COMMUNICABLE

DISEASE

TUBERCULOSIS

SUBMITTED TO:
MAAM CAROL RUTH VALLES

SUBMITTED BY :
JOJIE FAYE GU

DATE SUBMITTED:
MAY 9 , 2013




I. Introduction
Tuberculosis is a disease caused by a bacterium called Mycobacterium tuberculosis that is
mainly acquired by inhalation of infectious droplets containing viable tubercle bacilli. The
bacteria usually attack the lungs, but they can also damage other parts of the body and is
common among crowded areas.
In 1993 , WHO declared TB as global emergency because of resurgence in many parts of the
world . And it was ranked as the sixth leading cause of morbidity and mortality .

II. Mode of transmission
Airborne droplet method through coughing , sneezing or singing.
Direct invasion of mucous membranes or breaks into the skin may occur.
Bovine tuberculosis results from the exposure to tuberculosis cattle .

III. Signs and Symptoms
Cough of that lasts 2 weeks or longer
Fever
Chest or back pains not referable to any musculo- skeletal disorders
Weight loss
Loss of appetite
Coughing up blood or mucus
Weakness or fatigue
Fever
Night sweats, body malaise , shortness of breath
IV. Methods of control
Preventive measures
Prompt diagnosis and treatment of infectious agent
BCG vaccination
Educate the public in mode of spread and methods of control and the importance of
early diagnosis.
Improve social conditions , which increases the risk of becoming infected as
overcrowding
Make available medical , laboratory and x-ray facilities for examination of patients
and for early treatment of persons at high risk .
Provide nursing care and outreach services for home .
V. MEDICATION AND ITS SIDE EFFECTS:

Rifampicin
body fluid discoloration
hepatotoxic
permanent discoloration of contact lenses
Isoniazid
Peripheral neuropathy (Give Vit B6/Pyridoxine)
Pyrazinamide
hyperuricemia /gouty arthritis (increase fluid intake)
Ethambutol
Optic neuritis
Blurring of vision (Not to be given to children below 6 y.o. due to inability to
complain blurring of vision)
Inability to recognize green from blue
Streptomycin
Damage to 8th CN
Ototoxic
Tinnitus
nephrotoxic

*Most hazardous period for development of clinical disease is the first 6-12 months after infection
Highest risk of developing disease is children under 3years old









The National TB Control Program
Vision:
A country where TB is no longer a public health problem
Mission
Ensure that TB DOTS services are available , accessible , affordable .
Goal:
To reduce by half TB prevalence and mortality from TB compared to 1990 figures by
2015
Targets
1. Cure at least 85 percent of the sputum smear positive patient discovered.
2. Detect at least 70 percent of the estimated new sputum smear-positive TB
cases .
KEY POLICIES
A. CASEFINDING
1. Direct Sputum Smear Microscopy (DSSM) shall be the primary shall be the
primary diagnostic tool in NTP case finding .
2. All TB symptomatic identified shall be asked to undergo DSSM for Dx before
start treatment .
3. Pulmonary TB symptomatic shall be asked to undergo other diagnostic tests.
4. No TB Dx shall be based on the results of the x-ray examinations alone.
5. Passive case finding shall be implemented in all health stations
6. Only trained medical technologies or microscpists shall perform DSSM (smearing
, fixing, staining, sputum specimens , as well as reading , recording and reporting
results) . However , in far flung areas , BHWs may be allowed to do it as long as
theyve been trained and are supervised by their respective NTP medical
technologists / microscopists .
B. TREATMENT
1. Aside from clinical findings , treatment of all TB cases shall be based on reliable
diagnostic technique , namely DSSM .
2. Domiciliary Treatment shall be the preferred mode of care .
C. Patients with the ff. conditions shall be recommended
for hospitalization :
1. Massive hemoptysis
2. Pleural effusion obliterating more than one-half of lung field .
3. Military TB
4. TB meningitis
5. TB pneumonia
6. Those requiring surgical intervention ot with complications
D. All patients undergoing treatment shall be supervised . No
patient shall initiate treatment unless patient And DOTS
facility staff have agreed upon a case holding mechanism
for treatment compliance .
E. The national and local government units shall ensure
provision of drugs to all smear- positive TB cases .
1. Fixed Dose combination (FDCs)
= two or more first line anti TB drugs are combined in one
tablet . There are 2,3,4- drug fixed dose combinations
2. Single drug formulation (SDF)
= Each drug is prepared individually . INH , Ethambutol and
pyrazinamide are in tablet from while Rifampin is in capsule
form .

