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TUBERCULOSIS
REFERENCE
GOAL/OBJECTIVES
General
The general objective of this lecture is to broaden our knowledge about
the disease and develop skills on how to render the best possible care to a
patient suffering from Pulmonary Tuberculosis.
Specific
To be able to define Pulmonary Tuberculosis as well as on how it is
acquired, factors, signs and symptoms.
To apply and enhance our skills learned from this lecture to actual
handling and caring of a patient who suffered from Pulmonary
Tuberculosis.
To determine the possible nursing intervention that will be a great help in
patients prognosis.
To be able to give the appropriate health teaching and better
understanding of the disease to the patient, family and significant others.
TABLE OF CONTENTS
DISEASE DEFINITION
According to World Health organization (WHO) and Center for
Disease Control (CDC) they define Tuberculosis (TB) is caused by
bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
Tuberculosis is curable and preventable. TB is spread from person to
person through the air. When people with lung TB cough, sneeze or spit,
they propel the TB germs into the air. A person needs to inhale only a few
of these germs to become infected. About onethird of the world's
population has latent TB, which means people have been infected by TB
bacteria but are not (yet) ill with the disease and cannot transmit the
disease. People infected with TB bacteria have a 10% lifetime risk of
falling ill with TB. However, persons with compromised immune systems,
such as people living with HIV, malnutrition or diabetes, or people who use
tobacco, have a much higher risk of falling ill.
As Department of Health (DOH) defines Tuberculosis as a disease
caused by a bacterium that is mainly acquired by inhalation of infectious
droplets containing viable tubercle bacilli. Infectious droplets can be
produced by coughing, sneezing, talking and singing. Coughing is
generally considered as the most efficient way of producing infectious
droplets. And as our institution San Lazaro Hospital (SLH), Tuberculosis
is a chronic bacterial infection and its characterized by formation of
granuloma in infected tissues and florid cell-mediated hypersensitivity.
2,500
2,250
2,000
1,750
1,500
2
1,250
1,000
750
500
250
2010
2011
2012
Cases
2013
Deaths
CFR (%)
INCIDENCE/PREVALENCE RATE
2014
2015
DISEASE
TYPES/CLASSIFICATION/STAGES/PHASE
S OF ILLNESS
DISEASE TYPE:
PULMONARY TUBERCULOSIS
Representing approximately 75% of all tuberculosis cases, pulmonary TB
is the most common form of the disease. Although the body forms a
tubercle around the invading bacteria, they can continue to replicate
inside, causing the tubercle to grow. As it gets larger, it may invade
different parts of the lung, affecting the ability to breathe or entering
blood supply lines. Eventually the tubercle may grow so large that it
bursts, spreading the bacteria that were inside.
EXTRA-PULMONARY TUBERCULOSIS
Adrenal Glands
When tuberculosis attacks the adrenal glands they become ineffective at
producing hormones, such as cortisol causing adrenal insufficiency.
Symptoms include weakness, muscle fatigue, weight loss, nausea and
vomiting. Today TB accounts for 20% of the cases of adrenal insufficiency
in developed countries.
Lymph Nodes
When the lymph nodes are infected, in the neck or elsewhere in the body,
they swell. Other symptoms may include fever and sweating. E.g. Scrofula
Genito-Urinary
Tuberculosis of the genito-urinary system can manifest in a variety of
symptoms depending on the location of the infection and its severity.
Infection can produce fibrosis which in turn can cause ureter stricture and
other blockages. It can also cause infertility, genital ulcers and kidney
malfunction.
Cutaneous
When tuberculosis affects the skin it presents as lesions and growths that
can persist for years and often leave scarring. e.g Lupus Vulgaris
Gastrointestinal
Whether caused by the ingestion of tainted food products, or by
swallowing infected sputum from the lungs, TB in the digestive tract
produces ulcer-like lesions. Signs and symptoms include abdominal pain,
diarrhea and blood in the stool.
Osteo-Articular
When TB affects the joints or the spine, it causes a softening of the bones.
As the bones soften, they can compress in the spine this may cause a
hunchback while in the joints this can present with arthritis like symptoms.
e.g Potts disease.
Cardiac
If the tuberculous bacteria spread to the heart, they most commonly
affect the pericardium, the sac that contains the heart and part of the
major blood vessels. The presence and growth of the tubercles can cause
fibrosis and a hardening of the pericardium which can restrict the action of
the heart. e.g Tuberculous pericarditis
Miliary
Miliary tuberculosis refers to a tuberculosis infection that has spread to
multiple locations in the body through the blood stream or lymph system.
It is characterized by the presence of multiple, small seed-like collections
of bacilli, rather than larger granulomas.
PATHOGENESIS
DIAGNOSTIC/CONFIRMATORY/LABS AND
PARAMETERS FOR ADMINISTRATION
Parameters For Admission
Any known PTB case with any of the following:
1. Massive hemoptysis
2. Severe dyspnea
3. Chest X-ray findings of:
- Pleural effusion obliterating more than of lung field
- Pneumothorax
- Atelectasis
- Pneumonia
M.E.T.H.O.D.S
APPROACH
discharge parameters)
(include