2. DEFINITION
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Tuberculosis is the infectious disease primarily affecting
lung parenchyma is most often caused by Mycobacterium
Tuberculosis. It may spread to any part of the body
including meninges, kidney, bones and lymph nodes.
5. MODE OF TRANSMISSION
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• Mainly by droplete infection and droplet
nuclei generated by sputum positive
patient.
• Coughing generates all size of droplet.
• Particle should be fresh enough to carry.
• Tuberculosis not transmitted by fomites.
7. CLASSIFICATION
ACCORDING TO PRESENTATION
1. Primary infection occurs when the bacteria are
inhaled and initiate an inflammatory reaction.
2. Latent TB infection (LTBI) occurs in a person
who does not have active TB disease. These
individuals are asymptomatic and cannot
transmit the TB bacteria to others.
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8. CLASSIFICATION
ACCORDING TO AREA
1. Pulmonary TB: It occurs only in the lungs.
2. Extra Pulmonary TB: the infection spread to
the other organs like bones, meninges, kidney
etc.
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9. PATHOPHYSIOLOGY
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MYCOBACTERIUM TUBERCULOSIS ENTRY
THROUGH DROPLETS
GOES IN PULMONARYALVEOLI
IMMUNE SYSTEM LODGED IN
ALVEOLAR MACROPHAGES
DETECTS PRESENCE OF PATHOGENS AND
ENGULPH THE BACTERIA
BACTERIA INHIBITS THE MACROPHAGE
TO FORM PHAGOLYSOSOME AND
REMAIN PROTECTED INSIDE IT
13. DIAGNOSTIC EVALUATION
History
Physical examination
Clubbing of fingers or toes
Swollen or tender lymph nodes in neck or other areas
Pleural effusion
Unusual breath sounds (crackles)
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20. MANAGEMENT
PHARMACOLOGICAL MANGEMENT
FIRST LINE ANTI- TUBERCULAR MEDICATIONS
Streptomycin 15mg/kg
Isoniazid or INH 5mg/kg (300mg/day max)
Rifampin 10mg/kg
Pyrazinamide 15-30 mg/kg
Ethambutol 15-25 mg/kg daily for 8 weeks continuing
for upto 4-7 months
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21. MANAGEMENT
SECOND LINE OF MEDICATIONS
Capreomycin 12 -15 mg/kg
Paraaminosalicylate sodium 200 -300 mg/kg
Cycloserine 15mg/kg
Vitamin B usually administered with INH
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22. MANAGEMENT
THIRD LINE OF MEDICATIONS
Rifabutin
Macrolides (clarithromycin)
Linezolid
Thioacetazone
Thioridazine
Arginine
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23. MANAGEMENT
Intensive phase (2-3 months)
Under direct supervision of a health worker or trained
person
Continuation phase (4-6 months)
A multiblister combipack with drugs for 1 week is given of
which the first dose is taken under supervision
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26. Ineffective airway clearance related
to thick, viscous sputum production
Goal: to maintain patent airway
Assess the respiratory function( sounds, rate, rhythms)
Assist patient with coughing and deep breathing exercises
Clear secretions from mouth and trachea, suction as
needed.
Maintain fluid intake of at least 2-3 L/ day.
Provide steam inhalation
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27. Impaired gas exchange related to
destruction of alveolar capillary
membrane
Goal: to maintain gas exchange
Assess the respiratory function( sounds, rate, rhythms)
Assess the oxygen saturation and ABG interpretations
Provide high fowler or semi- fowler position
Provide chest physiotherapy
Provide oxygen supplement
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28. Imbalance nutrition: less than body
requirement related to frequent cough
Goal: to maintain nutritional balance
Assess patient’s nutritional status
Monitor intake –output of the patient
Encourage small and frequent meals with high protein and
carbohydrates
Provide respiratory therapy 1-2 hours before or after
meals.
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29. Risk for infection related to inadequate
primary defense
Goal: to decrease risk of infection
Assess patient’s immunity level.
Identify risk factors that can enhance chance of risk
Instruct patient to cough or sneeze into tissue
Maintain good hygiene of the patient
Administer anti-infective agents as prescribed by
physician
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