Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. It spreads through droplets in the air when an infected person coughs or sneezes. Risk factors include immunosuppression, smoking, chronic illness, substance abuse, malnutrition, and certain geographical areas. Diagnosis involves chest x-rays, sputum smears, the Mantoux test, and the Quantiferon Gold test. Treatment consists of a multi-drug regimen over several months to kill the bacteria and prevent drug resistance. Nursing care focuses on airway clearance, maintaining nutrition and oxygen levels, preventing infections, and ensuring medication adherence.

1. SUBJECT: MEDICAL SURGICAL
NURSING
TOPIC: TUBERCULOSIS

2. DEFINITION
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 Tuberculosis is the infectious disease primarily affecting
lung parenchyma is most often caused by Mycobacterium
Tuberculosis. It may spread to any part of the body
including meninges, kidney, bones and lymph nodes.

3. RISK FACTORS
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Immunosuppressive
Smoking Chronic Illness

4. RISK FACTORS
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Substance Abuse
Malnutrition Geography

5. MODE OF TRANSMISSION
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• Mainly by droplete infection and droplet
nuclei generated by sputum positive
patient.
• Coughing generates all size of droplet.
• Particle should be fresh enough to carry.
• Tuberculosis not transmitted by fomites.

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7. CLASSIFICATION
ACCORDING TO PRESENTATION
1. Primary infection occurs when the bacteria are
inhaled and initiate an inflammatory reaction.
2. Latent TB infection (LTBI) occurs in a person
who does not have active TB disease. These
individuals are asymptomatic and cannot
transmit the TB bacteria to others.
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8. CLASSIFICATION
ACCORDING TO AREA
1. Pulmonary TB: It occurs only in the lungs.
2. Extra Pulmonary TB: the infection spread to
the other organs like bones, meninges, kidney
etc.
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9. PATHOPHYSIOLOGY
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MYCOBACTERIUM TUBERCULOSIS ENTRY
THROUGH DROPLETS
GOES IN PULMONARYALVEOLI
IMMUNE SYSTEM LODGED IN
ALVEOLAR MACROPHAGES
DETECTS PRESENCE OF PATHOGENS AND
ENGULPH THE BACTERIA
BACTERIA INHIBITS THE MACROPHAGE
TO FORM PHAGOLYSOSOME AND
REMAIN PROTECTED INSIDE IT

10. PATHOPHYSIOLOGY
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STARTREPLICATION INSIDETHE
MACROPHAGE
PRIMARYINFECTION OCCUR
CELLMEDIATED IMMUNITY GETS ACTIVATED, SURROUNDS
THE CELLAND FORMS GRANULOMA IN 3 WEEKS
NECROSISOF TIUSSUE AT
INFECTION SITE
INVOLVELYMPH NODES
CALCIFICATION (LATENT TB)

11. CLINICAL
MANIFESTATIONS
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12. CLINICAL
MANIFESTATIONS
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BONCHO
PNEUMONIA
CHEST
TIGHTNESS
DYSPNEA

13. DIAGNOSTIC EVALUATION
 History
 Physical examination
 Clubbing of fingers or toes
 Swollen or tender lymph nodes in neck or other areas
 Pleural effusion
 Unusual breath sounds (crackles)
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14. DIAGNOSTIC EVALUATION
Physical examination (if miliary TB)
 Swollen liver
 Swollen lymph nodes
 Swollen spleen
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15. MONTOUX TEST
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16. DIAGNOSTIC EVALUATION
 Blood test (to detect interferon gamma release
in blood)
 Sputum examination
 Biopsy of tissue
 Bronchoscopy
 Chest x-ray
 Thoracentesis
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17. CHEST X- RAY
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18. QUANTIFERON GOLD TEST
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20. MANAGEMENT
PHARMACOLOGICAL MANGEMENT
FIRST LINE ANTI- TUBERCULAR MEDICATIONS
 Streptomycin 15mg/kg
 Isoniazid or INH 5mg/kg (300mg/day max)
 Rifampin 10mg/kg
 Pyrazinamide 15-30 mg/kg
 Ethambutol 15-25 mg/kg daily for 8 weeks continuing
for upto 4-7 months
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21. MANAGEMENT
SECOND LINE OF MEDICATIONS
 Capreomycin 12 -15 mg/kg
 Paraaminosalicylate sodium 200 -300 mg/kg
 Cycloserine 15mg/kg
 Vitamin B usually administered with INH
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22. MANAGEMENT
THIRD LINE OF MEDICATIONS
 Rifabutin
 Macrolides (clarithromycin)
 Linezolid
 Thioacetazone
 Thioridazine
 Arginine
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23. MANAGEMENT
 Intensive phase (2-3 months)
Under direct supervision of a health worker or trained
person
 Continuation phase (4-6 months)
A multiblister combipack with drugs for 1 week is given of
which the first dose is taken under supervision
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24. MANAGEMENT
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NURSING MANAGEMENT

26. Ineffective airway clearance related
to thick, viscous sputum production
Goal: to maintain patent airway
 Assess the respiratory function( sounds, rate, rhythms)
 Assist patient with coughing and deep breathing exercises
 Clear secretions from mouth and trachea, suction as
needed.
 Maintain fluid intake of at least 2-3 L/ day.
 Provide steam inhalation
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27. Impaired gas exchange related to
destruction of alveolar capillary
membrane
Goal: to maintain gas exchange
 Assess the respiratory function( sounds, rate, rhythms)
 Assess the oxygen saturation and ABG interpretations
 Provide high fowler or semi- fowler position
 Provide chest physiotherapy
 Provide oxygen supplement
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28. Imbalance nutrition: less than body
requirement related to frequent cough
Goal: to maintain nutritional balance
 Assess patient’s nutritional status
 Monitor intake –output of the patient
 Encourage small and frequent meals with high protein and
carbohydrates
 Provide respiratory therapy 1-2 hours before or after
meals.
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29. Risk for infection related to inadequate
primary defense
Goal: to decrease risk of infection
 Assess patient’s immunity level.
 Identify risk factors that can enhance chance of risk
 Instruct patient to cough or sneeze into tissue
 Maintain good hygiene of the patient
 Administer anti-infective agents as prescribed by
physician
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