https://www.tbnewswatch.

com/local-news/tuberculosis-count-reaches-11-1010919

Tuberculosis
By: Tara Bulluck, Alyssa Garbarek, Taylor
Lessard, Jordan Matis, Caitlyn Wegner

https://ojo.pe/salud/tuberculosis-tiene-capacidad-biologica-camaleonica-y-se-adapta-a-todo-lugar-230986-noticia/
History of Tuberculosis
● Egyptians
● Ancient Greece
● Industrial Revolution
● United States of
America
What’s in a name
Villemin Koch

Sanitorium Cure A Contemporary View

What is Tuberculosis?
● Tuberculosis (TB) is a
chronic, progressive
mycobacterial infection, often
with a period of latency
following initial infection.
● TB most commonly affects the
lungs. Symptoms include
productive cough, fever,
weight loss, and malaise.

https://www.verywellhealth.com/tuberculosis-symptoms-914924
 Types of Tuberculosis

https://www.google.com/search?q=latent+vs+active+tuberculosis&tbm=isch&ved=2ahUKEwjEmbLC7ernAhUDTa0KHR9TAXsQ2-cCegQIABAA&oq=latent+vs+ac+tuberculosis&gs_l=img.1.0.0i7i30.473501.478756..479787...0.0..0.187.1211.11j2......0....1..gws-wiz-img.......0i67j0j0i7i5i30j0i5i30.oM1PWVEMb-k&ei=9BpUXsTP
G4OatQWfpoXYBw&bih=937&biw=1920&rlz=1C1GCEB_enUS885US885&safe=active&ssui=on#imgrc=kMSOCAOVwjbebM&imgdii=PXNeZhY4tVnBdM
Latent Tuberculosis Active Tuberculosis Disease
Infection (LBTI)

● Infected with the tuberculosis bacterium

● Signs and symptoms are present
however the disease is not active
● Positive TB test
● No symptoms, don’t feel sick
● Disease is contagious and can be spread
● Not contagious
● Needs to be treated immediately
● Positive TB test
● Can be deadly
● Can develop an active TB infection if not
treated, should be treated to prevent
spread
● An estimated 2 billion people have
latent TB
● Most people have latent TB their entire
life without it becoming active
https://www.shutterstock.com/image-vector/tuberculosis-versus-healthy-lungs-symbol-tb-600626735
 Pathophysiology
● Inhalation. Tuberculosis begins when a susceptible person inhales mycobacterium tuberculosis and becomes
infected.
● Transmission. The bacteria are transmitted through the airways to the alveoli, and are also transported via
lymph system and bloodstream to other parts of the body.
● Defense. The body’s immune system responds by initiating an inflammatory reaction and phagocytes engulf
many of the bacteria, and TB-specific lymphocytes lyse the bacilli and normal tissue.
● Protection. Granulomas new tissue masses of live and dead bacilli, ate surrounded by macrophages, which
form a protective wall.
● Ghon’s tubercle. They are then transformed to a fibrous tissue mass, the central portion of which is called a
Ghon tubercle.
● Scarring. The bacteria and macrophages turns into a cheesy mass that may become calcified and form a
collagenous scar.
● Dormancy. At this point, the bacteria become dormant, and there is no further progression of active disease.
● Activation. After initial exposure and infection, active disease may develop because of a compromised or
inadequate immune system response.
 Main Causes of Tuberculosis
● Tuberculosis is caused by bacteria (mycobacterium
tuberculosis) that spread from person to person
through microscopic droplets released into the air.
● This can happen when someone with the untreated,
active form of tuberculosis coughs, speaks, sneezes,
spits, laughs or sings.
● Although tuberculosis is contagious, it's not easy to
catch. You're much more likely to get tuberculosis from
someone you live with or work with than from a
stranger.
● Most people with active TB who've had appropriate
https://www.everydayhealth.com/tuberculosis/guide/risk-factors-causes-prevention/

drug treatment for at least two weeks are no longer

contagious.
Patients at High Risk

https://www.pinterest.com/pin/418271884134790948/
 Assessment
Physical Assessment Ask the patient questions

● Vital signs ○ What are your symptoms, and when did they start?
● Weight loss ○ Does anyone you know have active tuberculosis?
● TB skin test ○ Do you have HIV or AIDS?
● Decrease in physical appearance ○ Were you born in another country, or have you
● Check lymph nodes for swelling traveled in another country?
● Use a stethoscope to listen to lung sounds ○ Have you ever lived with someone who had
while the patient is breathing. tuberculosis?
○ Were you vaccinated against tuberculosis as an
infant?
○ Have you ever had tuberculosis or a positive skin
test?
○ Have you ever taken medicine for TB? If so, what
kind and for how long?
○ What kind of work do you do?
○ Do you use alcohol or illegal drugs?

https://www.healthcentral.com/article/lungs-101-learning-basic-lung-sounds
 TB Skin Test
The most commonly used diagnostic tool for tuberculosis is a simple skin test. A small amount of a substance
called PPD tuberculin is injected just below the skin on the inside forearm.

