Madrigalejos, Jane D.

4BSN1

Pulmonary Tuberculosis (PTB)

 Pulmonary tuberculosis is a chronic or acute infection in which it primarily affects lung parenchyma (alveoli) but PTB may also invade other
organs such as meninges, kidneys, bones and lymph nodes.
Causes
 Mycobacterium tuberculosis
 Exposure to others strains of mycobacteria (sometimes)
Signs and Symptoms
 A low-grade fever - Crackles
 Cough
 Night sweats
 Fatigue
 Weight loss
 Cough may be nonproductive
 Hemoptysis
Risk Factors
 Close contact with someone who has active
 Immunocompromised status (eg, those with HIV infection and cancer)
 Substance abuse (IV/injection drug users and alcoholics)
 Any person without adequate health care (the homeless; impoverished; minorities, particularly children under age
 15 year and young adults between ages 15 and 44 year)
 Preexisting medical conditions or special treatment (eg, diabetes, chronic renal failure, malnourishment, selected
 Immigration from countries with a high prevalence of TB (southeastern Asia, Africa, Latin America, Caribbean)
 Institutionalization (eg, long-term care facilities, psychiatric institutions, prisons) Living in overcrowded, substandard housing Being a health
care worker performing high-risk activities: administration of aerosolized pentamidine and other medications, sputum induction procedures,
bronchoscopy, suctioning, coughing procedures, caring for the immunosuppressed patient, home care with the high-risk population, and
administering anesthesia and related procedures (eg, intubation, suctioning)
Pathophysiology

Infected Person Droplets

Modifiable Risk Factors Non-Modifiable Risk factors

-Close Contact with someone who -Immunocompromised
has active TB - Any person without adequate
-Substance Abuse health care
-Immigration from countries with - Preexisting medical
high prevalence of TB conditions or special treatment
-Institutionalize

Macrophages which
Mycobacterium Tuberculosis Formation of granuloma Lung Damage formation
lies on the lung airways
goes to alveoli by mixture of of Lesion (Granuloma or
take up bacilli but
Macrophages and Bacilli Tuberculoma)
bacilli reproduce.

Primary Infection Local Site infection

Gohn Complex evident in spill over goes to
Chest X-ray regional lymph nodes
in the lungs
Diagnostic Test Nursing Responsibilities
Chest X-rays -Explain the procedure
-Ensure that the patient is
not pregnant
-Assess the ability of the
patient to hold his or her
breath
-Remove all metallic
objects in the Body.
Normal Values Abnormal values Analysis
-Normal Chest X-ray Reveals lesions in the
shows normal size and upper lobes,
shape of the chest wall and the acid-fast
and the main structures bacillus smear contains
in the chest. mycobacteria.
-No densities
produced by fluid,
tumors, foreign bodies
found.

QuantiFERON-TB -Explain the procedure NEGATIVE POSITIVE

Gold Test (Blood -Ensure that patient is
test) ready for the test.

Tuberculin Skin -Explain the procedure 0-4 mm is normal  5 mm or higher

Test -Prepare the child for the in HIV patient
procedure higher chances
of being at risk.
Note: Those train  10 mm is
individual and considered
havecertification can only indication of TB
done this procedure. for children and
drug induced
individual
 15 mm indicates
TB.
Stains and Culture No presence of -Presence of
of Sputum Mycobacterium Mycobacterium
Tuberculosis. Tuberculosis
In the culture.

Medical Management

Medical Management Pulmonary TB is treated primarily with antituberculosis agents for 6 to 12 months. A prolonged treatment duration is
necessary to ensure eradication of the organisms and to prevent relapse. The continuing and increasing resistance of M. tuberculosis to TB
medications is a worldwide concern and challenge in TB therapy.
Several types of drug resistance must be considered when planning effective therapy:
• Primary drug resistance: resistance to one of the firstline antituberculosis agents in people who have not
had previous treatment
• Secondary or acquired drug resistance: resistance to
one or more antituberculosis agents in patients undergoing therapy
• Multidrug resistance: resistance to two agents, isoniazid (INH) and rifampin. The populations at greatest
risk for multidrug resistance are those who are HIV positive, institutionalized, or homeless.

