Tuberculosis, Kochs Disease, Phthisis

One of the most deadly re-emerging infectious disease In the era of HIV/AIDS, the global resurgence of tuberculosis has been very dramatic Inadequate courses of anti-TB drugs lead to the spread of drug resistance and multi-drug resistance

Far advanced classification lesions are more extensive than

moderate

Inactive TB Symptoms of tuberculosis are absent

Sputum is absent for tubercle bacilli after repeated examination There is no evidence of cavity on chest x-ray Active Tuberculin test is positive X-ray of the chest is generally progressive Symptoms due to lesions are usually present Sputum and gastric content are positive for tubercle bacilli Active not determined

First described on March 24, 1884 by ROBERT KOCH. Who

subsequently received the Nobel Prize in physiology or medicine for this discovery in 1905 every 1620 hours

Gram positive obligate aerobes mycobacterium that divides

Cause: by mycobacterium tuberculosis, a small rod-like bacillus nonspore forming bacilli, which can withstand weak disinfectant and can survive in a dry state for weeks but can only grow within a host organism It retain certain stain after being treated with acid solution, thus it is classified as ACID FAST BACILLUS (AFB) AFB can also be visualized by fluorescent microscopy and by auramine-rhodamine stain Mycobacterium, in general are soil or environmental organism The initial infection usually is unnoticed

When activity has not been determined from a suitable period observation or adequate laboratory and x ray studies

Manifestation: Pagtaas ng temperature ng katawan kapag hapon Pinagpapawisan tuwing gabi Panlalambot at pagbaba ng timbang cough dry to productive dyspnea, hoarseness of voice

Mode of Transmission:

by deliberate inoculation of microorganism or by droplets

From an infected person to a non-infected person is by aerosolization of contaminated secretions

Hemoptysis considered pathognomonic to the disease

occasional chest pain sputum positive for AFB

Most infectious when the person is coughing, sneezing

Pathology:

If bacilli from droplets in the air penetrates in sufficient quantity to the deeper recess of the lung, then infection can occur

If mycobacterium tuberculosis is deposited in the alveoli of the

lung then it is taken up by alveolar macrophages

Diagnostic Procedures: Sputum analysis for AFB confirmatory Chest x ray (cavitary lesion) Tuberculin test (mantoux test, time test) PPD Purified Protein Derivative

Formation of a single, gray like granulomatosus lesion, called a After 2-3 weeks inside of the tubercle softens, and a (cheese
like) necrosis occur, then tuberculosis is positive at this point

Ghons tubercle, then the person now has primary tuberculosis

Mantoux Test (more reliable) ID injection of tuberculin extract into the inner aspect of forearm to detect infection/exposure to CA. Localized reaction- detected in 48 to 72 hours (+) induration of 10 mm or above

After infection, mycobacterium tuberculosis, either free of

macrophages or within the macrophages themselves drain into lymph channels, causing the formation of casseous granulomas

If the bacillus seeds other sides of the body, such as bone,

kidneys, and meninges. This can set the stage in the future for extrapulmonary tuberculosis (Milliary Tuberculosis) If the bacilli became walled off in calcified lesions which show up on the chest x-ray If a person resolves the primary tubercular infection in the above manner, they have no symptoms and they are not infectious Period of Communicability:

Nursing Management: MAINTAIN REPIRATORY ISOLATION Administer medicine as ordered Always check sputum for blood or purulent expectoration Encourage questions and conversation so that the patient can air his or her feelings Teach or educate the patient all about PTB Encourage patient to stop smoking Teach how to dispose secretion properly

Advise to have plenty of rest and eat balanced diet

Be alert of drug reaction

Emphasize the importance of follow-up check-up

Prevention: Submit all babies for BCG immunization Educate the public in mode of spread and methods of control and the importance of early diagnosis Avoid overcrowding Improve nutritional and health status Advise persons who have been exposed to infected persons to receive tuberculin test if necessary CXR and prophylactic Isoniazid

The patient is capable of discharging organism all through life if

he remains untreated. The disease is highly communicable during its active phase

Sources of infection: sputum, blood from hemoptysis, nasal discharge, and saliva

Quantitative Classification of Tuberculosis:

Minimal characterized by slight lesion without demonstrable

excavation, confined to a small part of one or both lungs Moderately advanced

One or both lungs may be involve The volume affected should not extend to one lobe Total diameter of the cavity should not exceed four centimeters

