Prepared by

NAEEMA AL-MORADI
NAWEL AL- WEASBI
ASHWAQ AL-QUBATI
JAWHARA AL-SIADI

supervision by
DR-RASHED AL-NAMER

Introduction- Causes
- Mode of transmission
- Symptoms
- Diagnosis
- Types of T
- Risk factors

Famous Affected Europeans

TO learn the drugs used in the treatment of. tuberculosis

To learn the uses, general drug action,interactions, and general adverse reactions
associated with the administration of the
.antitubercular drugs
To learn important preadministration and ongoing assessment activities the nurse should
perform on the patient taking an antitubercular
.drug
List some nursing diagnoses particular to a .patient taking an antitubercular drug
.Explain directly observed therapy (DOT)-

Tuberculosis or TB , is a bacterial infection that

causes more death in the world than any other
infectious disease . About 2 million people are
infected with TB world wide in US about 15
million people are infected .when TB become
active , it kills 60% of those who are not treated
this amount to 3 million deaths world wide every
.year

Causes :
TB is an infection caused by a bacterium called
mycobacterium tubercle bacillus
TB spreads from person to person through all as
a person with active TB coughs sneezes or
. expels air

After a person becomes infected, the TB bacteria

are controlled by the persons immune system.
The infection become latent , or confined when
the bacteria speed out of control the infection
.becomes active

Tuberculosis primarily affects the lungs, other

organs may also be affected. For example, if
the immune system is poor the infection can
spread from the lungs to other organs
.of the body
Extrapulmonary (outside of the lungs)
Tuberculosis;
is the term used to distinguish tuberculosis affecting the
lungs from infection with the M. tuberculosis bacillus in
other organs of the body.

Extrapulmonary sites

Transmissions of TB usually only occurs after

one or more months of exposure to some one
.with active TB

Natural History of TB Infection

Exposure to TB
No infection
(70-90%)

Infection
(10-30%)

Latent TB
(90%)
Never develop
Active disease
Die within 2 years

Active TB
(10%)

Untreated
Survive

Treated
Die

Cured

:Symptoms
:Early symptoms

Weight loss

Fever

Night sweat

loss of appetite

Coughing

Short of breath

<Sputum <bloody

Back pain

Diagnosis :

DIAGNOSIS;

* History and symptoms

* skin test called a mantoux test .the substance
called PPD is injection under the skin in the
forearm and examined 28-27 hrs. if area well
forms around injection site person infected with
. T.B

Blood test known as Quantiferon TB can show if*

.patient expose or infected with TB

.Sputum culture to determine types of TB bacteria *

X-ray show cavities or lesion in*

.lung

RISK FACTORS
Immune suppressed patient- 1
)HIV-long term corticosteroids drugs (

Old age

Poverty& homeless

Health care worker

smoking

Tuberculosis responds well to long-term treatment

with a combination of three or more antitubercular
drugs.

Antitubercular drugs are used to treat active

cases.
Or as a prophylactic to prevent the spread
of tuberculosis.
Antitubercular drugs are classified as primary and
secondery -line drugs.

Classification of drugs:

Anti-tuberculosis drugs can be divided into

two major Categories that base on their
efficacies and toxicities.

*First-line drugs:
Good effective, less toxicity and being well
tolerated for patients.

Second-line drugs:
Second-line drugs are used to treat extrapulmonary
tuberculosis and used as alternatives to the first-line
drug when drug resistance occurs or when a particular
therapy is required.
Drugs are less effective and more toxic.

- filed defects causing drug i.e.

Ethambutol

I
R
S
T

- Isoniazid

- Rifampin
- streptomycin
- Twice a day given drug
i.e. Pyrazinamide. All other drugs given
once a day.

Salicylates like para -aminosalicylic or

acid-4-aminosalicylic acid
E Ethionamide
C Cycloserine
O Old drug : Thiacetazone
N New drugs : Quinolones e.g Ciprofloxacine ,
levoflaxacine, moxifloxacine.
D Drugs rarely used : Aminoglycosiders ,
Capreomycine

Antitubercular drugs are used in

combination with other antitubercular
drugs to treat active tuberculosis.
Isoniazid (INH) is the only antitubercular
drug used alone.
primary use is in preventive therapy
(prophylaxis) against tuberculosis.

Bacterial resistance develops, sometimes rapidly, with the use

of antitubercular drugs.
Treatment is based on laboratory studies identifying the drugs
towhich the organism is susceptibleTo slow the development
of bacterial resistance, the Centers for Disease Control (CDC)
recommends the use of three or more drugs with initial
therapy, as well as in retreatment.
Using a combination of drugs slows the development of
bacterial resistance.
Tuberculosis caused by drug-resistant organisms should be
considered in patients who have no response to therapy and in
patients who have been treated in the past.

