DEFINITION

 Infectious disease
 Primarily affects the lung parenchyma
 May be transmitted to other parts of the body including meninges, kidneys ,bones and
lymph nodes
 World deadliest disease
 Remains as a major public health problem in Philippines
 Synonymously to the word “phthisis” and “koch’s disease”

Infectious Agent:

Mycobacterium Tuberculosis
 Primary infectious agent
 Acid fast aerobic rod bacilli that grows slowly and its sensitive to
heat and UV.
 Divides 16 to 20 hours, extremely slow rate compared with others,
which usually divide in less than one hour.

Mycobacterium bovis and Mycobacterium avium

 Have rarely been associated with the development of a TB infectious.

Mode of transmission:

Airborne droplet
 method through coughing, sneezing, signing, talking
 Smaller than 5 microns and more than 5 feet
 Principles: A larger micron settles smaller microns fly in the air and was inhaled by the
susceptible host.

Direct invasion
 Through mucous membranes or breaks in the skin may occur but it is extremely rare.

Unpasteurized milk or dairy products

 From cattle that has m-bovis.

Clinical Manifestation:

 Low grade afternoon fever- pathognomonic sign of PTB

 Cough- productive and/or non-productive
 Night sweating
 Fatigue
 Weight loss
 Hemoptysis- may also occur
Risk Factors:

 Close contacts with someone has active TB. Inhalation of airborne nuclei from an
infected person is proportional to the amount of time spent in the same airspace, and
proximity of the person, and the degree of ventilation.
 Immunocompromised status- HIV infection, cancer, transplanted organs, prolonged high-
dose corticosteroid therapy.
 Substance abuse (IV/Injection drug users and alcoholics)
 Inadequate health care- homeless, impoverished, minorities, particularly children under
age 15 year old and young adults between (15 and 44 year old)
 Pre-existing medical conditions or special treatment (eg. diabetes, chronic renal failure,
malnourishment, selected malignancies, haemodialysis
 Immigration from countries with a high prevalence of TB (South Eastern Asia, Africa,
Latin, America, Caribbean)
 Institutionalizations- long term care facilities, prisoners
 Living in overcrowded, substandard housing
 Occupation (health care provider)
 Smoking- prolonged used of cigarettes.

INCUBATION PERIOD
 From 2 to 10 weeks

PATHOPHYSIOLOGY
 Infection of lungs caused by Mycobacterium tuberculosis, an acid-fast bacterium.
 Causes tubercles, fibrosis, and calcification within the lungs.
 Tubercle bacillus may be communicated to others by means of drop formation
(inhalation), ingestion, or inoculation.
 Predisposing factors include debilitating diseases such as alcoholism, cardiovascular
disease, HIV infection, diabetes mellitus, and cirrhosis, as well as poor nutrition and
crowded living conditions.
 The emergence of multi-drug-resistant tuberculosis has complicated management of
the disease.
 Chronic, progressive, and reinfection phase is most frequently encountered in adults
and involves progression or reactivation of primary lesions after months or years of
latency.
 Swallowing infected sputum may lead to laryngeal, oropharyngeal, and intestinal
tuberculosis.
 Mycobacterium Tubercle Bacilli

Dried Droplet Nuclei

Inflammation in Alveoli

Lymph Nodes Filter Drainage

Primary Tubercle
Necrosis
Caseation

Calcified Liquefaction

“GHON TUBERCLE” Coughed up

Primary

Cavity
NURSING CARE
1.) ISOLATION:

 The pt is remove from frequently contact w/members of the family and public
 It serves to prevent the spread of tubercle bacilli
 Positive Sputum patient should be grouped together and negative sputum patient
should be together

2.) The TB education program for the patient:

 The nurse must impress the pt and his family with the necessary of controlling the
spread of TB
 Educate pt regarding personal hygienic but also the members of the family about the
necessary medical aseptic technique.
 Proper disposal of secretions from mouth and nose should be prioritized in this
program.
 Used of tissue, handkerchief, or towel when coughing or sneezing.

DRUG OF CHOICE
RIFAMPICIN- common side effects are hepatitis and febrile reaction
ISONIAZID- can cause peripheral neuritis
PYRAZINAMIDE- hyperuricemia is one of the side effects
ETHAMBUTOL- can cause optic neuritis or blindness
STREPTOMYCIN- only anti-tuberculosis drugs that is injectable

 Initial treatment phase

- It consist of multi-medication regimen of isoniazid, rifampicin, pyrazinamide,

and ethambutol
- It was administered daily for 8 weeks or 2 months

 Continuation treatment phase

- Include isoniazid and rifampicin

- It last for 4 to 7 months, which is 4-month period are used for the large
majority of patient and 7-month period are recommended for patient with
cavitary PTB whose sputum culture after initial treatment phase is positive.

NOTE: people are considered non-infectious after 2 to 3 weeks of CONTINUOUS medication

therapy.
: Isoniazid is given with vitamin B to prevent “isoniazid associated- peripheral
neuropathy”
DIAGNOSTIC PROCEDURES
 SPUTUM CULTURE- direct sputum smear microscopy (DSSM) is the most definitive
examination for PTB.
 CHEST X-RAY- the results may reveals lesions on the upper lobe of the lungs.
 TUBERCULIN SKIN TEST- (matoux test) the results has induration (hardening) and
erythema. This is also done to know if you’ve been exposed to PTB.

METHODS OF CONTROL
 BCG vaccination after birth and at school entrants for the booster dose.
 Educate the public in the mode of spread and methods of control and the importance of
early diagnosis.
 Improve social risk condition, such as overcrowding
 Early detection and treatment