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COUNSELING PAPER

TUBERCULOSIS

Instructor: Dwi Kurniawati Sambodo, S.Farm., M.Si.,Apt

Arranged by :

Name : Awit Nulhakimah Fajarini

Student ID Number : 34170178

Class : A/DF/IV

DIII PHARMACY STUDY PROGRAM


INSTITUTE OF HEALTH SCIENCE
YOGYAKARTA
2019

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FOREWORD

Thank God I pray to Allah SWT for blessing and gift of His grace is so great, I can finish KPIO
The paper titled "Tuberculosis" in the hope to be useful in increasing knowledge and insights.

I thanked him profusely to all those who were very helpful in making this paper. As a human,
I am aware that in making this paper is far from perfect, therefore I hope there will be constructive
feedback so that this paper can be useful both for themselves and the user of this paper.

Akhirulkalam I say may Allah guide us all in the shade of His mercy and compassion.

Author,

Yogyakarta, May 7th, 2019

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TABLE OF CONTENTS

FOREWORD ................................................................................................................................. 2
TABLE OF CONTENTS .................................................................................................................... 3
CHAPTER I.......................................................................................... Error! Bookmark not defined.
PRELIMINARY .............................................................................................................................. 4
A. BACKGROUND ............................................................................................................................. 4
B. FORMULATION OF THE PROBLEM .............................................................................................. 4
C. PURPOSE ..................................................................................................................................... 4
CHAPTER 2 ................................................................................................................................... 5
DISCUSSION ................................................................................................................................. 5
A. DEFINITIONS OF TUBERCULOSIS ................................................................................................. 5
B. PATHOPHYSIOLOGY .................................................................................................................... 5
C. TRANSMISSION OF TUBERCULOSIS............................................................................................. 6
D. CLASSIFICATION OF DISEASES AND TYPE OF PATIENTS .............................................................. 7
E. MANAGEMENT WITH TUBERCULOSIS ........................................................................................ 9
F. TREATMENT WITH TUBERCULOSIS ........................................................................................... 12
G. TB TREATMENT IN SPECIAL CIRCUMSTANCES .......................................................................... 14
H. PREVENTION ............................................................................................................................. 16
CHAPTER 3 ................................................................................................................................. 17
CLOSING .................................................................................................................................... 17
A. CONCLUSION ............................................................................................................................. 17
BIBLIOGRAPHY........................................................................................................................... 18

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CHAPTER

PRELIMINARY
A. BACKGROUND
Tuberculosis (TB) is one of the most deadly diseases in the world. The World Health
Organization / World Health Organization (WHO) estimates that one-third of the world
population is infected with Mycobacterium tuberculosis, Pulmonary TB is a worldwide health
problem with morbidity and mortality continue to rise. This disease is closely associated with
poverty, malnutrition, shantytowns, substandard housing, and inadequate health
care.Mycobacterium tuberculosis has infected a third of the world's population.
Every year there are 9 million new cases and deaths of nearly 2 million people. In all
countries there have this disease, but the largest in Africa by 30%, Asia 55%, and to China
and India on its own for 35% of all cases of tuberculosis.

B. FORMULATION OF THE PROBLEM


1. What does the term tuberculosis?
2. How pathophysiology tuberculosis ?
3. How transmission tuberculosis ?
4. Anything classification of disease and the type of patient ?
5. How the treatment of patients with tuberculosis ?
6. How the treatment of tuberculosis patients ?

