tuberculosis by ishfaq ahmad

1. BY
ISHFAQ AHMAD

2. M. TUBERCULOSIS

3. It is an infectious disease
usually caused by
Mycobacterium Tuberculosis.
Tuberculosis generally effects
the lungs, but can also effect
other parts of the body.

4. Contd…
 It is characterized by the formation of tubercles
or granulomas in lungs.
 Granulomas means localized collection of cells
usually produced in response to an infectious
process.
 It may be transmitted to other body parts such as
meninges, bones, kidneys, lymph nodes.

5. INCIDENCE
Incidence is more common in
developing countries of Africa and Asia.
Other factors contributing to higher
incidence of Tuberculosis are:
 Mall nutrition
 Inadequate medical care
 Poverty
 Over crowded area
 Uncontrolled diabetes
 Immunocompromised states like AIDS

6. RISK FACTORS
 Mal nutrition
 Excessive alcohol addiction
 Infant and children under 5 years of age
 Immuno- suppressive clients
 HIV infection
 Poor health
 smoking

7. CAUSATIVE ORGANISM
Tubercle bacillus or Koch’s bacillus
(discovered by Robert Koch in 1882)
called Mycobacterium Tuberculosis.
It is mainly an aerobic bacteria.

8. PATHOPHYSIOLOGY
Transfer to lymph system and blood stream
(in cerebral cortex, kidneys, bones)
Mycobacterium bacilli inhales
Transmitted through airways to alveoli
Multiplication

9. Phagocytes engulf so many bacteria
Immune system responds
T & B lymphocytes bacilli spreads in normal tissues
Accumulation of exudate in alveoli
Bronchopneumonia

10. MODE OF TRAMSMISSION
1. INHALATION: Organisms present in fresh air
droplets can transmit from an open case of
pulmonary tuberculosis.
2. INGESTION: This mode of infection of
human tubercle bacilli is from self
swallowing of infected sputum of an open
case of pulmonary tuberculosis or ingestion
of bovine tubercle bacilli from the milk of
diseased cows. This can led to tonsillar or
intestinal tuberculosis.

11. Contd….
3. INNOCULATION: This can occur when
the organisms inoculate into the skin
from an infected postmortem tissue.
4. TRANSPLACENTAL ROUTE: Results in
development of congenital
tuberculosis in foetus from an infected
mother and is a rare mode of
transmission.

12. INGESTION

13. TYPES OF TUBERCULOSIS
A. Primary tuberculosis
B. Secondary tuberculosis
A. Primary tuberculosis:
The infection of an individual who has
not been previously infected or
immunized is called primary tuberculosis
or Ghon’s complex or childhood
tuberculosis.

14. Contd…
B. Secondary tuberculosis:
The infection of an individual who has
been previously infected is called
secondary or chronic tuberculosis.

15. SIGN & SYMPTOMS
 In pulmonary tuberculosis, patient is free from
symptoms in early stages of disease.
 In lateral stage some symptoms are find out.
 These symptoms are:

16. Contd…
1. Referable to lungs
 Productive cough
 Haemoptysis
 Dyspnea
 Pleural effusion
 Orthopnea

17. Contd…
2. Systemic features
 Fever
 Night sweating
 Fatigue
 Loss of appetite
 Loss of weight

18. HAEMOPTYSIS

19. DIAGNOSIS
 History and physical examination.
Positive Monteux test.
Sputum culture for acid fast bacilli.
Chest x ray(presence of nodular patches)
CBC (increase WBC, ESR)

20. MONTOUX TEST

21. MEDICAL MANAGEMENT
 Use of antibiotics to kill the bacteria
 Active tuberculosis is best treated with
combinations of several antibiotics to reduce
the risk of developing antibiotic resistance.
 Latent tuberculosis is treated with either
isoniazid alone, or a combination of isoniazid
with either Rifampicin or Rifapentine.
 Treatment lasts for six months.

22. Contd…
New onset:
 Rifampicin, Isoniazid, pyrezinamide
and Ethambutol for first two months.
 Then Rifampicin and Isoniazid only for
last four months.

23. DRUGS
 Isoniazid 5mg/kg/day oral/IM
 Rifampicin 10mg/kg/day PO
 Ethambutol 25mg/kg/day PO
 Streptomycin 15mg/kg/day IM
 Pyrazinamide 20mg/kg/day PO

24. NURSING MANAGEMENT
Nursing Assessment:
Obtain history of exposure to TB
Assess for symptoms of active disease
 Productive cough, night sweats,
afternoon temperature elevations,
weight loss chest pain etc.
Auscultate lungs for crackles.

25. Contd…
During drug therapy, assess for liver
dysfunction
 Question the patient about loss of
appetite, fatigue, joint pain, fever, clay
coloured stool, dark urine.
 Monitor for fever, abdominal
tenderness, nausea, vomiting.
 Monitor results of periodic liver
function studies.

26. NURSING DIAGNOSIS
 Fatigue
 Imbalanced nutrition: less than body
requirements
 Impaired gas exchange
 Ineffective airway clearance
 Risk of injury
 Ineffective coping

27. COMPLICATIONS
 Pleural effusion
 Pneumonia
 Asthma
 ARDS
 Lung abscess

28. KEY OUTCOMES
 The patient will:
Identify measures to prevent or reduce fatigue
Consume adequate daily calories as required
Maintain adequate ventilation and
oxygenation
Maintain patient airway
Remain free from complications

29. NURSING INTERVENTIONS
Administer ordered antibiotics and antituberculer
agents.
Isolate the infectious patients in a quiet, properly
ventilated room
Place a covered trash can nearby. Tell the patient to
wear a mask when comes outside his room.
Visitors and health care personals should also take
proper precautions while in the patients room.
Make sure the patient gets plenty of rest.

30. Contd…
Provide the patient with well balanced high calorie
foods preferably in small, frequent meals to conserve
energy.
Watch for adverse reactions to the medications.
Administer isoniazid with food. This drug can cause
hepatitis or peripheral neuritis, so monitor levels of
aspartate aminotransferace and alanine
aminotransferace. To prevent or treat peripheral
neuritis give pyridoxine (vit-B6) as ordered.
If the patient receives Ethambutol watch for the signs
of optic neuritis.

31. Contd…
If the patient receives Rifampicin, watch for
the signs of hepatitis and flu like symptoms as
well as other complications like haemoptysis.
Perform chest physiotherapy, including
postural drainage several times a day.
Give the patient supportive care and help him
to adjust the changes he may have during his
illness and let the family take part in the
patient’s care whenever possible.