INTRODUCTION
Tuberculosis (TB) remains a leading cause of morbidity and mortality in the world, especially in
developing countries. A combination of factors including high costs, limited resources and the
poor performance of various diagnostic tests make the diagnosis of TB difficult in developing
countries.
DEFINITION
Tuberculosis is the infectious diseases 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.
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne
infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks
the lungs. However, it can spread from there to other organs. Pulmonary TB is curable with an
early diagnosis and antibiotic treatment.
INCIDENCE
According to WHO:
1.4 million people died from TB in 2020.
In 2019, 10 million people fell ill with TB.
5.6 Million men.
3.2 million women.
1.2 children.
According to the World Health Organization (WHO), the estimated incidence rate of TB
in India is 2.84 million. About 40 percent of the population in India is infected with TB
bacteria, of which the majority is latent TB
What is latent TB?
Being exposed to M. tuberculosis doesn’t necessarily mean you’ll get sick. Among the 2.5
billion people who carry the germ, most have latent TB.
People with latent TB aren’t contagious and have no symptoms because their immune system is
protecting them from getting sick. But it is possible for latent TB to develop into active TB. Most
people with the germ have up to a 15 percent lifetime riskTrusted Source of getting sick with TB.
The risk can be far higher if you have conditions that compromise your immune system such as
HIV infection. When you start showing symptoms, you may become contagious and have
pulmonary TB.
RISK FACTORS
The risk for getting pulmonary TB is highest for people who are in close contact with those who
have TB. This includes being around family or friends with TB or working in places such as the
following that often house people with TB:
Close contact
Immuno-comprromised status
Drug abuse and alcoholism
Lacking adequate health care
Pre-exsisting condition
Immigrants
Institutionalisation
Occupation.
Transmission
Person-to-person
Less frequent by ingestion of M.bovis found in unpasteurized milk
Transplacental route ( rare route)
ETIOLOGY
Mycobacterium tuberculosis
Characteristics of mycobacterium :
Slightly curved shaped
Thick lipid cell wall
Can remain dormant for years
Aerobic
Non-motile
Multiplies slowly (18-24) hours
b. Droplet nuclei (coughing, sneezing, laughing)
c. Exposure to tuberculosis.
d. Co- infection with HIV.
IH
(M
TPfD
rcthalvxdis)pkgb,yw
PATHOPHYSIOLOGY
oB
neum
CLINICAL MANIFESTATIONS
A. Constitutional symptoms
Cough
Anorexia
Low grade fever > 2 weeks
Night sweat
Fatique
Weight loss
Pulmonary symptoms
Dyspnea
Non-resolving broncho pneumonia
Chest tightnes
Non- productive cough
Mucopurulent sputum with hemoptysis
Chest pain
DIAGNOSTIC STUDIES
History collection
Physical examination
Sputum microscopy for AFB (Acid Fast Bacilli)
Chest X-ray
Mantoux/ Tuberculin skin test- the intradermal administration of tuberculin. It uses
purified protein derivative (PPD) and is the best way to diagnose latent M. tuberculosis
infection.
Thoracocentesis - a procedure that removes fluid from the space between the outside of
your lungs and the wall of your chest
Bronchocopy - a procedure that involves inserting a scope through your mouth or nose to
allow your doctor to see your lungs and airways
CT- scan- an imaging test to check lungs for signs of an infection
Biopsy- a procedure to remove a sample of lung tissue
MANAGEMENT
Medical Management
It’s important to get treatment for latent TB even if there are no symptoms. One can still develop
pulmonary TB disease in the future. One may only need one TB drug if one has latent TB.
If the patient has pulmonary TB, the doctor may prescribe several medicines. There is a need to
take these drugs for six months or longer for the best results.
The most common TB medicines are:
isoniazid
pyrazinamide
ethambutol (Myambutol)
rifampin (Rifadin)
The doctor might recommend an approach called directly observed therapy (DOT) to ensure that
treatment is completedly. Stopping treatment or skipping doses can make pulmonary TB
resistant to medicines, leading to MDR-TB.
With DOT, a healthcare professional meets every day or several times a week to administer the
medication so that they don’t have to remember to take it on your own.
