EXTRAPULMONARY
TUBERCULOSIS
CONTENTS
01 02 03
Anatomical structure of
Description Etiology/Causes
the affected parts
04 05 06
Pathophysiologic process Diagnostic & Laboratory
Signs and Symtomps
of the disease Tests
07 08 09
Nursing Management/
Medical Management Surgical Management
Interventions
a. Drugs a. surgery if any
WHAT IS EXTRAPULMONAR
TUBERCULOSIS?
Over the last decades, extrapulmonary locations of the disease have become more
frequent. This is thought to be due to the increased prevalence of acquired
immune deficiency syndrome and the increased number of organ transplants.
Although extrapulmonary tuberculosis (EPTB) is less frequent than PTB and is a
secondary target for national TB control programs, its significance has increased
worldwide during the HIV epidemic.
Meningeal tuberculosis
(TB meningitis)
• Meningitis frequently manifests in the absence of
infection in other extrapulmonary locations.
• It is common in children (below four years of age) and
immunosuppressed individuals such as those with human
immunodeficiency virus (HIV) infection and can occur
with or without an associated PTB.
Lymphadenitis
(Scrofula)
• Scrofula is a medical disorder characterized by
extrapulmonary manifestations of TB infection induced
by the causative bacterium.
• Doctors also call scrofula as “cervical tuberculous
lymphadenitis”
• Scrofula is the most common form of tuberculosis
infection that occurs outside the lungs.
• Historically, scrofula was called the “king’s evil.”
Tuberculosis
Pleurisy
• Tuberculous pleural effusion is the second most common
form of extrapulmonary tuberculosis (TB) (after
lymphatic involvement) and is the most common cause
of pleural effusion in areas where TB is endemic
• Rare in children 2–12 years old and is commonly found in
adolescents 12–16 years old and adults
• Higher frequency in patients having HIV with TB
Miliary Tuberculosis
• Miliary TB, also known as generalized hematogenous TB, develops when a
tuberculous lesion erodes into a blood artery, dispersing millions of tubercle
bacilli throughout the body and into the blood. When a latent focus is reactivated
or during primary infection, significant uncontrolled dissemination is possible.
Miliary TB is most common among:
• Children < 4 years old
• Immunocompromised people
• Older people
.
• Miliary TB got its name in 1700 from JOHN JACOB MANGET based on how it
appears on autopsy findings.
Bone and Joint Infection (Pott’s Disease)
• Pott’s disease is characterized by softening and
collapse of the vertebrae, often resulting in a
hunchback curvature of the spine.
• This type of tuberculosis is more common in
underdeveloped countries. It accounts for 2.2% to
4.7% of the total tuberculosis cases in Europe and
the U.S.
Gastrointestinal Tuberculosis
• It is secondary to haematogenous or lymphatic
spread but also may result from swallowed
bronchial secretions or direct spread from local
sites, such as lymph nodes or fallopian tubes.
• The ileocecal region is the most commonly
affected site.
Genitourinary Tuberculosis
• Genitourinary tuberculosis (GUTB) makes up to 20% of
all EPTB. .
• . The disease usually manifests as a secondary infection
in the bladder and ureter following kidneys, with
extensive calcification of affected organs.
• Genital TB can affect many male genital tract organs.
However, ovaries, endometrium, and peritoneum can
also be affected, and symptoms are mistaken for
menstrual irregularity, abdominal pain, pelvic
inflammatory disease, and even infertility
Etiology/Causes
What causes Meningeal tuberculosis
(TB meningitis)?
• Tuberculous meningitis (TBM) is caused by the seeding
of the meninges with the bacilli of Mycobacterium
tuberculosis (MTB) and is characterized by inflammation
of the membranes (meninges) around the brain or spinal
cord
• Tuberculosis bacteria enter the body by droplet inhalation
i.e. breathing in bacteria from the coughing/sneezing of an
infected person.
