Pulmonary Tuberculosis

Koch’s Disease, Phtisis,

MARISSA S. FERNANDEZ, RN,MAN

CLINICAL INSTRUCTOR
 Tuberculosis (TB) – is a chronic, contagious disease, and infectious disease
commonly affected the lungs. It is characterized by the formation of tubercles in
the tissue (tends to undergo caseation, necrosis and calcification.
 Pulmonary TB is a bacterial infection of the lungs that can cause a range of
symptoms, including chest pain, breathlessness, and severe coughing.
 Pulmonary TB can be life-threatening if a person does not receive treatment.
People with active TB can spread the bacteria through the air.
 = The world’s deadliest disease and remains as a major public health problem.
 = Badly nourished, neglected and fatigued individuals are more prone
 = Susceptibility is highest in children under 3 years
 Etiologic agents:
 Mycobacterium tuberculosis – a rod-shapd, acid-fast bacilli. Human are the primary reservoir.
 Mycobacterium bovis – found in cattle. Bovine TB is acquired through the ingestion of
unpasteurized dairy products or contact airborne secretions from infected cattle.

 Incubation period: two to 10 weeks

 Mode of transmission:
 M. tuberculosis – airborne droplet nuclei yhat produced when persons with pulmonary TB
cough, sneeze, laugh, or sing.
 M. bovis – may penetrate the GI mucosa or invade the lymphatic tissue of the oropharynx. It
occurs in large amount of bacteria are ingested in unpasteurized milk.
 Sources of infection: sputum, blood from hemoptysis, nasal discharge and saliva.
 Period of communicability: lifetime if not treated and highly communicable during its active
phase.
 Symptoms of TB can develop slowly and may vary. The main symptoms of
pulmonary TB include:
 a bad cough that lasts for at least 3 weeks
 chest pain
 coughing up blood or phlegm from the lungs
 breathlessness
 More general symptoms of TB can include:
 weight loss
 a loss of appetite
 nausea and vomiting
 low energy or fatigue
 fever and chills
 night sweats
 Quantitative Classification:
 1. Minimal TB – characterized by slight lesions without demonstrable excavation and is
confined o a small part of one or both lungs.
 2. Moderately advanced TB
 - one or both lungs may be involved
 - the volume affected should not extend to one lobe
 - total diameter of the cavity should not exceed 4cm.
 3. Far advanced TB – lesions are more extensive than those found in moderately advanced
cases.
 Clinical Classification:
 1. Inactive (latent) TB
 - absent of TB symptoms
 - no evidence of cavity on CXR
 - TB organisms are present in the client’s body, but the immune system stops from spreading
 - does not manifest symptoms and not contagious; but the organisms are still alive and one
day can be active.
 2. Active
 - (+)Tuberculin (Mantoux test)
 - progressive chest x-ray
 - symptoms due to lesions are present
 - sputum amd gastric content are positive for tubercle bacilli
 - capable of spreading the disease
 - 90% active cases are from reactivation of latent TB infection
 3. Activity not determined – from a suitable period of observation or adequate laboratory and
X-ray studies.
 Pathophysiology:
Mycobacterium Tuberculosis (inhaled)

Alveoli (Ghon’s tubercle)

Aggregation of lymphocytes

Death of cells

Caseous necrosis

Cheesy secretion
 Signs and symptoms of active TB include:
 Coughing for three or more weeks.
 Coughing up blood or mucus.
 Chest pain, or pain with breathing or coughing.
 Unintentional weight loss.
 Fatigue.
 Fever.
 Night sweats.
 Chills.
 Diagnostic procedures:
 1. medical history and physical examination
 2. Chest x-ray (AP for children, PA for adult)
 3. CT scan and MRI
 4. Sputum analysis for acid-fast bacillus (AFB)- confirmatory test
 5. Tuberculin testing – Mantoux test (PPD), Tine test (OT), Heaf test/multiple patch
 What are the complication of tuberculosis?
 Clinical manifestations of TB include primary TB, reactivation TB, laryngeal TB,
endobronchial TB, lower lung field TB infection, and tuberculoma.
 Pulmonary complications of TB can include: 
 hemoptysis, - coughing up of blood
 pneumothorax, - air in the pleural space due to tension
 bronchiectasis, disease in the bronchial tubes in which dilated and usually secrete
offensive pus in large quantities
 extensive pulmonary destruction,
 malignancy,
 chronic pulmonary aspergillosis.
 Treatment Modalities:
 1. short course chemotherapy (SCC) – given for 6 to 9 months are
 = INH – isoniazid
 = Rifampicin (Rifadin, Remactane)
 = Pyrazinamide (PZA)
 = Ethambutol (EMB)
 2. second line
 = Cycloserine/ ethionamide – for drug-resistant TB
 = Streptomycin and ethambutol
 = amikacin/ and quinolone
 3. direct observed therapy (DOT) to prevent non-compliance
 Elements of DOTS:
 1. political commitment with increased and sustained financing
 2. case detection through quality-assured bacteriology
 3. standardized treatment, with supervision and patient support
 4. an effective drug supply and management system
 5. monitoring and evaluation system, and impact measurement

 Prevention and control:

 1. BCG immunization on all babies
 2. avoid overcrowding
 3. improve nutritional and health status
 4. must undergo tuberculin test and cxr, prophylactic isoniazid once people
exposed to infected person.
 Nursing Diagnosis:
 1. imbalanced nutrition less than body requirements
 2. impaired gas exchange
 3. ineffective airway clearance
 4. ineffective coping
 5. risk for injury
 Nursing Management:
 1. maintain respiratory isolation until patient responds to treatment or until no
longer contagious
 2. administered medications as ordered
 3. always check the sputum for blood or purulent expectoration
 4. teach or educate patients and families about TB
 5. emphasize the need to stop smoking
 6. advise to get plenty of rest and eat balanced diet
 7. be alert on drugs reactions
 8 if patient receiving ethambutol observe optic neuritis; Rifampicin observe for
hepatitis and purpura
 9. emphasize the importance of regular follow-up examinations and instruct
patient.