The document discusses tuberculosis (TB), including: - TB is caused by Mycobacterium tuberculosis and spreads through airborne droplets. - Risk factors include substance abuse, HIV infection, and being a child under 5 years old. - Diagnosis involves tuberculin skin testing and sputum culture. Treatment consists of a multi-drug regimen over 6-9 months. - Complications of untreated TB include development of drug-resistant strains like multidrug-resistant TB.

2.  National TB Control Program (RNTCP) was Launched in 1962
 RNTB Control Program –1993 /DOTS (Directly Observed
Treatment, Short-course)
 BCG:-Bacille Calmette Guerin- Live attenuated vaccine
 B.C.G vaccination Programme was launched in year :-1951
 At birth, dose of BCG vaccine is: 0.05 ml I/D until 1 month
 0.1 ml I/D after 1 month
 BCG vaccine dilute with NS

3.  Lung infection caused by M. tuberculosis, (Acid fast Bacilli)
 First discovered in 1882 by Robert Koch
 Transmitted by Inhalation of airborne droplets
(Talking - cough - sneezing – laughing).
 Mycobacterium tuberculosis infects about 35% world’s population
Introduction:-

4. Risk Factors for Tuberculosis
 Substance abuse
 DM, HIV, infection
 Anti- rejection drug
 Child younger than 5 years of age
 Drinking unpasteurized milk if cow is infected with bovine
tuberculosis

5.  Primarily affects pulmonary system, especially upper lobes
 Acute TB: Primary lesion
 Chronic TB: Progressive, re-injection & reactivation of primary lesions
after mouths or years. common in adults.
 Swallowing infectious sputum may cause/lead to laryngeal.
oropharyngeal or intestinal TB.
 Extra-pulmonary TB- Involves bone, kidneys
Types of TB

6.  Classical Sign –
◦ Progressive Cough (2 wks)
◦ Night Sweat/Sleep hyper-hidrosis
◦ Weight loss
◦ Low-grade fever.
 1st Symptoms:-A cough with expectoration of mucoid
sputum
C/F:-

7. ◦ Ghon's complex :-lesion seen in lung that is
caused by TB
◦ (1to 1.5-cm area of gray white inflammation )

8.  An individual who received a BCG vaccine will
have a positive tuberculin skin test result &
should be evaluated for TB with a chest x-ray.
 Chest x-ray- Active or calcified lession
D/E:-

9.  Tuberculin Test /Mauntoux- test/ Mendel-
Mantoux test/ Pirquet test (1907)
 Injection of PPD (Purified Protein Derivative)
 M. tuberculosis, heating to 100 °C to kill bacilli &
subsequent filtering
 Store temp 2-8 °C
 I/D, dose – 0.1ml (5 TU tuberculin units) to Inner
surface of forearm.
(Indicate exposure to tubercle bacilli)

10.  Determination: after 48-72
hrs
 10 mm or greaten Positive
 6-9 mm Doubtful
 <6mm Negative
 5 mm for inmuno-
compromissed client, HIV
positive

11.  5 mm for inmuno-compromissed client, HIV
positive

13.  Find out it:-
 Heaf gun

14. Heaf test/ Ster-needle test:-Determine whether or not
children had been exposed to TB infection
 Administered by a Heaf gun
 Gun injected PPD
 Test was read B/W 2 & 7 days later

15.  Tine test:- Multiple-puncture tuberculin skin test
 Read 48 to 72 hours later

16.  Quouti FERON Gold Test- (1 mL) A blood analysis
test by interferon-gamma (IFN-y ) release assay,
 Results can be available in 24 hours
 More specific than tuberculin test.

