College of Nursing, Allied
Hospital Faisalabad, FMU
Subject:Community Health Nursing
Name : Ayesha Sajid
Submitted to: Madam Shahida
Topic : Tuberculosis
Submitted date : 18 September 2023
Table of Content:
Definition of tuberculosis
Types of tuberculosis
Clinical manifestations
Epidemiology
Risk factors
Mode of Transmission
Complications
Diagnostic Evaluation
Prevention
Treatment
Definition:
Tuberculosis is an infectious disease of parenchyma of
lung caused by mycobacterium Tuberculosis
characterized by formation of tubercle. It primarily
affecting lungs but can also affect intestine, bones , joints,
lymph nodes , skin and other tissues of body.
Types of tuberculosis:
1. PULMONARY TUBERCULOSIS
2. AVIAN TUBERCULOSIS (Micobacterium avium; of
birds)
3. BOVINE TUBERCULOSIS (Mycobacterium bovis; of
cattle)
4. MILIARY TUBERCULOSIS /DISSEMINATED
TUBERCULOSIS (Invade the blood stream and spread
to all body organs.
Clinical manifestations :
The outset of tuberculosis is insidious and early
symptoms vary from one individual to other.
[Link] cough, later moist with varying amount of
sputum.
[Link] is usually steady and progressive loss of
weight and this is associated with general
malaise and fatigue.
3.A persistent pyrexia is present characteristically
raised in the evening and lowered in the
morning. The evening Pyrexia is accompanied
by heavy night sweats.
[Link] some cases cough associated with blood
stained sputum.
[Link] a later state chest pain.
[Link].
[Link] weakness and wasting.
[Link] of appetite anorexia
[Link] of muscles.
10. Haemoptysis.
Epidemiology:
Geographical distribution:
World wide, particularly in developing and under
developed countries.
Agent:
Mycobacterium tuberculosis: Human and bovine
strains of the bacillus are of importance to man
and fairly resistant to the action of chemicals and
heat.
Virulence: Tubercle bacilli in India are less virulent
than those of Europe.
Host Factors
Age: It can occur at any age. Majority of cases 20 to 40
Years. In Pakistan prevalence is higher in the elder age
group.
Sex: More in males than in females, more prevalent
among males over 40 years. It effects all races and is
not a hereditary disease.
Nutrition: Studies have shown that diet had no
discernible influence on the recovery of patients
Immunity: Man has no inherited immunity against the
disease. It is acquired as a result of natural infection or
BCG vaccine. There is an infection immunity but it is not
an absolute iminurity. It breaks down in the face of heavy
superinfection.
. Environmental factors: Standard of living is related,
factors with occurrence of disease and social factors
a. Overcrowding Insanitary and over crowded and
substandard houses
b. Poverty: Low income group is highly infected 6.
Education: Low level of education leads to ignorance
about health
d. Occupation: Silicotics, doctors, nurses, students of
medical field
e. Large families: Chances of contact are greater
f. Industrialisation: It is responsible for higher incidence
g. Malnutrition: Predisposes the disease.
Social customs
1. Habits of indiscriminate spitting
[Link] of common hooka
[Link] habits in same utensils
d. Pardah system which is common in Muslims and
Some ladies of Hindus, is also cause of infection
e. Early marriages, repeated pregnancies and frequent
motherhood
f. People hide their diseases due to social stigma
Economic aspects: It is a chronic disease which
brings a large quantum of human suffering and a
great in economic Joss. Mass treatment by the
government is not possible due to high costs.
Epidemiological traid of tuberculosis:
Risk factors:
[Link] who have been Recently Infected
with TB Bacteria
Close contacts of a person with infectious TB
disease
Persons who have immigrated from areas of
the world with high rates of TB
Children less than 5 years of age who have a
positive TB test
Groups with high rates of TB transmission,
such as homeless persons, injection drug
users, and persons with HIV infection
Persons who work or reside with people who
are at high risk for TB in facilities or
institutions such as hospitals, homeless
shelters, correctional facilities, nursing homes,
and residential homes for those with HIV
[Link] with Medical Conditions that Weaken
the Immune System
Babies and young children often have weak
immune systems. Other people can have weak
immune systems, too, especially people with
any of these conditions:
HIV infection (the virus that causes AIDS)
Substance abuse
Silicosis
Diabetes mellitus
Severe kidney disease
Low body weight
Organ transplants
Head and neck cancer
Medical treatments such as corticosteroids or
organ transplant
Specialized treatment for rheumatoid arthritis
or Crohn’s disease
Mode of Transmission
1. Droplet infection and droplet nuclei generated by an
“open case.”
2. Inhalation of fine dust containing tubercle bacilli
from infected sputum.
3. Ingestion of contaminated food and milk
The period of time from infection to onset of TB
[Link] period may be weeks, or months or
years depending upon host parasite relationship and
dose of infection. The risk of infection and disease is
closely related to the closeness of contact, extent of
the disease, sputum positivity of the source case,
and the host parasite
Complications:
1. Hemoptysis
2. Pleurisy
3. Pleural effusion.
4. Empyema
5. Pneumothorax
6. Aspergilloma
7. Endobronchitis
8. Brochiectasis
9. Laryngitis
10. Cor pulmonale
11. Ca bronchus
12. Enteritus
13. Millary Tuberculosis
14. HIV related opportunistic infections
Diagnostic Evaluation:
The case is one whose sputum is positive for tubercle
bacilli. All others are termed suspects. Case finding
tools are:
a. Sputum examination: Sputum examination of
two consecutive specimens (e.g. on the spot and
overnight sputum) of patients with following
symptoms
i. Cough more than two weeks duration.
ii. Chest pain.
iii. Haemoptysis-spitting of blood.
b. MMR (Mass minature radiography)
c. Tuberculin testing: One TU (tuberculin unit) is
equal to 0.00002 mg, (International Standard
PPD- purified protein derivatives). Old tuberculin
is replaced by PPD. It is given by intradermal
route
Mantoux test -PPD injection 1 TU to fore arm
results in red papule after 72 hours, palpable
oedema or induration more than 10 mm in the
longitudinal diameter is considered acceptable
infection with bacilli. Occurrence of non-specific
reaction has lessened the value of Tuberculin
test.
