S TIME SPECIFIC CONTENT TEACHING BLACK A.V.

EVALUA
NO OBJECTIVE LEARNING BOARD AIDS TION
ACTIVITY
1 ½ State the Introduction
min introduction Tuberculosis is an infectious disease that primarily
affects the lungs parenchyma. It is also may be
transmitted to other part of the body including the
kidneys, bones & lymph nodes etc. the primary
infectious agent mycobacterium tuberculosis is an
acid fast aerobic that grows slowly & is sensitive to
heat & ultraviolate light.

Definition:-
It is an infectious disease caused by mycobacterium
tuberculosis & lungs is the common site of disease.

Anatomy & physiology of lungs

There are two lungs one lying on each side of the
midline of the thoracic cavity they are cone shaped &
have an apex, base, costal surface & midline surface.
Apex :-
This is rounded & rises into the root of the neck about
25 mm above the level of the middle third of clavicle.
It lies close to the first rib & the blood vessels &
nerve in the root of the neck

Base :-
This is concave & semilunar in shape & rice on the
thoracic surface on the diaphragm.
Costal surface :-
The surface is convex & lies against the costal
cartilages, the ribs & the intercostals muscles.
Medial surface :-
This surface is concave & has a roughly triangular
shaped area, called hilum at the level of the 5th, 6th &
7th thoracic vertebrae.
Associated structure of lungs :-
The area between the lungs in the mediastinum. It is
also occupied by the heart, great vessels, trachea,
right & left bronchi oesophagus, lymph nodes, lymph
vessels & nerve.
The right lungs is divided into three
distinct lobes superior, meddle & inferior. The left
lung is smaller because the heart occupies space left
of the midline. If is divided into two lobes superior &
inferior.

Etiology:-
The risk factor of tuberculosis [TB] are given below :
 Inhaled the air which is contaminated with
mycobacterium tuberculi
 Close contacted with an infected person .
 Living in crowd and powerty.
 Occupation
 Malnutrition
Pathophysiology :
A succeptible person inhales micro bacterium bacilii
and becomes infected. The bacteria are transmitted
through the airway to the alveoli, where they are
deposited and began to multiply. The bavilli also are
transpposrted via lymph system and blood streem to
other parts of the body and other areas of the lungs
the bodies immune reaction phagocyte ingulf many of
the bacteria and TB – specific lymphocytes
destroy.the bacilli and normal tissue reaction result in
the accumulation of exudates in the alveoli causing
bronchopneumonia . the initaial infection usullay
occurs 2-10 weaks after exposure .
After initial exposure and infection the person may
develop active disease because of a compromised or
in adequate system response .

Clinical manifestation : a person with tuberculosis

have following sign and symptoms they are :
1. low grade fever
2. cough, cough may be non productive or
mucopurulent sputum may be expectorated
3. night sweat
4. fatigue
5. weight loss
6. hemoptysis
 7. chest pain

Diagnostic findings ;
1. A complete history
2. Physical examination
3. Chest x ray
4. Acid fast basillus smear
5. Sputum culture
6. Montus test
7. Polymerase chain reaction(PCR).
8. according to revised national tuberculosis
control program to find out :
 ask the patient if he have had cough for 3
weeks or more .
 for the patient with cough 3 week or
more ensure that 3 sputum
examinations(spot-morning –spot).are
done in a designated microscopy center.

Management :
pulmonary TB is treated :primarily with
chemotherapeutic agent for 6-12 months .
Several types of drugs resistancy must be
considered when planning effective therapy.
1. Primary drug resistance: resistance to one of
the first line anti tuberculosis agent In a person
who has not had previous treatment.
2. Secondary or acquired drug resistance:
 resistance to one or more anti tuberculosis
agent in a patient under going therapy.
3. Multi ddrug resistance :resistency to two agents
isoniazid and rifampcin the population at
highest risk for multi drug resistance are those
who are HIV positive, institutionised or home
less.

The increasing prevalence of drug resistance points

out the need to began TB treatment with four or more
medications to insure completion of therapy and to
develop and evaluate new anti TB medications.

DOTS (direct observed treatment and short course): a

health worker and other trained person who is not a
family member watch the patient swallow every dose
of medicine in the intensive phase in the continuation
phase, every week at least the first of the three dose
must be given under direct observation. This is the
only way to insure that the patient is cured.

Nursing management: it is most important

management after medical management, the nurses
should observe the patients need and treat them
accordingly.

1.Assessment : assess for impaired gas exchange

nursing diagnosis ; Impaired gas exchange related to
decrease effective lung surface.
Expected out come ; Patients breathing pattern will be
normal .

Implementation with rational :

1. Give comfortable position to extend the lung
surface.
2. Promote bed rest/ limit activity to reduce
oxygen consumption.
3. encourage patient for deep breathing and
coughing exercise to promote normal breathing
pattern.
4. give the inhalton to clean the airway
obstruction.
5. give the oxygen therapy to maintain normal
breathing pattern.

Evaluation : patient may have normal breathing

pattern .

2.assessment : assess for chest pain .

nursing diagnosis ; Chest pain related to coughing .

expected out come ; Chest pain will be reduce.

Implementation with rational :

1. Give comfortable position to proper lung
expansion.
 2. give the bed rest to provide comfort and rest .
3. Explain the coughing exercise. Proper
coughing pattern will reduce pain.
4. give the medication as per prescription to
reduse coughing.

Evaluation : patient may have no complaint of chest

pain .

3.Assessment : Assess for fever

Nursing diagnosis: fever related to tissue perfusions.
Expected out comes: fever will be reduce.
Implementation with rational :
1. check the vital sign to identify the variation in
temperature
2. loosen the tight clothing to provide comfort
3. Provide the proper ventilation. Cool air reduces
the body temperature by conduction.
4. Give the cold water and drinks to reduce the
body temperature.
5. Give the medication as per prescription to
reduce the fever.

Evaluations; the patient may be having the

temperature with in the normal range.

4.assessment : assess for impaired nutrition status .

nursing diagnosis : altered nutrition less than body
 requirement related to anorexia .

expected out comes; patients nutritional status will

be maintained .
Implementation with rational:
1. check the body weight to identify the changes
in body weight .

5.assess for the knowledge deficiency :