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Disease Information
Name(s) of Disease: Tuberculosis…
General description: Chronic recurrent infectious disease usually affecting the lungs but
may affect any other organ. Caused by Mycobacterium tuberculosis
Pathology/ Causes: Respiratory:
Primary: spreads through blood and lymph, very uncommon. Granulomatous tissue
erodes bronchus or blood vessel spreading disease throughout lungs, organs
Reactivation TB: tubules are broken and TB is active again, Previously healed lesion
ruptures when immune system is suppressed due to age, disease, immunosuppression.
Chronic: infected person spreads disease continually by droplet infection into
environment.
Process:
1. Bacilli enter upper airway via droplet
2. Implant in alveolus or bronchiole
3. local inflammation develops into granulomatous lesions called tubercle
4. Infected tissue dies and forms cessation necrosis.
5. with adequate immune response, scar tissue develops, scar calcifies (visible on Xray)
6. With inadequate immune response: disease develops with cavitation
Caseation Necrosis: infected tissue dies and has a cheesy like center, scar tissue develops,
you are infected, but do not have TB, it still can activate
Signs and Symptoms: initial may be asymptomatic, may see classic signs: night sweats,
bloody cough, weight loss, fatigue, low grade afternoon fever, dry cough that becomes
productive,
DX:
PPD: TB skin test, <5 mm: negative,
>5 positive if you’ve been in close contact with infected person
10-15: foreign born, IV drug user? lived in crowded environment?
>15, positive:
Abnormal chest x-ray if >5.
Sputum acid fast smear and cultures x3, Acid Fast Bacilli test, checking for the bacilli, if
all three sputum are negative: no respiratory isolation. Chest X-rays to diagnose and to
see how it’s responding to treatment.,
After diagnosis, theses tests are done to establish a baseline: Liver function test, I&H and
ryfanmin (turns your urine orange), Ethambutol, (monitor vision for color change
between red and green), and visual acuity, repeat afb’s and chest x-rays
TX: Meds: prevent and treat TB: 2 or more drugs for at least 6-9 months to prevent TB
organism from mutating into drug-resistant form if TB is active, Treat people in their
homes, skin test for everyone in household, respiratory isolation, antibiotics, Baccilli
Calmette-Guerin (BCG) vaccine (prophalactically)
Commonly used drugs: Streptomycin (can lose hearing),
INH (isoniazid) 300mg orally for 6-12 months.
Diet: no restrictions
Nursing interventions: Teach about meds and medicate. Also teach about reemerging threat, covering mouth and proper disposal of sputum Don’t drink with
these meds, and no Tylenol, urine will be orange, periodic vision and hearing
tests…monitor for hepatotoxicity, hearing, and vision
Major Complications: Medications with nasty and dangerous side effects, so people
don’t want to take them, Tuberculosis empyema: pus in the pleural cavity,
Bronchopleural fistula, pneumothorax
Other: Can still transmit disease for the first 2 weeks of treatment. Get them to a non
infectious state b-4 they go home.
More TB now because there are drug resistant strains, which came from people having it
and not knowing, and their immune systems making new strands, you have to take
treatment…
It is a curable, slow growing organism, transmitted by droplet
There is a stigma with TB: prisons, drug users, homeless, shelters, dirty disease