungs, constitutes a case of extra-pulmonary
TB.
7/24/2022 12
13. Classification based on the History of
previous TB treatment
New patients
• Patients who have never been treated for TB or have
taken anti- TB drugs for less than one month.
Relapse patients
• Patients who have previously been treated for TB were
declared cured or treatment completed at the end of
their most recent course of treatment, and are now
diagnosed with a recurrent episode of TB (either a true
relapse or a new episode of TB caused by reinfection).
7/24/2022 13
14. CONTD….
Treatment after failure patients
• Are those who have previously been treated for
TB and whose treatment failed at the end of their
most recent course of treatment.
Treatment after loss to follow-up patients
• Patients who have previously been treated for TB
and were declared lost to follow-up at the end of
their most recent course of treatment. (These
were previously known as Treatment After
Default patients)
7/24/2022 14
15. CONTD…..
Other previously treated patients
• Patients are those who have previously been
treated for TB but whose outcome after their
most recent course of treatment is unknown or
undocumented.
Patients with unknown previous TB treatment
history
• Patients with unknown previous TB treatment
history who do not fit into any other categories
listed above.
7/24/2022 15
16. Classification based on Drug
Resistance
1. Primary drug resistance: resistance to one of
the first line ATT agents in a person, who has
not had previous treatment.
2. Secondary or acquired drug resistance:
resistance to one or more antituberculosis
agents in a patient undergoing treatments.
7/24/2022 16
17. Contd….
3. Multi- drug resistance: resistance to two
agents, Isoniazid and Rifampicin.
• The populations at highest risk for multi-drug
resistance are those who are HIV- positive,
institutionalized or homeless.
7/24/2022 17
21. INCIDENCE
• With the increased incidence of AIDS, TB has
become more a problem in the U.S., and the
world.
• TB is one of the top 10 leading cause of death
and the leading cause of single infectious
agent (above HIV/AIDS) in the world.
7/24/2022 21
22. INCIDENCE
• Globally, nearly 10 millions people developed
TB in 2017 and TB caused an estimated 1.3
million deaths in the same year.
• By the end of 2020, TB case incident rate
needs to be falling at 4 to 5 % per year, and
case fatality ratio needs to fall to <= 5%.
7/24/2022 22
23. Tuberculosis Burden in nepal
• TB is one of the major public health problems
of nepal.
• In 2017/18, a total of 32,474 cases were
notified and registered at NTP.
• TB case notification: 152/100,000 (in 2018)
• Among the reported cases, Male: Female ratio
is 1.7:1.
NATIONAL TB MANAGEMENT GUIDELINES, 2019
7/24/2022 23
25. Transmission and Risk factors
• TB spreads from person to person by airborne
transmission.
• An infected person releases droplet nuclei (
usually particles 1 to 5 micrometer in diameter)
through talking, coughing, sneezing, laughing etc.
• Larger droplets settle, smaller droplets (Airborne
droplet nucluei- 1 -5 micometre in size are small and remains
suspended) remain suspended in air and are
inhaled by a susceptible person.
7/24/2022 25
27. RISK FACTORS
• Inhalation of airborne nuclei from an infected
person.
• Close contact with the person who has active TB
• Immuno-compromised status
– HIV infection
– Cancer
– Transplanted organ
– Prolonged high doses of corticosteroid therapy
• Substance abuse– I/V drug users, alcoholics
7/24/2022 27
28. RISK FACTORS
• Any person without inadequate health
care(Homeless, impoverished, children under the
age of 15, young adults between the age of 15 to 44
years.)
• Pre-existing medical conditions—
malignancies, CRF, DM, malnourishment,
hemodialysis, gastrectomy etc.
