The document discusses tuberculosis (TB), including:
- TB is caused by Mycobacterium tuberculosis and spreads through airborne droplets.
- Risk factors include substance abuse, HIV infection, and being a child under 5 years old.
- Diagnosis involves tuberculin skin testing and sputum culture. Treatment consists of a multi-drug regimen over 6-9 months.
- Complications of untreated TB include development of drug-resistant strains like multidrug-resistant TB.
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Tuberclasis
1.
2. National TB Control Program (RNTCP) was Launched in 1962
RNTB Control Program –1993 /DOTS (Directly Observed
Treatment, Short-course)
BCG:-Bacille Calmette Guerin- Live attenuated vaccine
B.C.G vaccination Programme was launched in year :-1951
At birth, dose of BCG vaccine is: 0.05 ml I/D until 1 month
0.1 ml I/D after 1 month
BCG vaccine dilute with NS
3. Lung infection caused by M. tuberculosis, (Acid fast Bacilli)
First discovered in 1882 by Robert Koch
Transmitted by Inhalation of airborne droplets
(Talking - cough - sneezing – laughing).
Mycobacterium tuberculosis infects about 35% world’s population
Introduction:-
4. Risk Factors for Tuberculosis
Substance abuse
DM, HIV, infection
Anti- rejection drug
Child younger than 5 years of age
Drinking unpasteurized milk if cow is infected with bovine
tuberculosis
5. Primarily affects pulmonary system, especially upper lobes
Acute TB: Primary lesion
Chronic TB: Progressive, re-injection & reactivation of primary lesions
after mouths or years. common in adults.
Swallowing infectious sputum may cause/lead to laryngeal.
oropharyngeal or intestinal TB.
Extra-pulmonary TB- Involves bone, kidneys
Types of TB
6. Classical Sign –
◦ Progressive Cough (2 wks)
◦ Night Sweat/Sleep hyper-hidrosis
◦ Weight loss
◦ Low-grade fever.
1st Symptoms:-A cough with expectoration of mucoid
sputum
C/F:-
7. ◦ Ghon's complex :-lesion seen in lung that is
caused by TB
◦ (1to 1.5-cm area of gray white inflammation )
8. An individual who received a BCG vaccine will
have a positive tuberculin skin test result &
should be evaluated for TB with a chest x-ray.
Chest x-ray- Active or calcified lession
D/E:-
9. Tuberculin Test /Mauntoux- test/ Mendel-
Mantoux test/ Pirquet test (1907)
Injection of PPD (Purified Protein Derivative)
M. tuberculosis, heating to 100 °C to kill bacilli &
subsequent filtering
Store temp 2-8 °C
I/D, dose – 0.1ml (5 TU tuberculin units) to Inner
surface of forearm.
(Indicate exposure to tubercle bacilli)
10. Determination: after 48-72
hrs
10 mm or greaten Positive
6-9 mm Doubtful
<6mm Negative
5 mm for inmuno-
compromissed client, HIV
positive
11. 5 mm for inmuno-compromissed client, HIV
positive
14. Heaf test/ Ster-needle test:-Determine whether or not
children had been exposed to TB infection
Administered by a Heaf gun
Gun injected PPD
Test was read B/W 2 & 7 days later
15. Tine test:- Multiple-puncture tuberculin skin test
Read 48 to 72 hours later
16. Quouti FERON Gold Test- (1 mL) A blood analysis
test by interferon-gamma (IFN-y ) release assay,
Results can be available in 24 hours
More specific than tuberculin test.
17. Sputum Culture- 3 Continuum sample Confirms
the diagnosis
NPO past midnight in preparation for early
morning sputum collection
Spontaneously expectorated sputum:-3
consecutive morning sputum's
Induced sputum:- Nebulizer of 3% saline
Ziehl-Neelsen stain done of smear (Acid fast)
18. Fix Smear
Put Carbol fuchsin & heat smear until steam comes
out (but don’t boil & dry )
Place slide for 5-10 min. (wash smear with water )
Put 3ml HCL acid & 97% Ethanol solution
put malachite green dye (Wash)
dry slide & see under microscope
Methods
Acid fast Bacilli (Red Color)
19. Treatment
Initial treatment 2 months
(Isoniazid, Rifampicin, Ethambutol, Pyrazinamide daily for 2
months
Followed by 4 months of Isoniazid & Rifampicin given 3 times
a week
Bacteriostatic” means that the agent prevents the
growth of bacteria Eg Ethambutol
Bactericidal” means that it kills bacteria Eg
20. Initial treatment 2 months
(Isoniazid, Rifampicin, Ethambutol, Pyrazinamide
daily for 2 months
Followed by 4 months of Isoniazid & Rifampicin
given 3 times a week
Bacteriostatic” means that agent prevents growth of
bacteria Eg Ethambutol
Bactericidal” means that it kills bacteria Eg
Management:-
21. First line drugs for TB "RIPE"
1.Isonizide (INH):- Batctericidal (Interfere with Cell wall
synthesis)Most common medication used for treatment of TB
Adult :- 300mg/day
Child :- 15 mg/kg/day
S/E:-
I:-Iron accumulation in mitochondria is called Sideroblastic anemia
N:-Neuropathy Peripheral (Affect CNS )
H:-Hepatitis
Vitamin B6 deficiency
22. Note:-
A client with a positive skin test for TB isn’t
showing signs of active disease.
Prevent development of active TB, client should
be treated with Isoniazid, 300 mg daily,
for 9-12 month
Note:-Safe to use during pregnancy
23. Nurses role:-
Administer isoniazid 1 hour before or 2 hours
after a meal because food may delay absorption.
Administer at least 1 hour before Antacids
Administer pyridoxine as prescribed to reduce
risk of neurotoxicity.
