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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.