Presented by: Cindy
Denti P
(115070207113038)
Tuberculosis is an infectious disease caused by the
bacterium Mycobacterium tuberculosis (TB). Although it
can affect almost every organ system, but TB bacteria is
more common in lung organ (80-85%) (Depkes, 2008).
Pulmonary tuberculosis with sputum examination indicates
the BTA (Basil Resistant Acid) positive, categorized as
infectious pulmonary tuberculosis (Depkes, 2005).
The cause of this disease is Mycobacterium tuberculosis
complex. Mycobacteria included in the family
mycobacteriaceae and included in the order
Actinomycetales.
This bacterium is a bacterium bacillus is very strong so it
takes a long time to treat. These bacteria often infects the
lungs (90%) compared to other parts of the human body
(Masrin, 2008).
a.
b.
Pulmonary tuberculosis
tuberculosis that attacks the lung tissue, not including the pleura (the
lining of the lung)
Body Extra Pulmonary Tuberculosis
Tuberculosis that attacks the body's organs other than the lung tissue,
such as the pleura (pleura), the lining of the brain, pericardium, lymph
nodes, bones, joints, skin, intestine, kidney, urinary tract, genitals and
others. Based on the severity, Extra Pulmonary Tuberculosis divided into
2, namely:
1) Extra Pulmonary Tuberculosis Lightweight
For example: Tuberculosis of lymph nodes, exudative
pleurisy, unilateral, bone (except spine), joints and glands
adrenal.
2) Extra Pulmonary Tuberculosis Weight
For example: meningitis, miliary, pericarditis, peritonitis,
pleurisy exudative duplex, spinal tuberculosis, Tuberculosis
intestine, urinary tract Tuberculosis and genitals.
Sources of infection are patients with
smear-positive pulmonary TB
especially at a time singing, coughing or
sneezing, in which the patient spread germs
into the air in the form of a spark sputum
(droplet nuclei).
The primary stage of the disease may be
symptom-free, or the individual may experience a
flu-like illness.This is called the inactive stage.
Fever
Hemaptoe
Chest pain
Night sweats
Weak ccurred in the weekly and monthly
This is an example of tuberculosis symptoms. Hemaptoe and the
use of a respirator muscle
Mycobacterium Tuberculosis enter the body through breathing then
tubercle bacilli that reach the alveolar surface causes an inflammatory
reaction, the body tries to react by phagocytosing polymorphonuclear
leukocytes kill bacteria but not the organism so to attack the alveoli.
The alveoli are attacked will consolidate the onset of symptoms of
acute pneumonia and continued in the phagocytes and bacteria
growing in the cells so that there is no heal by itself but which spreads
through the lymph toward the regional lymph nodes that causes
tuberculosis.
Tuberculin skin test. Mantoux test : a skin test to determine
whether an individual has been infected with TB bacilli
Assessment of medical history
X-ray chest lesi the upper lobe
Wipe BTA Is there mikobacterium
Sputum smear morning to culture (when, in the morning, when)
0-4 mm: not considered significant
> 5mm: may be significant
> 10 mm: significant
Significant (positive): M. tuberculosis exposed lately, or past
BCG (bacilli Calmette-Guerin), there is not always active
disease in the body.
Not significant: by no means free of TB infection
(immunosuppressed) retest 1 to 2 weeks
TREATMENT
Pulmonary tuberculosis treated primarily with chemotherapy agents
(anti-tuberculosis agent) for a period of 6 to 12 months.
Five front-line medications used are Isoniasid (INH), rifampicin (RIF),
streptomycin (SM), Ethambutol (EMB), and Pyrazinamide (PZA).
Kapremiosin, kanamycin, ethionamide, para-aminosilat sodium,
amikacin, and siklisin is a drug - a second line drug (Smeltzer & Bare,
2001).
Types, Traits, and Doses of
Tuberculosis (Depkes,
2008)
Type AntiTraits
Dose (mg/kg)
Dose (mg/kg)
Tuberculosis
Agent
day
3 x week
Isoniasid ( H )
Bakterisid
5
(4-6 )
10
( 8-12 )
Rifampicin (RIF)
Bakterisid
10
( 8 -12 )
10
( 8- 12 )
Pyrazinamid ( Z )
Bakterisid
25
( 20-30 )
35
( 30-40 )
Steptomycin ( S )
Bakterisid
15
( 12-18 )
Etambutol ( E )
Bakteriostatik
15
( 15-20 )
30
( 20-35 )
Administrative control
Reducing exposure to M. tuberculosis
early detection
Isolation of patients
Appropriate treatment
Outreach to the community about TB
Proper sputum collection (in the open space
that not many people)
Environmental control
Reducing airborne droplet nuclei
Maximize the amount of natural ventilation room
Exposing the mattress every week
Personal respiratory protection
Prevent inhalation of droplet nuclei
Using masks
Cough ethical
WHO (1999) Guidelines for prevention of tuberculosis in
health care facilities, in resource-limited settings
Smeltzer & Bare (2004) Buku Ajar keperawatan Medikal
Bedah Brunner Suddarth. Jakarta: EGC
Departemen Kesehatan RI (2008) Pedoman Nasional
Penanggulangan Tuberkulosis
Knechel, NA (2009) Tuberculosis: Pathophysiology, Clinical
Features, and Diagnosis. Crit Care Nurse, 29:34-43.
WHO (2014) Tuberculosis
The immune system is responsible for fighting infections
that invade the body. Effort to attack these infections can
weaken the immune system, and cause the CD4 count
decreases, although usually after recovery, CD4 rise again.
But when an HIV-infected immune system must fight other
infections, HIV attacks against reduced. So if the infection
becomes active TB in people with HIV, their CD4 counts
can be decreased dramatically.
Correct use of medication in accordance with the schedule (adherence)
is crucial to avoid the emergence of resistant strains of TB. In order to
assure compliance, especially in the advanced phase after we feel
healed, the WHO strategy-S DOT (Directly Observed Therapy Shortcourse or treatment with direct supervision). Supervision is carried out
by a treatment
or PMO, which is tasked to assist the patient in treatment until
complete. PMO can be family members or health care workers who
are easily affordable by TB patients. The purpose of DOT-S are:
Achieving high cure rate
Prevent breaking treatment
Overcoming side effects of OAT
Preventing the emergence of resistance due to non-compliance...
Five key element in the DOTS strategy are:
(1) Commitment;
(2) Diagnosis is right and good;
(3) Availability and smooth distribution of drugs;
(4) Monitoring of patients taking the medication;
(5) The recording and reporting of patients with a
cohort system (WHO, 2006).