What causes Lymphadenitis
(Scrofula)
• The major cause of scrofula in the immunocompromised
patients is Mycobacterium tuberculosis (95%), and
atypical and nontuberculous mycobacteria cause the rest
(5%).
What causes
Tuberculosis
Pleurisy?
• Development of tuberculous pleural effusion may occur as
a result of delayed hypersensitivity reaction to
mycobacteria or mycobacterial antigens in the pleural
space in sensitized individuals or by rupture of a
subpleural focus of pulmonary disease into the pleural
space
What causes miliary TB?
• Miliary TB is due to
lymphohaematogenous spread of
M. tuberculosis, during primary
infection or reactivation.
What causes bone and joint infection (Pott’s
Disease)?
• Skeletal tuberculosis can also be caused by
pulmonary tuberculosis. Mycobacteria can easily
spread from your lungs to your bones, spine, or
joints through blood vessels. This can affect your
long bones or spinal vertebrae.
.
What causes Gastrointestinal Disease?
Infection of GIT by mycobacteria can occur in five ways:
• Sputum ingestion by a patient with active pulmonary
disease from Mycobacterium tuberculosis
• Hematogenous spread from a distant focus
• Lymphatic spread through infected nodes
• Direct extension from a contiguous site
• Ingestion of milk products infected with Mycobacterium
bovis – particularly seen with consumption of raw milk
.
What causes Genitourinary Tuberculosis?
• GUTB occurs by hematogenous spread of bacilli from
the primary disease sites such as the lung and
reactivation of LTBI due to immunosuppression.
• GUTB can be sexually transmitted until treatment clears
mycobacteria from semen, urine, or other genital
secretions.
03
ANATOMICAL STRUCTURE OF
THE AFFECTED PARTS
Central Nervous System
The nervous system detects external and internal stimuli
(sensory input), processes and responds to sensory input
(integration), controls body movements through skeletal
muscles, maintains homeostasis by regulating other systems,
and is the center for mental activities.
The CNS consists of the brain and the spinal cord. The brain
is housed within the skull and the spinal cord is housed
within the vertebral canal of the vertebral column. The brain
and spinal cord are continuous with each other, transitioning
from the brain to the spinal cord at the foramen magnum of
the skull.
Brain
The brain is the part of the central nervous system (CNS)
that is contained within the cranial cavity. The four
divisions of the brain are the
(1) brainstem,
(2) cerebellum,
(3) diencephalon, and
(4) cerebrum.
Meninges
The meninges are connective tissue membranes that
surround and protect the brain and spinal cord. The
three meningeal membranes are the (1) dura mater, (2)
arachnoid mater and (3) pia mater. The most superficial
and thickest membrane is the dura mater (doo′ră mā′ter;
tough mother), which is composed of dense irregular
connective tissue.
Spinal Cord
The spinal cord is the major communication link
between the brain and the PNS inferior to the head.
It integrates incoming information and produces
responses through reflex mechanisms.
Meninges of the Spinal Cord
The meninges are connective tissue membranes
that surround the spinal cord and brain. There
are three layers that compose the meninges,
which lie between the bone and the spinal cord
or brain.
three main functions:
• Fluid balance
• Lipid absorption
• Defense
Lymph nodes are round, oval, or bean-shaped
Lymphatic Vessels
bodies distributed along the various lymphatic
vessels. They filter lymph, which enters and exits The lymphatic vessels are essential for the
the lymph nodes through the lymphatic vessels. maintenance of fluid balance. Lymphatic
The lymph nodes are connected in a series, so that vessels originate as small, dead-end tubes
lymph leaving one lymph node is carried to another called lymphatic capillaries.
lymph node, and so on.
The lymphatic trunks either connect to large
veins in the thorax or join to yet larger vessels
called lymphatic ducts, which then connect to
the large veins
Respiratory System
The respiratory system exchanges these gases
between the air and the blood, and the
cardiovascular system transports them
between the lungs and the body cells. Without
healthy respiratory and cardiovascular
systems, the capacity to carry out normal
activity is reduced.
