Pulmonary TB

TUBERCULOSIS CURRENT REGIMEN

1. PULMONARY
TUBERCULOSIS
SUDESHNA BANERJEE DUTTA
S.R.S.V.M B.SC NURSING COLLEGE

2. INTRODUCTION
PulmonaryTuberculosis(TB)isaninfectious
diseasethatmainlyaffectthelungsparenchyma.
TBisacontagiousbacterial(M.tuberculosis)
infectionthatmainlyaffectsthelungsparenchyma,
butmayspreadtootherorgans.

3. TBhasremainedanenemyofhumansocietyfor
allage.
TBisnotonlyaproblemforthepersonsuffering
fromitortheirfamiliesbutapublichealth
problemoftheentireworld.

4. DEFINITION
INFLAMMATORY
DISEASE
•It is a Chronic specific
Inflammatory infectious
Disease caused by
Mycobacterium tuberculosis
In human.
•Usually attacks the lungs but
It can also effect any part of
the body.

5. ETIOLOGY
TB is caused by the bacteria M. tuberculosis
(most common cause).
Other than tuberculosis –includes;
M. avium intracellulare
M. kansasi
M. scrofulaceuru
M. ulcerans
M. marinum and etc.

6. It also caused by breathing in
air droplets from a cough or
sneeze of an infected person
this is called Primary TB.
Risk factors of tuberculosis
are;
Elderly
Infants
Low socioeconomic status
Crowded living conditions
Disease that weakens
immune system like HIV
Alcoholism
Recent Tubercular infection
(within last 2 years) and etc.

7. TBspreadfrompersontopersonbyairborne
transmission.Infectedpersonreleasedroplet
nuclei(1-5micrometerindiameter)through,
Talking
Coughing
Sneezing
Laughing
Singing
Ifnottreatedproperly,TBcanbefatal.

8. Primary pulmonary infection
GHON COMPLEX (in lungs)
GHON FOCUS (in regional lymph nodes)
Disease
spread from
both
Disease
spread from
lymph nodes
•Bronchopneumonia
•Consolidation
•Hyperinflation(partial
obstruction)
•Collapse(complete
obstruction)
PLEURAL EFFUSION, MILLIARY TB,
PERICARDIAL EFFUSION

9. Ghon’s complex
It is a lesion seen in the lung that is caused by
TB. The lesions consist of a calcified focus of
infection & associated lymph nodes.
The lesions can retain viable bacteria so they
are sources of long-term infection & may be
involved in reactivation of the disease in future.

10. SYMPTOMS
TheprimarystageofTBusuallydoesn’tcause
symptoms.WhensymptomsofTBoccur,theymay
includes;
➢Fatigue
➢Fever
➢Unintentionalweightloss
➢Coughupofmucusandblood(hemoptysis)
➢Excessivesweatingatnight.
➢Breathing difficulty
➢Chest pain
➢Wheezing.

11. DIAGNOSTIC TESTS
Tuberculin skin test (PPD test);
➢0.1 ml of PPD(purified protein derivative) is
injected ID.
➢After 48-72 hours check induration.
➢If induration is equal to & more than 10mm, then
it’s a positive result.

12. ✓History taking
✓Physical examination (crackles, clubbing of
fingers or toes called cellular hypertrophy due to
hypoxia, swollen lymph nodes, pleural effusion)
✓Chest CT Scan
✓Bronchoscopy
✓Biopsy of the affected tissue
✓Chest X-Ray
✓Thoracentesis

13. ✓Interferon-gamma Blood test/ Quantiferon gold test
➢Patient’s blood is mixed with M. tubercular surface
proteins
➢Incubate the blood for 16-24 hours
➢If patient is infected with tuberculosis bacteria, their
white blood cells produce interferons in response to the
tubercular proteins.
✓Sputum examination and Cultures: Is examined under a
microscope to look for tuberculosis bacteria.

