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PULMONARY TUBERCULOSIS

● Is an infectious disease that primarily

affects the lung parenchyma
● Primary agent: Mycobacterium
Tuberculosis (acid fast aerobic rod)

Risk factors

● Close contact with infected (inhalation,

airborne)
● Immunocompromised status
● Immigration from countries with a high
prevalence of TB (Africa, SEA, Latin
America)
● Crowded substandard housing
● Being a health care worker
● Person without adequate health care

2 Stages

Inactive

● Started to grow in the lungs but has not

shown any symptoms
● Body calcifies them – Gohn tubercle can
remain for yr.
● When Gohn tubercle begin to grow
infection can be activated

Active

● Myobacteria reach the pulmonary

alveoli, where they invade and replicate
● Primary site -> Gohn focus, located
either the upper part of the lower lobe
or the lower part of the upper lobe

Note: A Ghon lesion, sometimes called a Ghon

focus, represents a tuberculous
caseating granuloma (tuberculoma) and
represents a sequela of primary pulmonary
tuberculosis infection.
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Pathophysiology of Pulmonary Tuberculosis

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Pott's Disease, also known as tuberculosis

spondylitis, is a rare infectious disease of the
spine which is typically caused by an extra spinal
infection. Pott's Disease is a combination of
osteomyelitis and arthritis which involves
multiple vertebrae.
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Clinical Manifestations ● Take pieces of cell and inoculate under

the skin
Pathognomonic sign: low grade fever in the ● If PPD is positive, you take a chest x-ray
afternoon in which they look for infiltration
- Cough (cloudy lungs)
- Night sweats ● 48 to 72 hours - result
- Fatigue ● Negative chest x-ray means you take 6
- Weight loss months of antibiotics
- Mucopurulent sputum ● Positive means you take 2 years of TB
- Hemoptysis drug
- Chills Note: What is being injected in PPD?
- Anorexia
- Pleuritic pain A tiny amount of tuberculin is injected under
the skin, usually in the forearm. Tuberculin is a
Note: sterile extract purified protein derivative (PPD)
● Difference between hemoptysis and made from the bacteria that cause TB.
hematemesis Chest X-ray
o Hemoptysis: expectoration of
blood/ blood-tinged sputum; ● Reveals lesions in the upper lobes of the
bright red or rust; alkaline lungs
o Hematemesis: preceded by
Tuberculin Skin Test
vomiting or retching; dark red
or brown, mixed with food Tubercle bacillus extract (tuberculin), purified
particles; acidic derivative protein is injected into intradermally
● Compresses pleuritic lining -> pleuritic on the inner aspect of the forearm approx. 4
chest pain cm. below the elbow

Diagnostic Procedures Add. DX. Procedure

● 0.1 ml PPD – elevation

● 6 to mm in diameter wheal
● Record: site antigen name, strength,
date and time
● Result: 48 to 72 hrs. after injection
● Delayed reaction – sensitive to
tuberculin
● Size determines the significance of the
reaction
o 0-4 mm: not significant
PPD – Purified Protein Derivative o >5 mm: at risk
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o >10 mm: significant with

normal or mild impaired
immunity Evaluate the presence cont.

Sputum Culture ANTI-TB DAILY DOSE SIDE EFFECT

DRUG
● Presence of AFB on sputum smear Isoniazid 5kg/mg (300 Peripheral
● Does not confirm TB, some AFB are not mg) max. neuritis,
daily hypersensitivity
M. Tuberculosis
Rifampin 10 mg/kg Fever, nausea
Interferon Gamma Release Assay (Rifadin) (600 mg) and vomiting
max. daily
● Evaluate the presence of TB in the blood Pyrazinamide 15 to 30 Hyperuricemia,
● More specific in PTB mg/kg (2 hepatotoxic,
grams) max. skin rash
● If client is (+) for PPD and IGRA client
Ethambutol 15 to 25 Optic neuritis
will undergo chest x-ray
mg/kg (1.6
grams)
Medical Management

● 6 to 12 months therapy
Nursing Management
Anti-TB Drugs
● Promoting Airway Clearance
● Hisoniazid o Increase fluid intake
● Rifampicin o Correct positioning to facilitate
● Zpyrazinamide airway drainage
● Ethambutol ● Promoting Adherence to Treatment
o Instruct the client about the
Initial Phase medication
● 1-2 months o Instruct client to take
● HRZE medication on empty stomach
● Vitamin B6 (Pyridoxine) – prevent or at least 1 hour before meals
peripheral neuropathy; taken every day because interferes medication
absorption
Continuation Phase o Pt. taking Isoniazid should avoid
foods that contain tyramine
● 3 to 6 months
(tuna, aged cheese, red wine,
● Isoniazid and rifampin
soy sauce) because it may result
Streptomycin – first drug effective against TB in headache, palpitation and
diaphoresis
Note: 3 to 8 months – Isoniazid and ethambutol o Avoid alcoholic bev. –
hepatotoxic effects
o Rifampin – discolor contact
lenses, recommend eyeglasses
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● Promoting Activity and Adequate

Nutrition
o Progressive activity
o Nutritional plan
● Preventing transmission of tuberculosis
infection