Lungs
The thoracic cavity contains two lungs. The lungs are divided into lobes,
bronchopulmonary segments, and lobules.
Pleura
The pleural membranes surround the lungs and protect against friction.
• Visceral pleura covers the surface of the lungs.
• Pleural cavity is filled with pleural fluid, which is
produced by the pleural membranes.
• Parietal pleura covers the inner thoracic wall, the
superior surface of the diaphragm, and the
mediastinum.
Blood Supply Lymphatic Supply
Deoxygenated blood is transported to the lungs through the The lungs have two lymphatic supplies. The superficial lymphatic vessels
pulmonary arteries, and oxygenated blood leaves through the are deep to the visceral pleura; they drain lymph from the superficial lung
pulmonary veins. Oxygenated blood is mixed with a small tissue and the visceral pleura. The deep lymphatic vessels follow the
amount of deoxygenated blood from the bronchi. bronchi; they drain lymph from the bronchi and associated connective
tissues.
Skeletal System
The skeletal system is the framework that helps maintain the
body’s shape and enables us to move normally. Muscles and
bones work together to move our bodies. When the muscles
contract, they pull on the bones, often with considerable force.
Axial Skeleton:
The axial skeleton forms the central axis of the body. It
protects the brain, the spinal cord, and the vital organs housed
within the thorax.
Appendicular Skeleton:
The appendicular skeleton consists of the upper and lower
limbs and the girdles that attach the limbs to the body.
Vertebral Column
The vertebral column performs five major functions:
(1) It supports the weight of the head and trunk,
(2) It protects the spinal cord,
(3) It allows spinal nerves to exit the spinal cord,
(4) It provides a site for muscle attachment, and
(5) It permits movement of the head and trunk.
Cardiovascular System The circulatory system has five unique functions:
• The heart 1. Carries blood. Blood vessels carry blood from the
• Blood vessels heart to almost all the body tissues and back to the
heart.
2. Exchanges nutrients, waste products, and gases
with tissues. Nutrients and oxygen diffuse from blood
vessels to cells in all areas of the body. Waste
products and carbon dioxide diffuse from the cells,
where they are produced, to blood vessels.
3. Transports substances. Hormones, components of
the immune system, molecules required for
coagulation, enzymes, nutrients, gases, waste
products, and other substances are transported in the
blood to all areas of the body.
4. Helps regulate blood pressure. The circulatory
system and the heart work together to maintain blood
pressure within a normal range of values.
5. Directs blood flow to tissues. The circulatory
system directs blood to tissues when increased blood
flow is required to maintain homeostasis.
Functions of the Heart
1. Generating blood pressure. Contractions of the
heart generate blood pressure, which is responsible
for moving blood through the blood vessels.
2. Routing blood. The heart separates the pulmonary
and systemic circulations and ensures better
oxygenation of the blood flowing to the tissues.
3. Ensuring one-way blood flow. The valves of the
heart ensure a one-way flow of blood through the
heart and blood vessels.
4. Regulating blood supply. The rate and force of
heart contractions change to meet the metabolic
needs of the tissues, which vary depending on such
conditions as rest, exercise, and changes in body
position
Pericardium
The pericardium, or pericardial sac, is a double-layered, closed sac
that surrounds the heart.
The fibrous pericardium is a tough, fibrous connective tissue layer
that prevents overdistension of the heart and anchors it within the
mediastinum.
The part of the serous pericardium lining the fibrous pericardium is
the parietal pericardium, and the part covering the heart surface is
the visceral pericardium, or epicardium. The parietal and visceral
portions of the serous pericardium are continuous with each other
where the great vessels enter or leave the heart.
The circulatory system has five unique functions:
1. Carries blood. Blood vessels carry blood from the heart
to almost all the body tissues and back to the heart.