DOTS STRATEGY
DOTS is the internationally recommended TB control strategy and
combines five elements :
1. Sustained political commitment
2. Accesss to quality assured sputum microscopy
3. Standardized short course chemo for all cases of TB under the proper case
management coditions , including direct observation of treatment
4. Uninterrupted supply of quality assured drugs
5. Recording and reporting system enabling outcome assessment of all patients
and assessment of aver all program performance
PUBLIC HEALTH NURSING RESPOSIBILIIES ( ADULT TB)
1. Together with other NTP staff workers, manage the procedures for case finding
activities .
2. Assign and supervise a treatment partner for patient who will undergo DOTS .
3. Supervise rural health midwifes
4. Maintain and update the TB Register.
5. Facilitate requisition and requisition of drugs and other NTP supplies.
6. Provide continuous health education to all TB patients and encourage family and
community participation with the TB control .
7. In coordination with the physician , conduct training of health workers
8. Prepare ,analyze , and submit the quarterly reports to the Provincial Health Office or
City Health Office .
MANAGEMENT OF CHILDREN WITH TB
1. Prevention
2. Casefinding
a. Cases of TB patients are reported and identified in two instances
The patient spught consultation , was screened and was found to
have signs and symptoms of TB
The patient was reported to have been exposed to an adult TB
patient .
b. All TB symptomatic children 0-9 years old , except sputum positive child
shall be subjected to Tuberculin testing .
c. A patient shall be suspected a having TB and will be considered as a TB
symptomatic if with any three of the following signs and symptoms
d. A child shall be clinically diagnosed or confirmed of having TB if he has any
three following conditions
Positive Hx of exposure to an adult / adolescent TB case
Presence of signs and symtoms \ of TB
Positive Tuberculin Test
Abnormal chest radiograph suggestive to TB
Laboratory findings suggestive or indicative to TB
e. For children with exposure to TB
f. For children with signs and symptoms of TB
3. Caseholding and Treatment
Caseholding mechanism
Treatment Regimen

1. Pulmonary TB
DRUGS DAILY DOSE
(mg/kg/body/weight)
DURATION
INTENSIVE PHASE
Isoniazid
Rifampicin
Pyrazinamide


10-15 mg/kg body weight
10-15 mg /kg body weight
20-30 mg / kg body weight


2 MOTHNS
CONTINUATION PHASE
Isoniazid
Rifampicin


10-15 mg/kg body weight
10-15 mg/kg body weight

4 MONTHS


2. Extra Pulmonary TB
DRUGS DAILY DOSE
(mg/kg/body/weight)
DURATION
INTENSIVE PHASE
Isoniazid
Rifampicin
Pyrazinamide

PLUS
Ethambutol or
Streptomycin


10-15 mg/kg body weight
10-15 mg /kg body weight
20-30 mg / kg body weight


15-25mg/kg body weight
20-30mg/kg body weight


2 MOTHNS
CONTINUATION PHASE
Isoniazid
Rifampicin


10-15 mg/kg body weight
10-15 mg/kg body weight

10 MONTHS


PUBLIC HEALTH NURSING RESPONSIBILITIES
1. Interview and open treatment cards for identified tuberculosis children
2. Perform tuberculin testing and reading to eligible children
3. Maintain NTP records
4. Manage requisition and distribution
5. Assist physician in supervision
6. Assist in training of other health workers on Tuberculin testing and reading .