17.  Sputum Culture- 3 Continuum sample Confirms
the diagnosis
 NPO past midnight in preparation for early
morning sputum collection

Spontaneously expectorated sputum:-3
consecutive morning sputum's

Induced sputum:- Nebulizer of 3% saline

Ziehl-Neelsen stain done of smear (Acid fast)


18. Fix Smear
Put Carbol fuchsin & heat smear until steam comes
out (but don’t boil & dry )
Place slide for 5-10 min. (wash smear with water )
Put 3ml HCL acid & 97% Ethanol solution
put malachite green dye (Wash)
dry slide & see under microscope
Methods
Acid fast Bacilli (Red Color)

19. Treatment
 Initial treatment 2 months
 (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide daily for 2
months
 Followed by 4 months of Isoniazid & Rifampicin given 3 times
a week
 Bacteriostatic” means that the agent prevents the
growth of bacteria Eg Ethambutol
 Bactericidal” means that it kills bacteria Eg

20.  Initial treatment 2 months
 (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide
daily for 2 months
 Followed by 4 months of Isoniazid & Rifampicin
given 3 times a week
 Bacteriostatic” means that agent prevents growth of
bacteria Eg Ethambutol
 Bactericidal” means that it kills bacteria Eg
Management:-

21.  First line drugs for TB "RIPE"
1.Isonizide (INH):- Batctericidal (Interfere with Cell wall
synthesis)Most common medication used for treatment of TB
 Adult :- 300mg/day
 Child :- 15 mg/kg/day
S/E:-
 I:-Iron accumulation in mitochondria is called Sideroblastic anemia
 N:-Neuropathy Peripheral (Affect CNS )
 H:-Hepatitis
 Vitamin B6 deficiency

22.  Note:-
 A client with a positive skin test for TB isn’t
showing signs of active disease.
 Prevent development of active TB, client should
be treated with Isoniazid, 300 mg daily,
for 9-12 month
 Note:-Safe to use during pregnancy

23.  Nurses role:-
 Administer isoniazid 1 hour before or 2 hours
after a meal because food may delay absorption.
 Administer at least 1 hour before Antacids
 Administer pyridoxine as prescribed to reduce
risk of neurotoxicity.

24. 2.Rifampicine (Rifadin )-Batctericidal (interfere
with RNA )
 Adult- 600mg (10mg/kg) ,,Child- 10-20 mg/kg day
 S/E- Red, orange urine, Thrombocytopenia, GI
upset, Hepatitis, RF, Fever ,Discoloration of body
fluid-:
 Drug interaction with – OCP (oral contraceptive pills), advice to
use alternative method
 N/R:-Take medication on empty stomach with 8
oz of water 1 hour before or 2 hours after meals
 Avoid taking antacids with medication.

25. 3.Pyrazinamide (PZA)- Bactericidal
 Adult- 15-30 mg/kg/day(2gm), -50 70mg/kg/BD
 Child – 15-20 mg/kg/day
 S/E- Hepatitis, Rash, GI upset, hyperurecenia,
difficult to control glucose in DM.

26. 4.Ethambutol (EMB)/ Myambutol:- Bacteriostatic
(Interfere with RNA synthesis )
 Adult- 40-50 mg/kg/day(2 gm)
 Child - 15-25 mg/kg/day
 S/E: Eye:- Decrease visual acuity
 Optic neuritis (2nd CN), Skin Rash

27. 5.Streptomycin:-Bactericidal inhibits mycobacterial
protein synthesis
 Adult : 15 mg/kg/day (1 gm)
 Child 15 mg/kg/day (1 gm)
 S/E- Ototoxicity, (8th Cranial Nerve damage) ,
Vertigo ,Renal toxicity

28.  Second line drug= inhibits cell metabolism.
 1. Kanamycin - Ototoxic & nephrotoxic

2. Para-aminosalicylic acid causes GI disturbances,
hepatotoxic

29.  Was developed by Karel Styblo
 Dots program -1993
DOTS (Directly Observed Treatment, Short-Course),
also known as TB-DOTS

30.  Multidrug-resistant strain of tuberculosis
(MDR-TB):-
 TB does not respond to at
least isoniazid & rifampicin, 2 most
powerful anti-TB drugs

31.  Instruct client to increase rich in iron, protein, &
vitamin C food
 Cultures are negative, client is no longer
considered infectious & usually can return to
former employment
Nurse’s role:-

32. 
1. A staff nurse has a tuberculosis (TB) skin test of
16-mm induration. A chest radiograph is negative,
and the nurse has no symptoms of TB. The
occupational health nurse will plan on teaching the
staff nurse about the
a. Use and side effects of isoniazid (INH).
b. Standard four-drug therapy for TB.
c. Need for annual repeat TB skin testing.
d. bacille Calmette-Guérin (BCG) vaccine.

