Prepared by supervision byNAEEMA AL-MORADI DR-RASHED AL-NAMERNAWEL AL- WEASBIASHWAQ AL-QUBATIJAWHARA AL-SIADI

-Introduction- Causes- Mode of transmission - Symptoms- Diagnosis - Types of T- Risk factors- Anti.TB drugs- Adverse reaction - Drug interaction- Nursing process

Famous AffFamous Affeected Europeanscted Europeans

-TO learn the drugs used in the treatment of tuberculosis .

-To learn the uses, general drug action, interactions, and general adverse reactions associated with the administration of the antitubercular drugs.

-To learn important preadministration and ongoing assessment activities the nurse should perform on the patient taking an antitubercular drug.

-List some nursing diagnoses particular to a patient taking an antitubercular drug.

-Explain directly observed therapy (DOT).

Tuberculosis or TB , is a bacterial infection that causes more death in the world than any other infectious disease . About 2 million people are infected with TB world wide in US about 15 million people are infected .when TB become active , it kills 60% of those who are not treated this amount to 3 million deaths world wide every

year.

Causes :TB is an infection caused by a bacterium called mycobacterium tubercle bacillus TB spreads from person to person through all as a person with active TB coughs sneezes or

expels air .

After a person becomes infected, the TB bacteria are controlled by the persons immune system.The infection become latent , or confined when the bacteria speed out of control the infection

becomes active.

Tuberculosis primarily affects the lungs, other organs may also be affected. For example, if the immune system is poor the infection can spread from the lungs to other organs

of the body.

Extrapulmonary (outside of the lungs) Tuberculosis;

is the term used to distinguish tuberculosis affecting the lungs from infection with the M. tuberculosis bacillus in other organs of the body.

Extrapulmonary sites

Transmissions of TB usually only occurs after one or more months of exposure to some one

with active TB.

*

Natural History of TB Infection

Exposure to TB

No infection (70-90%)

Infection(10-30%)

Latent TB (90%)

Active TB(10%)

Untreated

Die within 2 years Survive

Treated

Die Cured

Never develop Active disease

Symptoms:

Early symptoms:

Weight loss

Fever

Night sweat

loss of appetite

Coughing

Short of breath

Sputum <bloody<

Back pain

Diagnosis :

DIAGNOSIS;

* History and symptoms* skin test called a mantoux test .the substance called PPD is injection under the skin in the forearm and examined 28-27 hrs. if area well forms around injection site person infected with

T.B .

*Blood test known as Quantiferon TB can show if patient expose or infected with TB.

*Sputum culture to determine types of TB bacteria.

*X-ray show cavities or lesion in lung.

RISK FACTORS1 -Immune suppressed patient

) HIV-long term corticosteroids drugs(

Old age

Poverty& homeless

Health care worker

smoking

Tuberculosis responds well to long-term treatment with a combination of three or more antitubercular drugs.• Antitubercular drugs are used to treat active

cases.

• Or as a prophylactic to prevent the spread of tuberculosis.

Antitubercular drugs are classified as primary and secondery -line drugs.

Classification of drugs:

• Anti-tuberculosis drugs can be divided into two major Categories that base on their efficacies and toxicities.

Second-line drugs: Second-line drugs are used to treat extrapulmonary tuberculosis and used as alternatives to the first-line drug when drug resistance occurs or when a particular therapy is required.Drugs are less effective and more toxic.

*First-line drugs: Good effective, less toxicity and being well tolerated for patients.

F - filed defects causing drug i.e. Ethambutol

I - Isoniazid

R - Rifampin

S - streptomycin

T - Twice a day given drug

i.e. Pyrazinamide. All other drugs given once a day.

 

• S Salicylates like para -aminosalicylic or

acid-4-aminosalicylic acid• E Ethionamide• C Cycloserine• O Old drug : Thiacetazone

• N New drugs : Quinolones e.g Ciprofloxacine , levoflaxacine, moxifloxacine.

• D Drugs rarely used : Aminoglycosiders , Capreomycine

 Antitubercular drugs are used in combination with other antitubercular

drugs to treat active tuberculosis. Isoniazid (INH) is the only antitubercular

drug used alone.

primary use is in preventive therapy (prophylaxis) against tuberculosis.

Bacterial resistance develops, sometimes rapidly, with the use of antitubercular drugs.

Treatment is based on laboratory studies identifying the drugs towhich the organism is susceptibleTo slow the developmentof bacterial resistance, the Centers for Disease Control (CDC) recommends the use of three or more drugs with initial therapy, as well as in retreatment.

Using a combination of drugs slows the development ofbacterial resistance.

