Presented by: Cindy Denti P

(115070207113038)

• Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis (TB). Although it can affect almost every organ system, but TB bacteria is more common in lung organ (80-85%) (Depkes, 2008).

• Pulmonary tuberculosis with sputum examination indicates the BTA (Basil Resistant Acid) positive, categorized as infectious pulmonary tuberculosis (Depkes, 2005).

• The cause of this disease is Mycobacterium tuberculosis complex. Mycobacteria included in the family mycobacteriaceae and included in the order Actinomycetales.

• This bacterium is a bacterium bacillus is very strong so it takes a long time to treat. These bacteria often infects the lungs (90%) compared to other parts of the human body (Masrin, 2008).

a. Pulmonary tuberculosis tuberculosis that attacks the lung tissue, not including the pleura (the lining of the lung)

b. Body Extra Pulmonary Tuberculosis Tuberculosis that attacks the body's organs other than the lung tissue, such as the pleura (pleura), the lining of the brain, pericardium, lymph nodes, bones, joints, skin, intestine, kidney, urinary tract, genitals and others. Based on the severity, Extra Pulmonary Tuberculosis divided into 2, namely:

1) Extra Pulmonary Tuberculosis Lightweight For example: Tuberculosis of lymph nodes, exudative pleurisy, unilateral, bone (except spine), joints and glands adrenal.

2) Extra Pulmonary Tuberculosis Weight For example: meningitis, miliary, pericarditis, peritonitis, pleurisy exudative duplex, spinal tuberculosis, Tuberculosis intestine, urinary tract Tuberculosis and genitals.

• Sources of infection are patients with smear-positive pulmonary TB especially at a time singing, coughing or sneezing, in which the patient spread germs into the air in the form of a spark sputum (droplet nuclei).

The primary stage of the disease may be symptom-free, or the individual may experience a flu-like illness.This is called the “inactive stage.”

Fever

Hemaptoe

Chest pain

Night sweats

Weak ccurred in the weekly and monthly

This is an example of tuberculosis symptoms. Hemaptoe and the use of a respirator muscle

• Mycobacterium Tuberculosis enter the body through breathing then tubercle bacilli that reach the alveolar surface causes an inflammatory reaction, the body tries to react by phagocytosing polymorphonuclear leukocytes kill bacteria but not the organism so to attack the alveoli.

• The alveoli are attacked will consolidate the onset of symptoms of acute pneumonia and continued in the phagocytes and bacteria growing in the cells so that there is no heal by itself but which spreads through the lymph toward the regional lymph nodes that causes tuberculosis.

Tuberculin skin test. Mantoux test : a skin test to determine whether an individual has been infected with TB bacilli

Assessment of medical history

X-ray chest lesi the upper lobe

Wipe BTA Is there mikobacterium

Sputum smear morning to culture (when, in the morning, when)

0-4 mm: not considered significant > 5mm: may be significant > 10 mm: significant Significant (positive): M. tuberculosis exposed lately, or past BCG (bacilli Calmette-Guerin), there is not always active disease in the body. Not significant: by no means free of TB infection (immunosuppressed) retest 1 to 2 weeks

TREATMENT• Pulmonary tuberculosis treated primarily with chemotherapy agents

(anti-tuberculosis agent) for a period of 6 to 12 months.

• Five front-line medications used are Isoniasid (INH), rifampicin (RIF), streptomycin (SM), Ethambutol (EMB), and Pyrazinamide (PZA). Kapremiosin, kanamycin, ethionamide, para-aminosilat sodium, amikacin, and siklisin is a drug - a second line drug (Smeltzer & Bare, 2001).

Types, Traits, and Doses of Tuberculosis (Depkes,

2008)Type Anti-Tuberculosis Agent

Traits Dose (mg/kg)day

Dose (mg/kg)3 x week

Isoniasid ( H ) Bakterisid 5(4-6 )

10( 8-12 )

Rifampicin (RIF) Bakterisid 10( 8 -12 )

10( 8- 12 )

Pyrazinamid ( Z ) Bakterisid 25( 20-30 )

35( 30-40 )

Steptomycin ( S ) Bakterisid 15( 12-18 )

-

Etambutol ( E ) Bakteriostatik 15( 15-20 )

30( 20-35 )

Administrative control

• Reducing exposure to M. tuberculosis early detection

• Isolation of patients

• Appropriate treatment

• Outreach to the community about TB

• Proper sputum collection (in the open space that not many people)

Environmental control • Reducing airborne droplet nuclei

Maximize the amount of natural ventilation room• Exposing the mattress every week Personal respiratory protection • Prevent inhalation of droplet nuclei • Using masks • Cough ethical

WHO (1999) Guidelines for prevention of tuberculosis in health care facilities, in resource-limited settings

Smeltzer & Bare (2004) Buku Ajar keperawatan Medikal Bedah Brunner Suddarth. Jakarta: EGC

Departemen Kesehatan RI (2008) Pedoman Nasional Penanggulangan Tuberkulosis

Knechel, NA (2009) Tuberculosis: Pathophysiology, Clinical Features, and Diagnosis. Crit Care Nurse, 29:34-43.

WHO (2014) Tuberculosis

• The immune system is responsible for fighting infections that invade the body. Effort to attack these infections can weaken the immune system, and cause the CD4 count decreases, although usually after recovery, CD4 rise again. But when an HIV-infected immune system must fight other infections, HIV attacks against reduced. So if the infection becomes active TB in people with HIV, their CD4 counts can be decreased dramatically.

• Correct use of medication in accordance with the schedule (adherence) is crucial to avoid the emergence of resistant strains of TB. In order to assure compliance, especially in the advanced phase after we feel healed, the WHO strategy-S DOT (Directly Observed Therapy Short-course or treatment with direct supervision). Supervision is carried out by a treatment or PMO, which is tasked to assist the patient in treatment until complete. PMO can be family members or health care workers who are easily affordable by TB patients. The purpose of DOT-S are:

Achieving high cure rate ✔

Prevent breaking treatment ✔

Overcoming side effects of OAT ✔

Preventing the emergence of resistance due to non-compliance...✔

• Five key element in the DOTS strategy are:

(1) Commitment;

(2) Diagnosis is right and good;

(3) Availability and smooth distribution of drugs; (4) Monitoring of patients taking the medication; (5) The recording and reporting of patients with a cohort system (WHO, 2006).