7/24/2022 28
29. RISK FACTORS
• Living in overcrowded , substandard housing
• Immigration from a countries with high
prevalence of TB( southeastern Asia)
• Being health worker performing high risk
activities- suctioning, coughing procedures,
bronchoscopy, intubation etc…)
7/24/2022 29
30. PATHOPHYSIOLOGY
Inhalation of mycobacterium by susceptible
person
Transmission to alveoli
Multiplication in alveoli
Transmission of bacilli to other areas of lung
and other parts of body(kidneys, bone,
meninges) 30
7/24/2022
31. Pathophysiology …
Initiation of inflammatory reaction
Accumulation of exudate in alveoli, causing
bronchopneumonia
Granulomas formation
31
7/24/2022
32. Pathophysiology …
Necrotic changes of granuloma, forming cheesy mass
and then become calcified and form collagenous scar
Transformation of granuloma into fibrous tissue mass(the
central portion of this is called ghon tubercle)
At this point, bacteria become dormant—no progression of
active TB
32
7/24/2022
33. Pathophysiology …
• In some cases, bacteria may remain active,
leading to disease
• In cases, where the bacteria are dormant
they may become reactivated after
exposure to infection
33
7/24/2022
34. PATHOPHYSIOLOGY
• The reactivation occurs through following
steps:
Ulceration of ghon tubercule
Cheesy material release into bronchi(making
bacteria airborne)
7/24/2022 34
35. Pathophysiology …
Ulcerated tubercle heals
and forms scar tissue
This causes Further
inflammation of infected
lungs
Causing further bronchopneumonia and
tubercle formation
35
7/24/2022
39. DIAGNOSIS
• HISTORY TAKING
• PHYSICAL EXAMINATION
– Clubbing of the fingers or toes (in people with
advanced disease)
7/24/2022 39
40. Contd….
– Swollen or tender lymph nodes in the neck or
other areas
– Fluid around a lung (pleural effusion)
– Unusual breath sounds (crackles)
7/24/2022 40
41. Contd…
IF MILIARY TB;
• A physical exam may show:
– Swollen liver
– Swollen lymph nodes
– Swollen spleen
7/24/2022 41
43. SPUTUM EXAMINATION
There are direct smear and culture:
– The presence of AFB on a sputum
smear may indicate disease but
does not confirm the diagnosis
–A culture is done to confirm the
diagnosis
43
7/24/2022
44. • Mantoux method---Injecting a
small amount of protein from
tuberculosis bacteria into intra-
dermal layer of inner aspect of
forearm approximately 4 inch
below the elbow.
44
7/24/2022
45. MANTOUX METHOD
• 0.1ml of purified protein derivative is injected
and the test result is read 48 to 72 hours after
injection.
• A reaction occurs when both induration and
erythema are present
7/24/2022 45
46. CONTD……
• A reaction of less than 5 mm is
considered negative , 5-9 mm is
considered positive (+)
• 10-19 mm is considered positive (++)
• More than 20 mm is considered positive
(+++)
• This indicates mycobacterium infection
46
7/24/2022
47. QUANTI-FERON-TB gold test
Interferon-gamma Blood test—ELISA test
• A sample blood is mixed with synthetic
proteins similar to those produced by the
tuberculosis bacteria.
47
7/24/2022
48. CONTD….
• If people are infected with tuberculosis
bacteria, their white blood cells produce
interferons-gama, in response to the synthetic
proteins.
White blood count and ESR
– The white blood count is usually normal.
–ESR is often elevated
7/24/2022 48
49. • Thoracocentesis (Pleural Fluid)
• Pleural biopsy
• The Xpert MTB/RIF assay is a new test that is
revolutionizing tuberculosis (TB) control by
contributing to the rapid diagnosis of TB disease
and drug resistance.
• The test simultaneously detects Mycobacterium
tuberculosis complex (MTBC) and resistance to
rifampin (RIF) in less than 2 hours.
49
7/24/2022
50. 50
Diagnosis of Pulmonary TB
Cough 3 weeks
AFB X 3
Broad-spectrum antibiotic 10-14 days
If symptoms persist, repeat AFB smears, X-ray
If consistent with TB
Anti-TB Treatment
If 1 positive,
X-ray and
evaluation
If 2/3 positive:
Anti-TB Rx
If negative:
7/24/2022
51. A. Medical management:
– For the patient suffering with TB, the medical
therapy is primary treatment.
– The treatment regimens should be continued for at
least 6 months to a total of 9 months.
Management
51
7/24/2022
52. • Ethambutol (E): Bacteriostatic for the tubercle
bacillus
• Isoniazid (H): Bacteriocidal against rapidly
developing cells
• Pyrazinamide (Z): Bacteriocidal effect against
dominant or semi dominant bacteria
• Rifampicin (R): Bacteriocidal against rapidly
developing cells and against semi dominant
bacteria
• Streptomycin: Bacteriocidal
First line drugs
52
7/24/2022
53. • These drugs are often used in special conditions like
resistance to first line therapy, extensively drug-
resistant tuberculosis (XDR-TB) or multidrug-resistant
tuberculosis (MDR-TB).
