Presentation by:

Group 2 – BSN III B-3

Acierto, Dyvi Karen

T.
Catanyag, Hussein
E.
Ignacio, Karen G.
Palanca, Aries

Presented to:
Mr. Louise Cadiz,
R.N.

September 22, 2009

Tuesday, 8:00am –
9:30am
What is Tuberculosis?

Tuberculosis, or TB, is an infectious

bacterial disease caused by
Mycobacterium tuberculosis, which
most commonly affects the lungs.
II. Classifications:
Class Type Description
No history of exposure
No TB exposure
0 Negative reaction to
Not infected
tuberculin skin test
History of exposure
TB exposure
1 Negative reaction to
No evidence of infection
tuberculin skin test
Positive reaction to
tuberculin skin test
Negative bacteriologic
TB infection
2 studies (if done)
No disease
No clinical, bacteriologic,
or radiographic evidence
of TB
M. tuberculosis cultured
(if done)
3 TB, clinically active Clinical, bacteriologic, or
radiographic evidence of
current disease
 History of episode(s) of
TB
or
Abnormal but stable
radiographic findings
Positive reaction to the
TB
4 tuberculin skin test
Not clinically active
Negative bacteriologic
studies (if done)
and
No clinical or
radiographic evidence
of current disease

Diagnosis pending
TB disease should be
5 TB suspect
ruled in or out within 3
months
How is it Transmitted?
It is transmitted from person to person via droplets from
the throat and lungs of people with the active respiratory
disease.
Airborne droplet method through:

♥ coughing or sneezing.
♥ singing
Direct invasion through mucous membranes or
breaks in the skin.

M. Bovine TB result from exposure to TB cattle,

usually by ingestion of unpasteurized milk or
dairy products
III. Etiology:
Myobacterium tuberculosis
-pathogenic bacterial species in the genus
Mycobacterium
-causative agent of most cases of tuberculosis.
-Robert Koch (1882)

Mycobacterium bovis
-slow-growing aerobic bacterium(16-20 hour
generation time)
-causative agent of tuberculosis in cattle (known
as bovine TB).
Mycobacterium canetti
-a novel pathogenic taxon of the Mycobacterium
tuberculosis complex
-was described in 1997 by Dr. Van Soolingen
-the natural reservoir, host range, and mode of
transmission of the organism are still unknown.

Mycobacterium microti
-also known as the 'Vole bacillus‘
-is a genus that includes the vole (small rodent
resembling a mouse but with a stouter body, a
shorter hairy tail, a slightly rounder head, and
smaller ears and eyes)
IV. Risk Factors
Elderly
Young children
HIV
Diabetes Mellitus
Malnutrition
Alcoholism
Overcrowding
Coughing & Sneezing
Contaminated Milk
Exposure to someone with TB
V. Pathophysiology
VI. Clinical Manifestations:
What are the Signs and Symptoms?
History of TB exposure

Productive cough of 2 weeks or more,

Low-grade fever, especially in the afternoon

(low grade fever but could be as high as 39ºC and lasted for an
average of 14 to 21 days)

Night sweats

Weight loss
Anorexia

Fatigue

Dyspnea

Chest Pain

Rales – Crackles

Hemoptysis (late symptoms)

Pleuritic chest pain

What are the Diagnostic Tests?

Mantoux Tuberculin Skin Test

Chest X-Ray

Sputum Exams
Mantoux Tuberculin Skin Test:
 5 mm or more is positive in
 HIV-positive person
 Recent contacts of TB case
 Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
 Patients with organ transplants and other immunosuppressed patients
 10 mm or more is positive in
 Recent arrivals (less than 5 years) from high-prevalence countries
 Injection drug users
 Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals,
homeless shelters, etc.)
 Mycobacteriology lab personnel
 Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid
therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
 Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
 15 mm or more is positive in
 Persons with no known risk factors for TB
 (Note: Targeted skin testing programs should only be conducted among high-risk groups)
 A tuberculin test conversion is defined as an increase of 10 mm or more within a 2-year period, regardless of
age.
Chest X-Ray:
In active pulmonary TB, infiltrates or
consolidations and/or cavities are
often seen in the upper lungs
with or without mediastinal or
hilar lymphadenopathy or pleural
effusions ( tuberculous pleurisy).
However, lesions may appear
anywhere in the lungs.
Sputum Test:
smears and cultures should be done for acid-fast
bacilli if the patient is producing sputum. The
preferred method for this is fluorescence
microscopy(auramine-rhodamine staining)
VII. Treatment:
Medication
Treatment Regimen for Category I and II

Anti-TB Drugs No. of tablets per day No. of tablets per day
Intensive Phase Continuation Phase
(2 months) (4 months)
Isoniazid 1 1
Rifampicin 1 1
Pyrazinamide 2
Ethambutol 2
Treatment Regimen for Category III

ANTI-TB Drugs No. of tablets/vial per day No. of tablets

Intensive Phase per day
(3 months) Continuation
First 2 months 3rd month Phase
(5 months)

Isoniazid 1 1 1
Rifampicin 1 1 1
Pyrazinamide 2 2
*Ethambutol
56 vials for 2 months
2 2 2
Streptomycin 1 vial/day*
Side Effects of Anti-TB Drugs

Drug Side-Effect
Rifampicin Urine discoloration
Hepatotoxicity
Isoniazide Peripheral nueropathy (numbness)
Hepatotoxicity
Ethambutol Nephrotoxicity
Streptomycin Ototoxicity
 DOTS – “directly observed treatment, short-
course”
 proven to be the most successful and cost-effective treatment
strategy. The objectives of the DOTS strategy are to decrease the risk
of infection, reduce morbidity and the transmission of infection, and
prevent TB deaths. Achieving these objectives through the DOTS
strategy is simple:

 Identify TB cases in communities around the world, particularly those

in developing countries.
 Treat TB cases by directly observing their medication intake for 6 to 8
months. This is to ensure that medication is taken in the right
combination and appropriate dosage in an effort to prevent the
development of multidrug resistant TB.
IX. Precaution:
What are the predisposing factors?
Lowered resistance caused by:
over-crowded, poorly ventilated living
conditions
poor sanitation
malnutrition
debilitating disease
immunosuppressive condition
Virulence of organism
Length of exposure
Period of Communicability
Communicable as long as tubercle bacilli are present
in the sputum.

The degree of communicability depends upon:

the number of bacilli in the air
virulence of bacilli
environmental conditions like overcrowding
Susceptibility and Resistance
The most hazardous period of development of clinical
disease is the first 6-2 months after infection

The risk of developing the disease is highest in

children under 3 years old and among adolescence,
young adults and elderly.
X. Nursing Management
 Provide adequate rest
 Institute nutritionally adequate diet
 Follow standard adequate diet
 Initiate effective isolation for client with confirmed or
suspected infectious TB
 Teach client:
 about TB and transmission of m. tuberculosis
 Cover mouth and nose with tissue when coughing or
sneezing
Nursing Responsibilities
(Medication)
Ensure compliance !!!!
Take on empty stomach
Avoid alcohol
Eat foods high in Vitamin B6 (pork, organ meats,
whole wheat bread, potatoes, oatmeal, legumes,
bananas)
Monitor weight
 to wear surgical mask over mouth and nose
when transported out of isolation area
 the importance of completing the full course of
prescribed medication (often 6-24 months)
 not to travel on commercial airlines while infectious