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Tuesday, October 18, 2011

Pulmonary Tuberculosis

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

2 comments :

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