TUBERCULOSIS

• Tuberculosis


  Other terms: Koch's Disease/ Phthisis / Galloping Consumption Disease
• Top 8 highest cases of TB in the world (Philippines)
• Tuberculosis: It is a chronic sub-acute or acute respiratory disease commonly affecting the lungs
• Tuberculosis


  • Characterized by the formation of tubercles in the tissue which tend to undergo cessation necrosis and calcification
• Etiologic Agents


  • Mycobacterium tuberculosis
  • M. africanum
  • M. bovis
• Source of Infection


  • Sputum
  • Blood from Hemoptysis
  • Nasal discharge
  • Saliva
• Mode of Transmission


  Airborne<|>Direct / Indirect contact with infected persons
• Incubation Period


  3 to 8 weeks (occasionally up to 12 weeks)
• Period of communicability


  As long as the tubercle bacilli are being discharged in the sputum
• Clinical Manifestations


  • Cough of two weeks or more
  • Afternoon rise of temperature
  • Chest or back pains
  • Hemoptysis
  • Significant weight loss
  • Fatigue
  • Body malaise
  • Shortness of breath
  • Night sweating
  • Sputum positive for AFB
• Diagnostic Tests


  • Sputum Analysis for AFB
  • Chest X-ray
  • Tuberculin Testing (for TB exposure)
  • Mantoux Test (PPD)
  • Tine Test
  • Heaf Test
• Short-course chemotherapy


  Six-month treatment (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol)
• Rifampicin


  • Empty stomach
  • Body fluid discoloration (red-orange)
  • Hepatotoxic (metabolism)
  • Nephrotoxic (elimination)
  • Permanent discoloration of contact lenses
• Isoniazid


  • Empty stomach
  • Peripheral Neuropathy
  • Avoid alcohol
  • Hepatotoxic
  • Nephrotoxic
  • Increase intake of Vitamin B6
• Pyrazinamide


  • Before meals
  • Monitor s/sx of liver impairment
  • Anorexia
  • Fatigue
  • Dark urine
  • Photosensitivity
  • Liver Function Studies
  • Causes hyperuricemia
• Ethambutol


  • Not affected by food
  • Report visual disturbances
  • Hepatotoxic
  • Not recommended for children (below 6 years old); can cause optic neuritis
• Streptomycin


  • After meals
  • Report Oliguria - nephrotoxic
  • Ototoxic
  • Neurotoxic
• Direct Observation Treatment Short Course


  Strategy to prevent non-compliance
• Nursing Management


  1. Maintain respiratory isolation

  2. Administer medicines as ordered

  3. Educate patient all about PTB

  4. Stop smoking

  5. Cough or sneeze into tissue paper and dispose secretion properly

  6. Provide the patient with a well-balanced, high-calorie diet, preferably in small, frequent meals to conserve energy

  7. Allow rest periods

  8. Caution the patient who is taking an oral contraceptive that the contraceptive may be less effective while she's taking rifampin
• Prevention and Control


  • Submit all babies for BCG (Bacille Calmette-Guerin) immunization
  • Avoid overcrowding
  • Improve nutritional and health status
  • Persons who have been exposed (Receive Tuberculin Test)