• There are six classes of second-line drugs (SLDs) used
for the treatment of TB.
Second line drugs
53
7/24/2022
55. • There is now only one category of treatment
for TB patients needing first-line treatment.
• All TB patients whether bacteriologically
confirmed or clinically diagnosed will receive
Treatment Regimen (2HRZE/4HR).
• In patients who require TB re-treatment, drug
susceptibility testing should be conducted to
inform the choice of treatment regimen.
TREATMENT REGIMEN
55
7/24/2022
56. • New TB cases
- Adult and Childhood
- Bacteriological or clinically diagnosed
- Pulmonary or extra-pulmonary
• Intensive phase: 2HRZE
• Continuation phase: 4HR
Categories of treatment and their anti-
TB drug regimens
56
7/24/2022
57. • Complicated/Severe Extra-pulmonary cases
(CNS TB, TB Pericarditis, Musculoskeletal TB,
Miliary TB etc.)
• Intensive phase: 2HRZE
Categories of treatment and their
anti-TB drug regimens
57
7/24/2022
58. CONTD…..
• Continuation phase: 7-10 HRE
• If treatment is required beyond 12 months,
then refer to a higher level center for
treatment decisions.
7/24/2022 58
59. • WHO has recommended fixed dose
combination drug for treatment of TB.
• It consist of:
–Isoniazid + rifampicin + pyrazinamide +
ethambutol: 75 mg + 150 mg + 400 mg + 275
mg.
Fixed dose combination drug
59
7/24/2022
62. What is DOTS?
• D.O.T.S. stands for Directly observed
treatment short course.
• It is a comprehensive strategy endorsed by the
World Health Organization and International
Union Against Tuberculosis and Lung Diseases
(IUATLD) to detect and cure TB patients.
7/24/2022 62
63. DOTS
• DOTS means that the patient taking the
medicine should be observed by a nominated
person, and the taking of the medicine should
be recorded.
• This ensures that the patient takes the
medication regularly, which is essential for the
medicines to be effective – and to prevent the
bacteria from becoming resistant and
the drug from becoming ineffective.
7/24/2022 63
64. History of DOTS
• The technical strategy for DOTS was developed
by Karel Styblo of the International Union Against TB
& Lung Disease in the 1970s and 80s, primarily in
Tanzania, but also in Malawi, Nicaragua and
Mozambique.
• Styblo refined “a treatment system of checks and
balances that provided high cure rates at a cost
affordable for most developing countries.”
• This increased the proportion of people cured of TB
from 40% to nearly 80%.
7/24/2022 64
65. Contd….
• During the early 1990s, WHO determined that of
the nearly 700 different tasks involved in Styblo's
meticulous system, only 100 of them were
essential to run an effective TB control program.
• From this, WHO's relatively small TB unit at that
time, led by Arata Kochi, developed an even more
concise "Framework for TB Control" focusing on
five main elements and nine key operations.
7/24/2022 65
66. Contd….
• On March 19, 1997, at the Robert Koch
Institute in Berlin, Germany, WHO announced
that "DOTS was the biggest health
breakthrough of the decade."
7/24/2022 66
67. DOTS program in nepal
• DOTS policy was adopted by
GoN in 1995.
• DOTS strategy was piloted in
1996 in 4 centers (Kathmandu,
Parsa, Nawalparasi and Kailali).
• DOTS have successfully been
implemented throughout the
country since April 2001.
• A total of 4244
DOTS treatment centers are
providing TB treatment
service.
7/24/2022 67
68. • Pneumonectomy for lung abscess---a surgical
procedure to remove a lung.
• Thoracoplasty-- involves the surgical removal
(resection) of rib segments
• Lobectomy—Removal of lobe
Surgical management
68
7/24/2022
70. ASSESSMENT
• Assess symptoms: fever, anorexia, weight
loss, night sweats, cough , sputum
production, fatigue
• Assess change in temperature, respiratory
rate, amount and color of secretions,
frequency and severity of cough
7/24/2022 70
71. –Evaluate breath sounds for consolidation.