Tuberculosis caused by drug-resistant organisms should be considered in patients who have no response to therapy and in patients who have been treated in the past.

ADVERSE REACTIONS:

(ETHAMBUTOL)

(ISONIAZID )

(PYRAZINAMIDE)

(RIFAMPIN)

Rash

Reddish-orange discoloration of body fluids including sweat, ,sputum and saliva. urine, tears

(Streptomycin)

Drug Interactions Antituberculosis drugs sometimes change

concentrations of other drugs 

ISONIAZID-The action of the anticoagulantsmay be enhanced when taken with Ionized.-increased serum levels ofPhenytoin with concurrent use of Isoniazid.

 PYREZINAMIDE

Decreases the effects of Allopurinol,Colchicines, and Probenecid.

 

RIFAMPIN-Decrease the effects of the anticoagulant or hypoglycemic drug.-Decrease in the effect of the oral contraceptives, Chloramphenicol,Phenytoin, and Verapamil when these agents are administered concurrently with Rifampin.

N U R S I N G P R O C E S S

ASSESSMENT

Preadministration Assessment

Patient history, medication history family history and a history of contacts.

Many laboratory and diagnostic tests may be necessary before starting .antitubercular therapy

Including:

Radiographic studies

Culture and sensitivity testscomplete blood count

Ongoing Assessment1-Observes the patient daily for the appearance of adverse

reactions.

2-Especially important when a drug is known to be nephrotoxic or ototoxi.

3-Report any adverse reactions to the primary health care provider.

4-Monitors vital signs daily or as frequently as every (4 ) hours when the patient is hospitalized.

1 -Disturbed Sensory Perception : Tactile, Auditory, Visual

related to adverse reactions of antitubercular drugs

2-Risk for Impaired Skin Integrity related to adverse reactionsof the antitubercular drugs

3-Noncompliance related to indifference, lack of knowledge,other factors

4-Risk of Ineffective Therapeutic Regimen Managementrelated to indifference, lack of knowledge, long-term treatmentregimen.

Nursing PlanningNursing Planning

*Optimal response to antitubercular therapy.

*Management of common adverse reactions.

Promoting an Optimal Response to therapy

-Allows time for the patient and family members to ask questions

-Necessary to refer the patient to other health care workers, such as a social service worker or a dietitian.

-Careful to rotate the injection sites. Previous injection sites for signs of swelling, redness, and tenderness.

-Should give antitubercular drugs by the oral route.

To help prevent the problem of noncompliance, directly observed therapy (DOT) is used drugs.

The nurse watches the patient swallow each dose of the medication regime.

DOT may occur daily or two to three times weekly, depending on the patient’s health care regimen .

Ethambutol

Administers Ethambutol once every 24 hours at the same time each day

It is a good idea to give the drug with food to prevent gastric upset.

If a dose is missed should tell the patient not to double the dose the next day.

Should explain to the patient that the urine, feces, saliva, sputum, sweat, and tears may be colored reddish-orange or brownish-orange and that this is normal.

MANAGING VARIOUS TREATMENT REGIMENSMANAGING VARIOUS TREATMENT REGIMENS

Gives Isoniazid to the patient whose stomach is empty, at least 1 hour before or 2 hours after meals.

If gastrointestinal upset occurs, the patient cantake the drug with food.

Teaches the patient to minimize alcohol consumption because of the increased risk of hepatitis.

This drug is given once a day with food to prevent gastric upset.

When administered on an outpatient basis, this drug is administered using DOT

Administers Rifampin once daily to the patient with an empty stomach, at least 1 hour before or 2 hoursafter meals.

Explain to patients that their urine, feces, saliva, sputum, sweat, and tears may be colored reddish-orange and that this is normal.

Streptomycin is usually administered daily as a single IM injection.

The preferred site is the upper outer quadrant of the buttock or the mild lateral thigh.

In patients 60 years of age or older, the dosage is reduced because of the risk of increased toxicity.

Careful patient and family education and close medical supervision are necessary.

The patient and family must understand that short-term therapy is of no value in treating this disease.

•The therapeutic effect is achieved. •Adverse reactions are identified ,

reported to the primary health care provider, and managed successful.

•The patient verbalizes and understanding of treatment modalities and the importance

of continued follow-up care. •The patient and family demonstrate

understanding of the drug regimen. •The patient complies with the prescribed

drug regimen.

BCG is live attenuated strain derived from M. bovis → stimulates development of hypersensitivity to M. tuberculosis.

Within 2-4wks swelling at injection site, progresses to papule about 10mm diameter & heals in 6-12 wks.