C. PURPOSE
1. Know understanding tuberculosis
2. Knowing pathophysiology tuberculosis
3. Knowing transmission tuberculosis
4. knowing ajust pa classification of disease and the type of patient
5. Knowing treatment of patients with tuberculosis
6. Knowing how can the treatment of patients with tuberculosis

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CHAPTER 2

DISCUSSION
A. DEFINITIONS OF TUBERCULOSIS
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. There
are several species of Mycobacterium, among others: Mycobacterium tuberculosis,
Mycobacterium africanum, Mycobacterium bovis, Mycobacterium leprae, etc. which is also
known as Acid Resistant Bacteria (BTA). Group of Mycobacterium tuberculosis bacterium
Mycobacterium other than that can cause disturbances in the respiratory tract are known as
MOTT (Mycobacterium Other Than Tuberculosis) which can sometimes interfere with
diagnosis and treatment of Tuberculosis.
In general, the nature of Mycobacterium tuberculosis, among others, are as follows:
• Rods with a length of 1-10 microns, the width from 0.2 to 0.6 microns.
• Is resistant to acid in Ziehl Neelsen staining method, a rod-shaped red in the
examination under the microscope.
• Require special media for culture, such as Lowenstein Jensen, Ogawa.
• Resistant to low temperatures so that it can survive for long periods at temperatures
between 4 ° C to - 70 ° C.
• Germs are very sensitive to heat, sunlight and ultra-violet rays. To direct exposure to
ultraviolet light, most germs will die within a few minutes. In sputum at a temperature
between 30-37 ° C will die within approximately one week.
• Germs can be dormant.

B. PATHOPHYSIOLOGY
Port dysentery Mycobacterium tuberculosis is the respiratory tract, gastrointestinal
tract, and open wounds on the skin. Most infections occur through the air (water bone),
through inhalation dropplite containing germs infected with the tubercle bacillus.
Tubercle bacillus that reaches the alveoli and inhaled typically consist of one to
three blobs. Basil greater tend to survive big nose passages and bronchi branch, so it does
not cause disease. Once in the alveolar space, germs will begin to cause inflammation.
Polymorphonuclear leukocytes seem fagocyt bacteria in this place, but do not kill the
organism.
After the first day, then leukocytes replaced by macrophages. The alveoli are
attacked will be consolidated and symptoms of acute pneumonia. This mobile pneumonia

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can be cured by itself, so there is no residue left or the process can continue and continue
difagosit or bacteria proliferate in the cell. Basil also spread through the lymph to the
regional lymph nodes. Macrophage infiltration into longer hold and most united, thus
forming epiteloit tubercle cells surrounded by fosit. This reaction usually takes 10-20 hours.

C. TRANSMISSION OF TUBERCULOSIS
a. Source Transmission of TB
Source of infection is tuberculosis patients, particularly those containing TB bacteria in
the sputum. At the time you cough or sneeze, patients spread germs into the air in the
form of droplets. The infection occurs when a person inhales air containing infectious
droplets. Once the cough can produce about 3,000 droplets containing the bacteria
Mycobacterium tuberculosis as much 0-3500. Meanwhile, if a sneeze can release as
much 4500-1000000 Mycobacterium tuberculosis.
b. Natural journey TB In Humans
There are four stages of the natural history of the disease. These stages include the step
of exposure, infection, illness and death, as follows:
1) Exposure, exposure improvement opportunities related to:
• The number of infectious cases in the community
• Opportunities contact with an infectious case
• The level of infectiousness sputum transmission source
• The intensity of the source of contagion cough
• The closeness of contact with the source of contagion
• The length of time in contact with the source of infection.
2) Infection, immune system reactions will occur after 6-14 weeks after infection.
Lesions usually recover completely but can only stay alive bacteria in these lesions
(dormant) and a time can be active again depends on the human immune system.
Spreading through the bloodstream or lymph may occur before the healing lesions.
3) Risk Factors, to be ill TB is dependent on:
• The concentration or amount of germs that are inhaled
• The length of time since infection
• An infected person's age
• The level of a person's immune system, people with a low immune system such
as HIV-AIDS infection and malnutrition (malnutrition) will facilitate the
development of active TB

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• HIV infection, a person who is infected with TB, 10% of them will become sick
with TB. But in an HIV-positive will increase the incidence of TB. People with HIV
are at risk 20-37 times to get TB than people who are not infected with HIV,
thereby TB transmission in the community will increase as well.
4) Died of deaths due to TB risk factors:
• As a result of late diagnosis
• Inadequate treatment
• Their initial health condition is bad or comorbidities
• TB patients without treatment, 50% of them will die and this risk is increased in
patients with HIV-positive. Similarly, people living with HIV, 25% of deaths are
caused by TB.