–Assess patient’s for living arrangements.
–Review results of physical and laboratory
evaluations.
71
7/24/2022
72. ASSESSMENT
• During drug therapy, assess for liver
dysfunction.
– Question the patient about loss of appetite,
fatigue, joint pain, fever, tenderness in liver
region, clay-colored stools, and dark urine.
– Monitor for fever, right upper quadrant abdominal
tenderness, nausea, vomiting, rash, and persistent
paresthesia of hands and feet.
– Monitor results of periodic liver function studies.
7/24/2022 72
73. Nursing management..
• Nursing diagnosis
–Ineffective airway clearance related to
copious tracheo-bronchial secretions,
poor cough effort.
–Activity intolerance related to fatigue,
fever.
73
7/24/2022
74. CONTD…
–Imbalance nutrition less than body
requirements related to loss of
appetite.
–Deficient knowledge of preventive
health measures and treatment
regimen and self care.
7/24/2022 74
75. Contd....
–Risk for impaired gas exchange related to
destruction of alveolar-capillary membrane,
thick, viscous secretions or Bronchial edema.
–Infection, risk for [spread/reactivation] related
to inadequate primary defense, decreased
cilliary action/stasis of secretions or extension
of infection, lowered resistance or
malnutrition.
75
7/24/2022
76. Nursing management..
Nursing Interventions
• Promoting airway clearance
–Assess respiratory function noting breath
sounds, rate, rhythm, and depth and use of
accessory muscles.
–Note ability to expectorate mucus and cough
effectively; document character, amount of
sputum, presence of hemoptysis.
76
7/24/2022
77. Nursing management..
• Place patient in semi or high-Fowler’s position.
Assist patient with coughing and deep-
breathing exercises.
• Clear secretions from mouth and trachea;
suction as necessary.
• Maintain fluid intake of at least 2500 mL/day
unless contraindicated.
–Humidify inspired air and oxygen.
77
7/24/2022
78. Nursing management..
• Administer medications as indicated:
–Mucolytic agents: acetylcysteine (Mucomyst);
–Bronchodilators: oxtriphylline (Choledyl),
theophylline (Theo-Dur);
–Corticosteroids (prednisone).
• Be prepared for/assist with emergency
intubation.
78
7/24/2022
79. Nursing management..
• Promoting activity
–Plan a progressive activity schedule to
increase activity tolerance and muscle
strength
79
7/24/2022
80. Nursing management..
Maintaining adequate nutrition….
• Document patient’s nutritional status on
admission, noting skin turgor, current weight
and degree of weight loss, integrity of oral
mucosa, ability or inability to swallow, presence
of bowel tones, history of nausea and vomiting
or diarrhea.
• Ascertain patient’s usual dietary pattern.
Include in selection of food.
80
7/24/2022
81. Nursing management..
• Monitor I&O and weight periodically.
• Investigate anorexia and nausea and vomiting,
and note possible correlation to medications.
• Monitor frequency, volume, consistency of
stools.
• Encourage and provide for frequent rest period.
• Provide oral care before and after respiratory
treatments.
81
7/24/2022
82. Nursing management..
• Encourage small, frequent meals with foods
high in protein and carbohydrates.
• Encourage to bring foods from home and to
share meals with patient unless
contraindicated.
• Refer to dietitian for adjustments in dietary
composition.
• Consult with respiratory therapy to schedule
treatments 1–2 hr before or after meals.
82
7/24/2022
83. Nursing management..
• Monitor laboratory studies: BUN, serum
protein, and albumin.
• Administer antipyretics as appropriate.
83
7/24/2022
84. Nursing management..
Promoting the understanding of disease
process/prognosis and prevention.
–Assess patient’s ability to learn.
– Note level of fear, concern, fatigue,
participation level; best environment in
which patient can learn; how much content;
best media and language; who should be
included.
84
7/24/2022
85. Nursing management..
–Provide instruction and specific written
information for patient to refer to schedule for
medications and follow-up sputum testing for
documenting response to therapy.
• Encourage patient to verbalize fears and
concerns. Answer questions factually. Note
prolonged use of denial.
85
7/24/2022
86. Nursing management..
• Identify symptoms that should be reported to
healthcare provider: haemoptysis, chest pain,
fever, difficulty breathing, hearing loss,
vertigo.
