PULMONARY

TUBERCULOSIS
The Misunderstood Disease

MA. CRISTINA TAMPINCO-REYES, BSN,RN

 OBJECTIVES:
 To provide a comprehensive review of the
mechanism of tuberculosis
(pathophysiology, clinical manifestations)
 To inform participants on ways to manage
the disease
(medical and nursing)
 PULMONARY TUBERCULOSIS
• Highly communicable disease that affects
lung parenchyma
• Caused by Mycobacterium tuberculosis
* acid-fast, aerobic rod
* commonly in the upper lobes
* May also affect the brain, intestines,
kidneys, joints and liver
PATHOPHYSIOLOGY
Inhalation of mycobacterium

Multiplication of bacteria in lower airways

Transmission of bacteria to other parts

(lymph nodes, kidneys, brain)

Immune system activated

Formation of Primary tubercle

Caseation necrosis

cavitation
 CLINICAL MANIFESTATIONS
 primarily asymptomatic
 low grade fever
 non-productive cough – persistent, maybe
with mucoid or mucopurulent sputum
 night sweats, chills
 fatigue
 anorexia & weight loss
 hemoptysis
Clinical Picture of
TUBERCULOSIS… Up Close
 DIAGNOSIS
• Physical Examination
• Chest X-ray – presence of multinodular
infiltrates with calcification
• Sputum Culture – confirmatory diagnosis
• Mantoux Test – most reliable determinant of
infection
TUBERCULIN SKIN TEST / MANTOUX TEST
 Standardized procedure using 0.1ml PPD
 Read after 48-72 hours
 Reaction occurs when BOTH induration
(hardening) and erythema (redness) are
noted
 Diameter of the induration is measured –
 10mm or more = exposure
 immunodeficient pts. 5mm>
is significant
 CLASSIFICATIONS OF
TUBERCULOSIS
CLASSIFICATION DESCRIPTION MEDICAL THERAPY
CLASS 0 No exposure, not None
infected
CLASS 1 Exposure, no evidence Preventive chemo
of infection
CLASS 2 With infection , no INH for 1 yr. for
disease reactors under age 35
CLASS 3 With disease, clinically Anti-TB drugs
active
CLASS 4 With disease, not No new therapy
clinically active
CLASS 5 Suspected disease, Preventive chemo with
diagnosis pending INH
 MEDICAL MANAGEMENT
 Treatment for 6 -12 months
 Non infectious after 2-3 weeks of continuous
medication therapy
 5 first-line medications: INH, rifampicin,
pyrazinamide, either streptomycin or
ethambutol
 Multiple medication regimen of INH,
rifampin, pyrazinamide & streptomycin OR
ethambutol given initially for 8 weeks
 If culture shows sensitivity to meds before
the 8th week , either ethambutol or
streptomycin is discontinued
 After 8 weeks - PZA
discontinued
DRUG STUDY
DRUGS SIDE EFFECTS TESTS REMARKS

Isoniazid Peripheral neuritis, AST (formerly SGOT) Daily alcohol intake

(INH) hepatitis, rash, fever ALT (formerly SGPT) interferes mets, risk for
hepatitis,antacids with Al
interfere absorption
Rifampicin Hepatitis, febrile AST, ALT, platelet count effect of contraceptives,
(RIF) reactions, hepatotoxicity anticoagulants,
increases when given corticosteroids,
with INH hypoglycemics,digitalis
Ethambutol Optic neuritis Visual acuity Vision check monthly
(EMB) (reversible upon DC) Give with food

Pyrazinamide Hyperuricemia, hepatitis, UA, AST, ALT Obtain baseline LFT, rpt
(PZA) arthralgia, GI irritation regularly
Give with food, drink 2L
water
Streptomycin 8th cranial nerve damage Vestibular function, Monitor kidney fxn tests,
(SM) (often irreversible), audiograms, creatinine monitor vestibular fxn with
nephrotoxicity level must be checked caloric stimulation tests
before treatment 1x/mo.,monitor hearing
with audiograms monthly
Vitamin B6 (pyridoxine) is usually administered with
INH to prevent peripheral neuropathy

