Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected. The causative agent is Mycobacterium tuberculosis (also known as the tubercle bacillus). Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. The primary infection usually involves the middle or lower lung area. It is also may be transmitted to other parts of the body, including the Meninges, kidneys, bone, joints, pericardium, GI tract and lymph nodes And this condition known as Extra pulmonary TB. The disease also can affects animals such as cattle, this is known as “bovine tuberculosis” which may sometimes be transmitted to man.The primary infectious agent, “ M.Tuberculosis”, is an acid – fast aerobic (AFB) rod that grows slowly and is sensitive to heat and ultraviolet light.

1. Pulmonary Tuberculosis (TB)

2. Pulmonary Tuberculosis (TB)

3. Introduction
• Tuberculosis (TB) is caused by bacteria
(Mycobacterium tuberculosis) that most often affect
the lungs. Tuberculosis is curable and preventable.
• TB is spread from person to person through the air.
When people with lung TB cough, sneeze or spit, they
propel the TB germs into the air. A person needs to
inhale only a few of these germs to become infected.
• The causative agent is Mycobacterium tuberculosis
(also known as the tubercle bacillus).

4. Pulmonary Tuberculosis (TB)
•Tuberculosis (TB) is an infectious disease that primarily
affects the lung parenchyma. The primary infection
usually involves the middle or lower lung area.
• It is also may be transmitted to other parts of the body,
including the Meninges, kidneys, bone, joints,
pericardium, GI tract and lymph nodes And this
condition known as Extra pulmonary TB.
• The disease also can affects animals such as cattle, this
is known as “bovine tuberculosis” which may
sometimes be transmitted to man.

5. • The primary infectious agent, “ M.Tuberculosis”, is an
acid – fast aerobic (AFB) rod that grows slowly and is
sensitive to heat and ultraviolet light.

6. Risk factors for TUBERCULOSIS
1) Close contact with someone who has active TB.
(Inhalation of airborne nuclei from an infected person is proportional to
the amount of time spent in the same air space, the proximity of the
person, and the degree of ventilation).
2. Immunocompromised status (e.g., those with HIV infection,
cancer, transplanted organs, and prolonged high-dose corticosteroid
therapy)
3. Substance abuse (IV or injection drug users and alcoholics)

7. Risk factors for TUBERCULOSIS
4. Any person without adequate health care (the
homeless; impoverished; minorities, particularly children
under age 15 years and young adults between ages 15
and 44 yrs)
5. Preexisting medical conditions or special treatment
(e.g., diabetes mellitus , chronic renal failure,
malnourishment, selected malignancies, hemodialysis,
transplanted organ, gastrectomy, or jejunoileal bypass)

8. Risk factors for TUBERCULOSIS
6. Immigration from countries with a high prevalence of
TB (southeastern Asia, Africa, Latin America, Caribbean)
7. Institutionalization (e.g., long-term care facilities,
psychiatric
institutions, prisons)
8. Living in overcrowded, substandard housing.

9. Risk factors for TUBERCULOSIS
•Being a health care worker performing high-risk
activities: such as
1. Administration of aerosolized pentamidine and other
medications
2. Sputum induction procedures, bronchoscopy, and
suctioning, coughing procedures.
3. Caring for the immunosuppressed patient, home care
with the high-risk population, and administering
anesthesia and related procedures (e.g., intubation,
suctioning).

10. Signs and symptoms
1. PULMONARY SYMPTOMS
A. Productive chronic cough ( More than 2 weeks)
B. Chest pain
C. Spiting or coughing up blood

11. SYSTAMATIC SYMPTOMS
• Fever & chills
• Night sweats
• Easy fatigability
• loss of appetite and weight loss
• Extra pulmonary TB pain inflammation and
dysfunction in any of the tissues infected.

