Pulmonary Tuberculosis: Medications and Nursing Management

Pulmonary Tuberculosis IMCI
Over 15,000 cases of Tuberculosis (TB) are reported annually and according to WHO, an estimated 1.6 million deaths resulted from TB in 2005.

Tuberculosis (TB) is an infectious disease that is cause by Mycobacterium tuberculosis transmitted by airborne or droplet method. TB commonly affects the lung parenchyma and may also be transmitted to meninges, kidneys, bones, and lymph nodes.

First-line Antituberculosis Medication

1) Rifampin - 10mg/kg (600 mg maximum daily)
2) Isoniazid (INH) - 5mg/kg (300 mg maximum daily)
3) Pyrazinamide - 15-30mg/kg (2.0 g maximum daily)
4) Ethambutol - 15-25 mg/kg (no maximum daily dose, but base on lean body weight)
5) INH + Rifampin - 150 mg and 300 mg capsules (2 capsules daily

Multi-drug Therapy for Tuberculosis

Category I - treatment for clients who are new pulmonary cases or secondary ill clients.
a) Intensive Phase - 2 months
Rifampin
INH
Pyrazinamide
Ethambutol
b) Maintenance Phase - 4 months
INH
Rifampin
Category II - treatment for clients who are on relapse, treatment failures or returning after default
a) Intensive Phase - 3 months
Rifampin
INH
Pyrazinamide
Ethambutol
Streptomycin
b) Maintenance Phase - 5 months
Rifampin
INH
Ethambutol
Pyrazinamide
Category III
Treatment for client with (-) sputum smear, minimal PTB and Extrapulmonary
a) Intensive Phase - 2 months
Rifampin
INH
Pyrazinamide
b) Maintenance Phase - 4 months
Rifampin
INH
Category IV - treatment for clients who are chronic (positive smear) after supervised re-treatment
Refer to specialized facility or DOTS Plus Center or Provincial/City NTP Coordinator

Nursing Management for Tuberculosis

The nurse must instruct the client to increase fluid intake to promote systemic hydration and to serve as an effective expectorant.
The nurse must teach the client that tuberculosis is a communicable disease and that taking medications is the most effective means of preventing transmission.
The nurse must instruct the client to take the medication either on an empty stomach or at least 1 hour before meals because food interferes with medication absorption.
The nurse must inform the client that Rifampin may discolor contact lenses and that the client may want to wear eyeglasses during treatment.
The nurse must instruct the client about the risk of drug resistance of the medication regimen is not strictly and continuously followed.
The nurse monitors for other side effects of anti-tuberculosis medications, including hepatitis, neurologic changes and rash.
The nurse carefully monitors vital signs and observes for spikes in temperature or changes in the client's clinical status.
The nurse must plan a progressive activity schedule that focuses on increasing activity tolerance and muscle strength because clients with tuberculosis are often debilitated from prolonged chronic illness and impaired nutritional status.

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