Pulmonary Tuberculosis
-reportable communicable, infectious, inflammatory disease that can occur in any part of the body
-a chronc disorder characterized by formation of granuloma/tubercles in the lung
-spreads via AIRBORNE DROPLET
**Mycobacterium tuberculosis
-aerobic
-acid fast bacilli
-transmitted by droplet nuclei
-non-motile
-killed by heat & ultraviolet light
S/SX:
Constitutional
-weight loss -afternoon fever -night sweats
-anorexia -body malaise
Local
-cough -dyspnea -hemoptysis
-rales/crackles
Diagnosis:
-CXR
-Skin test (PPD):>10 mm after 48hr
-sputum examination: one needs 3 samples to make a positive diagnosis
-Culture:GOLD STANDARD
-WBC & ESR: elevated
WHO CLASSIFICATION:
PTB exposure PPD TOD SSx
I + - - -
II + + - -
III + + + +
IV + + + -
V + + +/- +/-
TB TREATMENT
Preventive Measures
-give Isoniazid, 300mg for 9-12 months
-WHO:
-newly infected (+PPD)
-close household contact
-susceptible healthcare workers
-(+) PPD + AIDS, steroid therapy, CRF
-inactive TB (+ PPD,CXR)
Therapeutic
2 Phases
a.Intensive Phase
-uses 2-3 drugs
-"bactericidal" phase
b.Maintenance Phase
-uses 2 drugs
-"sterilizing" phase
**done in 6,9,12,24 months
MEDICATIONS:
Primary Anti-tubercular Agents
Rifampicin
-Rifadin;impairs RNA synthesis
-negates effects of OCPs
-s/e: hepatitis or yellowish
discoloration of urine & sweat, nausea, vomiting ,thrombocytopenia,
drowsiness
*monitor liver function test
*teach about color changes of urine, feces (red-orange)
*avoid activities that require alertness
Isoniazid
-INH; interfers with DNA synthesis
-used as prophylactic tx
-s/e: peripheral neuritis & hepatotoxicity
-->Pyridoxine (B6) used to counteract effects of INH
Pyrazinamide
-s/e: hyperuricemia
Ethambutol
-Myambutol; impairs RNA synthesis
-s/e:optic neuritis, skin rash
Streptomycin
-s/e: ototoxicity (8CN damage)
-use in caution in renal patients
Nursing Care
a. respiratory precautions:2-4 weeks
b. needs well ventilated private room
c. mask to all visitors & staff, discard mask after use
d. strict handwashing after each contact with patient
e. small frquent meals with suppements
f. activity as tolerated
g. take medications as prescribed
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2 comments :
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