Care of patients with pulmonary tuberculosis

It is a disease of infectious nature , caused by a bacterium called Mycobacterium tuberculosis. This bacteria can be located in any part of the body but usually attacks the lungs .
Mycobacterial infection : a chronic infectious disease characterized by the formation of granuloma tissue accumulation products predominance of mononuclear cells .
Chronicity is due to the persistence of etiologic agents that have developed mechanisms that allow survival and even growth in one of the most powerful effectors cells of the

immune system defense: phagocytic cells of the monocyte – macrophage line .
TB bacteria become active if the immune system fails to prevent growth. Some people develop TB soon after infection , others later when , for various reasons , the immune system is depressed .
The difference between infection and disease

TB Infection TB
• absence of symptoms
• health status
• not transmit TB bacilli
• test usually tuberculinăPozitiv
• normal chest radiography
• negative sputum examination

• symptoms include:
– Cough for more than 2 weeks
– Chest pain
– hemoptysis
– asthenia
– Lost appetite
– fever
• transmit tuberculosis bacilli
• usually tuberculin test
positive
• radiological abnormalities
• examination of sputum positive

– Care for Lung wards or hospitals :
 similar treatment of patients with other respiratory diseases ;
 specific care of patients with TB ( pulmonary and Extrarespiratory ) ;
– Character of infectious and contagious pulmonary TB :
 isolation from the rest of the sick ;
 separate functional circuits ;
– Increased susceptibility to bacterial and fungal superinfection ;

Categories of patients with tuberculous infection :
– Depending on the location of TB infection :
 respiratory TB ;
 extrapulmonary TB : osteo- articular ganglion , meningitis, tuberculosis, digestive localizations ( intestine , liver , peritoneal ) .
– Depending on the stage of TB infection :
 suspected Disease Control ( refutation / confirmation of infection ) ;
 active pulmonary TB without direct examination BK + , V + BK active pulmonary TB on direct examination : patients with special social and psychological profile ;
 active pulmonary TB / cured with severe respiratory failure and ventilator .

Data collection
Characteristics of social and psychological profile of the patient with TB :
– Cases socially disadvantaged ;
– Deficit of social integration capacity ;
– Alcoholics with psychiatric disorders ;
– Disorders of behavior: aggression, negativism ;
Types of attitude toward illness :
– Exaggerating disease severity and symptoms : neurotic behavior ;
– Denial and minimizing the severity of disease: social and therapeutic indiscipline .
Dependence Events
2. CLINICAL MANIFESTÃRILE
– Often insidious onset ,
– But it is often acute illness with hemoptysis or aspect or pseudopneumonic
– The clinical picture is nonspecific .
General manifestations are: asthenia , anorexia , weight loss ( significant at> 10% of initial weight ) , mostly nocturnal sweating and feeling feverish with variable temperature . In women may develop amenorrhea recent unjustified .
Respiratory symptoms are usually dominated by persistent cough , cough that lasts 3 weeks requires a radiological investigation and / or bacteriological TBP . Purulent sputum is usually in small quantities , but may be absent , especially in women. Hemoptysis is relatively common, sometimes the inaugural ( and reason for medical consultation ) . Usually small ( even just hemoptoice sputum ) , but can be massive , life- threatening .
Chest physical examination is relatively poor (especially early or localized forms ) and nonspecific . Localized crackles may be present , especially after coughing, located supraclavicular , suprascapular or interscapulovertebral , in the forms of endobronchial involvement may cause wheezing or ronflante located. Rarely is currently full syndrome of dew and exceptional breath amphorae ( large cavern , located superficially) .
Note : The clinical manifestations are nonspecific and sometimes absent.
Persistent cough (> 3 weeks ) is the most important ring for pulmonary tuberculosis .
2. radiological signs
Chest radiography is the core of the diagnostic approach and a persistent cough
important element in the diagnostic approach in most respiratory diseases. It does however allow positive diagnosis of pulmonary tuberculosis ( as in many other lung diseases ), being an element of guidance rather than certainty diagnosis.
Radiological lesions may be present in pulmonary tuberculosis are numerous and very different :
– Nodules with different sizes :
• micronoduli (< 3mm ) with well-defined edges , presumed to result from hematogenous dissemination ; presence in both lung fields define disseminated miliary image features disseminated tuberculosis ;
• acinar nodules ( size 4-10 mm or larger if resulting confluence of several acini ) that is condensation of one or more acini neighbors , have relatively imprecise edge , contour relatively irregular and slightly inhomogeneous structure ( bronhiologramã air leakage ) are supposed bronchogenic dissemination of the results .
• macronodul ( > 10 mm , often a few centimeters in diameter ) , typically only well-defined , sometimes visible calcification .

– Opaque fibrous nature : the band or extended opacitãþi sometimes include an entire lobe or even hemitorace
– Complications : pneumothorax or piopneumotorax , pleurisy accompaniment .

