Pulmonary Tuberculosis

1. Pulmonary Tuberculosis z.. Prepared By: Deepak Kapoor Email-kapoor.deepak@live.com For Nursing Students Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

2. Tuberculosis ? Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

3. History of Tuberculosis in India Ancient India The first references to tuberculosis in Asian civilization is found in the Vedas. The oldest of them (Rigveda, 1500 BCE) calls the disease yaksma (tuberculosis).The Atharvaveda calls it another name: balasa. It is in the Atharvaveda that the first description of scrofula is given. The Sushruta Samhita, written around 600 BCE, recommends that the disease be treated with breast milk, various meats, alcohol and rest. The Yajurveda advises sufferers to move to higher altitudes. The Manu Smriti, written around 1500 BCE, states that sufferers of yaksma are impure and prohibits Brahmans from marrying any women that has a family history of the disease. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

4. Introduction Tuberculosis (TB) is a major public health problem in India. India accounts for one-fifth of the global TB incident cases. Each year nearly 2 million people in India develop TB, of which around 0.87 million are infectious cases. It is estimated that annually around 330,000 Indians die due to TB. According to WHO, India accounts for about 20% of the global TB cases. Each year, about 2 million people in India develop TB, and over 300,000 die because of it. Director-general of health services Dr R K Srivastava says, "By the end of 2015, India will bring in universal access for quality diagnosis and treatment for all TB patients in the community. The programme aims to achieve early detection and treatment of 90% of estimated TB cases in the community, including HIV associated TB and successful treatment 90% of all new TB patients and 85% of all previously-treated TB patients." Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

5. Meaning and Definition Pulmonary Tuberculosis Pulmonary Tuberculosis (TB) is a bacterial infection caused by a germ called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks. If a person is exposed, he should go to his doctor for tests. A person is more likely to get TB if he has a weak immune system. An infectious disease of humans and animals caused by the tubercle bacillus and characterized by the formation of tubercles on the lungs and other tissues of the body, often developing long after the initial infection. Tuberculosis of the lungs, characterized by the coughing up of mucus and sputum, fever, weight loss, and chest pain. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

6. Etiology/ Causes Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis). You can get TB by breathing in air droplets from a cough or sneeze of an infected person. • Causes of TB includes: • HIV infection, • Low socioeconomic status, • Alcoholism, homelessness, • Crowded living conditions, • Diseases that weaken the immune system, • Migration from a country with a high number of cases, • And health-care workers. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

7. Clinical Manifestation People with a latent TB infection don’t have any symptoms, don’t feel sick and cannot infect others. They do, however, test positive to the Mantoux Skin Test. Treating latent TB is important since it can get activated, especially if the immune system is weakened for any reason, including nutritional deficiencies or infection with HIV. In the case of an active infection, signs and symptoms vary according to the organ that is affected. • In case the lungs are affected, the symptoms are: • A cough persisting for 2 to 3 weeks and beyond, which is usually worse in the mornings • Chest pain • Blood in the sputum (the mucus and saliva produced when coughing or clearing throat) • Breathlessness Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

8. Clinical Manifestation • Back pain may be caused by tuberculosis of the spine, and blood in the urine may be caused by tuberculosis in your kidneys. • TB in the brain can cause headaches, a stiff neck, confusion, vomiting, an altered mental state, seizures and other signs and symptoms related to the nerves. • In general, a person with active TB in any organ may have these signs and symptoms: • Weight loss • Loss of appetite • Chills • Fever • Sweating in the night time while sleeping, • even if the weather is cold. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

9. More Specific & Overlapping Symptoms of Tuberculosis Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

10. Diagnosis for Tuberculosis Lung Sound – During the physical exam, doctor will use a stethoscope to listen carefully to the sound of patient’s lungs when he breathe. Sound of wheezing can be identified in case of tuberculosis. But its not sufficient to diagnosis of TB. Tuberculosis skin test – A small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you're likely to have TB infection. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

11. Diagnosis for Tuberculosis Chest X-ray -If a person have had a positive skin test, doctor is likely to order a chest X-ray. This may show white spots in his lungs where immune system has walled off TB bacteria, or it may reveal changes in his lungs caused by active tuberculosis. Sputum tests -If your chest X-ray shows signs of tuberculosis, your doctor may take a sample of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. These bacteria can also be tested to see if they are resistant to the effects of medications commonly used to treat tuberculosis. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

12. Diagnosis for Tuberculosis Chest CT scan- Tuberculosis. Colored axial computed tomography (CT) scans of sections through the chest of a 36 year old with pulmonary tuberculosis (TB). The chest CT scanning machine takes many pictures, called slices, of the lungs and the inside of the chest. A computer processes these pictures; they can be viewed on a screen or printed on film. Show the size, shape, and position of your lungs and other structures in your chest. Follow up on abnormal findings from standard chest x rays. Find the cause of lung symptoms, such as shortness of breath or chest pain. the lungs are dark blue with affected areas lighter blue. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

13. Medical Management/Rx The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. The most commonly used drugs include: • Isoniazid • Rifampin • Pyrazinamide • Ethambutol Other drugs that may be used to treat TB include: • Moxifloxacin Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