If one aren’t on DOT, make a schedule for taking the medicines so that you don’t miss a dose.
Here are some tips to help you remember to take your medicines:
Take medicines at the same time every day.
Make a note on your calendar each day to show that you’ve taken your medicine.
Ask someone to remind you to take your medicine every day.
Keep your medicines in a pill organizer.
You won’t need to go to the hospital unless you’re unable to take the medication at home or have
a bad reaction to the treatment.
Surgical Management
The following are the types of operation currently performed:
Lung resection of different size:
o Wedge resection
o Segmentectomy
o Lobectomy and bilobectomy
o Combined resection (lobectomy plus minor resection)
o Pneumonectomy or pleuropneumonectomy
o Lung resections with different correction methods of the haemithorax’s volume
Extrapleural thoracoplasty
Extrapleural pneumolysis
Thoracomyoplasty
Pleuurectomy and decortications of the lungs
Operation on the bronchi:
o Occlusion
o Resection
o Bronchoplasty
o Re-amputation of the stump
Thoracocentesis and thoracostomy
Artificial pneumothorax and pneumoperitoneum
Operations on both lungs
According to the literature analysed, the principle types of operation to treat TB today are
lung resection of different sixes, using posterolateral thoracotomy under general
anaesthesia with double lumen endotrrachael tube and artificial ventilaton of the lung.
Mobilization of the lung ( or the part of it to be resected) is approached in such a way as
to avoid contamination of the pleural space.however, anatomicsl recestions are
preferable.
Nursing Management
Nursing management includes the following:
Nursing Assessment
The nurse may assess the following:
Complete history. Past and present medical history is assessed as well as both of the
parents’ histories.
Physical examination. A TB patient loses weight dramatically and may show the loss in
physical appearance.
Nursing Diagnosis
Based on the assessment data, the major nursing diagnoses for the patient include:
Ineffective airway clearance related to thick, viscous, or bloody secretions.
Activity intolerance related to imbalance between oxygen supply and demand.
Imbalanced nutrition: less than body requirements related to inability to ingest
adequate nutrients
Risk for infection related to inadequate primary defenses and lowered resistance.
Risk for impaired gas exchange related to decrease in effective lung surface.
Nursing Care Planning & Goals
The major goals for the patient include:
Promote airway clearance.
Adhere to treatment regimen.
Promote activity and adequate nutrition.
Prevent spread of tuberculosis infection.
Nursing Interventions
Nursing interventions for the patient include:
Promoting airway clearance. The nurse instructs the patient
about correct positioning to facilitate drainage and to increase fluid intake to promote
systemic hydration.
Adherence to the treatment regimen. The nurse should teach the patient that TB is a
communicable disease and taking medications is the most effective means of preventing
transmission.
Promoting activity and adequate nutrition. The nurse plans a progressive activity
schedule that focuses on increasing activity tolerance and muscle strength and a
nutritional plan that allows for small, frequent meals.
Preventing spreading of tuberculosis infection. The nurse carefully instructs the patient
about important hygienic measures including mouth care, covering the mouth and nose
when coughing and sneezing, proper disposal of tissues, and handwashing.
Acid-fast bacillus isolation. Initiate AFB isolation immediately, including the use of a
private room with negative pressure in relation to surrounding areas and a minimum of
six air changes per hour.
Disposal. Place a covered trash can nearby or tape a lined bag to the side of the bed to
dispose of used tissues.
Monitor adverse effects. Be alert for adverse effects of medications.
Evaluation
Expected patient outcomes include:
Promoted airway clearance.
Adhered to treatment regimen.
Promoted activity and adequate nutrition.
Prevented spread of tuberculosis infection.
Discharge and Home Care Guidelines
Before the discharge, the nurse should instruct the patient to:
Disposal of secretions. Cough and sneeze into tissues and to dispose of all secretions in a
separate trash can.
Isolation. Wear a mask when going outside of the room.
Activity and nutrition. Remind the patient to take a lot of rest and to eat balanced meals
to aid recovery.
Adverse effects. Advise the patient to watch out for adverse effects of medications and to
report them to the physician immediately.
Documentation Guidelines
The focus of documentation should include:
Recent or current antibiotic therapy.Signs and symptoms of infectious process.
