Pulmonary Tuberculosis Lecture Notes PDF

Pulmonary tuberculosis Prepared by Dr/ Ayman Senosy Lecturer of Medical Surgical Nursing  Objectives By the end of this lecture, the student will be able to: Define Tuberculosis State causes and risk factors of Tuberculosis Identify clinical manifestat...

Pulmonary tuberculosis Prepared by Dr/ Ayman Senosy Lecturer of Medical Surgical Nursing  Objectives By the end of this lecture, the student will be able to: Define Tuberculosis State causes and risk factors of Tuberculosis Identify clinical manifestations and diagnostic findings State complications of Tuberculosis Mention medical management of Tuberculosis Explain Nursing management of Tuberculosis  Outlines Definition of Tuberculosis s Causes and risk factors of Tuberculosis Clinical manifestations and diagnostic findings Complications of Tuberculosis Medical management of Tuberculosis Nursing management of Tuberculosis  Tuberculosis Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes The primary infectious agent is Mycobacterium tuberculosis  Risk Factors TB spreads from person to person by airborne transmission Poverty, Substandard housing and overcrowding. Immunocompromised persons preexisting medical conditions or special treatment (eg, diabetes)  Clinical Manifestations The signs and symptoms of pulmonary TB are insidious. Most patients have a low-grade fever, cough, night sweats, fatigue, and weight loss. The cough may be nonproductive, or mucopurulent sputum may be expectorated. Hemoptysis also may occur  Assessment and Diagnostic Findings A complete history, physical examination Sputum culture: Tuberculin skin Chest x-ray CT or MRI scan Bronchoscopy  Complications Malnutrition Multidrug resistance and Adverse side effects of medication therapy Spread of TB infection (miliary TB)  Medical Management Pulmonary TB is treated primarily with chemotherapeutic agents (antituberculosis agents) for 6 to 12 months Vitamin B (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy  Nursing process: Assessment The nurse performs a complete history and physical examination. Clinical manifestations of fever, anorexia, weight loss, night sweats, fatigue, cough, and sputum production Assessment Assessment of respiratory function through assessing the lungs for consolidation by evaluating breath sounds (diminished, bronchial sounds, crackles) and dullness on percussion. Enlarged, painful lymph nodes may be palpated as well.  Diagnosis Ineffective airway clearance related to copious tracheobronchial secretions Deficient knowledge about treatment regimen and preventive health measures and related ineffective individual management Activity intolerance related to fatigue, altered nutritional status, and fever  Planning and Goals The major goals for the patient include maintenance of a patent airway, increased knowledge about the disease and treatment regimen and adherence to the medication regimen, increased activity tolerance, and absence of complications.  Nursing Interventions IMPROVING AIRWAY PATENCY ADVOCATING ADHERENCE TO TREATMENT REGIMEN: PROMOTING ACTIVITY AND ADEQUATE NUTRITION:  IMPROVING AIRWAY PATENCY Assess respiratory function noting breath sounds, rate, rhythm, and depth, and use of accessory muscles. Note ability to expectorate mucus and cough effectively; document character, amount of sputum, presence of hemoptysis. Place patient in semi or high-Fowler’s position.  IMPROVING AIRWAY PATENCY Assist patient with coughing and deep-breathing exercises. Administer medication as doctor order (mucolytic, broncodiator) Increasing fluid intake promotes systemic hydration and serves as an effective expectorant. The nurse instructs the patient about correct positioning to facilitate airway drainage (postural drainage)  ADVOCATING ADHERENCE TO TREATMENT REGIMEN: The multiple-medication regimen that a patient must follow can be quite complex. Understanding the medications, schedule, and side effects is important. The patient must understand that TB is a communicable disease and that taking medications is the most effective means of preventing transmission The nurse carefully instructs the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene.  PROMOTING ACTIVITY AND ADEQUATE NUTRITION: The nurse plans a progressive activity schedule that focuses on increasing activity tolerance and muscle strength. Small, frequent meals may be required. High-calorie nutritional supplements may be suggested The nurse collaborates with the dietitian, physician, social worker, family, and patient to identify strategies to ensure an adequate nutritional intake and availability of nutritious food.  Evaluation The plans& goals are achieved through the following: Maintains a patent airway by managing secretions with hydration, humidification, coughing, and postural drainage Demonstrates an adequate level of knowledge Maintains activity schedule  Discharge plan: The nurse plays a vital role in caring for the patient with TB and the family, which includes assessing the patient’s ability to continue therapy at home. Educate patient about how to use the prescribed medications and side effects Liver enzyme, blood urea nitrogen, and serum creatinine levels should be monitored to detect medication-related changes in liver and kidney Function  Discharge plan: Informs the patient that rifampin may discolor contact lenses, so the patient may want to wear eyeglasses during treatment Support patient’s physical and psychological status to increase adherence to the prescribed treatment  Discharge plan: The nurse instructs the patient and family about infection control procedures, such as proper disposal of tissues, covering the mouth during coughing, and hand hygiene. Encourage patient to use well-balanced diet. Inform patient about the importance to make sputum culture to evaluate the effectiveness of the treatment