Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis that usually affects the lungs. It spreads through the air when infected people cough, sneeze, or spit. Most infections result in latent, asymptomatic infections, but about 10% eventually progress to active disease without treatment. Risk factors include close contact with an active case, immunocompromised status, and living in crowded housing. Symptoms can include cough, fever, night sweats, and weight loss. Diagnosis involves chest x-rays, sputum culture and tuberculin skin testing. Treatment involves several months of antibiotic therapy to prevent drug resistance.
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Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis that usually affects the lungs. It spreads through the air when infected people cough, sneeze, or spit. Most infections result in latent, asymptomatic infections, but about 10% eventually progress to active disease without treatment. Risk factors include close contact with an active case, immunocompromised status, and living in crowded housing. Symptoms can include cough, fever, night sweats, and weight loss. Diagnosis involves chest x-rays, sputum culture and tuberculin skin testing. Treatment involves several months of antibiotic therapy to prevent drug resistance.
Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis that usually affects the lungs. It spreads through the air when infected people cough, sneeze, or spit. Most infections result in latent, asymptomatic infections, but about 10% eventually progress to active disease without treatment. Risk factors include close contact with an active case, immunocompromised status, and living in crowded housing. Symptoms can include cough, fever, night sweats, and weight loss. Diagnosis involves chest x-rays, sputum culture and tuberculin skin testing. Treatment involves several months of antibiotic therapy to prevent drug resistance.
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Pulmonary tuberculosis is an infectious disease caused by mycobacterium tuberculosis that usually affects the lungs. It spreads through the air when infected people cough, sneeze, or spit. Most infections result in latent, asymptomatic infections, but about 10% eventually progress to active disease without treatment. Risk factors include close contact with an active case, immunocompromised status, and living in crowded housing. Symptoms can include cough, fever, night sweats, and weight loss. Diagnosis involves chest x-rays, sputum culture and tuberculin skin testing. Treatment involves several months of antibiotic therapy to prevent drug resistance.
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Pulmonary Tuberculosis
I. Definition - is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims.
II. Incubation period
2± 10 weeks From the first entry until the appearance of the first signs & symptoms
III. Etiology overcrowded homes Malnutrition Deficiencies in Vitamin A, D, C Inadequate levels of immunity Alcoholism & smoking
IV. Risk Factors
Close contact with someone who has active TB Immunocompromised status Preexisting medical conditions Living in overcrowded or substandard housing Significant reaction to tuberculin skin test
V. Clinical Manifestations 1.Primary Infection Change of behavior from normal tolistlessness Easy fatigability Alertness to apathy From normal activity to irritability Fleeting infection of respiratory/GIT associated w/ fever Crepitant rales
2. Post primary/Progressive Primary Tuberculosis
Visibly ill due to fever Cough gradually becomes distressing Abnormal physical signs are easily elicited Breath sounds increased (audible crepitant rales) Hemoptysis is rare 3. Chronic Pulmonary Tuberculosis a. Generalized Systemic Signs General malaise, anorexia, easy fatigability, apathy, irritability, indigestion, general influenza-like symptoms Physical signs are meager - tachycardia, low BP, dyspnea, cyanosis Afternoon fever (38°C ± 39°C) Night sweat Loss of weight Malaise
b. Pulmonary Signs & Symptoms
Insidious onset of cough with mucopurulent sputum Fine crepitant rales over apical areas Hemoptysis & chest pain Pleural pain Dyspnea
VI. Pathophysiology (Book-Based)
Predisposing Factors: Precipitating Factors:
-Age -Occupation
-Immunosupressed persons -Smoking
-Systemic infections -Alcoholism
-DM
-End stage of renal disease
-HIV or AIDS
Exposure or inhalation of infected aerosol through droplet nuclei
(Exposure to infected clients by coughing, sneezing, talking)
