PULMONARY TUBERCULOSIS
It is a communicable disease caused by Mycobacterium tuberculosis an aerobic, acid-fast bacillus. It is an air-borne infection.
Mode of Transmission
Droplet infection - coughing, laughing, sneezing and singing
Causes
Repeated close contact with an infected individual not yet diagnosed.
Risk factors
HIV infection malnourished old age, genetic, disposition, immunosuppressant. alcoholism and drug abuse, other diseases (chronic ren 1 failure, diabetes mellitus, malignancy), personnel and residents of long term care facilis es, health workers.
Humans develop bovine TB when drinking raw milk from affected cattle.
Pathophysiology
Primary infection: First time client infected
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Bacilli inhaled
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Pass down bronchial system and implant in bronchioles and alveoli
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After implantation-bacilli multiply
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Many infecting tubercle bacilli engulfed phagocytes
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Within phagocytes they continue to multiply. (While cellular immune response activated)
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Bacilli-spread through lymphatic channels lymph nodes circulating blood
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Bacilli find favourable sites upper portion of lungs, kidneys, epiphyseal lines of the bone and cerebral cortex
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Necrotic degeneration of the central portion of the lesion.
(Produces cavities filled cheese like mass of tubercle bacilli, dead WBC and necrotic lung tissue)
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In time, material liquefies and drain into tracheobronchial tree
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Healing of primary lesion.
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Forms a scar around the lesion.
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Control of organism not maintained
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Tuberculosis
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Secondary Infection When client's resistance is lowered.
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Reactivation of lesion.
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Secondary infection
Clinical Manifestations
- Early stages-free of symptoms.
- Fatigue, malaise, anorexia, weight loss, low grade fever, chills and night sweats, chest pain, chest tightness,
- Irregular menses - premenopausal women/
- Cough with mucopurulent sputum
- Haemoptysis advanced cases.
Diagnosis
History taking, tuberculin skin test, chest x-ray, sputum acid fast bacilli smear/culture,
Treatment
1. A combination of drugs to which the organisms are susceptible is given to destroyable bacilli as rapidly as possible.
2. Current recommended regimen of uncomplicated pulmonary TB is
- 2 months of bactericidal drugs-isoniazid, rifampin, pyrazinamide and ethambutol,
- 4 months of isoniazid and rifampicin.
- 6 months of treatment kills 3 population of bacilli: those rapidly dividing, those slowly dividing and those only intermittently dividing.
3. Obtain sputum smears every 2 weeks until they are negative, sputum cultures d not become negative for 3-5 months.
4. Second Tine drugs Capreomycin (Capastat), Kanamycin (Kantrex), ethionamid (Trecator SC), paraminosalicylic acid and cycloserine (Seromycin) used i patients with resistance, for retreatment and in those with intolerance to other agents.
Complications: Pleural effusion, tuberculosis pneumonia and other organ involvement with TB.
Nursing Management
1. Obtain history of exposure to TB
2. Assess for symptoms of active disease productive cough, night sweat afternoon temperature elevation, weight loss and pleuritic chest pain.
3. Administer and teach self-administration of medication as ordered
4. Encourage rest and avoidance of exertion.
5. Monitor respiratory rate, sputum production dyspnea
6. Provide supplemental oxygen as ordered.
7. Be aware that TB is transmitted by respiratory droplets or secretions.
8. Use masks for high-risk procedures such as suctioning, bronchoscopy.
9. Educate patients to control spread of infection through secretions.
a. Cover mouth and nose when coughing or sneezing. Do not sneeze into bare hand
b. Wash hands after coughing or sneezing.
c. Dispose of tissues promptly into closed plastic bag.
10. Encourage a nutritious diet to promote healing and improve defense against infection.
11. Monitor weight
12. Provide small frequent meals and liquid supplements during symptomatic period.
13. Administer vitamin supplements as ordered, particularly pyridoxine (Vit Bs) to prevent peripheral neuropathy in patients taking isoniazid
14. Educate patient about efiology, transmission and effects of TB. Stress the importance of continuing to take medicine for prescribed time because bacilli multiply very slowly and thus can only be eradicated over a long period of time.
15. Teach patient-side effect of drugs.
16. Encourage TB testing of persons residing with patient.
17. Instruct basic hygiene practices and investigate living conditions. Crowded, poorly ventilated conditions contribute to development and spread of TB.
18. Encourage follow-up chest x-rays for rest of life to evaluate for recurrence.