24. 2.Rifampicine (Rifadin )-Batctericidal (interfere
with RNA )
Adult- 600mg (10mg/kg) ,,Child- 10-20 mg/kg day
S/E- Red, orange urine, Thrombocytopenia, GI
upset, Hepatitis, RF, Fever ,Discoloration of body
fluid-:
Drug interaction with – OCP (oral contraceptive pills), advice to
use alternative method
N/R:-Take medication on empty stomach with 8
oz of water 1 hour before or 2 hours after meals
Avoid taking antacids with medication.
25. 3.Pyrazinamide (PZA)- Bactericidal
Adult- 15-30 mg/kg/day(2gm), -50 70mg/kg/BD
Child – 15-20 mg/kg/day
S/E- Hepatitis, Rash, GI upset, hyperurecenia,
difficult to control glucose in DM.
28. Second line drug= inhibits cell metabolism.
1. Kanamycin - Ototoxic & nephrotoxic
2. Para-aminosalicylic acid causes GI disturbances,
hepatotoxic
29. Was developed by Karel Styblo
Dots program -1993
DOTS (Directly Observed Treatment, Short-Course),
also known as TB-DOTS
30. Multidrug-resistant strain of tuberculosis
(MDR-TB):-
TB does not respond to at
least isoniazid & rifampicin, 2 most
powerful anti-TB drugs
31. Instruct client to increase rich in iron, protein, &
vitamin C food
Cultures are negative, client is no longer
considered infectious & usually can return to
former employment
Nurse’s role:-
32.
1. A staff nurse has a tuberculosis (TB) skin test of
16-mm induration. A chest radiograph is negative,
and the nurse has no symptoms of TB. The
occupational health nurse will plan on teaching the
staff nurse about the
a. Use and side effects of isoniazid (INH).
b. Standard four-drug therapy for TB.
c. Need for annual repeat TB skin testing.
d. bacille Calmette-Guérin (BCG) vaccine.
ANS: A
MCQ
33. 3.Which action by the occupational health nurse at a
manufacturing plant where there is potential
exposure to inhaled dust will be most helpful in
reducing incidence of lung disease?
a. Teach about symptoms of lung disease.
b. Treat workers who inhale dust particles.
c. Monitor workers for shortness of breath.
d. Require the use of protective equipment.
ANS: D
34. 4.The health care provider writes an order for
bacteriologic testing for a patient who has a
positive tuberculosis skin test. Which action will
the nurse take?
a. Repeat the tuberculin skin testing.
b. Teach about the reason for the blood tests.
c. Obtain consecutive sputum specimens from the
patient for 3 days.
d. Instruct the patient to expectorate three
specimens as soon as possible.
ANS: C
35. 5. The right forearm of a client who had a purified
protein derivative (PPD) test for tuberculosis is
reddened and raised about 3mm where the test
was given. This PPD would be read as having which
of the following results?
a. Indeterminate
b. Needs to be redone
c. Negative d. Positive
c. Negative
36. 6. A client with primary TB infection can expect to
develop which of the following conditions?
a. Active TB within 2 weeks
b. Active TB within 1 month
c. A fever that requires hospitalization
d. A positive skin test
d. A positive skin test
A primary TB infection occurs when the bacillus has
successfully invaded the entire body after entering
through the lungs.
37. 7. A client with a positive Mantoux test result will
be sent for a chest x-ray. For which of the
following reasons is this done?
a. To confirm the diagnosis
b. To determine if a repeat skin test is needed
c. To determine the extent of the lesions
d. To determine if this is a primary or secondary
infection
c. To determine the extent of the lesions
38. 8.A client is diagnosed with active TB and started
on triple antibiotic therapy. What signs and
symptoms would the client show if therapy is
inadequate?
a. Decreased shortness of breath
b. Improved chest x-ray
c. Nonproductive cough
d. Positive acid-fast bacilli in a sputum sample
after 2 months of treatment.
d. Positive acid-fast bacilli in a sputum sample
after 2 months of treatment.
39. 9. A client who is HIV+ has had a PPD skin test.
The nurse notes a 7-mm area of induration at the
site of the skin test. The nurse interprets the
results as:
a. Positive
b. Negative
c. Inconclusive
d. The need for repeat testing.
a. Positive
40.
41. It is a surgical procedure create opening through
neck into trachea (windpipe)
Maintaining patent airway
TRACHEOSTOMY
42. Burns of the airway
Cancer in the neck
Chronic lung disease, Coma
Diaphragm dysfunction
Injury to larynx
Need for prolonged respiratory or ventilator
support
Obstruction of the airway by a foreign body
Vocal cord paralysis
Note:-E.T. Tube cannot be inserted.
Indication:-
43. Emergency & prophylactic.
Temporary & permanent.
According to placement
High ring (2nd & 3rd) Incision made above isthmus
Low ring (3rd & 4th ) Incision made below isthmus
Type of tracheostomy
44. Types of tracheostomy tube:-
Double Lumen (Most commonly used) or single Lumen
tube
Cuffed or non –cuffed tube
Cuffed
Cuffed (20mm of Hg)
Check every 8 hrs
Non –cuffed tube
Used in school age children
Fenestrated or non-fenestrated
45.
46. Between the 2nd & 3rd/3rd or 4th tracheal rings.
Position:-Rose position
Site
47.
48. 1st day on tracheotomy need suction every 30 mt
Clean inner cannula if present.
Remove disposable inner connula & put new.
Care of non disposal inner cannula, remove &
place in soaking solution like H2O2 for 5 min &
rinse with saline.
Nursing Care -
49. Change tracheotomy ties.
Place 4x4" tracheotomy dressing.
Cover the tracheotomy with moist gauze or cotton
Normal tracheotomy cuff pressure Maintain at 18-
25mmHg