Askep TB Paru: Ns. Nury Sukraeny, S.Kep., MNS

Ns. NURY SUKRAENY, MNS.
Faculty of Nursing and Health Science

University of Muhammadiyah Semarang
Askep TB Paru
Ns. Nury Sukraeny, S.Kep., MNS.

Definition
• An infectious disease that primarily affects the lung
parenchyma. It also may be transmitted to other
parts of the body, including the meningen, kidneys,
bones, and lymph nodes.
• A chronic infection of the lung, is caused by a
mycobacterium that results in the development of
tubercles in the lungs.
• Tubercles are nodules or swelling of lymphocytes
and epithelioid cells that form the lesions seen in TB.
Incidence
• In 2013, an estimated 9.0 million people developed
TB and 1.5 million died from the disease (1.1 million
among HIV-negative people and 0.4 million among
HIV-positive people).
• Among these deaths there were an estimated 210
000 from MDR-TB, a relatively high total compared
with 480 000 incident cases of MDR-TB.
• An estimated 1.1 million (13%) of the 9 million
people who developed TB in 2013 were HIV-positive.
WHO, 2014
Incidence
• About 60% of TB cases and deaths occur
among men, but the burden of disease among
women is also high.
• In 2013, an estimated 510 000 women died as
a result of TB, more than one third of whom
were HIV-positive.
• There were 80 000 deaths from TB among
HIV-negative children in the same year.
WHO, 2014
Incidence
• The South-East Asia and Western Pacific Regions
collectively accounted for 56% of the world’s TB
cases in 2013.
• The African Region had approximately one quarter
of the world’s cases, and the highest rates of cases
and deaths relative to population (280 incident
cases per 100 000 on average, more than double
the global average of 126).
• India and China had the largest number of cases
(24% and 11% of the global total, respectively).
WHO, 2014
Incidence
• In 2015, there were an estimated 10.4 million
new (incident) TB cases worldwide, of which
5.9 million (56%) were among men, 3.5 million
(34%) among women and 1.0 million (10%)
among children. People living with HIV
accounted for 1.2 million (11%) of all new TB
cases.
(WHO, 2016)
Incidence
• Six countries accounted for 60% of the new cases: India,
Indonesia, China, Nigeria, Pakistan and South Africa.
• Global progress depends on major advances in TB
prevention and care in these countries.
• Worldwide, the rate of decline in TB incidence remained
at only 1.5% from 2014 to 2015.
• This needs to accelerate to a 4–5% annual decline by
2020 to reach the first milestones of the End TB Strategy.
(WHO, 2016)
PATHOPHYSIOLOGY
• Mycobacterium tuberculosis gain entrance to the body through
droplets, which are inhaled into the alveoli.
• Macrophages are unable to successfully kill the mycobacterium
organism but they can develop giant cells to enclose the organism.
T-lymphocytes work with the macrophages to form granulomas
(masses of inflamed granulation tissue) that may kill the
mycobacterium.
• The residual effect of the primary infection usually is a hard calcified
lesion known as a Ghon complex. Latent tuberculosis infection
(present or potential disease that is currently not active) is
discovered when a person exposed to the mycobacterium has a
positive PPD test. This person is without an active clinical picture of
disease and with a normal CXR. This person has a 10% chance of
developing TB if preventive pharmacological treatment is not
initiated. Because treatment regimens have 60–90% effectiveness,
the chances of acquiring active TB is low in healthy individuals.
• Upon exposure it typically takes six to eight weeks to
convert to a positive PPD.
• Extrapulmonary TB can occur in patients with HIV
infection.
• In extrapulmonary TB the mycobacterium is able to
move from the lung to other body organs, causing
disease.
• Extrapulmonary TB disease usually appears in an
isolated organ system, but pulmonary and
extrapulmonary TB may exist simultaneously.
• CT scans, chest X-ray (CXR), sputum culture,
bloodwork, and aspiration of nodules may be required
to diagnose extrapulmonary TB (Rockwood, 2007).
• Most people acquiring new infection achieve immunological
control and develop a latent TB infection.
• Secondary TB disease can present years after exposure when
resistance is lowered.
• Occurrence of active disease is most often noticed in the first
two to three years after infection.
• Patients present to the health care system with flu-like
symptoms and believe they have a respiratory tract infection
when in fact they have been infecting individuals with the
Mycobacterium bacteria.
• There are a wide variety of pathological conditions that may
increase the development of active TB from latent TB, such
as HIV, substance abuse, recent infection of TB, diabetes
mellitus (DM), prolonged corticosteroid therapy, cancer of
the head and neck, and end-stage renal disease (ESRD).
Table 32-3 identifies common extrapulmonary TB
infection sites and clinical presentations.
CLINICAL University of Muhammadiyah Semarang
MANIFESTATIONS
• TB presents a broad clinical picture from absence of
illness to end-stage disease. In the absence of clinical
symptoms the illness is rarely infectious. However, TB
should be suspected in a patient who presents with two
or more weeks of cough, fever, or weight loss who is
known to have TB infection or is at risk for developing
the disease. Weight loss over three pounds per week is
considered significant because healthy weight loss is one
to two pounds per week. Night sweats, weakness, and
chills may be present with progressive disease and
hemoptysis.
• Presenting symptoms of TB in adults are often

