📐LITERATURE REVIEW ON PULMONARY TUBERCULOSIS

Tuberculosis is a contagious infection that usually attacks the lungs, can also spread to other

parts of the body like the spine and brain. It is caused by bacteria known as mycobacterium

tuberculosis.

Types of Tuberculosis

(a) Pulmonary Tuberculosis; occurs when mycobacterium tuberculosis primarily attacks the

lungs. The bacteria is airborne that is highly contagious (Kumar & Bagga, 2015). Once the

bacterium has invaded the pulmonary system, it destroys pulmonary tissues. When early

diagnosed it is treatable.

(b)Extra-Pulmonary Tuberculosis

Types of Pulmonary Tuberculosis

Miliary tuberculosis- is disseminated TB “military” describes the appearance on chest x-ray of

every small nodules throughout the lungs that look like millet seeds. Occur shortly after primary

infection (Kumar & Bagga, 2015). May lead to chronic illness and slow decline.

Osteal tuberculosis- infection of any bone can occur but one of the most common sites is the

spine. Spinal infection can lead to compression fractures and deformity of the back.

Renal tuberculosis-can cause asymptomatic pyuria and spread to the reproductive organs and

affect reproduction. In men, epididymitis may occur.

Laryngeal tuberculosis-can infect larynx or the vocal cord area... It’s extremely infectious.

Tuberculosis pleurisy-usually develops after initial infection. A granuloma ruptures unto the

pleural space (Kumar & Bagga, 2015). Once the bacteria invade the space, the amount of fluid

increases dramatically and compresses the lung causing dyspnea and sharp chest pain that

worsens with deep breath.

Pulmonary tuberculosis pneumonia- uncommon type of TB presents as pneumonia and is very

infectious, patients with productive cough and high fever. Occurs in immunosuppressed people,

young children and elderly.

Causes of Pulmonary Tuberculosis

Mycobacterium Tuberculosis

Mycobacterium Africanus

Mycobacterium Avium

Mycobacterium Bovis

Risk Factors to Pulmonary Tuberculosis

Malnutrition.

Alcoholism.

Overcrowding.

Chronic renal failure

Organ transplant

Immunosuppressed people.

Mode of Transmission: Pulmonary Tuberculosis is transmitted form the infected person the

healthy person through inhalation of air droplets containing the tubercle bacilli.

Symptoms of Pulmonary Tuberculosis

Drenching night sweat.

Cough of any duration.

Unexplained weight loss.

Fever usually low grade with evening chills.

Chest pains and dyspnea.

Signs: varying degree of dyspnea, anemia, and low grade fever.

Pathophysiology of Pulmonary Tuberculosis

When a person gets exposed to the tubercle bacilli for the 1 st time, a primarily RB

infection results. Following inhalation of infective droplets of the tubercle bacilli, most are

deposited in the upper airway and are cleared by the ciliated mucosal cells. The bacilli are

usually deposited in the sub-pleural part of the lungs (Adigun & Singh, 2020). In the alveoli of

the lungs, the tubercle bacilli are ingested by non-specifically activated alveolar macrophages

and phagocytosis of bacilli sets up an inflammatory response involving monocytes, CD4+T

lymphocytes and the subsequently activated macrophages with specific activity against

mycobacterium tuberculosis.

Diagnosis of Pulmonary Tuberculosis

Chest x-ray – chest radiology in pulmonary tuberculosis typically shows apical fibrosis, there

may be cavitations, pleural effusion.

Full blood count – these may be lymphocytosis and anemia.

Culture using solid media such as Lowenstein Jensen media or liquid media.

Polymerase chain reaction – based tests for pulmonary tuberculosis using gene expert MTB/RIF.

Can also be used to test for rifampicin resistance.

Biopsy of various organs e.g. lymph node.

Liver function test to check for AST, ALT and bilirubin levels.

Prevention of Pulmonary Tuberculosis

Avoid overcrowding places

Avoid contact with chronically coughing individuals

Good ventilation

Vaccination of BCG vaccine in children

Good nutrition

Good social condition

Complications; bronchiectasis, fibro-thorax, respiratory failure, pneumothorax, and massive

hemoptysis

The reasons for administering anti-tubercular drugs to the positive patients are to:

To prevent relapse of the disease

To prevent the tuberculosis drug resistance cases

To prevent transmission of the disease

To prevent long term complications resulting from pulmonary tuberculosis

To cure patients

Categorization of Pulmonary Tuberculosis according to World Health Organization

Category 1: a newly diagnosed tuberculosis case

Category 2: re-treatment case of tuberculosis

Category 3: sputum smear negative, not seriously ill but with extra-pulmonary tuberculosis

Category 4: a multidrug resistance Tuberculosis

HOME VISITS

First Home Visit

I scheduled my first home visit on 15th November, in accordance to the effectiveness and
flexibility of my client. I made preparations as we had planned and I called Jacob to remind him
of our planned home visit.I was accompanied by my friend We boarded a matatu at the hospital
which took us to Kamuwongo market where we took a motorbike taking us to Jacobs’s place of
residenc. He offered us seats and we commenced our program with a word of prayer, and I
started teachings according to my lesson plan.ed). The family maintains a high cleanliness of the
house and the rooms are cleaned daily. It has four rooms which are all ventilated. All the rooms
are fully occupied by the family members. Each room is occupied by two people except the
sitting room which is shared by all family members. In each room there is a single bed which is
shared by two family members.