D. CLASSIFICATION OF DISEASES AND TYPE OF PATIENTS


Determining the classification of the disease and the type of TB patients need a
"case definition", which includes four things:
• Location or diseased organs (pulmonary or extrapulmonary)
• Bacteriology seen from the results of microscopic examination of sputum (smear
positive or Smear negative);
• The severity of the disease (mild or severe)
• History of previous TB treatment (new or have been treated).
Benefits and objectives determine the classification and type of patient are:
• Determining the appropriate treatment alloy
• Registration of cases correctly
• Determine the priority of smear positive TB treatment
• Cohort analysis of treatment outcomes
Some terms in the definition of the case:
a. Cases of TB : TB Patients who have demonstrated microscopically or diagnosed by a
doctor.
b. Sure TB cases (definitive): patients with a positive culture for Mycobacterium
tuberculosis or no culture facilities, at least 2 of 3 sputum specimens SPS smear positive
result.
Classification based on the affected organs:
a. Pulmonary tuberculosis, is TB that attacks the tissue (parenchymal) lung. Not including
the pleura (lining of the lung) and gland at the hilum.

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b. Extra-pulmonary TB, is TB that attack organs other than the lungs, eg pleura, the lining
of the brain, membranes of the heart (pericardium), lymph glands, bones, joints, skin,
intestine, kidney, urinary tract, genitals, etc.
The classification is based on the results of a microscopic examination of sputum, Namely
the pulmonary TB:
a. Smear positive pulmonary tuberculosis
• At least two of the three specimens of sputum smear positive result SPS
• 1 specimen of sputum smear positive result SPS and chest X-ray photograph showed
a picture of TB
• SPS 1 sputum specimen smear positive result and a positive TB bacteria culture
• One or more specimens of sputum positive results after 3 sputum specimens SPS on
previous inspection results are smear negative and there is no improvement after
antibiotic treatment of non OAT.
b. Smear negative pulmonary tuberculosis, Cases that do not meet the definition of smear
positive pulmonary TB. The diagnostic criteria smear negative pulmonary TB should
include:
• At least three specimens of sputum smear result SPS negativ
• Abnormal chest X-ray shows a picture of TB
• No improvement after antibiotic treatment of non OAT
• Specified (considered) by the doctors to be given treatment.
The classification is based on the severity of the disease:
a. Smear negative pulmonary tuberculosis positive chest radiograph divided based on the
severity of the disease, namely the heavy and light form. When severe forms
radiographic picture shows a picture of extensive lung damage (eg, the "far advanced"),
and or the patient's general condition is bad.
b. Extra-pulmonary TB divided based on the severity of the disease, namely:
• Extra-pulmonary TB light, for example: the lymph node TB, pleurisy eksudativa
unilateral, bone (excluding spine), joints, and adrenal glands.
• Severe extra-pulmonary TB, eg meningitis, miliary, pericarditis, peritonitis, pleurisy
eksudativa bilateral, spinal tuberculosis, intestinal tuberculosis, TB urinary tract and
genitals.
Note:
• When a pulmonary TB patients also have extra-pulmonary TB, then for the sake of
recording, the patient should be recorded as pulmonary TB patients.

