Pulmonary tuberculosis

DEFINITION:

Pulmonary tuberculosis is an infectious disease caused

by slow- growing bacteria that resembles a fungus,
Myobacterium tuberculosis, which is usually spread from
person to person by droplet nuclei through the air. The lung
is the usual infection site but the disease can occur elsewhere in
the body. Typically, the bacteria from lesion
(tubercle) in the alveoli. The lesion may heal, leaving scar
tissue; may continue as an active granuloma, heal, then
reactivate or may progress to necrosis, liquefaction, sloughing,
and cavitation of lung tissue. The initial lesion may
disseminate bacteria directly to adjacent tissue, through the
blood stream, the lymphatic system, or the bronchi.

PATHOPHYSIOLOGY:

The most common transmission is HUMAN to HUM AN.

The predominant medium through which TB is spread is air.
Mucus droplets containing the bacteria are released from an
infected individual when they perform any type of forceful
expiratory effort. These particles remain suspended in the
air and, once inhaled by a susceptible person, they can
cause infection inside the lungs.TB infectionbe gi ns when
themycobacteria reach the pulmonary alveoli. The course of
the infection initially presents as a primary infection which
causes inflammation in a small area within the lung and is
usually self-limiting.
The primary site of infection in the lungs is called the Ghon
focus
• upper part of the lower lobe or the lower part of the
upper lobe

• Bacteria are picked up by dendritic cells.

• These cells can transport the bacilli to lymph nodes.

Further spread is through the bloodstream to other tissues and

organs where seconda ry TB lesions can develop in other parts
of the lung, peripheral lymph nodes, kidneys, brain,and bone.It
takes 4-12 weeks after being infected for the primary infection
to arise.The body’s reaction to the infection is ace ll-me d ia t e
d immune response. This response is usually adequate to
control the infection, but may not eliminate allbacteria. The
remaining bacteria resolve into a calcified lesion where they are
housed during a latent period.In a small number of cases, the
infection may not become inactive (latent) after the primary
infection and may progress to a more destructive chronic form
of primary TB

MANIFESTATIONS:

Chest pain
Coughing up blood
Productive, prolonged cough for more than three weeks

Systemic symptoms:
Fever
Chills
Night sweats
Appetite loss
Weight loss
Pallor
And often atendency to fatigue

DIAGNOSTIC PROCEDURES:

Chest X-ray
In active pulmonary TB, infiltrates or cavities are often seen in
the upper lungs with or without mediastinal or
hilarlymphadenopathy or pleural effusions ( tuberculous
pleurisy).However, lesions may appear anywhere in the lungs.
Abnormalities on chest radiographs may be suggestive of, but
are never diagnostic of,TB. However, chest radiographs may be
used to rule out the possibility of pulmonary TB in a person
who has a positive reaction to the tuberculin skin test and no
symptoms of disease.

Mantoux Skin Test

A standard dose of 5 Tuberculin units (0.1 mL) is injected
intradermally and read 48 to 72 hours later. A person who has
been exposed to the bacteria is expected to mount an immune
response in the skin containing the bacterial proteins.
The reaction is read by measuring the diameter of
induration(palpable raised hardened area) across the forearm
in millimeters. If there is no induration, the result should be
recorded as "0 mm". Erythema (redness) should not be
measured.
Classification of tuberculin reaction:
5 mm or more
Positive in HIV-positive person
Recent contacts of TB case
Persons with nodular or fibrotic changes on chest x-ray
consistent with old healed TB
Patients with organ transplants and other immunosuppressed
patients
10 mm or more
Positive in Recent arrivals from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings (e.g.,
prisons, nursing homes, hospitals, homeless shelters, etc.)
Mycobacteriology lab personnel
Persons with clinical conditions that place them at high risk
(e.g., diabetes,prolonged corticosteroid therapy, leukemia, end-
stage renal disease, chronic malabsorption syndromes, low
body weight, etc)
Children less than 4 years of age, or children and adolescents
exposed to adults in high-risk categories
15 mm or more
Persons with no known risk factors for TB
Sputum cultures
-should be done for acid-fast bacilli if the patient is producing
sputum. The preferred method for this is fluorescence
microscopy (auramine-rhodamine staining),which is more
sensitive than conventional Ziehl-Neelsen staining.
Why it is done?
To detect and identify the bacteria or fungi that are causing an
infection of the lungs or the airways leading to the lungs.
Identify the best antibiotic to treat the infection.
Monitor treatment of an infection.
How To Prepare?
Do not use mouthwash before collecting a sputum sample
because it may contain antibacterial substances that could affect
your results.
If bronchoscopy will be used to collect your sputum sample, do
not drink or eat for 6 hours before having the test.
Tell your health professional if you have recently taken any
antibiotics.
How It Is Done?
Usually, the sputum sample is collected early in the morning
before you eat or drink anything.
The health professional collecting the sample may tap on your
chest to help loosen the sputum in your lungs before you
cough.
Once the sputum sample is collected, it will be placed in ac
onta ine r with the culture medium that promote the growth of
infecting organisms.
The organism that causes tuberculosis may take 6 weeks to
grow.
Any bacteria or fungi that grow will be identified under a mic
roscope or by chemical tests.
Sensitivity testing, to determine the best antibiotic to use
against the organism that grows, often takes 1 to 2 additional
days

MEDICAL AND SURGICAL INTERVENTIONS

Short course regimen with at least 3 anti-TB drugs for 2 months

during the intensive phase and 2 anti-TB drugs for 4 months
during the continuation phase.
Domiciliary treatment shall be the preferred mode of care.
Anti-TB Drugs
Isoniazid (INH) is an organic compound that is the first-line
anti-tuberculosis medication in prevention and treatment.
Isoniazid is never used on its own to treat active
tuberculosis because resistance quickly develops.
Rifampicinis a bactericidal antibiotic drug
Pyrazimideis largely bacteriostatic but can be bacteriocidal on
actively replicating tuberculosis bacteria.
Ethambutolis a bacteriostaticantimycobacterial drug
prescribed to treat tuberculosis
Streptomycin - it kills sensitive microbes by inhibiting protein
synthesis

NURSING INTERVENTIONS

Auscultatedbreath sounds and assessed air movement to

ascertain status and note
progress.
Elevate the head of the bed/change position every 2 hours and
PRN to take advantage
of gravity decreasing pressure on the diaphragm and enhancing
drainage of ventilation
to different lung segments
Encouraged deep breathing and coughing exercise
Encouraged increase fluid intake
Provided supplemental humidification if needed
Provided back tapping after nebulization to move the secretions
in the lungs

BORROMEO,ELVIN R.
BSN 3-A