They get water from the nearby water vending kiosk supplied by KIMWASCO and sometimes
from the river. They also rely on rain water when it rains. They do farming as one their sources
of food. They foods like maize, sorghum, millet, beans and cow peas. When there is high to
moderate rainfall, they harvest at least five bags for category of the cereal planted. Their basic
diet is Ugali, Githeri and rice. They also buy food from the market during dry periods. They buy
food staffs like rice, flour, fruits and vegetables.
Within the homestead they have a pit latrine is located 200m away from the house. There is
also a dustbin where the deposit their waste e,g papers ,used containers and they are burned
after sometimes .This helps in keeping the compound clean and tidy. They clean their
compound on daily basis and this enables them to enhance cleanliness. They keep animals like
cows, goats and chicken. They have five cows, twenty goats and a number of chicken. They rely
on the animals to get milk, meat and eggs. They too sell the animal to get money for other uses.
The goats and cow grazes from the nearby forest and drinks from the nearby river while the
chicken are fed from home, they too hover around the compound for search of extra food, eg
insects like termites. The animal houses are located around 200m from the compound and this
prevents unnecessary interaction between the family members and the animals, this also helps
to prevent the transmission of animal diseases and spread of animal parasites to the family
members and above all keeping the compound clean as they don’t defecate around the home.

Their compound is always clean and tidy. There are many planted trees around the compound
from which they shelter during sunny season. There are also some fruits planted but they
haven’t yet matured e.g. mango and pawpaw.

Adults who lives in the Age and occupation State of health

house

1.JACOB NZAMA BUSINESS MAN ,48 YRS pulmonary tuberculosis

2.ROSE JACOB BUSINESS LADY, 44 YRS GOOD HEALTH

 CHILDREN’S NAME AND STATE OF HEALTH IMMUNIZATION
YEAR OF BIRTH

EMMANUEL KIMANZI (2008) Dental issues Fully immunized

CYPRIAN KINYWA (2012) Good health Fully immunized

EDNAH PEACE (2015) Lack of appetite Fully immunized

Occupation of the head of the Household-Jacob is a business man who owns a butchery. He
runs the butchery himself and he reports to be making profit which he uses to provide for his
family.
Main source of income: Their only main source of income is the butchery owned by the head
and the shop owned by the wife.
Other sources of income – they sell surplus of their food and some of kept animal to get
money. They sell the kept animals when they are in financial crisis or in an emergency. They
also get money from their three grown children who are already working.
Family history and background: Jacob got married to Rose in 1997 since then to 2015 they
were blessed with six children (four girls and two boys). The first born is a girl who is already
working as well as second and third born. They got their children as

1 born -1998/6/16
st

2 born -2002/2/3
nd

3 born 2005/3/20
rd

4 born 2008/12/28
th

5 born 2012/12/28
th

6 born 2015/6/26
th

The last three children are all schooling (primary level). All the children were fully immunized
according to KEPI guidelines. The fourth born has dental problems at sometimes and they have
been seeking medical advises. He also reports some mild headache which sometimes does not
have relieving factors. They presented a card to indicate that they have been taking him to
hospital.

Student’s assessment of the family Advice given/action taken

I assessed the family members and there I advised the parent to take him to the
were some issues which were stressing them. dentist for review and further management. I
advised the Emmanuel to be brushing his
The first born son has dental issues whereby
with toothpaste at least two times a day and
the gums bleads easily and with no reason.
not vigorously so as to prevent brushing the
The gums may sometimes inflammate and
gum. I also advised the parents to be getting
others form pus.
him a new toothbrush every month so as to
prevent further infection and to ensure
effective cleaning of the teeth.
I advised them to see dentist as soon as the
issue arise.

On assessing their source of water for I advised them to be boiling the drinking
domestic use I noticed that sometimes the water and keep it in a clean Jerican and at
water used for drinking was not healthy safe and accessible place. I boiled some
/clean. water for them as I show them how to do it.

There is history of lack of appetite among the
family members generally including the
family.
The family has been taking fairly a balanced
diet from the response of the questionnaires
I administered concerning their diet.
I advised them to eat available fruits and
vegetables which will help them in gaining
the appetite. I also advised them if the
problem persist, they should seek medical
assistance.
I explained to the family the importance of
taking a well-balanced diet which are not
limited to boosting of body immunity.