Signs and symptoms of infectious process.Breath sounds, presence and character of
secretions, and use of accessory muscles for breathing.
Breath sounds, presence and character of secretions, and use of accessory muscles for
breathing.Character of
Character of cough and sputum.Respiratory rate, pulse oximetry, oxygen saturation, and
vital signs.
Respiratory rate, pulse oximetry, oxygen saturation, and vital signs. Level of activity.
Level of activity.Causative or precipitating factors.
Causative or precipitating factors.Client reports of difficulty or change.
Client reports of difficulty or change.Caloric intake.
Caloric intake.Individual cultural or religious restrictions and personal preferences.
Individual cultural or religious restrictions and personal preferences.Plan of care.
Plan of care.Teaching plan.
Teaching plan.Responses to interventions, teaching, and actions performed.
Responses to interventions, teaching, and actions performed.Attainment or progress
toward desired outcomes.
Attainment or progress toward desired outcomes.Modifications to
Modifications to plan of care.Discharge needs.
Discharge needs.
PROGNOSIS
Pulmonary TB is curable with treatment, but if left untreated or not fully treated, the disease
often causes life-threatening concerns. Untreated pulmonary TB disease can lead to long-term
damage to these parts of the body:
lungs
brain
liver
heart
spine
New drugs and treatments are currently being developed to prevent latent TB and TB, especially
as MDR-TB grows. In some countries, this involves a vaccine called Bacillus Calmette-Guérin
(BCG). This vaccine is useful to prevent severe forms of TB outside the lungs in children, but it
doesn’t prevent development of pulmonary TB.
PREVENTION
It can be difficult to avoid contracting TB if you work in an environment frequented by people
with TB or if you’re caring for a friend or family member with TB.
Following are a few tips for minimizing your risk for pulmonary TB:
Provide education on preventing TB like cough etiquette.
Avoid extended close contact with someone who has TB.
Air out rooms regularly.
Cover your face with a mask that is approved for protection against TB.
Anyone exposed to tuberculosis should be tested, even if they show no symptoms. The Centers
for Disease Control and Prevention has detailed guidelines and precautionsTrusted Source for
people who work or visit a healthcare setting.
How to protect others?
People with latent TB aren’t contagious and can go about their day-to-day lives as usual.
But if you have pulmonary TB disease, you need to stay home and avoid close contact with
others. Your doctor will tell you when you’re no longer contagious and can resume a regular
routine.
COMPLICATIONS
If left untreated or mistreated, pulmonary tuberculosis may lead to:
Respiratory failure. Respiratory failure is one of the most common complication of
pulmonary tuberculosis.
Pneumothorax. Pneumothorax becomes a complication when tuberculosis is not treated
properly.
Pneumonia. One of the most fatal complications of tuberculosis is pneumonia as it could
cause infection all over the lungs.
HEALTH EDUCATION
Stay home. Don't go to work or to school until your healthcare provider says you can go
back. Don't have close contact with anyone until your healthcare provider says it's OK.
Make sure that your family, friends, and coworkers or classmates are tested.
Keep your hands clean. Wash them if you use them to cover your mouth when you
cough.
When you cough or sneeze, take steps to prevent the spread of TB:
o Cover your mouth and nose with a tissue.
o Put your used tissue in a closed bag and throw it away.
o If you don't have a tissue, cough or sneeze into your upper sleeve or elbow, not
your hands.
o Wash your hands often with soap and clean, warm or cold water for at least 20
seconds. If soap and water are not available, use an alcohol-based hand gel.
Important care advice
Take your medicine exactly as directed. Keep taking it even if you start to feel better.
You will take medicine for several months and maybe longer. This will depend on your type of
TB. Not taking your medicine for the full course may lead you to get sick again. It also increases
the chance of drug-resistant TB. Drug-resistant TB means that 1 or more of the typical medicines
for TB don’t work.
Follow your healthcare provider's direction about when it's OK to be in close contact with
others.
If you are taking birth control pills, ask your healthcare provider if there are interactions
with the TB medicine that could make the birth control less effective. Ask if you should use an
additional backup method of birth control.
Check with your healthcare provider before taking any over-the-counter medicines.