Within 48 to 72 hours, a health care professional will check the arm for swelling at the injection site. A hard,
raised red bump means you're likely to have TB infection. The size of the bump determines whether the test
results are significant.

https://www.vectorstock.com/royalty-free-vector/evaluation-of-mantoux-test-response-vector-22319063
 Lab Assessments
● Quantiferon Gold: Blood tests may be used to confirm or rule
out latent or active tuberculosis.
● Sputum culture: Positive for Mycobacterium tuberculosis in the
active stage of the disease.
● Ziehl-Neelsen (acid-fast stain applied to a smear of body
fluid): Positive for acid-fast bacilli (AFB).
● Enzyme-linked immunosorbent assay (ELISA)/Western blot:
May reveal presence of HIV.
● Electrolytes: May be abnormal depending on the location and
severity of infection; e.g., hyponatremia caused by abnormal
water retention may be found in extensive chronic pulmonary TB.
● ABGs: May be abnormal depending on location, severity, and
residual damage to the lungs. https://www.dailymail.co.uk/health/article-3455299/Simple-new-blood-test-detects-TB-spot-patients-infectious.html
●
Imaging Assessments
Chest x-ray: May show small, patchy infiltrations of early lesions in the upper-lung field,
calcium deposits of healed primary lesions, or fluid of an effusion. Changes indicating more
advanced TB may include cavitation, scar tissue/fibrotic areas.
● CT or MRI scan: Determines degree of lung damage and may confirm a difficult diagnosis.
● Bronchoscopy: Shows inflammation and altered lung tissue. May also be performed to
obtain sputum if patient is unable to produce an adequate specimen.
● Histologic or tissue cultures (including gastric washings; urine and
cerebrospinal fluid [CSF]; skin biopsy): Positive for Myco­bacterium tuberculosis and
may indicate extrapulmonary involvement.
● Needle biopsy of lung tissue: Positive for granulomas of TB; presence of giant cells
indicating necrosis.
● Pulmonary function studies: Decreased vital capacity, increased dead space, increased
ratio of residual air to total lung capacity, and decreased oxygen saturation are secondary
to parenchymal infiltration/fibrosis, loss of lung tissue, and pleural disease (extensive
chronic pulmonary TB). https://link.springer.com/article/10.1007/s11739-016-1601-9
 Nursing Diagnoses
● Risk for infection related to inadequate
primary defenses and lowered resistance.
● Ineffective airway clearance related to
thick, viscous, or bloody secretions.
● Risk for impaired gas exchange related
to decrease in effective lung surface.
● Activity intolerance related to imbalance
between oxygen supply and demand.
● Imbalanced nutrition: less than body
requirements related to inability to ingest
adequate nutrients.
https://nurseslabs.com/nursing-diagnosis/
Article 1 Preventative Therapy Regimen
Preventative Therapy Regimen
● Six months of preventative therapy with Isoniazid confers a
high degree of protection against the progression to
clinically active TB.
● Twelve months of therapy is recommended for a person
infected with TB.
**Isoniazid typically used alone for preventive therapy in a
single daily dose of 10mg/kg…. Treatment therapy when
added with other medications**

Monitoring
● Compliance
● Exclude the possibility of current TB
● Previous completion of preventative therapy
● Contraindications: adverse reactions, acute/active liver
disease
US Department of Health & Human Services. Core Curriculum on Tuberculosis. Retrieved From:
Article 2 - World Health Organization
● Those infected with HIV are 19 times more likely to develop active TB - any immunodeficiency
increases risk of active TB
● HIV and TB are a deadly combination, nearly all HIV positive people with TB will die
● Dx - sputum samples - microscopy detects only half the number of TB cases and cannot detect drug
resistance
○ Rapid test Xpert MTB/RIF detects TB and resistance to Rifampicin (most important TB Medication)
○ DX - can be made within 2 hours
○ Particularly difficult to diagnose in children
● Tx- TB disease is treated with a standard 6-month course of 4 antimicrobial drugs
○ multidrug resistance is treatable with second-line drugs - expensive and toxic, chemotherapy drugs can be
used
Article 3 Tuberculosis - EVP
● Highly infective - Droplet transmission
● Infants, young children, and elderly are the most susceptible
● Primary symptoms include
○ Severe cough (> 2 weeks), thick bloody sputum, chest pain, weakness / fatigue,
unexplained weight loss, loss of appetite, chills, fever, night sweats
● What to do if you suspect you have TB
○ Get tested, stay at home, warn family / housemates, circulate air in your room, cover your
mouth when coughing or sneezing, wash hands frequently, consider wearing a surgical
mask - (N95 or other disposable particulate respirators)
http://eds.a.ebscohost.com.libproxy.bryantstratton.edu:2048/eds/detail/detail?vid=5&sid=b77765da-a008-4d7f-9a52-211a367e7959%40sdc-v-sessmgr01&bdata=JkF1dGhUeXBlPWNvb2tpZSxpcCx1aWQsdXJsJnNpdGU9
ZWRzLWxpdmU%3d#AN=2009866383&db=nup
From the Textbook
● Nursing interventions
○ Protect and educate ourselves, the patient, and loved ones - (Isolation, negative pressure, masks
○ Emphasise smoking cessation
○ Assess client’s mental status, anxiety is common
○ Ensure proper and adequate nutrition
○ Educate our patient about pharmaceuticals including SE/AE
● Isoniazid - “Kills actively growing mycobacteria outside cell and inhibits growth of dormant bacteria” (Ignatavicius,
2018)
○ No antacids / alcohol
○ Increase intake of B-complex vitamins
○ Report signs of liver toxicity - dark urine, yellowed skin, RUQ abdominal pain/discomfort
● Rifampin - “Kills slower-growing organisms, even those that reside inside macrophages” ( Ignatavicius, 2018)
○ Expect red/orange staining of skin, secretions, urine
○ Report signs of liver toxicity
○ Women on oral contraceptive should use barrier contraceptives during and 1-month post treatment
Nursing and Medical Interventions https://www.kcl.ac.uk/news/why-nursing-higher-education-is-essential

