Management of Patients withLower Respiratory Disorders Pulmonary Tuberculosis (TB) At the end of the lecture, the student will be able to Describe the patho-physiology of the disease. Discuss the major risk factors and clinical manifestations of the disease. Use the nursing process as a framework for patient care. Discuss medical , surgical and nursing management of the disease.

1. MANAGEMENTOF
PATIENTSWITH
LOWERRESPIRATORY
DISORDERS
PULMONARY
TUBERCULOSIS (TB)
Jamilah Saad Alqahtani
Nurse Lecturer, MSN, TOT, OR Nurse
Specialist, RGN, BSN

2. Objectives
• At the end of the lecture, the student will be
able to
◦ Describe the patho-physiology of the disease.
◦ Discuss the major risk factors and clinical
manifestations of the disease.
◦ Use the nursing process as a framework for
patient care.
◦ Discuss medical , surgical and nursing
management of the disease.

3. Risk Factors
• Cigarette smoking
• Passive smoking
• Occupational exposure
◦ dust and chemicals
• Genetic abnormalities
◦ Lack of alpha 1-antitrypsin

4. Pulmonary Tuberculosis (TB)
◦ An infectious disease that largely affects the lung tissues.
◦ May spread to other body parts: the meninges of the brain, kidneys,
bones.
◦ The primary infectious agent : Mycobacterium tuberculosis
◦ Infection spreads through airborne transmission. (example: talking,
sneezing, laughing, or singing)
Ghon’s
Tubercle or
lesion
Normal lung Xray

5. Clinical Manifestations
◦ Low-grade fever
◦ Night sweats
◦ Anorexia and weight loss
◦ Fatigue
◦ Non-productive cough or with mucopurulent
sputum.
◦ Hemoptysis

6. Assessment & Diagnostic Tests
◦A complete history & physical examination
◦Tuberculin skin test (Mantoux test) ppd
◦Chest x-ray - shows lesions in the upper lobes
◦Sputum culture - contains mycobacterium.

7. TUBERCULIN SKIN TEST or MANTOUX TEST
◦ Determine whether a person has been infected with the TB bacillus.
◦ Purified protein derivative (PPD) (0.1 mL) is injected at the inner aspect of
the forearm 4 inches below the elbow
◦ Result is read 48-72 hours after injection
◦ 0-4 mm (not significant) : NEGATIVE reaction
◦ 5-10 mm (significant to people at risk/positive to HIV patients, close contact with active
TB, x-ray result consistent of TB)
◦ 10 mm greater (significant to people with normal immunity)

8. MANTOUX TEST

9. TB Classification
◦Class 0: no exposure; no infection
◦Class 1: exposure; no evidence of infection
◦Class 2: latent infection; no disease
◦Class 3: disease; clinically active
◦Class 4: disease; not clinically active
◦Class 5: suspected disease; diagnosis pending

10. Medical Management
•Administer antituberculosis agents for 6 to 12 months to
destroy organism and prevent relapse
• RIPE (first line drugs)
◦ Rifampin (2 months) Continuation
◦ Isoniazid (INH) Initial Phase (4-7 months)
◦ Pyrazinamide Phase
◦ Ethambutol
• NOTE!!! People are non-infectious after 2-3 weeks of continuous
drug therapy.

11. Drug Side Effects & Interventions
◦ Isoniazid: peripheral neuritis
◦ Give vitamin B (pyridoxine)
◦ Rifampin: orange urine and other body secretions, hepatitis
◦ Monitor AST and ALT
◦ Pyrazinamide: hyperuricemia
◦ Monitor uric acid
◦ Ethambutol: optic neuritis
◦ Monitor visual acuity

12. Nursing Management
◦ Promote airway clearance
◦ Increase fluid intake and positioning (postural drainage)
◦ Support compliance to treatment program
◦ Instruct to take drug on empty stomach or at least 1 hour before meals
◦ Instruct about drug resistance
◦ Promote activity and adequate nutrition
◦ Prevent spread of tuberculosis infection
◦ Mouth care
◦ Cover mouth and nose when coughing and sneezing
◦ Proper disposal of tissue
◦ Handwashing
◦ Report cases to health department

13. THANK
YOU!