Pulmonary Tuberculosis is caused by mycobacterium tuberculosis. It not only affects the lungs but also bones, joints, lymph glands and meninges of the brain
Types of infection
(a) Primary infection: which is usually symptomless but can cause enlargement of the hilar glands and pulmonary collapse in young children. within a few months of the primary infection serious forms of tuberculosis are likely to arise unless the individual’s resistance to the infection is good.
(b) Post-primary infection: at the later stage the adult type of pulmonary tuberculosis develops either from the breakdown of primary infection or buy fresh infection, there is the variable amount of disease in one or both lungs, often with cavitation.
Signs and Symptoms
(a) Onset is very gradual, first of all, there is a dry cough, lassitude with loss of appetite and sweating at night.
(b) A persistent cough (often remaining after a cold or other respiratory infection)
(c) There is a slight rise in temperature.
(d) Haemoptysis (usually slight)
(e) Progressive loss of weight
(f) Evening rise of temperature, which may be very slight, but in advance cases the hectic intermittent type of fever is often seen.
(g) Night sweats become very pronounced in the later stages.
(h) Pleurisy with effusion may set in.
(a) From the history of the patient.
(b) Clinical examination by M O
(c) Sputum examination under a microscope for the presence of acid-fast bacillus (AFB).
(d) X-ray of the chest.
(e) Montoux test (skin test).
(f) The main difficulty in diagnosing pulmonary tuberculosis in the early stage is that no symptoms may be present unless the disease is advanced. the only certain method of detection is by an x-ray examination of the chest which reveals the local focus of infection
Treatment and nursing care
(a) Specific Treatment:
Chemotherapy is the most important measure in the treatment of pulmonary tuberculosis. The drugs used area streptomycin, isoniazid (INH) ethambutol and PAS. at least two and sometimes three of these are used in combination, as the organism is very prone to become drug-resistant if the drugs are used individually. Chemotherapy is continued for about two years.
(b) Symptomatic Treatment:
- Strict bed rest is seriously ill and febrile cases.
- Cough mixture for cough
- Antipyretic for febrile patients.
- In the case of hemoptysis, the doctor should be informed at once.
(c) Surgical Treatment:
Surgical treatment in the form of thoracoplasty and lung resection is required in a few patients, especially those whose infection is due to the resistant organisms.
(d) Nursing Care:
- Building up the patient’s resistance to tuberculosis is helped generous and attractive meals, fresh airs and a cheerful atmosphere. Milk, eggs, cod liver oil and iron tonics are advisable.
- Occupational therapy and participation in social activities form part of treatment as the patient progressive.
- Explain the patient the nature of disease, hygienic precaution to prevent the spread of infection.
- If a patient with an active lesion is treated at home, the safety of the other members of the family must be considered and the following measures adopted,
(a) He must be expelled expectorate into sputum cup containing disinfectant.
(b) Sputum can then be flushed down the water closet and the container boiled in a pan kept for that purpose.
(c) The paper handkerchief should be used and promptly but.
(d) Toilet articles must be kept strictly separate from those of the rest of the family and the same applies to crockery and cutlery.
(e) Close contacts and kissing to children must be avoided.
(f) All dusting must be carried out with damp duster.
(g) protective clothing such as overall, rubber gloves, and a face mask should be worn by those who attend the patient handle sputum cups are clean his room
- Newborn infants should be immunized with the B.C.G. vaccine within 3 months.
- Other personal should be immunized if they should negative results to Mantoux skin tests.