 INH may be used as prophylactic

(preventive) measure for those at risk for 6-
12 months
 Liver enzyme, BUN, creatinine levels should
be checked monthly
HOSPITALIZED CLIENT
 Respiratory isolation, door tightly closed
 Room shld have at least 6 exchanges of
fresh air per hour, ventilated to outside
environment
HOSPITALIZED CLIENT..
 Nurse must wear mask (particulate
respirator) when caring for client. If with risk
of contamination of clothing, gown must be
worn
 Wash hands thoroughly before & after
caring for client
 Patient must wear mask when required to
leave the room
 Isolation is discontinued when no longer
infectious
 NURSING MANAGEMENT
PREVENT SPREAD OF DISEASE
• Client information on the disease process
• Reassure that after 2-3 weeks of medications, it
is unlikely that patient can infect anyone
• Instruct to cover mouth & nose when sneezing,
coughing & dispose off fomites properly
• Wash hands thoroughly before & after caring
 PROMOTE AIRWAY CLEARANCE
• Hydration
• Suction secretions as necessary
• Postural drainage
 ADVOCATE ADHERENCE TO TREATMENT
REGIMEN
• Enhance patient understanding on meds &
schedule
• Stress importance of compliance
• Advise on side effects & ways to minimize them
• Inform client the need to do sputum cultures every
2-4 weeks. Three negative sputum cultures renders
patient non-infectious
PROMOTE ACTIVITY & ADEQUATE
NUTRITION
• Plan a progressive activity schedule, resume
activities gradually
• Advise on adequate nutrition rich in iron, protein
and vitamin C
• Plan nutritious, small, frequent meals
• Weigh twice a week
MONITOR & MANAGE POTENTIAL
COMPLICATIONS
 Malnutrition
 Side effects of medication therapy
• Take meds on empty stomach or 1 hr before
meals
• Pts on INH should avoid foods containing tyramine
& histamine (tuna, aged cheese, red wine, soy
sauce, yeast extracts)
• Rifampin may increase metabolism of some meds
(eg. Beta-blockers, oral anticoagulants, digoxin,
quinidine, corticosteroids, oral hypoglycemics &
contraceptives, theophylline & verapamil)
 Rifampin may discolor contact lenses & urine
Q&A
QUESTION: A nurse performs an admission
assessment on a client with a diagnosis of
tuberculosis. The nurse reviews the results of which
diagnostic test that will confirm the diagnosis?
A. bronchoscopy
B. chest xray
C. sputum culture
D. tuberculin skin test

C. SPUTUM CULTURE
QUESTION: A community health nurse is
conducting an education session with community
members regarding tuberculosis. The nurse tells the
group that one of the first symptoms associated with
tuberculosis is
A. a bloody, productive cough
B. cough with expectoration of
mucoid sputum
C. chest pain
D. dyspnea

B. COUGH WITH MUCOID SPUTUM

QUESTION: Isoniazid and rifampin have been
prescribed for a client with PTB. A nurse reviews the
medical record of the client. Which of the following, if
noted, would require physician notification?

A. heart disease
B. allergy to penicillin
C. Hepatitis B
D. rheumatic fever

C. HEPATITIS B
QUESTION:A client exposed to PTB is taking
isoniazid & develops signs & symptoms of the
disease. The client is instructed to add rifampin to
his medicines. A nurse explains to the client that the
purpose of adding this medicine is
A. that rifampin offsets the side effects of INH
B. to be certain that resistant organisms are
eliminated
C. that these medications potentiate each
other
D. that INH offsets the side effects of rifampin

B. TO BE CERTAIN THAT RESISTANT

ORGANISMS ARE ELIMINATED
QUESTION: A female patient is scheduled for chest
radiography. Which of the following questions is of
most importance to the nurse assessing this client?
A. Is there any possibility that you could be
pregnant?
B. Are you wearing any metal chains or
jewelry?
C. Can you hold your breath easily?
D. Are you able to hold your arms above your
head?

A. IS THERE ANY POSSIBILITY THAT YOU

COULD BE PREGNANT?
QUESTION: A client is taking PZA for 1 month. The
client asks a nurse if the therapy is due to be terminated
soon. The nurse evaluates that the medication will
probably will be continued based on a positive finding in
which of the following reports?
A. blood culture
B. sputum culture
C. urine culture
D. wound culture

B. SPUTUM CULTURE
QUESTION: A nurse is reading a Mantoux test for a
client with no documented health problem. The site
has no induration but with 1mm ecchymosis. The
nurse interprets the result as:
A. positive
B. negative
C. uncertain
D. borderline

B. NEGATIVE
QUESTION:A nurse is caring for a client diagnosed
with PTB. Which assessment would not be
consistent with usual clinical presentation of PTB &
may indicate the development of a concurrent
problem?
A. nonproductive or productive cough
B. anorexia & weight loss
C. chills & night sweats
D. high grade fever

D. HIGH GRADE FEVER

QUESTION: A nurse is teaching a client with PTB
about dietary elements that must be increased in the
diet. The nurse suggests that the client increase
intake of
A. meats & citrus fruits
B. grains & broccoli
C. eggs & spinach
D. potatoes & fish

A. MEATS & CITRUS FRUITS

QUESTION: A nurse has conducted discharge
teaching with a client who was diagnosed with PTB.
The client has been taking medication for a week &
a half. The nurse evaluates that the client has
understood the information if the client makes which
of the following statements?
A. I need to continue drug therapy for 2 months
B. I should not be contagious after 2-3 wks of
medication therapy
C. I can’t shop at the mall for the next 6 months
D. I can return to work if a sputum culture
comes back negative

B. I SHOULD NOT BE CONTAGIOUS AFTER

2-3 WKS OF MEDICATION THERAPY
And Good Day!