Radiological lesions not provide certainty of diagnosis of tuberculosis . Suspicion of tuberculosis is increased following arguments:
– Preferential localization of the lesion dominant apical and posterior segments of the upper lobes
– Apical segment (upper) lower lobe ; dominant location in the lower half occurs only in 15 % of cases ;
– Combination of injuries away, or even two lobes of both lungs
– Move slowly while radiological lesions (eg . Cavitãþilor zoom in 2 weeks , multiplying and / or acinar nodules confluence , the occurrence of condensation inside a cavitãþi ) .
Three . DIAGNOSIS OF PULMONARY TUBERCULOSIS
Pulmonary tuberculosis diagnosis is based on clinical arguments , epidemiological and radiological plus the results of sputum smear microscopy for the presence of acid- resistant bacilli ( AFB ) . Was harvested at least 3 sputum samples .
Diagnosis of pulmonary tuberculosis requires at least one sample positive microscopy

Addiction problems
1.Hemoptizie
2.Risc complications
3.Tuse excruciating
4.Alterarea thermal equilibrium – Fever
May . Weight loss ,
June . Loss of appetite – anorexia
Objectives
January . Medication administration tuberculostatics
February . Adherence to treatment
Three . Relapse prevention tuberculous
Adverse 4.Prevenirea
May . Reduction in population bacillus dissemination
June . Supervision and education of patients with tuberculosis
July . Food and bed rest
August . Ensure environmental
Peculiarities of care of patients with TB infection
Ensuring environmental conditions :
Organization or hospital department phtiziology the same principles as those of sections / infectious disease hospitals :
– Separate functional circuits for the sick , food , linen, drugs
– Current and terminal disinfection rigorous;
– Existence of septic tanks ;
– Daily Cremation crematory septic material ;
– Use disposable sanitary materials ;
– Rigorous protection measures by medical personnel .
Wards optimal environment : light , thermal comfort , ventilation direct terraces
Cleaning : daily , wet or suction means followed by disinfection pavement waterproofing surfaces of walls , furniture and household items ;
Spitting : disposable metal incinerated , disinfected several times daily by superheated steam ;
Placing patients in the wards : Depending on the degree of infectiousness ;
Prolonged hospitalization : psychological comfort (both familiar facilitating integration in corporate patients and staff ) ;
Positive attitude of staff towards the patients ( psychological effect ) ;

Overall care of patients with TB :
Position patient in bed :
– Horizontal, lying down with a pillow ;
– Position semişezândă can facilitate maintenance cavitary lesions ajar ;
– Special Positions by location cavitary lung lesions :
– Upper lobes : Trendelenburg ( assumed progressive) ;
– Special position to facilitate postural drainage ;
– Lateral decubitus for associated pleural effusion .
Sleep mode :
– Adapted disease severity ;
– Immobilization in bed for hemoptysis in appropriate positions ;
– Avoid physical exertion supported .
aerotherapy :
– Direct vent in the room or on the terrace
Nutrition :
– Adapted disease severity ;
– Patients emacizaţi : high calorie diet : 3500 cal / day , women, men cal/zi- 4000 ;
– Insulin therapy in patients with associated diabetes ;
– Avoid foods that trigger hyperacidity meteoroids ;
– Intestinal TB : low intake of dietary fiber and those irritating ( fried foods , spices, fats) addition of fat-soluble vitamins , high protein diet .
Management of patients with TB
– Febrile curve ;
– Night sweats = sign of unfavorable outcome ;
– Growth rate ;
– Follow-up sputum : quantity, change physical appearance or aspect hemoptoic ;
– Referral and prompt announcement hemoptysis , sudden breathlessness , chest pangs intense ;
– Early suspicion of TB localization secondary intestinal abdominal pain , weight loss , low grade fever , nausea , chairs semiconsistente with mucus , flatulence ;
– Recognizing signs of acute respiratory failure and ventilatone ;
– Tracking of possible side effects and drug intolerance :
– Adverse reactions or side effects of corticosteroid tuberculostatics .

Specific explorations conducted in patients with TB :
– Intradermorecaţia tuberculin ;
– Proper harvesting of biological products for bacteriological examination ( sputum , pleural fluid , ascites fluid , cerebrospinal fluid , feces , gastric aspirate ) ;
– Explorations radiological and other imaging investigations ;
– Endoscopic explorations : fibrobronchoscopy , pleuroscopie ;
– Functional exploration : evidence spirometric ventilatory ;

Tuberculostatics medication administration :
– Treatment strictly supervised ( DOTS ) as prescribed schedule ( double , triple , quadruple combination ) daily or intermittent ;
– Drug Side Effects :
 renal toxicity : Streptomycin , HIN , kanamycin ;
 Hepatotoxicity : HIN , PZM , EMB , RMP ;
 ototoxic : streptomycin , kanamycin , viomicina ;
 nerve toxicity : PZM , EMB , HIN ;
 Report any unusual symptoms , new medical devices .

Health education of patients with TB :
– Awareness contagious nature , transmission of disease;
– Awareness of the nature of the disease curable by proper treatment ;
– Conduct appropriate routes of transmission interruption ;
– Avoiding autoinfecţiilor digestive side ;
– Adopt a healthy lifestyle at discharge : schedule organized life ;
– Importance abandonment of smoking and alcohol relapse prevention ;
– The importance of ambulatory regimen and regular checks to prevent relapse ;
– Prophylaxis of intra-familial transmission and disease in the workplace ;
– Understanding the need for active treatment , possibly aggressive .

note
– Mycobacterium tuberculosis , the etiological agent of tuberculosis , is an aerobic bacillus , acid- resistant ,
with relatively slow multiplication which is destroyed by ultraviolet rays .
– Transmission of TB occurs almost exclusively by air and with people.
– The source of infection is represented almost exclusively by patients with pulmonary tuberculosis , and especially those with positive sputum microscopy . Density of sources of infection , and the duration and degree of intimacy of contact they are the determinants of the risk of infection for healthy people.
– Clinical manifestations are nonspecific and sometimes absent. Persistent cough (> 3 weeks ) is the most important ring for pulmonary tuberculosis .
– It is desirable that the imposition of anti-TB treatment should be based on an argument bacteriological

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