2. Exchanges nutrients, waste products, and gases with
tissues. Nutrients and oxygen diffuse from blood vessels to
cells in all areas of the body. Waste products and carbon
dioxide diffuse from the cells, where they are produced, to
blood vessels.
3. Transports substances. Hormones, components of the
immune system, molecules required for coagulation,
enzymes, nutrients, gases, waste products, and other
substances are transported in the blood to all areas of the
body.
4. Helps regulate blood pressure. The circulatory system
and the heart work together to maintain blood pressure
within a normal range of values.
5. Directs blood flow to tissues. The circulatory system
directs blood to tissues when increased blood flow is
required to maintain homeostasis.
Blood vessels are hollow tubes that conduct blood through the tissues of the body. The
three main types of blood vessels are arteries, capillaries, and veins.
Arteries carry blood away from the heart. Although the arteries form a continuum from the
largest to the smallest branches,
• Aorta
All arteries of the systemic circulation are derived either directly or indirectly from the
aorta (ā-ōr′tă), which is usually divided into three general parts: (1) the ascending aorta, (2)
the aortic arch, and (3) the descending aorta. The descending aorta is divided further into a
thoracic aorta and an abdominal aorta
Blood flows from arterioles into capillaries, the most common blood vessel type. Capillary
walls are the thinnest of all the blood vessels. Most of the exchange that occurs between
the blood and interstitial spaces occurs across the thin walls of capillaries.
From the capillaries, blood flows into veins, vessels that carry blood toward the heart.
When compared with arteries, the walls of the veins are thinner and contain less elastic
tissue and fewer smooth muscle cells. As the blood returns to the heart, it flows through
veins with thicker walls and greater diameters.
Digestive System
Ingestion is the intake of solid or liquid food into the stomach.
Mastication is the process by which the teeth chew food in the
mouth.
Propulsion is the movement of food from one end of the digestive
tract to the other.
Mixing. Some contractions do not propel food from one end of the
digestive tract to the other but, rather, move it back and forth within
the digestive tract to mix it with digestive secretions and help break
it into smaller pieces.
Secretion. As food moves through the digestive tract, secretions are
added to lubricate, liquefy, buffer, and digest the food. The mucus,
secreted along the entire digestive tract, lubricates the food and the
lining of the tract.
Digestion is the breakdown of large organic molecules into their
component parts.
Absorption is the movement of molecules out of the digestive tract
and into the blood or into the lymphatic system.
Elimination is the process by which the waste products of digestion
are removed from the body.
Small intestine
Propulsion and Mixing. Segmental contractions mix the chyme, and peristaltic
contractions move the chyme into the large intestine
Absorption. The circular folds, villi, and microvilli increase surface area. Most
nutrients are actively or passively absorbed. Most of the ingested water or the
water in digestive tract secretions is absorbed.
Large intestine
Propulsion and Mixing. Slight segmental mixing occurs. Mass movements propel
feces toward the anus, and defecation eliminates the feces.
Ileocecal valve/junction. The site where the ileum connects to the large intestine
is the ileocecal junction. It has a ring of smooth muscle, the ileocecal sphincter,
and a one-way ileocecal valve. Together, the sphincter and valve allow intestinal
contents to move from the ileum to the large intestine,
Urinary System
The urinary system is the major excretory system
of the body. Some organs in other systems also
eliminate wastes, but are not able to fully
compensate in case of kidney failure. The urinary
system consists of two kidneys, the primary
excretory organs.
The kidneys, filter a large volume of blood. Wastes
from the blood are collected and form urine. Urine
consists of (1) excess water; (2) excess ions; (3)
metabolic wastes, including the protein by-product,
urea; and (4) toxic substances.
In addition to their role as excretory organs, the
kidneys are important for many other important
metabolic activities.
Structure of a Nephron
The nephron is the histological and functional
unit of the kidney. There are four separate
regions of a nephron. These four regions
include:
(1) a renal corpuscle,
(2) a proximal convoluted tubule,
(3) a loop of Henle, and
(4) a distal convoluted tubule.
