PULMONARY TUBERCULOSIS

PRESENTED BY:
MIS.M.K.KAKU
NURSING TUTOR
 INTRODUCTION
• Pulmonary tuberculosis is a contagious
bacterial infection that mainly involves the
lungs and may spread to the other organs.
• Pulmonary tuberculosis is caused by a
Mycobacterium Tuberculosis.
• Person can get TB by breathing in the air
droplets from a cough or sneeze of an infected
person.
 CAUSES OF TUBERCULOSIS
• The cause is linked to the Mycobacterium
tuberculosis.
 Close contact with someone who have active
TB.
 Immunocompromised status such as...
o Patient with HIV infection
o Cancer
o Prolonged high dose of steroidal therapy
 Substance abuse: Alcolholism,Iv drug abuse,
Cocain
 Pre-existing medical conditions such as....
o Diabetes mellitus
o Chronic renal failure
o Leukaemia
 Migration to the areas where the TB is
pandemic
 Overcrowding
 due to Poverty and Low socioeconomic status
 Malnutrition
 Children under the 15 years of age
 TRANSMISSION
• TB is spread through the air from the one
person to another.
• Tuberculosis is spread by the airborne droplet
nuclei which are 1-5 micrometer particles
containing 1 to 400 bacilli each.
• They are expelled in the air by coughing,
sneezing, talking and remain suspended in the
air for many hours.
• People nearby may breathe in this air with
these bacteria and become infected.
 PHASES OF TB
1. Active phase: This phase is when the bacteria
are dormant in the body. At these stage they
multiplying and spreading in the body casing the
tissue damage. Person with TB in these phase
can spread the infection to nearby people.
2. Latent Phase: This phase is when a infected
person has a bacteria within the body but are in
control of immune system and do not cause
symptoms. At these phase infection cannot
spread to nearby people.
 PATHOPHYSIOLOGY
• A susceptible person get infected by Inhalation
of TB bacteria.
• The bacteria transmitted through the airway to
the alveoli.
• Here they deposited and begin to multiply.
• Inflammatory reaction is initiated by body’s
immune system.
• Phagocytes engulf many bacteria and TB specific
bacteria destroy the bacilli and normal tissue.
• Accumulation of exudates in the affected part.
• At one phase the cell - mediated immunity
becomes active and bacterias are surrounded
by macrophages and they become inactivated
and cant spread to other tissue and organs .
This is called granuloma formation.
• After some time, caseous necrosis of these
area occur which contains cheese like
necrosed material. These areas are known as
GHON FOCUS.
• At this time bacteria are in control of
body’s immune system.
• If patient becomes immunocompromised
these bacteria becomes uncontrolled &
can spread to other tissue of the lung
and more necrosis occur and cavities
occur.
• This allows the bacteria to spread to
other organs known as extra pulmonary
tuberculosis
 SIGN & SYMPTOMS
• Usually people show symptoms of
tuberculosis when they have active phase of
disease.
• Early symptoms includes:
 Fever
 Chills
 Loss of appetite
 Cough lasts for 3 weeks or more
 Mucoid sputum
 Breathing difficulty
 Wight loss
 Unusual breath sounds
 Chest pain
 Clubbing of fingers
 Enlarged lymph nodes
 Fatigue and weakness
 Other symptoms are appear in case of extra
pulmonary TB.
 DIAGNOSIS
• History and physical examination
• Chest X- ray
• Tubercullin skin test (Mantoux test)
• Sputum culture test for acid fast bacilli
• QuantiFERON - TB test
• CB-NAAT ( Cartridge Based Nucleic Acid
Amplification test) to check resistance
 MANAGEMENT
• The goal of treatment is to cure the infection
with drugs that fight with bacteria.
• TB treatment involves combination of many
drugs for prolonged to eradicate the bacteria and
prevention of relapse.
• First line drugs:
1. Isoniazid
2. Refampicin
3. Pyrezinamide
4. Ethambutol
• Treatment is divided into initial phase and
continuation phase
• Second line drugs: If TB bacteria becomes resistant to
first line drugs the second line drugs are used such as,
1. Quinolones
2. Bedaquiline
3. Clofazymin
4. Ethionamide
5. Linezolid
6. Cycloserine
 These drugs are used in different regimens.
 NURSING MANAGEMENT
• Assessment of vitals.
• Administer Oxygen therapy.
• Administer medications prescribed.
• Encourage patient for early ambulation if
possible which enables mobilization of
secretions.
• Teach the patient breathing exercises, it
promotes relaxation and increase CO2
excretion.
• Encourage patient for cough.
• Encourage patient for adequate hydration.
• Encourage or provide mouth care after
coughing and for personal hygiene which
increases the sense of well being.
• Aware patient for all the measures for
prevention of TB to other people.
• Provide diet education and encourage for
taking treatment regularly until the corse
complete.
• Provide psychological support and reduce
anxiety of patient.