12. Signs and symptoms

13. Assessment and Diagnostic Findings
1. A complete history and physical examination.
2. Tuberculin skin test (Mantoux test)
3. Chest x-ray
4. Acid-fast bacillus smear and sputum culture are used to
diagnose TB.
5. If the person is infected with TB, the chest x-ray usually
reveals lesions in the upper lobes and the acid-fast
bacillus smear contains mycobacterium.

14. TUBERCULIN SKIN TEST (The Mantoux Test)
• The Mantoux test is used to determine if a person has been infected
with the TB bacillus.
• The Mantoux test is a standardized procedure and should be
performed only by those trained in its administration and reading.

15. • Tubercle bacillus extract (tuberculin), purified protein derivative
(PPD), is injected into the intradermal layer of the inner aspect of the
forearm, approximately 4 inches below the elbow.
• The test result is read 48 to 72 hours after injection.
• The site, antigen name, strength , Lot number, Date, and time of the
test are recorded.

16. Site of Tuberculin skin test

17. Purified protein derivative

18. Inspect presence or absence of indurations of Tuberculin
skin test

19. Inspect presence or absence of indurations of Tuberculin
skin test

20. Interpretation of Tuberculin skin test
• The size of the indurations determines the significance of the
reaction.
• A reaction of 0 to 4 mm is considered not significant; a reaction of
5 mm or greater may be significant in individuals who are
considered at risk.
• In duration of 5mm or more than in diameter indicates positive
reaction and need for anti tuberculosis treatment for latent TB
infection in high risk group.
• In duration of 10 mm or more in diameter indicates a positive
reaction and need for treatment of latent TB infection in person at
risk.

21. Treatment
• TB is a treatable and curable disease. Active, drug-
susceptible TB disease is treated with a standard 6
month course of 4 antimicrobial drugs that are
provided with information, supervision and support to
the patient by a health worker or trained volunteer.
• Without such support, treatment adherence can be
difficult and the disease can spread. The vast majority
of TB cases can be cured when medicines are
provided and taken properly.

22. Medical management client with TB
• Pulmonary tuberculosis is treated primarily with anti
tuberculosis agents for 6 to 12 months.
• A prolonged treatment duration is necessary to
ensure eradication of the organisms and to prevent
reoccurrence.
• Several types of drug resistance must be considered
when planning effective therapy:

23. 1. Primary drug resistance: resistance to one of the first-line
anti tuberculosis agents in a person who has not had
previous treatment.
2. Secondary or acquired drug resistance: resistance to one
or more anti tuberculosis agents in a patient undergoing
therapy.
3. Multidrug resistance: resistance to two agents, isoniazid
(INH) and rifampin. The populations at highest risk for
multidrug resistance are those who are HIV-positive,
institutionalized, or homeless.

24. Anti Tuberculosis medications

25. Anti Tuberculosis medications

27. DOTS or Directly Observed Treatment Short course is the
internationally recommended strategy for TB control that has
been recognized as a highly efficient and cost-effective strategy.
DOTS comprises five components.

28. DOTS comprises five components.
• 1. Sustained political and financial commitment. TB can be cured and the
epidemic reversed if adequate resources and administrative support for TBsis
by quality ensured sputum-smear microscopy. Chest symptomatic examined
this way helps to reliably find infectious patients.
• control are provided.
• 2. Diagno3. Standardized short-course anti-TB treatment (SCC) given under
direct and supportive observation (DOT).Helps to ensure the right drugs are
taken at the right time for the full duration of treatment.
• 4. A regular, uninterrupted supply of high quality anti-TB drugs. Ensures
that a credible national TB programme does not have to turn anyone away.
• 5. Standardized recording and reporting. Helps to keep track of each
individual patient and to monitor overall programme performance.