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• When a patient with extra-pulmonary TB in several organs, it noted as extra-
pulmonary TB in the most severe organ disease.
Classification is based on a history of previous treatment patients are divided into several
types, namely:
a. New, Is patients who have not been treated with OAT or have been swallowed OAT is
less than one month (4 weeks).
b. Relapse , Is a TB patient who previously received TB treatment and was declared cured
or treatment is complete, re diagnosed with smear-positive (smear or culture).
c. Treatment after dropping out of treatment , Is a patient who has been treated and
broke up two months or longer treatment with smear positive.
d. Failing that, is patients whose sputum examination results remain positive or turned
positive in the fifth month or more during the treatment.
e. Moving is patients transferred from health care facilities that have another TB register
to continue treatment.
f. Etc : are all cases that do not meet the above conditions. In this group, including the
case of the Chronicle, that is patients with smear-positive test results still after
completion of treatment replications. TB smear negative pulmonary and extra-
pulmonary TB, can also experience a relapse, failure, default or become chronic cases.
Although very rare, it must be proven pathological, bacteriological (culture),
radiological, and specialist medical considerations.

E. MANAGEMENT WITH TUBERCULOSIS


TB management involves finding and treatment of patients administered using the
DOTS strategy. The main purpose of treatment of TB patients is to reduce mortality and
morbidity and prevent transmission by means of curing the patient. TB disease management
is a part of disease surveillance; not only to ensure that patients took the drug until declared
cured, but also deals with the management of the required aids, the officer involved,
recording, reporting, evaluation of activities and action plans.
a. The discovery of TB patients
Activity invention consists of netting suspected patients, diagnosis, disease classification
and determination of the type of patient. The discovery of the patient is the first step in
the activities of the TB control program. The discovery and cure of infectious TB
patients, would have significantly can reduce morbidity and mortality from TB, TB

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transmission in the community and is a transmission of TB prevention activities are
most effective in the community.
1) discovery strategy
• The discovery of the TB patients is done passively with active promotion.
Networking suspected patients do in the health services, supported by active
extension either by health workers and the community to improve the coverage
of suspect TB patients.
• Examination of contacts of TB patients, especially those with smear-positive and
the child's family who suffered from TB symptoms at, should be examined
sputum.
• The invention is active from house to house, considered to be cost effective.
2) Clinical symptoms of TB patients
The main symptom of pulmonary TB patients are productive cough for 2-3 weeks or
more. Can Cough followed by additional symptoms that sputum mixed with blood,
coughing up blood, shortness of breath, weakness, loss of appetite, weight loss,
night sweats without physical activity, fever, chills more than one month. Such
symptoms above can be found also in the lungs than TB disease, such as
bronchiectasis, chronic bronchitis, of asthma, lung cancer, and others. Given the
prevalence of TB in Indonesia are currently still high, everyone who comes to health
care facilities with the above symptoms, regarded as a suspect (suspect) TB patients,
and the need to direct microscopic examination of sputum.
3) Microscopic examination of sputum
Sputum function for diagnosis, treatment success rate and determine the potential
for contagion. Sputum examination for diagnosis is done by collecting three sputum
specimens collected in two consecutive day visit in the form of As-As-morning (SPS).
• S (as): sputum collected at the time of TB suspects came to visit the first time. On
the way back, the suspect carrying a pot to collect sputum expectoration in the
morning on the second day.
• P (morning): sputum collected at home on the morning of the second day, soon
after waking. Pot was taken and submitted himself to the officer in health care
facilities.
• S (as): Sputum was collected in health care facilities on the second day, When you
turn in morning phlegm.
4) examination of cultures