Nursing Management
 Promoting Airway Clearance
 Advocating Adherence to Treatment Regimen
 Promoting Activity and Adequate Nutrition
 Preventing Spreading of Tuberculosis Infection
 Tell the patient to wear a mask when outside his room. Visitors and health care personnel should also take proper precautions while in
the patients’ room.
 If the patient is a woman, advise her that hormonal contraceptives may be less effective while she’s taking rifampin.
Nursing Diagnosis
 Ineffective Airway Clearance may be related to thick, viscous, or bloody secretions
 Risk for ineffective Therapeutic Regimen Management: risk economic difficulties
 Activity Intolerance may be related to imbalance between O2 supply and demand, possibly evidenced by reports of fatigue,
weakness, and exertional dyspnea
 Imbalanced Nutrition: less than body requirements may be related to inability to ingest adequate nutrients.
 Risk for Infection
 Risk for impaired Gas Exchange
 Drug Mechanism of Action Side Effects Adverse Effects Contraindications Nursing
Considerations
Drug Name: Rifampin Interferes with Red-orange or red- hepatitis, blood Concomitant therapy Preferably take on
Generic Name: bacterial RNA brown discoloration dyscrasias, Stevens- with amprenavir, empty stomach with
Rifadin synthesis by of urine, feces, saliva, Johnson saquinavir, ritonavir; 8 oz of water 1 hr
binding to DNA- skin, syndrome, antibiotic- hypersensitivity to before or 2 hrs after
PO, IV: ADULTS, dependent RNA sputum, sweat, tears. associated colitis other rifamycins. meal (with food if GI
ELDERLY: 10 polymerase, Occasional (5%–3%): occur rarely upset). • Avoid
mg/kg/day. preventing attachment Hypersensitivity alcohol during
Maximum: 600 to DNA, reaction treatment. • Do not
mg/day. CHILDREN: thereby blocking take
10– RNA transcription. any other medications
20 mg/kg/day in without consulting
divided doses q12– physician, including
24h. antacids; must
Maximum: 600 take rifampin at least
mg/day 1 hr before antacid.
• Urine, feces,
Classification Anti- sputum, sweat, tears
Tuberculosis may
become red-orange;
soft contact lenses
may be permanently
stained. •
Assessment Diagnosis Planning Interventions Rationale Evaluation
Subjective Ineffective Airway Short-term Goal: Independent
“Nahihirapan po Clearance may be  Monitor respirations  indicative of After 1 hour of
akong huminga, lalo related to thick, After 1-3 hours of and breath sounds, respiratory nursing
na kapag ka viscous, or bloody Nursing intervention noting rate and distress and/or interventions client
nakahiga.” secretions client will be able to Sounds accumulation of is able to have
maintain vital signs secretions normal vital signs.
Objective
BP 110/80
BP: 130/80 Temperature - 37.2
Temperature: 37.8  Position head  to open or Pulse - 85
C Long-term Goal: appropriate for maintain open RR - 20
Pulse 89 age/condition airway in at-rest Sp02 – 96
RR 24 After 4-8 of nursing or
SpO2 93 intervention client compromised. Presence of
will be able to Bloody Sputum
-Bloody and Thick maintain airway and  Elevate head of
Sputum decreased viscosity bed/change position  to take
(Hemoptysis) of mucus every 2 hours and prn advantage of
- Coughing gravity
decreasing
pressure on the
diaphragm and
enhancing
drainage
of/ventilation to
different lung
segment.

 Increase fluid intake  Hydration can

to at least 2000 help liquefy
mL/day within viscous
cardiac tolerance secretions and
improve
 secretion
clearance.

 Encourage/provide
opportunities for rest;
limit activities
to level of respiratory  Prevents/reduces
tolerance. fatigue.

 Apply Tepid Sponge

Bath
 To reduce body
 Administer temperature into
nasal cannula at 1-2 normal
liters per minute
(L/min)
 To improve
Dependent oxygen in the
body
 Administer oxygen
therapy as ordered by
the doctor.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Activity Intolerance Short term goal: Independent - To reduce After 2 hours of
may be related to - Plan care to fatigue. nursing intervention
“Pagod na pagod imbalance between After 1-2 hours of carefully client is able to have
yung katawan ko O2 supply and nursing intervention balance rest normal vital sign.
kahit konting kilos demand, possibly client will be able to periods with
lang ginagawa ko.” evidenced by reports have normal vital activities T – 37.4 C
As verbalize by the of fatigue, weakness, signs - Helps to PR – 97 BPM
patient. and exertional - Provide positive minimize RR – 20 BPM
dyspnea atmosphere, frustration and BP 110/80
Long term goal: while rechannel O2- 96
acknowledging energy
Objective: After 4-8 hours of difficulty of the After 8 Hours of
situation for the nursing intervention
nursing intervention
client
T- 37.5 C the client will be able - Assist with client is able to
PR – 102 BPM to have maintain vital activities and maintain within
- Assist with
RR – 22 BPM sign within normal provide/monito normal range vital
activities and
BP 130/80 range and increase r client’s use of sign and increase
provide/monitor
O2 – 94 activity tolerance assistive device activity tolerance.
client’s use of
assistive device
-Weakness Ambulating
-Fatigue
-Dyspnea
Dependent
- To increase
- Administer
oxygen level in
oxygen therapy
the body.
as prescribed by
the Physician.
Assessment Diagnosis Planning Implementation Rationale Evaluation Evaluation
Decreased Imbalance Nutrition Short term goal: - Monitor client’s - to limit exposures, After 30 mins of
monocytes and Less than body visitors/caregivers thus reduce cross- nursing intervention
lymphocytes level requirements. After 30 mins to 1 for respiratory contamination. client is able to
hour of nursing illnesses. verbalize
Monocytes 0.09 interventions client Offer masks and understanding of
K/cumm will be able to tissues to individual
Lymphocytes Verbalize client/visitors causative/ risk
0.8 K/cumm understanding of who are factor of infection.
individual coughing/
causative/risk sneezing - Reduces risk of cross- -After 4 hours of
factor of infection. contamination. nursing intervention
- Provide for client is able to
isolation, as demonstrate life
Long term goa: indicated (e.g., style changes
wound/skin, promote safe
After 3-5 hours of respiratory, environment.
nursing reverse). Educate
intervention client staff in infection
will be able to control procedure
Demonstrate
techniques, - Perform/instruct
lifestyle changes to in daily mouth - at high-risk for
promote safe care. Include use nosocomial/healthcare
environment. of antiseptic associated infections
mouthwash for
individuals in
acute/long-term
care settings.