Tubercle bacilli invasion in the apices of the lungs or near the pleurae of lower lobes
Bronchopneumonia develops in the lung tissue
(Phagocytosed tubercle bacilli are ingested by macrophages) -bacterial cell wall binds with macrophages -arrest of a phagosome which results to bacilli replication
Necrotic Degeneration occurs
(production of cavities filled with cheese-like mass of tubercle bacilli, dead WBCs, necrotic lung tissue)
drainage of necrotic materials into the
tracheobronchial tree (eruption of coughing, formation of lesions)
PRIMARY INFECTION
Lesions may calcify (Ghon’s Complex)
And form scars and may heal over a period of time
Tubercle bacilli immunity develops (2-6weeks after infection)
(maintains in the body as long as living bacilli remains in the body)
Acquired immunity leads to further growth of bacilli and development of
ACTIVE INFECTION
SIGNS AND SYMPTOMS
Pulmonary symptoms
-dyspnea
-non-productive or productive cough
-hemoptysis
-chest pain -crackles may be present on auscultation
General symptoms
-fatigue
-weight loss
-anorexia
-low grade fever with sweats
SECONDARY INFECTION
Severe occurrence of lesions in the lungs
Cavitation in the lungs occur
Active infection is spread throughout the body systems
(infiltration of tubercle bacilli in other organs)
-TB of the bones
-Pott’s disease
-Renal TB
Severe occurrence of client becomes clinically ill
Bad prognosis
DEATH
VII. Diagnostic Examinations
1. Chest x-ray 2. Sputum, smear, & culture Finding the acid-fast bacilli in the sputum obtained by coughing & expectoration Culture are helpful to determine bacterial susceptibility to anti-TB drugs Purulent material should be cultured 3. Tuberculin skin test Tubercle bacillus & purified protein derivative Inject (Intradermal) at the inner forearm 4inches below the elbow Result : 48 ± 72 hours after injection Measure diameter of indurations in mm Interpretation of results 0 ± 4 mm : not significant > 5mm : Significant to those who are at risk: due to cross reaction to other mycobacterium infections : due to incompletely developed sensitivity >10 mm : significant to those who have normal/mildly impaired immunity: positive reaction
VIII. Treatment 1.Prophylaxis a.BCG (Bacilli Calmette Guerin) simplest, safest, most economical, & most effective measure of prevention Administered during neonatal period &repeated before primary school Given at a dose of 0.05 ± 0.1 ml intradermally over the deltoid muscle
b. Primary Chemoprophylaxis Administration of Isoniazid (INH) to uninfected subjects Administer INH instituted 8 wks after BCG vaccination in groups with high risk infection Recommended daily : 5 mg/kg of body weight given in single dose
c. Secondary Chemoprophylaxis Progression of primary lesions can be prevented with INH with a daily dose of 5 ± 10 mg/kg of bodyweight Administered to patients with: Measles Pertusis Influenza Intake of steroids & immunosuppressive After surgery under general anesthesia
2. Specific chemotherapy a.Isoniazid (INH) - oral Duration: at least 1 yr For curative purposes, should be combined with another drug to delay drug resistance Adverse reaction: cephalopathy hepatitis
b. Rifampicin (RMP) - oral
Duration: 6 months Has anti-mycobacterial activity & most effective anti-TB drug discovery of INH Adverse reaction: hypersensitivity & hepatotoxicity
c. Ethambutol (EMB) - oral
Duration: 3 months for initial treatment Dosage should be adjusted in patients w/decreased renal function Adverse reaction: retinal degeneration
d. Streptomycin (SM) - IM
Duration: 3 months - in most cases Skin test before administration Should not be given as the sole agent because bacterial resistance develops more rapidly Adverse reaction: nephrotoxicity, vertigo, ataxia
e. Morphozinamide Hydrochloride (MZA) - oral
Duration: with INH Pyrazinamide derivative Very effective anti-TB drug especially in caseous forms of TB Adverse reaction: Hepatitis
f. Para-amino salicylic Acid (PAS) - oral
Duration: with INH Weakest among anti-TB drug Delays the emergence of resistant strains of tubercle bacilli Adverse reaction: gastric irritation
X. Nursing Management Maintain respiratory isolation until patient responds to treatment or no longer contagious Administer medicines as ordered Check sputum always for blood Encourage questions, conversation, to air their feelings Teach or educate patient Encourage to stop smoking Teach patient to cough/sneeze into tissue paper & dispose secretions properly Advise patient to have plenty of rest & eat balance diet Be alert on signs of drug reaction
