SCHOOL OF NURSING

THE ASSAM KAZIRANGA UNIVERSITY

HEALTH EDUCATION
ON
S

TUBERCULOSIS

SUBMITTED TO:
SUBMITTED BY:
MRS. VINEETHA. M
MR. SHAMEZ UDDIN KHAN
ASSOCIATE PROFESSOR
B.S.C. NURSING 3RD SEM
MEDICAL SURGICAL NURISNG
SCHOOL OF NURSING
SCHOOL OF NURSING
 STUDENT PROFILE

Name of the instructor :

Name of the Groups :
Course :
Name of the Topic :
Subject :
Date :
Time :
Venue :
Name of Student :
Method of Teaching : Lecture methods, Lecture cum discussion.
AV AIDs : Blackboard and chalk, Pictures, Charts, leaflets, pamphlet, and
Powerpoint presentation with videos assisted teaching.
General Objective:
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

INTRODUCTION
Tuberculosis (TB) is an infectious disease caused by
Mycobacterium tuberculosis. It usually involves the lungs,
but any organ can be infected, including brain, kidneys,
and bones. About one third of the world's population are
infected with TB. According to 2019 estimates, nearly 10
million people had tuberculosis in the world, with 1.2
million being children. TB is one of the 10 leading causes
of death in the world. Worldwide 1.4 million people died
of the disease (including 208,000 people with HIV).¹¹ It is
the leading cause of mortality in patients with HIV
infection. The incidence of TB worldwide declined until
the mid-1980s when HIV disease emerged. The major
factors contributing to the resurgence of TB were: (1) high
rates of TB among patients with HIV infection and (2) the
emergence of MDR strains of M. tuberculosis.

DEFINITION
"Tuberculosis is defined as, "A contagious bacterial
infection caused by Mycobacterium tuberculosis that
involves the lungs"."
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

TYPES OF TUBERCULOSIS

1. Primary tuberculosis is the form of disease that

develops in a previously unexposed and therefore
unsensitized person. It is the initial infection,
characterized by Ghon’s complex (lesion in lung
caused by TB). The chief implications of primary
tuberculosis are as follows:

a. It induces hypersensitivity and increased resistance.

b. The foci of scarring may harbor viable bacilli for

years, perhaps for life, and thus be the nidus for
reactivation at a later time when host defenses are
compromised.

c. Uncommonly, the disease may develop without

interruption into so-called progressive primary
tuberculosis.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

2. Secondary (or post primary) tuberculosis is the pattern

of disease that arises in a previously sensitized host. It may
follow shortly after primary tuberculosis, but more
commonly it arises from reactivation of dormant primary
lesions many decades after initial infection, particularly
when host resistance is weakened.

3. Miliary tuberculosis occurs when organisms drain

through lymphatics into the lymphatic ducts, which empty
into the venous return to the right side of the heart and then
into the pulmonary arteries. Individual lesions are either
microscopic or small, visible (2 mm) foci of yellow-white
consolidation scattered through the lung parenchyma (the
word miliary is derived from the resemblance of these foci
to millet seeds).
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

ETIOLOGY

Agent Factors

Mycobacterium tuberculosis is a facultative intracellular

parasite, i.e. it is readily ingested by phagocytes and is
resistant to intracellular killing.

Source of Infection

1. Human source: Human to human.

2. Bovine source: The bovine source of infection is usually
infected milk.

Community

Patients are infective as long as they remain untreated and

effective antimicrobial treatment reduces infectivity by
90% within 48 hours.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

Host Factors

1. Age: Tuberculosis can affect all age groups.

2. Sex: More prevalent in males than in females.
3. Hereditary: Tuberculosis is not a hereditary disease.
4. Immunity: Man has no inherited immunity against
tuberculosis.

Mode of Transmission

Tuberculosis is transmitted mainly by droplet infection and

droplet nuclei generated by sputum, positive patients with
pulmonary tuberculosis.

Incubation Period

The time from receipt of infection to development of the

tuberculin test ranges from 3 to 6 weeks.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

RISK FACTORS

1. The most common risk factor associated with TB is

HIV and other conditions that impair the immune system.

2. Patient’s dependent on alcohol or other chemical

because of malnutrition, debilitation and generally poor
health; older alcoholics who are of minority races are even
at greater risk.

3. Infants and children under the age of 5 years.

4. People with lifelong conditions, such as diabetes or

kidney diseases.

5. People who inject drugs.

6. Tobacco use.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids
PATHOPHYSIOLOGY OF TUBERCULOSIS

1. Main Pathophysiology Flow

Exposure to Mycobacterium tuberculosis
↓
Entry as droplet infection into alveoli and bronchioles
↓
Multiplication of bacteria
↓
Local inflammatory response: exudate in alveoli resulting
in bronchopneumonia
↓
Granuloma formation
Infected macrophages spread infection to lymph nodes:
'Primary Ghons Focus' formation
↓
3 Possible Outcomes:
1. Infection clears
2. Primary TB
3. Latent TB
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

2. Progression to Disease

From Primary TB:

Primary TB → Progressive disease → Pulmonary TB /
Extrapulmonary TB / Miliary TB

From Latent TB:

Latent TB → Progressive disease → Pulmonary TB /
Extrapulmonary TB / Miliary TB

3. Factors Affecting Transmission

• Bacillus load
• Concentration of bacillus
• Length of time of exposure
• Immune system of the exposed person
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

4. Factors for Reactivation: Latent TB → Progressive

Disease

• Immunodeficiency
• Extremes of age
• Severe malnutrition
• Immunosuppression
• Drug addiction
• Chronic diseases
• Diabetes
• Pregnancy
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