DOTS ( Direct Observed Treatment Short course) Is the name for comprehensivewhich primary health services around the world are using to detect and cure TB patients.

elements of DOTS:

Political will in terms of funds and manpower Sputum microscopy sevice Regular drug supply

 Recording books to monitor the patients progress until cured Drug intake supervised by the health worker and family member

Isasara ang pintuan sa inyong silid. Kakailanganin ninyong takpan ang inyong ilong at bibig kapag nasa labas kayo ng inyong silid. Kung mayroon kayong positibong pagsusuri sa balat o may TB: Takpan ang inyong bibig kapag umuubo kayo, bumabahin o tumatawa. Pagkatapos, hugasan ang inyong mga kamay. Hugasan ang inyong mga kamay bago kumain. Kumain ng 3 beses at uminom ng 6-8 na basong likido bawat araw. Pumunta sa lahat ng pakikipagtipan sa doktor. Tawagan agad ang inyong doktor kung kayo ay: May lumalalang ubo. Umuubo ng dugo. Nahihirapang huminga. Nababawasan ang timbang kahit pa kumakain kayo ng masustansiyang pagkain. May lagnat o nagpapawis sa gabi. May kulay kayumangging ihi o kulay abo na dumi. Naninilaw ang balat o mga mata. Kausapin ang inyong doktor o nars kung mayroon kayong mga katanungan o pag-aalala.

Tuberkulosis (TB) Ang TB ay isang karamdamang dulot ng mga mikrobyo na tinatawag na bakterya na kadalasang umaapekto sa mga baga. Maaari kayong mahawaan ng TB kapag nalanghap ninyo ang mga mikrobyo. Mas manganganib kayong magkaroon ng TB kung mayroon kayong mahinang sistema ng kabal sa katawan (immune system). Ang sistemang ito ay maaaring manghina dahil sa di-masustansiyang pagkain, karamdaman, mga gamot, o ibang mga sanhi. Mga Palatandaan Ang mga taong may TB ay maaaring mayroong ilan o lahat ng mga palatandaang ito: Ubo Lagnat Pagbaba ng timbang Pag-ubo ng dugo Pakiramdam na nanghihina at pagod Sakit sa dibdib Pagsusuri Gagawin ang pagsusuri sa balat upang tingnan kung kayo ay nahawaan. Ang ibig sabihin ng positibong pagsusuri ay nahawaan kayo ng mikrobyo. Gagawa ang inyong doktor ng x-ray ng dibdib at pagsusuri sa plema (sputum) upang tingnan kung mayroon kayong TB. Susuriin din ang balat ng mga miyembro ng inyong pamilya at iba pang kasamahan ninyo sa bahay. Ang ibig sabihin ng negatibong pagsusuri ay hindi kayo nahawaan. Maaaring walang reaksyon ang pagsusuri sa balat kung mahina ang inyong sistema ng kabal sa katawan. Maaaring suriin kayo ng inyong doktor para sa TB kung negatibo ang pagsusuri sa inyong balat, ngunit mayroon pa rin kayong mga palatandaan. Ang Inyong Pangangalaga Kung positibo ang pagsusuri sa inyong balat o mayroon kayong TB, maguumpisa kayong uminom ng gamot. Inumin ang inyong mga gamot ayon sa ibinilin. Inumin ang inyong mga gamot sa parehong oras bawat araw at huwag tigilan ang pag-inom sa mga ito. Maaaring kailanganin ninyong inumin ang inyong mga gamot sa loob ng 6-24 na buwan. Kung hindi ninyo iinumin ang inyong mga gamot, maaaring bumalik ang inyong TB at mas mahirap itong gamutin. Maaari rin ninyong mahawaan ang ibang tao kung hindi ninyo iinumin ang lahat ng inyong mga gamot. Huwag iinom ng alak habang umiinom ng mga gamot na ito dahil ang alak ay maaaring magdulot ng mga problema sa atay. Maaaring maging kulay dalandan ang inyong ihi at ibang likido sa katawan dahil sa isa sa mga gamot na ginagamit upang gamutin ang TB. Kung malala kayo at kailangang dalhin sa ospital: Maaaring ihiwalay kayo sa ibang pasyente. Pipigilan nitong mahawaan ng TB ang ibang tao. Ihihiwalay kayo hanggang nakainom na kayo ng mga gamot sa TB ng 23 linggo o hanggang wala nang mikrobyo ang inyong plema (sputum). Ang sinumang papasok sa inyong silid ay gagamit ng takip sa ilong at bibig (mask).