definition of pulmonary tuberculosis, types, causes and risk factors, signs and symptoms, diagnostic evaluation, first line treatment, second line treatment, prevention, DOTs chemotherapy, surgical management of resection procedure, physiological lungs exclusion, nursing management.

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SUBJECT – MEDICALAND SURGICAL NURSING
TOPIC – PULMONARY TUBERCULOSIS/DOTs
PREPARED BY DOLISHA WARBI

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DEFINITION:
Tuberculosis is the infectious diseases primarily affecting lungs parenchyma.
It is most often causes by mycobacterium tuberculosis.
It may be spread to other part of the body, including meninges, kidney bones and lymph node.
TYPES:
1.Active TB: In this form, the bacteria actively multiply and cause symptoms.
2.Latent TB: The bacteria are present in the body but are inactive and don't cause symptoms. However, latent TB
can become active if the immune system weakens.

3. CAUSES & RISK FACTOR:
Ø Immunocompromised.
Ø Pre existing medical condition.
Ø Close contact with infected person.
Ø Living in overgrounded area.
Ø Immigration from high prevalence country.
Ø Inadequate health care.
Ø Malnutrition.
Ø Health worker.
Ø Substances abuse.
SIGNS AND SYMPTOMS:
• Persistent Cough (dry/mucopurulent/blood)more than three week.
• Fever/chill/night sweating.
• Unexpected weight loss.
• Breathing difficulty.
• Pain in chest.
• Fatigue.
• Fluid around lungs.
• Enlarged/tender lungs.
• Hemoptysis.
• Unusual breath sound – crackles.
• Unresolved pneumonia.
• Unintentional weight loss.
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4. DIAGNOSTIC EVALUATION:
o Medical history.
o Physical examination.
o Chess x ray / CT Scan.
o Sputum tests.
o Lung biopsy.
o Blood tests
o Tuberculin skin tests (TST): Tuberculin Skin Test (TST): A small amount of tuberculin is injected under the skin,
and the reaction is checked after 48-72 hours.
o Interferon-Gamma Release Assays (IGRAs): Blood tests that measure the immune response to TB.
o Sputum Smear Microscopy: Microscopic examination of sputum to detect the presence of TB bacteria.
o Chest X-ray: Imaging test to identify abnormalities in the lungs.
o Molecular Tests (e.g., GeneXpert): Detect the genetic material of TB bacteria, providing rapid diagnosis and
information on drug resistance.
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5. MANAGEMENT:
1. FIRST LINE TREATMENT –
a) Isoniazid.
b) Rifampin.
c) Pyrazinamide.
d) Ethambutol
e) Streptomycin.
2. SECOND LINE DRUG –
a) Capreomycin.
b) Amikacin.
c) Macrolides.
PREVENTION:
a) Vaccination – BCG.
b) Wear mask.
c) Hygiene.
d) Wash food / vegetable.
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6. MEDICAL MANAGEMENT:
Treated with Chemotherapeutic agents (antituberculosis agents) for 6 -12 months (carboplatin, cisplatin).
Isolation and Infection Control.
DOTs (Directly Observed Treatment short course):
Directly Observed Treatment Short-course (DOTS) is a strategy recommended by the World Health Organization
(WHO) for the management of tuberculosis.
It is used to ensure the person receives and takes all medication as prescribed and to monitor response to treatment.
Treatment categories and sputum examination schedule in DOTs Chemotherapy:
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7. SURGICAL MANAGEMENT:
Resectional procedures
§ Lobectomy
§ Segmentectomy
§ Pneumonectomy
§ Pleuropnemonectomy
Other operations
Ø Decortication
Ø Closure of bpf(bronchopleural fistula)
Ø Rib resection / eloesser flap.
Physiological lung exclusion
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8. NURSING MANAGEMENT:
i. Administer prescribed medication.
ii. Teach self administration of medication to a patient.
iii.Encourage rest.
iv. Monitor breath sound, respiratory rate sputum production and dyspnea.
v. Provide supplemental oxygen as order.
vi. Maintain clean environments to patient and to our self example wear gown
and hand washing.
vii.Assess the nutritional status of the patient.
viii.Provide small and frequent meals and liquid supplement encourage to take
high protein diet.
ix. Monitor weight.
x. Administer vitamin supplements as order.
xi. Instruct for follow up medication.
xii.Monitor the side effect of drug therapy.
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