The Renal Corpuscle - The
filtration portion of the nephron is
housed in the renal corpuscle. In
the renal corpuscle, there is a
network of capillaries twisted
around each other like a ball of
yarn called the glomerulus
Ureters
The ureters are tubes through which urine
flows from the kidneys to the urinary
bladder. The ureters extend inferiorly and
medially from the renal pelvis and exit the
kidney at the renal hilum. The ureters
descend through the abdominal cavity and
enter the urinary bladder
PATHOPHYSIOLOGY
EXTRAPULMONARY
TUBERCULOSIS
occurs as result of contiguous spread of
tubercle organisms to adjoining structures,
such as pleura or pericardium, or by
lymphohaematogenous spread during
primary or chronic infection
PREDISPOSING FACTORS PRECIPITATING FACTORS
Age: HIV / AIDS
Children below 14 years old Chemotherapy
Adults more than 65 years old Malnutrition
Diabetes
Immunosuppressive medications
Lymphohaematogenous spread
Meningeal Tuberculosis
Lymphadenitis
Tuberculosis Pleurisy
Miliary Tuberculosis
Gastrointestinal Tuberculosis
Pott’s Disease
DIAGNOSTIC/
LABORATORY TEST
▪️C hest X-Ray
▪️M ycobacterial Culture
️️Tuberculin Skin Test
▪️B iopsy
SIGNS AND SYMPTOMS
Meningeal tb Genitourinary Tuberculosis
• Fever and chills. • increased frequency urination
• Mental status changes • dysuria
• Nausea and vomiting. • Suprabic pain
• Sensitivity to light (photophobia) • Hematuria
• Severe headache. • Fever
• Stiff neck (meningismus)
Scrofula Tuberculosis
Tuberculosis Pleurisy • Fevers (rare)
• nonproductive cough • Painless swelling of lymp nodes in
• chest pain the neck and other areas of the body
• Sores (rare)
• Sweating
SIGNS AND SYMPTOMS
Miliary Tuberculosis
• fever and chills
• weakness
• weight loss Gastrointestinal tb
• general discomfort • weight loss
• Abdominal pain
• Fever
• Night sweat
Spinal Tuberculosis or Potts • Anemia
Disease
• backpain
• Tenderness
• Scoliosis
PHARMACOLOGY
RIFAMPICIN Generic Name
CLASSIFICATION INDICATIONS
Anti microbial • indicated for the treatment of tuberculosis and tuberculosis-related
mycobacterial infections.
• Combined with pyrazinamide and isoniazid, it is used in the initial phase
PREGNANCY CATEGORY of the short-course treatment of pulmonary tuberculosis.
C
MECHANISIM OF ACTION CONTRAINDICATIONS
Inhibits RNA synthesis by blocking RNA transcription in susceptible
Hypersensitivity to drug or other rifamycin derivatives
organisms (mycobacteria and some gram-positive and gram-negative
bacteria).
DOSAGE
Adults:
600 mg P.O. or I.V. infusion b.i.d. for 2 days
Children ages 1 month and older:
10 mg/kg/day P.O. or I.V. infusion (up to 600 mg/day) q 12 hours for 2 days
Infants younger than 1-month-old:
5 mg/kg P.O. or I.V. infusion q 12 hours for 2 days
CNS
ataxia, confusion, drowsiness, fatigue,
EENT headache, asthenia, psychosis,
conjunctivitis; discolored tears, saliva, generalized numbness
and sputum
GI
Hepatic nausea, vomiting, diarrhea, abdominal
jaundice cramps, dyspepsia, epigastric distress,
flatulence, discolored feces, anorexia,
sore mouth, and tongue,
GU pseudomembranous colitis
discolored urine
Metabolic Respiratory
hyperuricemia dyspnea, wheezing
Musculoskeletal Hematologic
myalgia, joint pain eosinophilia, transient leukopenia,
hemolytic anemia, hemolysis,
disseminated intravascular coagulation
(DIC), thrombocytopenia
Skin
flushing, rash, pruritus, discolored
sweat, erythema multiforme, toxic
epidermal necrolysis, stevens-johnson Other
syndrome flulike symptoms, hypersensitivity
reactions including vasculitis
ISONIAZID Generic Name
CLASSIFICATION INDICATIONS
Antitubercular • the treatment of all forms of tuberculosis in which organisms are
susceptible.