:ADVERSE REACTIONS
(ETHAMBUTOL)

( ISONIAZID)

(PYRAZINAMIDE)

(RIFAMPIN)

Rash

Reddish-orange discoloration of body fluids including sweat,

,sputum and saliva. urine, tears

(Streptomycin)

Drug Interactions
Antituberculosis drugs sometimes change
concentrations of other drugs

ISONIAZID

PYREZINAMIDE

RIFAMPIN

-The action of the anticoagulants

may be enhanced when taken with Ionized.
-increased serum levels of
Phenytoin with concurrent use of Isoniazid.
Decreases the effects of Allopurinol,
Colchicines, and Probenecid.
-Decrease the effects of the anticoagulant or
hypoglycemic drug.
-Decrease in the effect of the oral
contraceptives, Chloramphenicol,
Phenytoin, and Verapamil when these agents
are administered concurrently with Rifampin.

NURSING PROCESS
ASSESSMENT
Preadministration Assessment

Patient history, medication history

.family history and a history of contacts
Many laboratory and diagnostic tests may be
necessary before starting .antitubercular therapy
:Including
Radiographic studies
Culture and sensitivity tests
complete blood count

Ongoing Assessment
Observes the patient daily for the appearance of adverse-1
.reactions
Especially important when a drug is known to be-2
.nephrotoxic or ototoxi
Report any adverse reactions to the primary health care-3
.provider
Monitors vital signs daily or as frequently as every (4 )-4
.hours when the patient is hospitalized

: Disturbed Sensory Perception- 1

Tactile, Auditory, Visual
related to adverse reactions of antitubercular drugs
Risk for Impaired Skin Integrity related to adverse reactions-2
of the antitubercular drugs
,Noncompliance related to indifference, lack of knowledge-3
other factors
Risk of Ineffective Therapeutic Regimen Management-4
related to indifference, lack of knowledge, long-term treatment
.regimen

Nursing Planning

.Optimal response to antitubercular therapy*

.Management of common adverse reactions*

Promoting an Optimal Response to therapy

Allows time for the patient and family members to ask questions Necessary to refer the patient to other health care workers, such as a
.social service worker or a dietitian

Careful to rotate the injection sites. Previous injection sites for signs of .swelling, redness, and tenderness
.Should give antitubercular drugs by the oral route -

To help prevent the problem of noncompliance, directly

.observed therapy (DOT) is used drugs
The nurse watches the patient swallow each dose of the
.medication regime
DOT may occur daily or two to three times weekly, depending
.
on the patients health care regimen

MANAGING VARIOUS TREATMENT REGIMENS

Ethambutol
Administers Ethambutol once every 24 hours at
the same time each day
It is a good idea to give the drug with food to prevent gastric
.upset

If a dose is missed should tell the patient

.not to double the dose the next day
Should explain to the patient that the urine,
feces, saliva, sputum, sweat, and tears may be
colored reddish-orange or brownish-orange and
.that this is normal

Gives Isoniazid to the patient whose stomach is empty, at

.least 1 hour before or 2 hours after meals
If gastrointestinal upset occurs, the patient can
.take the drug with food
Teaches the patient to minimize alcohol consumption because of
.the increased risk of hepatitis

This drug is given once a day with food to prevent

.gastric upset
When administered on an outpatient basis, this
drug is administered using DOT

Administers Rifampin once daily to the patient with

an empty stomach, at least 1 hour before or 2 hours
.after meals
Explain to patients that their urine, feces, saliva,
sputum, sweat, and tears may be colored reddish.orange and that this is normal

Streptomycin is usually administered daily as a single IM

.injection
The preferred site is the upper outer quadrant of the
.buttock or the mild lateral thigh
In patients 60 years of age or older, the dosage is reduced
.because of the risk of increased toxicity

Careful patient and family education and close

.medical supervision are necessary
The patient and family must understand that
short-term therapy is of no value in treating this
.disease

.The therapeutic effect is achieved

, Adverse reactions are identified
,reported to the primary health care provider
.and managed successful
The patient verbalizes and understanding
of treatment modalities and the importance
.of continued follow-up care
The patient and family demonstrate
.understanding of the drug regimen
The patient complies with the prescribed
.drug regimen

BCG is live attenuated strain derived from M. bovis

.stimulates development of hypersensitivity to M. tuberculosis
Within 2-4wks swelling at injection site, progresses to papule
.about 10mm diameter & heals in 6-12 wks