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  1. 1.  National TB Control Program (RNTCP) was Launched in 1962  RNTB Control Program –1993 /DOTS (Directly Observed Treatment, Short-course)  BCG:-Bacille Calmette Guerin- Live attenuated vaccine  B.C.G vaccination Programme was launched in year :-1951  At birth, dose of BCG vaccine is: 0.05 ml I/D until 1 month  0.1 ml I/D after 1 month  BCG vaccine dilute with NS
  2. 2.  Lung infection caused by M. tuberculosis, (Acid fast Bacilli)  First discovered in 1882 by Robert Koch  Transmitted by Inhalation of airborne droplets (Talking - cough - sneezing – laughing).  Mycobacterium tuberculosis infects about 35% world’s population Introduction:-
  3. 3. Risk Factors for Tuberculosis  Substance abuse  DM, HIV, infection  Anti- rejection drug  Child younger than 5 years of age  Drinking unpasteurized milk if cow is infected with bovine tuberculosis
  4. 4.  Primarily affects pulmonary system, especially upper lobes  Acute TB: Primary lesion  Chronic TB: Progressive, re-injection & reactivation of primary lesions after mouths or years. common in adults.  Swallowing infectious sputum may cause/lead to laryngeal. oropharyngeal or intestinal TB.  Extra-pulmonary TB- Involves bone, kidneys Types of TB
  5. 5.  Classical Sign – ◦ Progressive Cough (2 wks) ◦ Night Sweat/Sleep hyper-hidrosis ◦ Weight loss ◦ Low-grade fever.  1st Symptoms:-A cough with expectoration of mucoid sputum C/F:-
  6. 6. ◦ Ghon's complex :-lesion seen in lung that is caused by TB ◦ (1to 1.5-cm area of gray white inflammation )
  7. 7.  An individual who received a BCG vaccine will have a positive tuberculin skin test result & should be evaluated for TB with a chest x-ray.  Chest x-ray- Active or calcified lession D/E:-
  8. 8.  Tuberculin Test /Mauntoux- test/ Mendel- Mantoux test/ Pirquet test (1907)  Injection of PPD (Purified Protein Derivative)  M. tuberculosis, heating to 100 °C to kill bacilli & subsequent filtering  Store temp 2-8 °C  I/D, dose – 0.1ml (5 TU tuberculin units) to Inner surface of forearm. (Indicate exposure to tubercle bacilli)
  9. 9.  Determination: after 48-72 hrs  10 mm or greaten Positive  6-9 mm Doubtful  <6mm Negative  5 mm for inmuno- compromissed client, HIV positive
  10. 10.  5 mm for inmuno-compromissed client, HIV positive
  11. 11.  Find out it:-  Heaf gun
  12. 12. Heaf test/ Ster-needle test:-Determine whether or not children had been exposed to TB infection  Administered by a Heaf gun  Gun injected PPD  Test was read B/W 2 & 7 days later
  13. 13.  Tine test:- Multiple-puncture tuberculin skin test  Read 48 to 72 hours later
  14. 14.  Quouti FERON Gold Test- (1 mL) A blood analysis test by interferon-gamma (IFN-y ) release assay,  Results can be available in 24 hours  More specific than tuberculin test.
  15. 15.  Sputum Culture- 3 Continuum sample Confirms the diagnosis  NPO past midnight in preparation for early morning sputum collection  Spontaneously expectorated sputum:-3 consecutive morning sputum's  Induced sputum:- Nebulizer of 3% saline  Ziehl-Neelsen stain done of smear (Acid fast) 
  16. 16. Fix Smear Put Carbol fuchsin & heat smear until steam comes out (but don’t boil & dry ) Place slide for 5-10 min. (wash smear with water ) Put 3ml HCL acid & 97% Ethanol solution put malachite green dye (Wash) dry slide & see under microscope Methods Acid fast Bacilli (Red Color)
  17. 17. Treatment  Initial treatment 2 months  (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide daily for 2 months  Followed by 4 months of Isoniazid & Rifampicin given 3 times a week  Bacteriostatic” means that the agent prevents the growth of bacteria Eg Ethambutol  Bactericidal” means that it kills bacteria Eg
  18. 18.  Initial treatment 2 months  (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide daily for 2 months  Followed by 4 months of Isoniazid & Rifampicin given 3 times a week  Bacteriostatic” means that agent prevents growth of bacteria Eg Ethambutol  Bactericidal” means that it kills bacteria Eg Management:-
  19. 19.  First line drugs for TB "RIPE" 1.Isonizide (INH):- Batctericidal (Interfere with Cell wall synthesis)Most common medication used for treatment of TB  Adult :- 300mg/day  Child :- 15 mg/kg/day S/E:-  I:-Iron accumulation in mitochondria is called Sideroblastic anemia  N:-Neuropathy Peripheral (Affect CNS )  H:-Hepatitis  Vitamin B6 deficiency
  20. 20.  Note:-  A client with a positive skin test for TB isn’t showing signs of active disease.  Prevent development of active TB, client should be treated with Isoniazid, 300 mg daily, for 9-12 month  Note:-Safe to use during pregnancy
  21. 21.  Nurses role:-  Administer isoniazid 1 hour before or 2 hours after a meal because food may delay absorption.  Administer at least 1 hour before Antacids  Administer pyridoxine as prescribed to reduce risk of neurotoxicity.
