Tuberculosis (powerpoint)

Tuberculosis Overview

  • Definition: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis primarily affecting the lungs.
  • Transmission: It spreads through airborne routes and can remain dormant in the body for years, activated only when the immune system is weakened.

Risk Factors

  • Close contact with untreated TB patients.
  • Low socioeconomic status and homelessness.
  • Individuals with immunosuppression (e.g., HIV, chemotherapy).
  • Crowded and poorly ventilated areas (e.g., prisons).
  • Advanced age.
  • Recent travel to endemic regions.
  • Substance use disorders.
  • Health care professions involving high-risk procedures.

Diagnostics

  • Mantoux Test: An intradermal skin test using purified protein derivative (PPD).

    • Initial wheal formation observed.
    • Read results between 48 to 72 hours.
    • A positive result shows redness and hardness.

  • Interpretation of PPD Results:

    • 5 mm or more at induration is considered positive for:
    • HIV-infected individuals.
    • Recent contacts of TB patients.
    • Patients with specific radiographic findings.
    • Organ transplant recipients.
    • Individuals on immunosuppressive therapy.
    • 10 mm or more is positive in any individuals, targeted testing should focus on high-risk groups.

  • Additional Tests:

    • QuantiFERON-TB Gold: Blood test detecting interferon-gamma from sensitized individuals.
    • Chest X-ray: Required if clinical manifestations are present or PPD is positive.
    • Acid-fast Bacilli Smear and Culture: Confirms active infection, positive cultures identify Mycobacterium tuberculosis.

Manifestations of TB

  • Common Symptoms:
    • Persistent cough (>3 weeks).
    • Purulent or blood-streaked sputum.
    • Fatigue and lethargy.
    • Weight loss and anorexia.
    • Night sweats and low-grade fevers, especially in the afternoon.
  • Atypical Symptoms: Older adults may present with altered mental status or other unusual behaviors.

Nursing Actions

  • Administer prescribed O2 therapy.
  • Implement airborne isolation techniques:
    • Use HEPA masks (N-95) and keep in a private room with negative airflow.
    • Place mask on patient during transportation.
  • Assess respiratory status regularly – check lung sounds and sputum characteristics.
  • Obtain necessary specimens; report lab findings promptly.
  • Encourage hydration and proper nutrition (protein, iron, and Vitamin C intake).

Medications for TB Treatment

  • Combination Therapy: Resistance to medications necessitates the use of up to four antibiotics for 6 to 12 months.
  • Current Treatment Regimen: Includes isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).

Directly Observed Therapy (DOT)

  • Concept: Ensures patient compliance with medication regimens by having a nurse directly observe the intake of medications, especially when treatments are lengthy (often >6 months).

First-Line Drugs

  • Isoniazid (INH): Bactericidal; inhibits mycolic acid synthesis.
    • Nursing Considerations: Monitor for hepatotoxicity and neurotoxicity; may require vitamin B6 supplementation.
  • Rifampin (RIF): Bacteriostatic/bactericidal; inhibits RNA polymerase.
    • Nursing Considerations: Assess liver function; expect orange discoloration in urine.
  • Pyrazinamide (PZA): Mechanism unknown; observe for gout and hepatotoxicity.
  • Ethambutol (EMB): Suppresses RNA synthesis; monitor visual acuity and color discrimination.

Second-Line Drugs for Resistant TB

  • Fluoroquinolones (e.g., Levofloxacin).
  • Injectable Aminoglycosides (e.g., Amikacin).
  • Thioamides (for multidrug-resistant TB).

Client/Family Education

  • All exposed family members should be tested for TB.
  • Importance of completing the full medication regimen (6-12 months).
  • Routine follow-ups necessary for 1 year (sputum samples required for monitoring).
  • Promote proper hand hygiene and mask-wearing in public for active TB.

Complications of TB

  • Miliary TB: Dissemination through bloodstream affecting multiple organs.
    • Symptoms include severe headaches, neck stiffness, and altered consciousness, potentially life-threatening.
  • Pericarditis: Inflammation leads to fluid accumulation, causing dyspnea and hypotension.
    • Nursing actions are similar to those for pulmonary TB.