vague and consist of a cough over three weeks
duration, pleuritic chest pain, hemoptysis,
fatigue, malaise, anorexia, night sweats, and
periodic fevers.
• Symptoms of extrapulmonary disease depend
on the site affected. As with pneumonia a
thorough clinical history must be completed.
DIAGNOSTIC TESTS
• Tuberculin skin tests, using the Mantoux method, are used to
evaluate the existence of infection or disease.
• A small amount of tuberculin is injected directly under the skin,
and the size of the induration is evaluated at 48 to 72 hours.
• Results are based on the amount of induration at the site and are
reported as significant. A 5 mm induration suggests the following:
recent contact, an immunocompromised person, and an
abnormal CXR. The patient may have a positive reaction to the TB
test if he or she: (a) has been exposed to the Mycobacterium
tuberculosis, (b) had TB previously that has been successfully
treated, (c) has been immunized for TB with the BCG vaccine, or
(d) is sick with TB.
• CXR and sputum for smear and culture are

other diagnostic tests for TB. Sputum for
smear and culture must be collected on three
different days to increase the chances of
identifying the mycobacterium. If the sputum
is collected at home, the specimen must be
kept refrigerated to avoid further
antimicrobial growth.
Xpert MTB/RIF
• In October 2013, WHO released a Policy
Update on Xpert MTB/RIF which expands the
recommended use of Xpert MTB/RIF to include
the diagnosis of TB in children and some forms
of extrapulmonary TB.
• The guidance also includes an additional
recommendation about the use of Xpert
MTB/RIF as the initial diagnostic test in all
individuals suspected of having pulmonary TB.
• The Xpert MTB/RIF assay remains the only fully automated

cartridge-based real-time DNA-based test that can detect
both TB and resistance to rifampicin in less than 2 hours,
and it is the the only mature technology representing a
new generation of automated platforms for molecular
diagnosis.
• Xpert MTB/RIF is an automated polymerase chain reaction
(PCR) test (that is, a molecular test) utilizing the GeneXpert
platform (Cepheid, Sunnyvale, CA, United States). Xpert
MTB/RIF is a single test that can detect both
Mycobacterium tuberculosis complex and rifampicin
resistance within 2 hours after starting the assay, with
minimal hands-on technical time (Figure 1).
Medical Management
• Most clients are treated briefly in the hospital, with long-term
treatment continuing at home.
• In the hospital, follow Airborne Precautions in addition to
Standard Precautions.
• The precautions include placing the client in an isolation room
with negative air pressure. (Air inflow is controlled through one
vent and air outflow is exhausted through another vent directly
to the outside and is not recirculated to other rooms.)
• The doors and windows of the client’s room must be kept closed
to maintain control of airflow. Caregivers should wear N95
particulate respirator masks because standard isolation masks do
not prevent Mycobacterium tuberculosis from passing through
WHO’s new End TB Strategy

• On May 19, 2014, the 67th World Health
Assembly (WHA) adopted WHO’s “Global
strategy and targets for tuberculosis
prevention, care and control after 2015”.
• This post-2015 global tuberculosis strategy,
labelled the End TB Strategy,
• The new strategy aims to address these

barriers by eliciting a strong, systemic
response to end the tuberculosis epidemic
drawing on the opportunities of the post-2015
development agenda especially those related
to achievement of universal health coverage
and social protection
NURSING DIAGNOSES
• Ineffective airway clearance related to the
inability to remove airway secretions
• Impaired gas exchange related to the active
inflammatory process
• Activity intolerance related to increased
metabolic demands
• Imbalanced nutrition, less than body
requirements, related to increased caloric
requirements

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Ns. NURY SUKRAENY, MNS.

Faculty of Nursing and Health Science

Ns. Nury Sukraeny, S.Kep., MNS.

• Presenting symptoms of TB in adults are often

• CXR and sputum for smear and culture are

• The Xpert MTB/RIF assay remains the only fully automated

WHO’s new End TB Strategy

• The new strategy aims to address these

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