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The role of culture and identification of Mycobacterium tuberculosis (Mt) in
particular TB control to determine whether the patient concerned is still sensitive to
the OAT used. Over the facilities allow, culture and identification of bacteria and
when required tests. Resistance can be used in several situations:
• TB patients who fall into the type of chronic patients
• Extra-pulmonary TB patients and TB patients child
• Health workers who treat patients with the dual immunity.
5) Examination Tests Resistance
Resistance testing can only be done in a laboratory capable of performing culture,
identification of bacteria and resistance tests according to international standards,
and have gained the quality assurance (Quality Assurance) by TB supranational
laboratory. It is intended that the results of such examinations provide the correct
conclusions So as the possibility of errors in the treatment of TB can be prevented.
b. diagnosis of TB
1) Diagnosis of pulmonary TB
• All suspected tuberculosis 3 sputum specimens examined within 2 days, that is
when -Morning - when (SPS).
• The diagnosis of pulmonary TB in adults is confirmed by the discovery of the TB
germs (BTA). At the national TB program, the discovery of microscopic
examination of sputum smear through the primary diagnosis. Other tests such as
chest X-ray, culture and sensitivity test can be used to support the diagnosis along
accordance with the indication.
• TB diagnosis is not justified based solely on radiographic examination alone.
Chest X-ray does not always give an idea typical of pulmonary TB, so often occurs
overdiagnosis.
• Overview of Pulmonary radiological abnormalities do not necessarily indicate
disease activity.
• For more details see the flow of diagnostic procedures for suspected pulmonary
TB.
2) The diagnosis of extra pulmonary TB
• Symptoms and complaints depending on which organs are affected, such as a stiff
neck on TB meningitis, TB pleural chest pain (Pleurisy), enlargement of superficial
lymph nodes in lymphadenitis tuberculosis and spinal deformity (gibbus) in
Ankylosing tuberculosis and others.

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• A definitive diagnosis is often difficult to enforce while working diagnosis can be
confirmed by a strong clinical symptoms of TB (presumptive) to rule out other
diseases Possible. The accuracy of the diagnosis depends on the method of taking
samples, and the availability of diagnostic tools, such as microbiological testing,
anatomic pathology, serology, chest X-ray and others.

F. TREATMENT WITH TUBERCULOSIS


stage Treatment , TB treatment should always include treatment of early stage and
advanced stage with a view:
a. Early stage
Treatment was given every day. Alloy treatment at this stage is intended to effectively
decrease the amount of bacteria present in a patient's body and minimize the effect of
fraction-resistant germs that may have been since before the patient is getting
treatment. Treatment of early stage on all new patients, should be given for 2 months.
In general, the treatment regularly and without any complications, transmission power
has been greatly decreased after treatment during the first 2 weeks.
b. Advanced stage
Treatment of advanced stage aims to kill any remaining germs are still present in the
body, particularly germs persister so that the patient can heal and prevent recurrence.
Table 1: First Line
TYPE CHARACTER SIDE EFFECTS
Isoniazid (H) bactericidal Peripheral neuropathy (nerve
disorders edge), toxic psychosis,
impaired liver function, seizures.

Rifampicin (R) bactericidal flu syndrome(Severe influenza


symptoms), gastrointestinal
disorders, red-colored urine, liver
dysfunction, thrombocytopenia,
fever, skin rash, shortness of
breath, hemolytic anemia.
Pyrazinamide (Z) bactericidal Gastrointestinal disorders, impaired
liver function, gout arthritis.
Streptomycin (S) bactericidal Localized pain injections, balance
and hearing disorders, anaphylactic
shock, anemia, agranulocytosis,

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thrombocytopenia.

Ethambutol (E) bacteriostatic Impaired vision, color blindness,


peripheral neuritis (nerve disorders
edge).

Table 2: Second Line


GROUP GROUPS TYPE OF MEDICINE
A Florokuinolon
• Levofloxacin (LFX)
• Moxifloxacin (MFX)
• Gatifloxacin (gfx) *

B OAT injectable
second-line • Kanamycin (Km)
• Amikacin (Am) *
• Capreomycin (Cm)
• Streptomycin (S) **
C Second-line oral OAT
• Ethionamide (Eto) / Protionamid (Pto)
*
• Cycloserine (Cs) / Terizidon (Trd) *
• Clofazimine (CFZ)
• Linezolid (Lzd)