29. First Line Antitubercular Medications
COMMONLY USED
AGENTS
ADULT DAILY DOSAGE MOST COMMON SIDE EFFECTS
isoniazid (INH) 5mg/kg (300mg max daily) Peripheral nruritis,hepatic enzyme
elevation ,hepatitis and
hypersensitivity.
rifampin (Rifadin) 10 mg/kg (600 mg
maximum daily)
Hepatitis, febrile reaction, purpura
(rare), nausea, vomiting.
rifabutin (Mycobutin)
streptomycin
5 mg/kg (300 mg maximum
daily) 15 mg/kg (1 g
maximum daily)*
8th cranial nerve damage (may lead to
deafness), nephrotoxicity
pyrazinamide pyrazinamide Hyperuricemia, hepatotoxicity, skin rash,
arthralgias, GI distress
ethambutol 15 to 25 mg/kg (no

30. Compilations
1. Pleural effusion
2. TB Pneumonia
3. Extra pulmonary TB
4. Multidrug-resistant tuberculosis (MDR-TB)
5. Serious reactions to drug therapy

31. Nursing assessment
1. Obtain history of exposure to TB and nurse performs a
complete history and physical examination.
2. Assess for symptoms of active disease – productive
cough, night sweat, anorexia & unintentional weight
loss, fever and pleuritic chest pain.
3. Auscultate lung for crackle.
4. During drugs therapy assess for liver dysfunctions.
5. Monitoring and managing potential complications.

32. Nursing diagnosis
1.Ineffective breathing pattern related to pulmonary infection
and potential for long term scaring with decreased lung
capacity.
2. Imbalanced nutrition less than body requirements related
to poor appetite, fatigue ,and productive cough.
3. Ineffective airway clearance related to copious
tracheobronchial secretions
4. Deficient knowledge about treatment regimen and
preventive health measures and related ineffective individual
management of the therapeutic regimen (noncompliance) .

33. Nursing interventions
1. Improving breathing pattern :
a) Encourage rest and avoidance of exertion if acutely ill.
b) Monitor breath sounds, respiratory rates, sputum
production,dyspnea and Stoll colour.
c) provide supplemental oxygen if ordered
d) Administer bronchodilator as needed.
e) Increasing fluid intake promotes systemic hydration and
serves as an effective expectorant.
f) The nurse instructs the patient about correct positioning to
facilitate airway drainage (postural drainage)

34. Nursing interventions
2.Improving nutritional status:
a) Explain the importance of eating a nutritious diet to
promote healing and improve defence against infection.
b) provide small and frequents meals Liquid nutritional
supplements may assist in meeting basic caloric
requirements.
c) Monitor weight and assess the nutritional status.
d) Provide vitamin supplements, as ordered.

35. ADVOCATING ADHERENCE TO TREATMENT REGIMEN
1. The multiple-medication regimen that a patient must follow can
be quite complex.
2. Understanding the medications, schedule, and side effects is
important. The patient must understand that TB is a
communicable disease and that taking medications is the most
effective means of preventing transmission.
3. The major reason treatment fails is that patients do not take
their medications regularly and for the prescribed duration.
4. The nurse carefully instructs the patient about important hygiene
measures, including mouth care, covering the mouth and nose
when coughing and sneezing, proper disposal of tissues, and
hand hygiene.

36. What is multidrug-resistant tuberculosis and how do we
control it?
The bacteria that cause tuberculosis (TB) can develop
resistance to the antimicrobial drugs used to cure the
disease. Multidrug-resistant TB (MDR-TB) is TB that does
not respond to at least isoniazid and rifampicin, the 2
most powerful anti-TB drugs.

37. What causes of (MDR- TB) Multidrug-resistant
tuberculosis
• Most people with TB are cured by a strictly followed, 6-month
drug regimen that is provided to patients with support and
supervision.
• Inappropriate or incorrect use of antimicrobial drugs, or use of
ineffective formulations of drugs (such as use of single drugs,
poor quality medicines or bad storage conditions), and
premature treatment interruption can cause drug resistance,
which can then be transmitted, especially in crowded settings
such as prisons and hospitals.

38. Solutions to control Multi- drug-resistant TB are to:
1.Cure the TB patient the first time around
2. Provide access to diagnosis
3. Ensure adequate infection control in facilities where
patients are treated
4. Ensure the appropriate use of recommended second-
line drugs.