• used in combination with rifampin and pyrazinamide
PREGNANCY CATEGORY
C
CONTRAINDICATIONS
MECHANISIM OF ACTION • Hypersensitivity to drug
Inhibits cell-wall biosynthesis by interfering with lipid and nucleic acid • Acute hepatic disease or previous hepatitis caused by isoniazid therapy
DNA synthesis in tubercle bacilli cells
DOSAGE
Adults:
5 mg/kg P.O. or I.M. (maximum of 300 mg/day) daily as a single dose, or 15
mg/kg (maximum of 900 mg/day) two to three times weekly; given with
other agents
Children:
10 to 15 mg/kg P.O. or I.M. (maximum of 300 mg/day) daily as a single
dose, or 20 to 40 mg/kg (maximum of 900 mg/day) two to three times
weekly
CNS
peripheral neuropathy, dizziness,
EENT memory impairment, slurred speech,
visual disturbances psychosis, toxic encephalopathy,
seizures
GI
nausea, vomiting
Hepatic
hepatitis
Respiratory
dyspnea
GU
gynecomastia
Hematologic
eosinophilia, methemoglobinemia,
hemolytic anemia, aplastic anemia,
agranulocytosis, thrombocytopenia
Metabolic
pyridoxine deficiency,
hyperglycemia, metabolic
acidosis
Other
fever, pellagra, lupus-like syndrome,
injection site irritation,
hypersensitivity reaction
PYRAZINAMIDE Generic Name
CLASSIFICATION INDICATIONS
antitubercular initial treatment of active tuberculosis in adults and children when combined
with other antituberculous agents.
PREGNANCY CATEGORY
C
CONTRAINDICATIONS
• Hypersensitivity to drug
MECHANISIM OF ACTION • Severe hepatic disease
The exact mechanism of action is not known. However, it exhibits • Acute gout
bacteriocidal or bacteriostatic action.
DOSAGE
Adults and children:
15 to 30 mg/kg/ day P.O., not to exceed 2 g/day; or 50 to 70 mg/kg P.O.
twice weekly, up to a maximum of 4 g/dose; or 50 to 70 mg/ kg/dose P.O.
three times weekly, up to a maximum of 3 g/dose
CNS
headache
Metabolic
hyperuricemia, gout
GI
nausea, vomiting, diarrhea, peptic
ulcer, abdominal cramps, anorexia
GU
dysuria, increased
uric acid secretion
Hepatic
hepatotoxicity
Musculoskeletal
joint pain
Hematologic
hemolytic anemia
Skin
urticaria, photosensitivity
ETHAMBUTOL Generic Name
CLASSIFICATION INDICATIONS
antitubercular indicated in combination with other anti-tuberculosis drugs in the treatment
of pulmonary tuberculosis.
PREGNANCY CATEGORY
B CONTRAINDICATIONS
• Children younger than age 13
MECHANISIM OF ACTION • Hypersensitivity to drug
• Inhibit the synthesis of one or more metabolites of susceptible bacteria. • Optic neuritis
• Changing cell metabolism during cell division
DOSAGE
Adults and adolescents:
In patients who haven’t received previous antitubercular therapy, 15 mg/kg
P.O. daily. In patients who have received previous antitubercular therapy, 25
mg/kg P.O. daily, decreased after 60 days to 15 mg/kg daily.