Limit your activity so you don't get too tired. Plan frequent rest periods.
Keep your healthcare appointments. You will need to be checked regularly for several
months to a year. This is to make sure you are not having side effects from the medicines. And to
be sure your TB is responding to treatment. If you miss an appointment, reschedule as soon as
possible.
You may be asked or required to have a healthcare worker watch you taking the TB
medicines. This is called directly observed therapy (DOT). This may happen anywhere from 1
time per week to up to 3 to 6 times per week. If you are receiving DOT, go to every session.
JOURNAL REFERENCE
Journal Of The American Academy Of Physician Assistants; Singer- Leshinsky, Stacey MSEd,
RPAC; February 2016; volume 29; issue 2, pg no- 20-25.
Abstract
Tuberculosis (TB) is a major public health concern worldwide and the world's second most
common cause of death from infectious disease after HIV/AIDS. With the emergence of resistant
strains of tuberculosis and increase in immunosuppressed patients, clinicians must be familiar
with the clinical presentation of this potentially deadly infection. This article reviews the
pathology, signs and symptoms, diagnostics, and management of TB, focusing on recent
advances in drug therapy for drug-sensitive and drug-resistant forms. A better understanding of
TB will help clinicians identify the disease early, reduce transmission, and provide treatment to
prevent complications and reduce patient morbidity and mortality.
Pulmonary tuberculosis (TB) remains a major cause of morbidity and mortality worldwide, with
about one-third of the world's population infected. 1 Between 10% and 20% of those infected will
progress to active TB, posing a serious health threat. The remaining patients will have latent TB,
which can advance to active infection in times of immunosuppression. The CDC reported 9,588
new cases of TB in the United States in 2013, a decline of 4.2% compared with 2012 and the
lowest number of cases recorded in the United States since 1953. 2 However, TB continues to be
a major health threat, especially among foreign-born persons.2 Worldwide, more than 1 million
patients with TB are coinfected with HIV, and of the more than 1.5 million TB-related deaths
reported in 2011, most resulted from multidrug-resistant or extensively drug-resistant
strains.3 The increased prevalence of TB among HIV-infected patients, the evolution of
multidrug-resistant strains, and a recent increase in international travel and immigration pose a
serious threat to TB control. TB must be addressed more effectively in the United States to avoid
a future epidemic of multidrug-resistant strains.3
This article reviews the pathology, clinical presentation, and diagnosis of TB, focusing on
advances in drug therapy. A better understanding of TB can help clinicians make accurate
diagnoses and better manage this potentially deadly contagious disease.
BIBLIOGRAPHY
1. Chintamani; Lewis’s Medical Surgical Nursing, Assessment and Management of
Clinical Problems; Elsevier, 2011, Reprint 2013, Page no-
2. Mariann M. Harding; Lewis;s Medical Surgical Nursing; Assessment And Management
of Clinical Problems; Eleventh edition; Elsevier; Page no.
3. Net reference:
www.nurseslabs.com
www.winchesterhospital.org
www.slideshare.com
ASSAM DOWNTOWN UNIVERSITY
FACULTY OF NURSING
CLASS PRESENTATION
ON
PULMONARY TUBERCULOSIS
SUBJECT – MEDICAL SURGICAL NURSING I
SUBMITTED TO: SUBMITTED BY:
MS. CYNOSURE SHARMA AMANDA KHARSAMAI
LECTURER 1ST YR. M.Sc. NURSING
FACULTY OF NURSING ROLL NO- 02
ASSAM DOWNTOWN UIVERSITY ASSAM DOWNTOWN UNIVERSITY
SUBMITTED ON: 01/11/2021
CONTENT
1. INTRODUCTION
2. DEFINITION
3. INCIDENCE
4. RISK FACTORS
5. ETIOLOGY
6. PATHOPHYSIOLOGY
7. CLINICAL MANIFESTATIONS
8. DIAGNOSTIC STUDIES
9. MANAGEMENT
I. Medical Management
II. Surgical Management
III. Nursing Management
10. PROGNOSIS
11. PREVENTION
12. COMPLICATIONS
13. HEALTH EDUCATION
14. JOURNAL REFERENCE
15. BIBLIOGRAPHY
