Tuberculosis

2. Overview

4. Twice as common in males as in females

7. Pathophysiology and Etiology

10. Multiply at varying rates

11. Characterized as acid-fast aerobic organisms

13. Pathology The bacilli of TB infect the lung, forming a tubercle (lesion) The tubercle: May heal, leaving scar tissue May continue as a granuloma, then heal, or be reactivated May eventually proceed to necrosis, liquefaction, sloughing, and cavitation

18. Clinical Manifestations

21. Diagnostic Evaluation

28. inoculation of tubercle bacillus extract (tuberculin) into the intradermal layer of the inner aspect of the forearm

34. Management

38. Massive pulmonary tissue damage, with inflammation and tissue necrosis eventually leading to respiratory failure Bronchopleural fistulas from lung tissue damage, resulting in pneumothorax Hemorrhage, pleural effusion, pneumonia Other organ involvement with TB

41. CNS effects (dysarthria, irritability, seizures, dysphoria, diminished concentration)

42. lupus-like syndrome, hypersensitivity reactions, and monoamine poisoning (rarely occurring with consumption of some wines and cheeses)

44. peripheral neuritis and cutaneous reactions

46. Rechallenge drugs sequentially every 3-4 days to find cause

50. Nursing diagnoses

51. Fatigue Imbalanced nutrition: Less than body requirements Impaired gas exchange Ineffective airway clearance Ineffective coping Ineffective therapeutic regimen management Risk for injury

52. Key Outcomes

54. consume adequate daily calories as required

55. maintain adequate ventilation and oxygenation

56. maintain a patent airway

57. use support systems to assist with coping

58. express an understanding of the illness and comply with treatment modalities

60. Administer ordered antibiotics and antitubercular agents. Isolate the infectious patient in a quiet, properly ventilated room and maintain TB precautions. Provide diversional activities and check on him frequently. Make sure the call button is nearby. Place a covered trash can nearby, or tape a waxed bag to the bedside for used tissues. Tell the patient to wear a mask when outside his room. Visitors and health care personnel should also take proper precautions while in the patient's room. Make sure the patient gets plenty of rest. Provide for periods of rest and activity to promote health as well as conserve energy and reduce oxygen demand.

61. Provide the patient with well-balanced, high-calorie foods, preferably in small, frequent meals to conserve energy. (Small, frequent meals may also encourage the anorexic patient to eat more.) Record the patient's weight weekly. If he needs oral supplements, consult with the dietitian. Watch for adverse reactions to the medications. Administer isoniazid with food. This drug can cause hepatitis or peripheral neuritis, so monitor levels of aspartateaminotransferase and alanineaminotransferase. To prevent or treat peripheral neuritis, give pyridoxine (vitamin B6) as ordered. If the patient receives ethambutol, watch for signs of optic neuritis; report them to the physician, who's likely to discontinue the drug. Check the patient's vision monthly, and give this medication with food.

62. If the patient receives rifampin, watch for signs of hepatitis, purpura, and a flulike syndrome as well as other complications such as hemoptysis. Monitor liver and kidney function tests throughout therapy. Perform chest physiotherapy, including postural drainage and chest percussion, several times per day. Give the patient supportive care, and help him adjust to the changes he may have to make during his illness. Include the patient in care decisions, and let the family take part in the patient's care whenever possible.

63. Community and home care considerations

64. Improve ventilation in the home by opening windows in room of affected person, and keeping bedroom door closed as much as possible. Instruct patient to cover mouth with fresh tissue when coughing or sneezing and to dispose of tissues promptly in plastic bags. Discuss TB testing of people residing with patient. Investigate living conditions, availability of transportation, financial status, alcohol and drug abuse, and motivation, which may affect compliance with follow-up and treatment. Initiate referrals to a social worker for interventions in these areas. Report new cases of TB to public heath department for screening of close contacts and monitoring.

65. Patient teaching

66. Show the patient and family how to perform postural drainage and chest percussion. Also teach the patient coughing and deep-breathing exercises. Instruct him to maintain each position for 10 minutes and then to perform percussion and cough. Teach the patient the adverse effects of his medication, and tell him to report them immediately. Emphasize the importance of regular follow-up examinations, and instruct the patient and family members concerning the signs and symptoms of recurring TB. Stress the importance of faithfully following long-term treatment Advise anyone exposed to an infected patient to receive tuberculin tests and, if a positive reaction occurs, chest X-rays and prophylactic isoniazid.

67. Warn the patient taking rifampin that the drug temporarily makes body secretions such as urine appear orange; reassure him that this effect is harmless. Caution the female patient taking oral contraceptives that the drug may be less effective while she's taking rifampin. Teach the patient the signs and symptoms that require medical assessment: increased cough, hemoptysis, unexplained weight loss, fever, and night sweats. Stress the importance of eating high-calorie, high-protein, balanced meals. Emphasize the importance of scheduling and keeping follow-up appointments.

68. http://nurseRD.blogspot.com www.authorstream.com/reynel89/Nursing www.slideshare.net/reynel89/slideshows THANK YOU!Have a nice day : ) - RDG