D D1 OAT first line


 Pyrazinamide (Z)
 Ethambutol (E)
 Isoniazid (H) high
dose

D2 new OAT
 Bedaquiline (BDQ)
 Delamanid (In) *
 Pretonamid

D3 additional OAT • The aminosalicylic


acid (PAS)
• Imipenem-silastatin
(ipm) *
• Meropenem (Mpm)
*
• Clavulanat
amoxicillin (Amx-
CLV) *

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• Thioasetazon

Information:
* Not supplied by program
** Does not include second-line injectable drug, but may be given on certain
conditions and are not provided by program
OAT alloys used in Indonesia is;
a. Category 1: 2 (HRZE) / 4 (HR) 3 or 2 (HRZE) / 4 (HR).
b. Category 2: 2 (HRZE) S / (HRZE) / 5 (HR) 3E3 or 2 (HRZE) S / (HRZE) / 5 (HR) E.
c. Category Children: 2 (HRZ) / 4 (HR) or 2HRZE (S) / 4-10HR.
d. Alloy OAT for TB patients Resistan Drugs: consists of OAT lines to-2 that Kanamycin,
capreomycin, Levofloxacin, Etionamide, Cycloserine, Moxifloxacin, PAS, Bedaquilin,
clofazimine, Linezolid, Delamanid and TB drugs other new and OAT lines-1, namely
pyrazinamide and ethambutol.

G. TB TREATMENT IN SPECIAL CIRCUMSTANCES


a. pregnancy, According to WHO, almost all OAT safe for pregnancy, except streptomycin.
Streptomycin can not be used in pregnancy because it is permanent ototoxic and can
penetrate the placenta barrier. This situation can result in hearing loss and balance
settled on the baby to be born. It needs to state that the success of treatment of
pregnant women is very important so that the birth process went smoothly and the
baby to be born to avoid the possibility of contracting TB.
b. Breastfeeding mothers and their babies, All types of OAT safe for nursing mothers. A
nursing mother with TB should receive OAT alloy adequately. Giving the right OAT is
the best way to prevent transmission of TB bacteria to their babies. Mother and baby
need not be separated and they can continue to breast-fed infants. INH preventive
treatment given to the baby according to weight.
c. TB patients contraceptive users, Rifampin interacts with hormonal contraceptives (birth
control pills, birth control injections, implants), so it can reduce the effectiveness of
contraceptives. A TB patient should use traditional non-hormonal contraception, or
contraception containing high dose estrogen (50 mcg).
d. TB patients with HIV infection / AIDS, The principle of treatment of TB-HIV patients is to
prioritize TB treatment. ARV (antiretroviral) started based on clinical stage of HIV
according to WHO standards. The use of streptomycin injections have to pay attention

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to principles of Universal Precaution (Universal Security Precautions) Treatment of TB-
HIV patients should be given an integrated way in the health-care facilities to maintain
compliance with regular treatment. TB patients at high risk for HIV infection should be
referred to VCT (Voluntary Counceling and Testing = Consul voluntary HIV test).
e. TB patients with acute hepatitis, Giving OAT in TB patients with acute hepatitis or
clinical jaundice, delayed until the acute hepatitis experience healing. In circumstances
where Tb is indispensable treatment can be given streptomycin (S) and Ethambutol (E) a
maximum of 3 months to the hepatitis healed and continued with rifampicin (R) and
isoniazid (H) for 6 months.
f. TB patients with chronic liver abnormalities, when there is suspicion of interference
liver physiology, liver physiology examination is recommended prior to treatment of TB.
If AST and ALT increased more than 3 times the OAT is not given and if they are in
treatment, should be discontinued. If the increase is less than 3 times, the treatment
can be carried or transmitted with strict supervision. Patients with liver abnormalities,
Pyrazinamide (Z) should not be used. OAT alloys that can be recommended is 2RHES /
6RH or 2HES / 10HE.
g. TB patients with renal failure, Isoniazid (H), rifampicin (R) and Pirasinamid (Z) can be in
the excretion of bile and can be transformed into compounds that are not toxic. OAT
this type can be given a standard dose in patients with renal impairment. Streptomycin
and Ethambutol is excreted through the kidneys, therefore, avoid use in patients with
renal impairment. If renal physiology monitoring facilities available, Ethambutol and
Streptomycin remains can be given with an appropriate dose renal physiology. OAT
alloy safest for patients with kidney failure is 2HRZ / 4HR.
h. TB patients with diabetes mellitus, Use of Rifampicin can reduce the effectiveness of
oral anti-diabetic medications (sulfonyl urea) so that the anti-diabetic drug dose should
be increased. Insulin can be used to control blood sugar, after completion of TB
treatment, continued with oral anti-diabetes. In patients with Diabetes Mellitus
common diabetic retinopathy complications, therefore caution with ethambutol
administration, because it can aggravate the disorder.
i. TB patients who need to receive additional corticosteroids, corticosteroids used only in
special circumstances that endanger the lives of patients, such as:
• TB meningitis
• TB miliary with or without meningitis
• TB Pleurisy eksudativa

