1. Focus on Tuberculosis

2. Tuberculosis (TB)
Infectious disease caused by Mycobacterium tuberculosis

3. TB Involves Lungs Larynx Kidneys Meninges Bones Adrenal glands
Lymph nodes

4. Tuberculosis Second most common cause of death from infectious disease
2 billion of world’s population estimated to be infected (one third of population)

5. Tuberculosis Prevalence
8 to 9 million new cases and 2 million deaths each year
14,000 new cases in the United States per year

6. Tuberculosis Resurgence High rates of TB with HIV infection
Multidrug-resistant strains of M. tuberculosis

7. Tuberculosis
Disproportionate in
Poor
Underserved
Minorities

8. Etiology and Pathophysiology
Spread via airborne droplets when infected person
Coughs
Speaks
Sneezes
Sings

9. Etiology and Pathophysiology
Spread
Not by hands or objects
Brief exposure rarely causes infection
Transmission requires close, frequent, or prolonged exposure

10. Etiology and Pathophysiology
Spread
Inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli
Multiply with no initial resistance

11. Etiology and Pathophysiology
Replicates slowly and spreads via the lymphatic system

12. Etiology and Pathophysiology
Favorable environments for growth
Upper lobes of lungs
Kidneys
Epiphyses of bone
Cerebral cortex
Adrenal glands

13. Etiology and Pathophysiology
If cellular immune system is activated
Tissue granuloma forms
Contains the bacteria and prevents replication and spread of disease

14. Etiology and Pathophysiology
Without sufficient immune response
Organism is not maintained
Active primary disease results
Immunosuppressed and diabetic patients are at higher risk for disease

15. Etiology and Pathophysiology
Dormant TB organisms persist for years
Few ever develop TB
Reasons for reactivation are not well understood

17. Classification Classes 0 = No TB exposure 1 = Exposure, no infection
2 = Latent TB, no disease
3 = TB, not clinically active
4 = TB suspected

18. Clinical Manifestations
Early stages are usually free of symptoms

19. Clinical Manifestations
Fatigue
Malaise
Anorexia
Weight loss
Low-grade fevers
Night sweats

20. Clinical Manifestations
Cough becomes frequent
Produces white, frothy sputum
Hemoptysis is not common and is usually associated with advanced disease

21. Clinical Manifestations
Acute symptoms (generalized flu symptoms)
High fever
Chills
Pleuritic pain
Productive cough

22. Complications Miliary TB
Large numbers of organisms invade the bloodstream and spread to all organs
Acute or chronic symptoms

23. Complications Pleural effusion and empyema
Caused by bacteria in pleural space
Inflammatory reaction with plural exudates of protein-rich fluid

24. Complications TB pneumonia
Large amounts of bacilli discharging from granulomas into lung or lymph nodes

25. Complications TB pneumonia manifestations Fever Chills
Productive cough
Pleuritic pain
Leukocytosis

26. Complications Other organ involvement CNS—meninges
Bone and joint tissue
Kidneys

27. Complications Other organ involvement Adrenal glands Lymph nodes
Genital tracts

28. Diagnostic Studies Skin testing
Intradermal administration of tuberculin
Induration at injection site indicates exposure
Sensitivity remains for life and individual should not be tested again

29. Diagnostic Studies Skin testing
Response ↓ in immunocompromised patients
Reactions ≥ 5 mm considered positive

30. Diagnostic Studies Skin testing
Two-step testing recommended for health care workers getting repeated testing and those with decreased response to allergens

31. Diagnostic Studies Chest x-ray Cannot make diagnosis solely on x-ray
Upper lobe infiltrates, cavitary infiltrates, and lymph node involvement suggest TB

32. Diagnostic Studies Bacteriologic studies
Stained sputum smears examined for acid-fast bacilli
Required for diagnosis

33. Diagnostic Studies Bacteriologic studies
On different days three consecutive sputum samples are collected from
Gastric washings
CSF
Fluid from an abscess or effusion

34. Diagnostic Studies QuantiFERON-TB (QFT) New test
Rapid blood test (few hours)
Does not replace cultures

35. Collaborative Care Hospitalization not necessary for most patients
Drug therapy used to prevent or treat active disease

36. Drug Therapy Active disease
Four drugs are used in initial phase for maximum effectiveness
Treatment is aggressive to combat resistant strains of TB

37. Drug Therapy Directly observed therapy (DOT)
Noncompliance is major factor in multidrug resistance and treatment failures
Requires watching patient swallow drugs
Preferred to ensure adherence

38. Drug Therapy Active disease
Patients should be taught about side effects and when to seek medical attention
Liver function should be monitored

39. Drug Therapy Latent TB infection
Individual is infected with M. tuberculosis, but is not acutely ill
Usually treated with INH for 6 to 9 months
HIV patients should take INH for 9 months

40. Drug Therapy
Vaccine
Bacille Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of the world
Efficacy not clear
Can result in positive PPD reaction

41. Nursing Assessment Assess for Productive cough Night sweats
Afternoon temperature elevation
Weight loss

42. Nursing Diagnoses Ineffective breathing pattern
Imbalanced nutrition: Less than body requirements
Noncompliance

43. Nursing Diagnoses
Ineffective health maintenance
Activity intolerance

44. Planning Goals Comply with therapeutic regimen
Have no recurrence of disease
Have normal pulmonary function
Take appropriate measures to prevent spread of disease

45. Nursing Implementation
Ultimate goal in the United States is eradication
Selective screening programs in high-risk groups to detect TB
Identify contacts of patient with TB

46. Nursing Implementation
Acute intervention
Airborne isolation
Appropriate drug therapy
Immediate medical workup

47. Nursing Implementation
Teach patient
Cover nose and mouth with tissue when coughing, sneezing, or producing sputum
Hand washing after handling sputum-soiled tissues

48. Nursing Implementation
Ambulatory and home care
Ensure patient can adhere to treatment
Teach symptoms of recurrence

49. Evaluation Expected outcomes Complete resolution of disease
Normal pulmonary function
Absence of any complications
No transmission of TB