Examination of the chest: It is expensive but more
sensitive and specific like sputum examination.
Prevention and control of tuberculosis :
A tuberculosis (TB) infection control plan is part of
General infection control program designed to ensure the
following:
1. Prompt detection of infectious TB patients,
2. Airborne precautions, and
3. Treatment of people who have suspected or
confirmed TB disease.
The TB infection control program should be based on a
three-level hierarchy of control measures include:
1. Administrative measures
2. Environmental controls
3. Use of respiratory protective equipment
1. Administrative measures
Assigning someone the responsibility for TB infection
control in the health care setting;
Conducting a TB risk assessment of the setting;
Developing and implementing a written TB infection-
control plan;
Ensuring the availability of recommended laboratory
processing, testing, and reporting of results.
Implementing effective work practices for managing
patients who may have TB disease;
Ensuring proper cleaning, sterilization, or disinfection
of equipment that might be contaminated.
Educating, training, and counseling health care
personnel, patients, and visitors about T infection
and TB disease;
2. Environmental controls
Primary environmental controls consist of controlling
the source of infection by using loca exhaust
ventilation (e.g., hoods, tents, or booths) and
diluting and removing contaminated air b using
general ventilation.
Secondary environmental controls consist of
controlling the airflow to prevent contamination c air
in areas adjacent to the source airborne infection
isolation (All) rooms; and cleaning the air t using high
efficiency particulate air (HEPA) filtration, or
ultraviolet germicidal irradiation.
3. Use of respiratory protective equipment
Implementing a respiratory protection program;
Training health care personnel on respiratory
protection; and
Educating patients on respiratory hygiene and the
importance of cough etiquette procedures.
Treatment plan
PHARMACOLOGICAL:
Always treat with multiple drugs
Treatment course depend on the categories of the
patient. Usually 6 months to 9 months
Four drugs (Isoniazid, rifampicin,ethambutol and
pyrszinamid) for 2 months .And two drugs (Isoniazid
and rifampicin) for 4 to 7 months .
DOTS (direct observed treatment short course) is
PHYSICAL MEASURES: Isolate patients with possible
TB given in a private room with negative
[Link] isolation until sputum smears are
negative for 3 consecutive determinations (usually
after approximately 2-4 weeks of treatment)
PULMONARY REHABILITATION
PR is a multidisciplinary programme, addressed to
patients with respiratory impairment this therapy is
individualized and involves physical training,
psychological counselling, nutritional support, along
with compliance with TB drug treatment.
Nutrition support:
Proper nutrition is an important element in all stages of
TB infection
Nutritional supplementation may have a positive role
in these patients recovery. Adding high calorie
supplements for patients with TB in first phase of
treatment has to be shown to have benefits on lean
mass, body weight and physical function after 6 weeks
Psychological support: relaxation techniques, stress
management.
Therapeutic education :Quitting smoking, avoiding
environment with toxins irritants or allergens that may
worsen the symptoms.
PR programs improves symptoms, exercise capacity
and social [Link] involves,
Breathing exercises
Upper and lower limb strengthening exercises and
Conditioning exercise
Relaxation exercise
Respiratory muscle strengthening exercises
Level walking
PR IN ACTIVE PHASE OF PULMONARY
TUBERCULOSIS :
Exercise training :
Initially typically bed rest and avoidance of exercise is
recommended in patient with severe hemoptysis
After few days, starting with passive exercise (arm,
shoulder, elbow knee )active – assisted and active
exercise
Exercise at slow pacewill be preferred first followed
by increasing the degree of precision and postural
control.
The exercise must target the both upper limb and
lower limb and walk test may be used
In order to mobilize the diaphragm expansion and
recovering the lung reserve volumes, abdominal –
diaphragmatic breathing, thoracic mobilization
against a resistance can be used. After 1 month, the
rib expansion exercise can be start.
PR IN POST TUBERCULOSIS SEQUELAE
Airway clearance techniques:
Postural drainage : it must be done before a meal,
once or several times a but not more than 20-30
min, during which time several positions will be
used, 5-10 min each. At the end of each position
period, the drained region will be tap for 1 min.
Another techniques used to diminish the sputum
load are as follow as: autogenic drainage,forced
expiration, vibration with special devices and manual
procedures such as clapping and percussions.
COUGH EDUCATION :Cough education is important for
patient with
TB and consist of: body positioning during coughing,
control of breathing in coughing (slowly nose
inspiration, short apnoea and strong air expiration in 2-
3 sessions). The goal is to achieve mobilization and
secretions removal from the bronchial tree.
Exercise Training: PR programme, including physical
aerobic training, therapeutic education and activities of
daily living. The sessions took place three times per
week for 8 weeks exercisetraining was aerobic,
performed on a treadmill for lower limb, with training
intensity starting from 60% and reaching 90% of the
maximum oxygen [Link] leads to
improvement in exercise tolerance, QOL, deminution
of chest pain and hemoptysis.