ANS: A
MCQ

33. 3.Which action by the occupational health nurse at a
manufacturing plant where there is potential
exposure to inhaled dust will be most helpful in
reducing incidence of lung disease?
a. Teach about symptoms of lung disease.
b. Treat workers who inhale dust particles.
c. Monitor workers for shortness of breath.
d. Require the use of protective equipment.

ANS: D


34. 4.The health care provider writes an order for
bacteriologic testing for a patient who has a
positive tuberculosis skin test. Which action will
the nurse take?
a. Repeat the tuberculin skin testing.
b. Teach about the reason for the blood tests.
c. Obtain consecutive sputum specimens from the
patient for 3 days.
d. Instruct the patient to expectorate three
specimens as soon as possible.
ANS: C

35.  5. The right forearm of a client who had a purified
protein derivative (PPD) test for tuberculosis is
reddened and raised about 3mm where the test
was given. This PPD would be read as having which
of the following results?
 a. Indeterminate
b. Needs to be redone
c. Negative d. Positive
 c. Negative

36.  6. A client with primary TB infection can expect to
develop which of the following conditions?
 a. Active TB within 2 weeks
b. Active TB within 1 month
c. A fever that requires hospitalization
d. A positive skin test
 d. A positive skin test
 A primary TB infection occurs when the bacillus has
successfully invaded the entire body after entering
through the lungs.

37.  7. A client with a positive Mantoux test result will
be sent for a chest x-ray. For which of the
following reasons is this done?
 a. To confirm the diagnosis
b. To determine if a repeat skin test is needed
c. To determine the extent of the lesions
d. To determine if this is a primary or secondary
infection
 c. To determine the extent of the lesions

38. 8.A client is diagnosed with active TB and started
on triple antibiotic therapy. What signs and
symptoms would the client show if therapy is
inadequate?
 a. Decreased shortness of breath
b. Improved chest x-ray
c. Nonproductive cough
d. Positive acid-fast bacilli in a sputum sample
after 2 months of treatment.
 d. Positive acid-fast bacilli in a sputum sample
after 2 months of treatment.

39.  9. A client who is HIV+ has had a PPD skin test.
The nurse notes a 7-mm area of induration at the
site of the skin test. The nurse interprets the
results as:
 a. Positive
b. Negative
c. Inconclusive
d. The need for repeat testing.
 a. Positive

41.  It is a surgical procedure create opening through
neck into trachea (windpipe)
 Maintaining patent airway
TRACHEOSTOMY

42.  Burns of the airway
 Cancer in the neck
 Chronic lung disease, Coma
 Diaphragm dysfunction
 Injury to larynx
 Need for prolonged respiratory or ventilator
support
 Obstruction of the airway by a foreign body
 Vocal cord paralysis
 Note:-E.T. Tube cannot be inserted.
Indication:-

43.  Emergency & prophylactic.
 Temporary & permanent.
According to placement
 High ring (2nd & 3rd) Incision made above isthmus
 Low ring (3rd & 4th ) Incision made below isthmus
Type of tracheostomy

44.  Types of tracheostomy tube:-
 Double Lumen (Most commonly used) or single Lumen
tube
 Cuffed or non –cuffed tube
 Cuffed
 Cuffed (20mm of Hg)
 Check every 8 hrs
 Non –cuffed tube
 Used in school age children
 Fenestrated or non-fenestrated


46.  Between the 2nd & 3rd/3rd or 4th tracheal rings.
 Position:-Rose position
Site

48.  1st day on tracheotomy need suction every 30 mt
 Clean inner cannula if present.
 Remove disposable inner connula & put new.
 Care of non disposal inner cannula, remove &
place in soaking solution like H2O2 for 5 min &
rinse with saline.
Nursing Care -

49.  Change tracheotomy ties.
 Place 4x4" tracheotomy dressing.
 Cover the tracheotomy with moist gauze or cotton
 Normal tracheotomy cuff pressure Maintain at 18-
25mmHg

50.  Infection
 Pneumonia
 Hemorrhage
 Tracheal injury
 Obstruction
 Subcutaneous emphysema
 Pneumothorax

Tracheostomy complications