TUBERCULOSIS - communicable disease.pptx

Tuberculosis (TB) is a contagious infection that usually attacks your lungs. It can also spread to other parts of your body, like your brain and spine. TB is spread through the air when people with lung TB cough, sneeze or spit. A person needs to inhale only a few germs to become infected.

mode of transmission, causes, manifestations, DOTS

1. Communicable diseases K. Udayasree Assistant professor Dept of MSN

2. Tuberculosis

3. Introduction Tuberculosis (TB) is a contagious infection that usually attacks your  lungs . It can also spread to other parts of your body, like your brain and spine.  TB is spread through the air when people with lung TB cough, sneeze or spit. A person needs to inhale only a few germs to become infected. Every year, 10 million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year – making it the world’s top infectious killer.

4. DEFINITION 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. INCIDENCE Over 9 million new cases and 2  million deaths per year worldwide 1/3rd of the world’s population is infected with M.tuberculosis ,  remains one of the top  three killers In the U.S India is the highest TB burden country in the world, home to 20 percent of cases occurring globally.

6.  TYPES PULMONARY TUBERCULOSIS   AVIAN TUBERCULOSIS ( Micobacterium avium ; of birds) BOVINE TUBERCULOSIS (Mycobacterium bovis ; of cattle) MILIARY TUBERCULOSIS /DISSEMINATED TUBERCULOSIS (Invade the blood stream and spread to all body organs.

7. Risk factors Close   contact with some one who have active TB . Immune compromised status (elderly, cancer) Drug abuse and alcoholism. Malnutrition. People lacking adequate health care. Pre existing medical conditions (diabetes mellitus, chronic renal failure). Immigrants from countries with higher incidence of TB. Institutionalization (long term care facilities) Living in substandard conditions. Occupation (health care workers)

8. MODE OF TRANSMISSION Human   beings acquire infection with tubercle bacilli by one of the following routes: Inhalation of organisms present in fresh cough droplets or in dried sputum from an open case of pulmonary tuberculosis. Ingestion sputum of an open case of pulmonary tuberculosis, or ingestion of bovine tubercle bacilli from milk of diseased cows. Inoculation of the organisms into the skin may rarely occur from infected postmortem tissue. Trans placental route results in development of congenital tuberculosis in foetus from infected mother and is a rare mode of transmission.

9. Pathophysiology:

10. CLINICAL MENIFESTATION CONSTITUTIONAL SYMPTOMS Anorexia Low grade fever Night sweats Fatigue Weight los

11. Clinical manifestations(cont.,) PULMONARY SYMPTOMS Dyspnea Non resolving bronchopneumonia Chest tightness Non productive cough Mucopurulent sputum with hemoptpysis Chest pain EXTRA PULMONARY SYMPTOMS Pain Inflammation

12. Assessment and diagnostic findings Complete history Physical examination Tuberculin skin test ( Mantoux test) Quantiform TB gold Sputum culture - Positive for Mycobacterium tuberculosis Drug susceptibility test Ziehl-Neelsen (acid-fast stain applied to a smear of body fluid): Positive for acid-fast bacilli (AFB). Scans – X ray, CT, MRI etc.,

13. TUBERCULIN SKIN TEST ( Montoux test)

14. Montoux test

15. Quantiform TB gold This test is an ELISA test that detects the release of interferon gamma by WBC when the blood of patient with TB is incubated with peptides similar to those in M. tuberculosis. Result is available within 24 hrs and are not affected by prior vaccination with BCG.

16. Treatment Medical management: First-line anti-tuberculosis drugs are referred as 2(RHZE) 3 /4(RHE) 3 i.e., 2 months ’ treatment with rifampicin 10mg/kg/day, isoniazid 5 mg/kg (300 mg max/day) , pyrazinamide 15 - 30 mg/kg/day ethambutol 15 - 25 mg/kg/day , followed by 4 months ’ treatment with rifampicin, isoniazid and ethambutol ) Abbreviations as follows: R – rifampicin H – isoniazid Z – pyrazinamide E – ethambutol S – streptomycin

17. Treatment regimen: Current RNTCP recommended

18. Dots therapy D irectly observed  treatment, short-course has five components: Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training ) Case detection by sputum smear microscopy Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months A regular drug supply A standardized recording and reporting system that allows assessment of treatment results

19. Nursing management: Assessment: Obtain history of exposure to TB Assess for symptoms of active disease Auscultate lungs for crackles During drug therapy assess for liver function

20. Nursing diagnosis: 1. Ineffective breathing pattern related to pulmonary infection and potential for long term scarring with decreased lung capacity Interventions: Administer and teach self administration of medications ordered Encourage rest and avoidance of exertion Monitor breath sounds respiratory rates , sputum production and dyspnoea Provide supplemental oxygen as ordered Encourage increased fluid intake Instruct about best position to facilitate drainage

21. 2 . Risk for   spreading infection related to nature of disease and patients symptoms Interventions: Be aware that TB is transmitted by respiratory droplets Use high efficiency particulate masks for high risk procedures including endoscopy Educate patient to control the spread of infection by covering mouth and nose while coughing and sneezing Isolation of patient Instruct about risk of drug resistance if drug regimen is not strictly and continuously followed Carefully monitor vital signs and observe for temperature changes

22. 3. Imbalanced nutrition less than body requirement related to poor appetite ,fatigue and productive cough Interventions: Explain the importance of eating nutritious diet to promote healing and defense against infection Encourage protein rich diet. Provide small frequent meals Monitor weight of the patient Administer vitamin supplements as ordered

23. Complications Pleural effusion Pneumonia Extra pulmonary tuberculosis

24. Prevention measures: ISOLATION No close contact with infected persons Ventilate   the room/house Cover the mouth Wear mask Finish entire course of medication Vaccinations Eat healthy Maintain good nutritional status No not smoke or substance abuse