14. TB PATIENT’S X-RAY NORMAL X-RAY

15. COMPLICATIONS
TB spine/ Pott’s spine (spinal pain & joint
destruction)
Meningitis
Cardiac tamponade (compression of the heart
caused by fluid collection in the sac surrounding
the heart)
Pneumonia
Serious reactions to drug therapy (hepato toxicity,
hypersensitivity)

16. TB MEDICAL REGIMEN
1
ST
LINE ANTI TB
MEDICINES
2
ND
LINE ANTI TB
MEDICINES
3
RD
THIRD LINE ANTI
TB MEDICINES
1.STREPTOMYCIN, 15
MG/KG
2.ISONIAZID, 5MG /KG
3.RIFAMPICIN,
10MG/KG
4.ETHAMBUTOL. 15-25
MG/KG
5.PYRAZINAMIDE, 15-
30 MG/KG MG/KG
1.CAPREOMYCIN
2.ETHIONAMIDE,
15MG/KG
3.PARAAMINOSALICY
LATE SODIUM, 200-
300 MG/KG
4.CYCLOSERINE,
15MG/KG
5.FLUOROQUINOLONE
1.RIFABUTIN
2.MACROLIDES
(CLARITHROMYCIN)
1.LINEZOLID
2.THIORIDAZINE
3.ARGININE
4.THIOACETAZONE
5.CLOFAZIMINE

17. DOTS (Directly Observed Treatment Short
Course)
It is a treatment of choice for TB.
INTENSIVE PHASE: A health worker or other trained
person watches the patient as the patient swallows
the drug in his presence.
CONTINUATION PHASE : The patient is issued
medicine for 1 week in a multi-blister combi pack, of
which the first dose is swallowed by the patient in
presence of health worker.

18. DOTS CONT…
After the end of 1 week, health worker checks the
empty multi-blister combipack to ensure the drug
is taken or not.
In this program, daily the drugs are given
currently. The cases are divided in in 2 phase
treatment facilities for 6-9 months.

19. CURRENT DOTS REGIMEN FOR TB:
TYPEOF TB
REGIMEN
INTENSIVE PHASE CONTINUATION &
MAINTENANCE
PHASE
CURRENT
TREATMENT
PATTERN
2MONTHS (HRZE)
DAILY
4 MONTHS (HRE)
DAILY
H: ISONIAZID
R: RIFAMPICIN
E: ETHAMBUTOL
Z: PIRAZINAMIDE

20. Definitions of DR-TB
Multi Drug Resistance (MDR) : A TB patient, whose
biological specimen is resistant to both H and R with
or without resistance to other first line drugs.
Extensive Drug Resistance (XDR) : A MDR TB patient,
whose biological specimen is additionally resistant to
a Fluoroquinolone (Ofloxacin, Levofloxacin, or
Moxifloxacin) and a second-line injectable anti TB
drug; Kanamycin, Amikacin, Capreomycin.

21. Treatment Drug resistant TB
TYPE OF TB
CASES
INTENSIVE PHASE
(IP)
CONTINUATION
PHASE (CP)
TOTAL
DURATIO
N
Regimen
for
MDR/RR-
TB
(6-9) LfxKm
EtoCs Z E
(18) LfxEtoCs
E
24-27
months
Isoniazide
(mono)
resistance
(6-9) LfxR E Z 6-9
months
Lfx:Levofloxacin
Km:Kanamycin
Eto: Ethionamide
Cs: Cycloserine
Z: Pyrazinamide
E: Ethambutol

22. TYPE OF TB
CASES
INTENSIVE PHASE
(IP)
CONTINUATION
PHASE (CP)
TOTAL
DURAT
ION
XDR-TB (6-12) Mfx(high
dose) Cm Eto Cs Z
Lzd Cfz E
(18) Mfx(high
dose) EtoCs Lzd
CfzE
24-30
months
Mfx:Moxifloxacin
Cm: Capreomycin
Lzd: Linezolid
Cfz:Clofazimine

23. Nursing care of TB patient
➢It includes breathing pattern, preventing transmission
of infection, promoting activity & improving nutrition
status & advocating treatment regimen.
➢Nurse should monitor breathe sound, respiratory rate,
sputum production & dyspnoea.
➢Provide supplemental oxygen as prescribed.
➢Increasing the fluid intake to promote systemic
hydration & serve as an effective expectorant.

24. ➢Nurse should instruct the patient about correct
positioning to facilitate breathing pattern.
➢The nurse teaches the patient about TB & it’s
communicability.
➢She should explain that medicines are the most
effective treatment to prevent transmission.
➢Nurse should instruct patient to take medicine either
on an empty stomach or 1 hour before taking meals to
avoid food interference with drug absorption.

25. ➢Nurse should review possible complications like
pleural effusion, fever, pneumonia etc.
➢Explain the importance of nutritious diet to improve
immunity