14. Brief Pharmacology- Tuberculosis I S O N I A Z I D Isoniazid is an antibiotic that is used to treat tuberculosis (TB). It works by killing the bacteria that cause the disease. RIFAMPIN This medication is a rifamycin antibiotic used to prevent and treat tuberculosis and other infections. This antibiotic treats only bacterial infections. It will not work for viral infections PYRAZINAMIDE Pyrazinamide is a drug used to treat tuberculosis. The drug is largely bacteriostatic, but can be bacteriocidal on actively replicating tuberculosis bacteria. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

15. Brief Pharmacology- Tuberculosis ETHAMBUTOL Ethambutol is a bacteriostatic antimycobacterial drug prescribed to treat tuberculosis. It is usually given in combination with other tuberculosis drugs, such as isoniazid, rifampicin and pyrazinamide. MOXIFLOXACIN Moxifloxacin is used to treat certain infections such as pneumonia, bronchitis, and sinus, skin, and abdominal infections caused by bacteria. Moxifloxacin is in a class of antibiotics called fluoroquinolones. It works by killing the bacteria that cause infections. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

16. Prognosis & Complications Prognosis(Expectations) Symptoms often improve in 2 - 3 weeks. A chest x-ray will not show this improvement until weeks or months later. The outlook is excellent if pulmonary TB is diagnosed early and treatment is begun quickly. • Complications • Pulmonary TB can cause permanent lung damage if not treated early. • Medicines used to treat TB may cause side effects, including liver problems. Other side effects include: • Changes in vision • Orange- or brown-colored tears and urine • Rash • A vision test may be done before treatment so doctor can monitor any changes in patient’s eyes' health over time. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

17. Nursing Assessment of Tuberculosis Patients A patient with tuberculosis may show certain signs and symptoms of the disease. During a nursing assessment, the nurse tries to find out the following: • If the patient has been exposed to someone who has tuberculosis • If the patient has any symptoms of tuberculosis by asking questions and performing a physical exam. The nurse looks for signs of a productive cough, night sweats, temperature elevation during the day, unintentional weight loss and chest pain. The nurse also listens to the patient's lungs for abnormal breath sounds. • If the patient is on drug therapy for tuberculosis, the nurse assesses for signs of liver abnormalities such as fatigue, joint pain, fever, tenderness in the liver area, clay colored stools, dark urine, vision changes, and loss of feeling in the hands and legs. The nurse also does this by monitoring the patient's liver function lab tests. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

18. Nursing Diagnoses For Tuberculosis A nursing diagnosis is a statement that describes a patient's response to his medical problem which in this case is tuberculosis. Nursing diagnoses for tuberculosis are as follows: • Risk for infection related to pulmonary TB disease • Ineffective breathing pattern related to decreased lung volumes and pulmonary infection • Ineffective therapeutic regimen related to long term treatment and lack of motivation • Imbalanced nutrition; less than body requirements related to fatigue, poor appetite, and productive cough Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

19. Nursing Interventions for Risk for Infection • The goal of care for this nursing diagnosis is to reduce the risk of spreading tuberculosis and making sure the patient's tuberculosis is effectively treated. The following nursing activities address these goals: • Teach the patient about the infectious nature of tuberculosis and the need to prevent its spread. • Place the patient in a negative pressure room and in a private room. • All nurses and visitors entering the patient's room should wear an N-95 mask. • Put a mask on the patient during transportation to other departments. Keep the door to the patient's room shut and place an isolation sign at a visible location near the door. • Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing. • Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag. • Teach the tuberculosis patient to stay in well ventilated areas and limit contact to other people while he or she is still able to spread the infection Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

20. Nursing Interventions for Ineffective Breathing Pattern Patients with tuberculosis may need to work harder to breathe due to coughing, nervousness or a high fever. Ineffective breathing pattern involves breathing at a faster or slower rate, use of accessory muscles to breathe and fast heart rates amongst other things. Nursing interventions for this problem are as follows: • Administer oxygen if ordered and as ordered by a physician. • Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs. • Position the patient in a high fowlers position to reduce the work needed to breathe. • Encourage and provide rest periods so the tuberculosis patient can have energy to breathe. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

21. Nursing Interventions to Improve Nutritional Status of TB Patients Proper nutrition is necessary for the body to heal and fight off infections. Nursing interventions to improve the nutritional status of TB patients includes explaining the importance of a nutritious diet, monitoring the patient's weight for improvement or maintenance, administering vitamin supplements as prescribed and providing small frequent meals. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

22. Nursing Interventions to Improve Compliance with Tuberculosis Drug Regimen It is important for tuberculosis patients to take their medications as prescribed. Failure to do this may result in drug resistant forms of tuberculosis. This would make the patient’s tuberculosis difficult to cure. To increase compliance with the drug regimen for tuberculosis which can be very long, the nurse does the following: • Teaches the patient about the importance of taking all prescribed medications because the bacteria that causes TB grows slowly and requires a long time to be eliminated. • Provide the TB patient with information about expected side effects of TB drugs so that they know when to seek a doctors care and when not to be alarmed. • Refer patients having a hard time sticking to their drug therapy for direct observation therapy, where someone will watch them take their medication as they should. Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)

23. Thanks for Watching my presentation If you found my presentation useful, then please Join my group “Redefining The Nursing With New Outlook” over Facebook and contribute your ideas to make nursing profession on the heights. From: Deepak Kapoor (kapoor.deepak@live.com) Click here to find us Prepared & Designed By: Deepak Kapoor (kapoor.deepak@live.com)