● Promoting airway clearance. The nurse instructs the patient about correct positioning to facilitate drainage
and to increase fluid intake to promote systemic hydration.
● Adherence to the treatment regimen. The nurse should teach the patient that TB is a communicable disease
and taking medications is the most effective means of preventing transmission.
● Promoting activity and adequate nutrition. The nurse plans a progressive activity schedule that focuses
on increasing activity tolerance and muscle strength and a nutritional plan that allows for small, frequent meals.
● Preventing spreading of tuberculosis infection. The nurse carefully instructs the patient about important
hygienic measures including mouth care, covering the mouth and nose when coughing and sneezing, proper
disposal of tissues, and handwashing.
● Acid-fast bacillus isolation. Initiate AFB isolation immediately, including the use of a private room with
negative pressure in relation to surrounding areas and a minimum of six air changes per hour.
● Disposal. Place a covered trash can nearby or tape a lined bag to the side of the bed to dispose of used
tissues.
● Monitor adverse effects. Be alert for adverse effects of medications.
 Interventions Comparison Example (List 5)
Textbook Article 1 Article 2 Article 3

Testing/Diagnosi -Chest x ray -Skin Test -Sputum samples - cannot detect -Blood tests
s -Sputum cultures -Chest X Ray drug-resistance -Skin tests
-Respiratory secretions -Positive HIV Test -Rapid test Xpert MTB/RIF -Chest X-ray
-NAAT - Nucleic Acid Amplification -Radiographic Exam- view of -Sputum samples
Test chest for abnormalities -Fluid or tissue tests

Nursing -Isolation, negative pressure, masks -Assess -Cessation of smoking is -Stay at home
Interventions/Ed -Emphasise smoking cessation -Educate recommended -Warn family / housemates
ucation -Assess client’s mental status -Compliance to medication -Discontinuation of alcohol use -Circulate air in your room
-Ensure proper and adequate regimen -Adequate nutrition -Cover your mouth when
nutrition -Labs (Hepatic) -Advise to seek care immediately coughing or sneezing, consider
-Educate our patient about -Daily weights when symptoms begin wearing a surgical mask - (N95
pharmaceuticals including SE/AE or other disposable particulate
respirators)
-Wash hands frequently

Treatment -Antibiotics- Rifampin, Isoniazid -Twelve months of therapy -TB disease is treated with a -For latent TB - Antibiotic to
recommended standard 6-month course of 4 prevent active TB
-Isoniazid antimicrobial drugs -For active TB - a combination
of drugs to treat the active
infection.
Kahoot!
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 References
Badash, M. (2018). Tuberculosis. Health Library: Evidence-Based Information

Belleza, M., Belleza, M., & Marianne. (2017, September 24). Pulmonary Tuberculosis: Nursing Care Management and Study Guide. Retrieved
February 24, 2020, from https://nurseslabs.com/pulmonary-tuberculosis/#Pathophysiology

Bragazzi, N.L., & Galluzzo, L., & Martini, M. (2017) The history of tuberculosis: from the first historical
records to the isolation of Koch's bacillus. Journal of Preventive Medicine and Hygiene 58(1): E9–E12

Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing - Concepts for Interprofessional Collaborative Care (9th ed., Vol. 1). St.
Louis, MO: Elsevier.

Tierney, D., By, Tierney, D., Nardell, E. A., & Last full review/revision Apr 2018| Content last modified Apr 2018. (2018, April). Tuberculosis
(TB) - Infectious Diseases. Retrieved February 2020, from h
ttps://www.merckmanuals.com/professional/infectious-diseases/mycobacteria/tuberculosis-tb#v1010710

Tuberculosis. (2019, January 30). Retrieved February 24, 2020, from

https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250?page=0&citems=10

WHO. (2019, October 17). Tuberculosis (TB). Retrieved from https://www.who.int/news-room/fact-sheets/detail/tuberculosis