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• TB with constrictive pericarditis.
During the acute phase of prednisone administered at a dose of 30-40 mg per day, then
decreased gradually. Old provision tailored to the type of disease and treatment
progress.
j. Indications operation, Patients who need to get surgery (resection of the lung), are:
1) For pulmonary tuberculosis:
• Severe coughing patient blood which can not be overcome by conservatives.
• Patients with bronchopleural fistula and empyema that can not be managed
conservatively.
• MDR TB patients with localized lung disorder.
2) For extra-pulmonary TB: extra-pulmonary TB patients with complications, such as
bone tuberculosis patients accompanied neurologic abnormalities.

H. PREVENTION
a. Cultivating PHBs or Behavior Clean and Healthy, eating nutritious food, and do not
smoke
b. Cultivate ethical behavior and how to remove phlegm cough for TB patients
c. Improve endurance by improving the quality of nutrition for the affected population TB
d. Counseling patients about cough etiquette.
e. Provision of tissues and surgical masks, disposal wipes, surgical masks and proper
disposal of sputum.
f. Posters, banners and materials for IEC.
g. Screening for workers treating TB patients.

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CHAPTER 3

CLOSING
A. CONCLUSION
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Group
of Mycobacterium tuberculosis bacterium Mycobacterium other than that can cause
disturbances in the respiratory tract are known as MOTT (Mycobacterium Other Than
Tuberculosis) which can sometimes interfere with diagnosis and treatment of Tuberculosis.
Management of TB patients: the discovery of the patients (strategy, symptoms,
sputum examination, examination and inspection of resistance culture) diagnosis of patients
(pulmonary TB and extra pulmonary TB).
Transmission: source (splashes sputum), natural history (exposure, infection, illness
and death).
TB treatment: early stage (Isoniazid (H), Rifampicin (R), Pyrazinamide (Z),
Streptomycin (S), Ethambutol (E)). The second phase (Florokuinolon group, OAT injectable
second-line, second-line oral OAT, OAT first line, the new OAT, additional OAT).
Treatment of patients with TB special: Pregnancy, breast-feeding mothers and their
babies, users of contraception, HIV / AIDS, TB patients with acute hepatitis, TB patients with
chronic liver abnormalities, kidney failure, diabetes mellitus, tuberculosis patients who need
to receive additional corticosteroids, surgery indications.
prevention: Cultivating PHBs or Clean and Healthy Behavior, eat a nutritious diet,
and not smoking, cultivate ethical behavior and how to remove phlegm cough for TB
patients, Improve endurance by improving the quality of nutrition for TB-affected
population.

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BIBLIOGRAPHY

Badan POM. 2017. IONI. Jakarta: BPOM RI.


Menkes.2016 . Penanggulangan Tuberculosis. Jakarta: Depkes RI
Santosa, Budi. 2005. NANDA Nursing diagnosis. Jakarta : Prima Medical

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