• Emphasize the importance of maintaining
high-protein and carbohydrate diet and
adequate fluid intake
86
7/24/2022
87. Nursing management..
• Explain medication dosage, frequency of
administration, expected action, and the
reason for long treatment period.
• Review potential interactions with other
drugs and substances.
• Review potential side effects of treatment
(dryness of mouth, constipation, visual
disturbances, headache, orthostatic
hypertension) and problem-solve solutions.
87
7/24/2022
88. Nursing management..
• Stress need to abstain from alcohol while on
INH.
• Refer for eye examination after starting and
then monthly while taking ethambutol
• Evaluate job-related risk factors, working in
foundry or rock quarry, sandblasting.
• Encourage abstaining from smoking.
88
7/24/2022
89. Nursing management..
• Review how TB is transmitted (primarily by
inhalation of airborne organisms, but may
also spread through stools or urine if
infection is present in these systems) and
hazards of reactivation.
• Refer to public health agency.
89
7/24/2022
90. Nursing management..
• Improving gas exchange
–Assess for dyspnea (using 0–10 scale),
tachypnea, abnormal or diminished breath
sounds, increased respiratory effort, limited
chest wall expansion, and fatigue.
–Note cyanosis and/or change in skin color,
including mucous membranes and nail beds.
90
7/24/2022
91. Nursing management..
–Demonstrate and encourage pursed-lip
breathing during exhalation, especially for
patients with fibrosis or parenchymal
destruction.
–Promote bed rest or limit activity and assist
with self-care activities as necessary.
–Monitor serial ABGs and pulse oximetry.
–provide supplemental oxygen as appropriate.
91
7/24/2022
92. Nursing management..
• Decreasing infection
–Review pathology of disease
(active and inactive phases; dissemination of
infection through bronchi to adjacent tissues
or via bloodstream and/or lymphatic system)
and potential spread of infection via airborne
droplet during coughing, sneezing, spitting,
talking, laughing, singing.
–Identify others at risk like household members,
close associates and friends.
92
7/24/2022
93. Nursing management..
• Instruct patient to cough or sneeze and
expectorate into tissue and to refrain from
spitting.
• Review proper disposal of tissue and good hand
washing techniques. Encourage return
demonstration.
• Review necessity of infection control measures.
93
7/24/2022
94. CONTD….
• Put in temporary respiratory isolation if
indicated.
• Monitor temperature as indicated.
• Identify individual risk factors for reactivation
of tuberculosis: lowered resistance associated
with alcoholism, malnutrition, use of
immunosuppressive drugs, corticosteroids,
presence of diabetes mellitus, cancer,
postpartum.
7/24/2022 94
95. Nursing management..
• Stress importance of uninterrupted drug
therapy.
• Review importance of follow-up and periodic
reculturing of sputum for the duration of
therapy.
• Encourage selection and ingestion of well-
balanced meals. Provide frequent small “snacks”
in place of large meals as appropriate.
95
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97. Nursing management..
• Expected outcome
–Maintain patent airway.
–Expectorate secretions without assistance.
–Demonstrate progressive weight gain and be
free of signs of malnutrition.
97
7/24/2022
98. CONTD….
–Verbalize understanding of disease
process/prognosis and prevention.
–Report absence of/decreased dyspnea.
–Demonstrate improved ventilation and
adequate oxygenation of tissues by ABGs
within acceptable ranges.
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99. COMPLICATIONS
• Bones: Spinal pain and joint destruction may
result from TB that infects your bones(TB
spine or potss spine)
• Brain(meningitis)
• Heart(cardiac tamponade)
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100. CONTD….
• Pleural effusion
• Tb pneumonia
• Serious reactions to drug therapy(hepato
toxicity;hypersentivity)
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102. REFERENCES
• Mandal G.N, Textbook of medical surgical nursing
(adult nursing) published by Makalu publication
house, 3rd edition.
• Brunner and siddarth, Textbook of Medical-
Surgical Nursing, 13th edition.
• https://dohs.gov.np/centers/national-
tuberculosis-center/ on 2021/ 07/23 at 11 am
• https://www.slideshare.net/krishnameera999/pu
lmonary-tuberculosis-ppt on 2021/07/23 at 11
am.
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