PULMONARY TUBERCULOSIS

• Infectious disease primarily

affecting the lung parenchyma
• Commonly caused by
Mycobacterium tuberculosis
 Infects 1/3 of the world’s population
 Leading cause of death from infectious

disease worldwide
• Closely associated with poverty,
malnutrition and overcrowding
 Transmission: airborne
Pathophysiology
 Clinical manifestations:
insidious in onset

 Low grade fever

 Cough
 Hemoptysis
 Night sweats
 Fatigue
 Anorexia
 Weight loss
 Assessment and Diagnostic
Findings

 History and PE
 Tuberculin skin test
 Chest X ray
 AFB smear
 Sputum culture
 Tuberculin skin test /
Mantoux test
 Determine if the person has been
infected
 PPD: injected intradermal
 Area of induration is read at 48-72
hours
 Interpretation:
• 0-4mm - not significant
∀ > or = to 5mm - significant for individuals
at risk (HIV)
• > or= to 10 mm- significant in normal
individuals
 Classification of TB
 Class 0 no exposure, no infection
 Class 1 (+) exposure, no evidence
of infection
 Class 2 latent infection, no
disease
 Class 3 (+) disease, clinically active
 Class 4 (+) disease, not clinically
active
 Class 5 suspect, diagnosis pending
 Medical Management:
 Chemotherapeutic agents for 6-
12 months
• To ensure eradication and prevent
relapse
 Multidrug treatment: to prevent
development of resistant strains
 Considered non-infectious after
2-3 weeks of therapy
Medical Management:
 TB DOTS
Categor
y
Type of TB Intensive Maintenanc
e

I New Smear (+) 2 HRZE 4 HR

Extensive
Parenchymal Lesions
II Treatment Failure 2 HRZES 5 HRE
Relapse
III Smear (-) with 2 HRZE 4 HR
minimal parenchymal
lesion
IV Chronic (still smear
(+) after supervised
re treatment
 Preventive Measures
 Prompt diagnosis and treatment of
infectious cases
 BCG vaccination of newborn, infants
and grade 1 (school entrants)
 Educate the public in mode of spread
and methods of control and the
importance of early diagnosis
 Provide public Health nursing and
outreach services for home
supervision
 Nursing Intervention
 1. Promoting Airway clearance
∀ ↑ fluid intake
• postural drainage
 2. Advocating adherence to treatment
regimen
• inform client about the drugs, schedule,
side effects
• prevention of transmission
 covering the mouth and nose during coughing
and sneezing
 proper disposal of tissues
 hand hygiene
 Nursing Intervention
 3. Promoting activity and adequate
nutrition
• progressive activity
• small frequent meals and liquid
nutritional supplements
 4. Monitoring and Managing Potential
Complications
• a. Malnutrition: collaborate with the
dietician, physician, patient and
family
 provide high calorie nutritional
supplement
• b. Side effects of medication
 assess for side effects

 take medicines before meals or 1

hour after meals
• c. Multidrug resistance
 monitor vital signs and observe for
changes in clinical status
• d. Spread of TB infection
 monitor vital signs and observe for