CNS
confusion, disorientation, malaise,
EENT dizziness, hallucinations, headache,
optic neuritis, blurred vision, peripheral neuritis
decreased visual acuity, red-green
color blindness, eye pain
GI
Hepatic nausea, vomiting, abdominal pain, GI
transient hepatic upset, anorexia
impairment
Respiratory
Metabolic bloody sputum, pulmonary infiltrates
hyperuricemia, hypoglycemia
Musculoskeletal Hematologic
joint pain, gouty arthritis eosinophilia, thrombocytopenia
Skin
Other
rash, pruritus, toxic epidermal
fever, anaphylactoid reactions
necrolysis
STREPTOMYCIN Generic Name
CLASSIFICATION INDICATIONS
• treat active tuberculosis (TB) infection if you cannot take other drugs
Aminoglycoside for TB
• if a type of TB that cannot be treated with other drugs (drug-resisant
PREGNANCY CATEGORY TB)
D
CONTRAINDICATIONS
Hypersensitivity to drug, other aminoglycosides, or bisulfites
MECHANISIM OF ACTION
Binds to 30S ribosomal subunit, inhibiting protein synthesis in bacterial
cells, which causes misreading of genetic code and, ultimately, cell death
DOSAGE
Adults:
15 mg/kg/day I.M., up to 1 g/day
Children:
20 to 40 mg/kg I.M. daily, up to 1 g/day
CNS
vertigo, numbness and tingling,
EENT peripheral neuropathy, myasthenia
amblyopia, ototoxicity gravis–like syndrome, neuromuscular
blockade, seizures
Hepatic
hepatic necrosis CV
nausea, vomiting
GU GI
azotemia, nephrotoxicity nausea, vomiting
Respiratory
apnea
Musculoskeletal
muscle weakness, twitching
Hematologic
eosinophilia, hemolytic anemia,
Skin pancytopenia, leukopenia,
rash, urticaria, exfoliative dermatitis, thrombocytopenia
toxic epidermal necrolysis,
angioedema
Other
fever, superinfection,serum sickness,
anaphylaxis
NURSING INTERVENTIONS
for Antitubercular Drugs
• Give isoniazid, ethambutol, and rifampicin in a single dose once daily, twice a week or 3 times a week.
• Give isoniazid and rifampin on an empty stomach, 1 hour before or 2 hours after a meal, with a full glass
of water. Isoniazid may be given with food if a gastrointestinal upset occurs.
• Continue assessments as described earlier for therapeutic effects.
• Recognize that tuberculosis treatment requires long-term compliance and that many reasons exist for
nonadherence
• Continue to monitor vital signs, breath sounds, and sputum production and quality. Immediately report
undiminished fever, increases in sputum production, hemoptysis, or increase in adventitious breath
sounds to the healthcare provider
NURSING INTERVENTIONS
for Antitubercular Drugs
• Continue to monitor periodic laboratory work: hepatic and renal function tests, CBC, and sputum culture
for AFB
• Continue to monitor for hepatic, renal, and cytotoxicity.
• Monitor for signs and symptoms of neurotoxicity, particularly peripheral and optic neuropathy.
• Monitor blood glucose in patients taking isoniazid
• Monitor dietary routine in patients taking isoniazid
• Patients taking rifampin should be cautioned that the drug may turn body fluids (tears, sweat, saliva,
urine) reddish-orange
NURSING INTERVENTIONS
for Antitubercular Drugs
• Encourage infection control measures based on the extent of the disease condition, and follow established
protocol in hospitalized patients
• Use opportunities during the administration of medications and during assessments to provide patient
education
• When administering medications, instruct the patient, family, or caregiver in proper self-administration
techniques followed by teach-back.
SURGICAL
MANAGEMENT
THERAPEUTIC LYMPH NODE EXCISION
THERAPEUTIC THORACENTESIS
PERICARDIECTOMY
VENTRICULOPERITONEAL SHUNT
NEPHRECTOMY