  22. 22. 2.Rifampicine (Rifadin )-Batctericidal (interfere with RNA )  Adult- 600mg (10mg/kg) ,,Child- 10-20 mg/kg day  S/E- Red, orange urine, Thrombocytopenia, GI upset, Hepatitis, RF, Fever ,Discoloration of body fluid-:  Drug interaction with – OCP (oral contraceptive pills), advice to use alternative method  N/R:-Take medication on empty stomach with 8 oz of water 1 hour before or 2 hours after meals  Avoid taking antacids with medication.
  23. 23. 3.Pyrazinamide (PZA)- Bactericidal  Adult- 15-30 mg/kg/day(2gm), -50 70mg/kg/BD  Child – 15-20 mg/kg/day  S/E- Hepatitis, Rash, GI upset, hyperurecenia, difficult to control glucose in DM.
  24. 24. 4.Ethambutol (EMB)/ Myambutol:- Bacteriostatic (Interfere with RNA synthesis )  Adult- 40-50 mg/kg/day(2 gm)  Child - 15-25 mg/kg/day  S/E: Eye:- Decrease visual acuity  Optic neuritis (2nd CN), Skin Rash
  25. 25. 5.Streptomycin:-Bactericidal inhibits mycobacterial protein synthesis  Adult : 15 mg/kg/day (1 gm)  Child 15 mg/kg/day (1 gm)  S/E- Ototoxicity, (8th Cranial Nerve damage) , Vertigo ,Renal toxicity
  26. 26.  Second line drug= inhibits cell metabolism.  1. Kanamycin - Ototoxic & nephrotoxic  2. Para-aminosalicylic acid causes GI disturbances, hepatotoxic
  27. 27.  Was developed by Karel Styblo  Dots program -1993 DOTS (Directly Observed Treatment, Short-Course), also known as TB-DOTS
  28. 28.  Multidrug-resistant strain of tuberculosis (MDR-TB):-  TB does not respond to at least isoniazid & rifampicin, 2 most powerful anti-TB drugs
  29. 29.  Instruct client to increase rich in iron, protein, & vitamin C food  Cultures are negative, client is no longer considered infectious & usually can return to former employment Nurse’s role:-
  30. 30.  1. A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the a. Use and side effects of isoniazid (INH). b. Standard four-drug therapy for TB. c. Need for annual repeat TB skin testing. d. bacille Calmette-Guérin (BCG) vaccine.  ANS: A MCQ
  31. 31. 3.Which action by the occupational health nurse at a manufacturing plant where there is potential exposure to inhaled dust will be most helpful in reducing incidence of lung disease? a. Teach about symptoms of lung disease. b. Treat workers who inhale dust particles. c. Monitor workers for shortness of breath. d. Require the use of protective equipment.  ANS: D 
  32. 32. 4.The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action will the nurse take? a. Repeat the tuberculin skin testing. b. Teach about the reason for the blood tests. c. Obtain consecutive sputum specimens from the patient for 3 days. d. Instruct the patient to expectorate three specimens as soon as possible. ANS: C
  33. 33.  5. The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results?  a. Indeterminate b. Needs to be redone c. Negative d. Positive  c. Negative
  34. 34.  6. A client with primary TB infection can expect to develop which of the following conditions?  a. Active TB within 2 weeks b. Active TB within 1 month c. A fever that requires hospitalization d. A positive skin test  d. A positive skin test  A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs.
  35. 35.  7. A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is this done?  a. To confirm the diagnosis b. To determine if a repeat skin test is needed c. To determine the extent of the lesions d. To determine if this is a primary or secondary infection  c. To determine the extent of the lesions
  36. 36. 8.A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate?  a. Decreased shortness of breath b. Improved chest x-ray c. Nonproductive cough d. Positive acid-fast bacilli in a sputum sample after 2 months of treatment.  d. Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
  37. 37.  9. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as:  a. Positive b. Negative c. Inconclusive d. The need for repeat testing.  a. Positive
  38. 38.  It is a surgical procedure create opening through neck into trachea (windpipe)  Maintaining patent airway TRACHEOSTOMY
  39. 39.  Burns of the airway  Cancer in the neck  Chronic lung disease, Coma  Diaphragm dysfunction  Injury to larynx  Need for prolonged respiratory or ventilator support  Obstruction of the airway by a foreign body  Vocal cord paralysis  Note:-E.T. Tube cannot be inserted. Indication:-
  40. 40.  Emergency & prophylactic.  Temporary & permanent. According to placement  High ring (2nd & 3rd) Incision made above isthmus  Low ring (3rd & 4th ) Incision made below isthmus Type of tracheostomy
  41. 41.  Types of tracheostomy tube:-  Double Lumen (Most commonly used) or single Lumen tube  Cuffed or non –cuffed tube  Cuffed  Cuffed (20mm of Hg)  Check every 8 hrs  Non –cuffed tube  Used in school age children  Fenestrated or non-fenestrated 
  42. 42.  Between the 2nd & 3rd/3rd or 4th tracheal rings.  Position:-Rose position Site
  43. 43.  1st day on tracheotomy need suction every 30 mt  Clean inner cannula if present.  Remove disposable inner connula & put new.  Care of non disposal inner cannula, remove & place in soaking solution like H2O2 for 5 min & rinse with saline. Nursing Care -
  44. 44.  Change tracheotomy ties.  Place 4x4" tracheotomy dressing.  Cover the tracheotomy with moist gauze or cotton  Normal tracheotomy cuff pressure Maintain at 18- 25mmHg
  45. 45.  Infection  Pneumonia  Hemorrhage  Tracheal injury  Obstruction  Subcutaneous emphysema  Pneumothorax  Tracheostomy complications