CLINICAL MANIFESTATIONS

[Link] symptoms

• Persistent cough for more than 2–3 weeks (starts as dry,

later becomes productive)
• Sputum may be mucoid or mucopurulent
• Chest pain
• Shortness of breath (dyspnea) – usually a late symptom
• Hemoptysis (coughing up blood) – seen in some patients

2. Constitutional (general) symptoms

• Low-grade fever (especially in the evening)

• Night sweats
• Fatigue
• Malaise (feeling weak and unwell)
• Loss of appetite (anorexia)
• Unexplained weight
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

3. Acute presentation (in some patients)

• High fever
• Chills
• Flu-like symptoms
• Pleuritic chest pain
• Productive cough

4. Extrapulmonary TB symptoms

• Depend on the organ affected:

- Kidney TB → Painful urination (dysuria), blood in
urine (hematuria)
- Bone and joint TB → Severe bone/joint pain
- TB meningitis → Headache, vomiting, enlarged lymph
nodes
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

DIAGNOSTIC EVALUATION

1. Medical history.
2. Physical examination: It reveals the following:
a. Clubbing of the fingers or toes (in people with
advanced disease).
b. Swollen or tender lymph nodes in the neck or other
areas.
c. Fluid around the lung.

3. Tuberculin skin test or mantoux test:

a. It is a standardized test.
b. Tubercle bacilli extract Purified Protein Derivate
(PPD) is injected in the intradermal layer of inner aspect of
forearm.
c. PPD intermediates strength, e.g. 5 tuberculin units in a
tuberculin syringe with a 26 to 27 gauge needle is used.
d. Needle is inserted under the skin only 0.1 ml of PPD is
injected, creating an elevation in the skin.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

e. Test is considered positive, if a raised area of in duration

occurs within 48-72 hours. A positive result indicates that a
person has been exposed to infection. It does not mean that
active disease is present.
f. Size of induration: It denotes the significance of
reaction.
i. Not significant – 0 to 4 mm.
ii. May be significant – 5 mm or greater.
iii. Significant – 10 mm or greater.

4. Chest X-ray: In TB infection, there are changes in the

structure of lungs, which of lungs are visible on the X-ray.

5. Sputum culture test: Diagnosis of tuberculosis is

confirmed by finding acid fast bacillinum smears of
sputum.

6. Quanti FERON -TB Gold test: It is a blood test which is

performed to detect active and latent tuberculosis.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

7. Drug susceptibility testing: It provides a definitive

diagnosis of drug-resistant TB.

8. Other tests: These be done to confirm diagnosis and

rule out other problems:

a. Bronchoscopy: In this procedure, a scope is inserted

through mouth or to nose that allow doctor to see patient’s
lungs and airways.

b. CT scan: Performed to check lungs for signs of an

infection.

c. MRI: A magnetic field and radio waves are used to

produce detailed images of the inside of the body.

d. Ultrasound scan: High frequency sound waves create

an image of part of the inside of the body.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

MEDICAL MANAGEMENT

Essential Drugs

1. First line drugs: These are the drugs which first

administered for disease. They have high clinical
effectiveness. They include the following:
a. Isoniazid
b. Ethambutol
c. Rifampicin
d. Streptomycin
e. Pyrazinamide

2. Second line drugs: They are used for the manage-

ment of drug resistant tuberculosis. They include the
following:
a. Kanamycin
b. Ethionamide
c. Para-amino salicylic acid
d. Cycloserine
Time Specific Objective Content Teacher’s Learner’ A.V Evaluation
Activity s activity aids

Components of TB treatment under RNTCP (Revised

National Tuberculosis Control Programme):

1. Domiciliary treatment
2. Short course chemotherapy
3. Intermittent regimen
4. Direct Observation of Treatment (DOT)

NURSING MANAGEMENT

1. The nurse should teach patient and family that TB is

infectious but it may be cured, if patient take his/her
medication as prescribed by the doctor.

2. Monitor respiratory rate, breath sounds, chest

symmetry and bilateral air entry.

3. Elevate the head of bed and assist the patient to assume

semi-fowler’s position.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

4. Change positions every 2 hourly.

5. Provide information regarding side effects of

prescribed medications.

6. Encourage patient for deep breathing exercises.

7. Instruct patient to cover his/her mouth or nose when

coughing, laughing or sneezing.

8. Instruct patient to wear mask in appropriate situations

when adviced.

9. Provide emotional and psychological support to patient

and family.

10. Provide high protein diet such as soyabean, milk,

leafy vegetables to patient.
 Teacher’s Learner’ A.V
Time Specific Objective Content Evaluation
Activity s activity aids

PREVENTION

[Link] patient to use a tissue to cover mouth and nose

while coughing and sneezing.

2. Used tissues should be flushed down the toilet or

disposed off carefully in the waste bin.

3. Instruct patient to perform frequent hand washing and to

wear facial mask.

4. Teach all family members also about importance of hand

washing.

5. Respiratory isolation is recommended until effective

drug therapy puts a stop to infectiousness. Risk of
transmission reduces after 2 weeks of drug therapy.
Time Specific Objective Content Teacher’s Learner’ A.V Evaluation
Activity s activity aids

COMPLICATIONS

1. Miliary TB: Invade in bloodstream.

2. Pleural effusion and empyema.
3. Tuberculosis pneumonia.
4. Other organ involvement such as CNS with
inflammation of meninges, bone (Pott’s disease of spine),
joints, kidney, lymph node, spleen, etc.
5. Hepatitis (inflammation of liver)
6. Change in vision.
7. Massive hemoptysis

REFERENCE

1) Medical Surgical Nursing -1 LEWIS

2) Adult Medical Surgical Nursing -1 DR. JOGINDRA
VATI PRABHJOT KAUR LAKHWINDER KAUR