Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Acid resistant germ stem can be a pathogenic organism or saprofit. There are several microbacterial pathogens, but only bovin and human strains of pathogenic to humans. These tubercles bacillus measuring 0.3 x 2 to 4 μm, this size is smaller than a red blood cell.
Aetiology
The cause is bacteria micro-organisms, the mycobacterium tuberculosis in length from 1 to 4 um thick and 1.3 to 0.6 um, one of those aerobic gram-positive bacteria and acid resistant or acid resistant bacilli.
Sign and symptoms
Signs and symptoms in an objective client is:
1. Circumstances that the client posture seemed lifted her shoulders.
2. The weight is usually decreased Bbadan clients; rather thin.
3. Fever, body temperature can reach 40 to 41 ° C.
4. Old stone, more than 1 month or a chronic cough.
5. Coughing that sometimes accompanied hemaptoe.
6. Shortness of breath.
7. Chest pain.
8. Malaise, (anorexia, decreased appetite, headache, muscle aches, sweating at night).
Examination Support
- Sputum culture: mycobakterium positive for the disease at the final stage.
- Ziehl Neelsen (acid fast on the use of glass for liquid blood smears) positive for acid fast bacilli.
- Skin test (Mantoux, cut vollmer); positive reaction (area of 10 mm length) occurred 48 to 72 hours after intra-dermal injection. Antigen showed past infection and the presence of anti-body but not the means indicate active disease. Significant reaction in patients who are clinically ill means that active TB can not be inherited or caused by a mycobacterium infection different.
- Elisa / Western blot: to declare the existence of HIV.
- Photo thorax; infiltrsi lesions may show earlier in the lung area, calcium deposits or lesions healed primary pleural fluid, shows more extensive changes in TB can enter the cavity of the fibrous areas.
- Histology or tissue culture (including cleaning of ulcer; urien and cerebrospinal fluid, skin biopsy) positive for mycobakterium tubrerkulosis.
- Needle biopsy of lung tissue; granules positive for TB; the giant cells showed necrosis.
- Elektrosit, can not normally depend on the location and asked infections; ex; Hyponaremia, because of abnormal water retention, obtained in large pulmonary TB. GDA can not normally depend on location, weight and the rest of the lung damage.
- Examination of lung function; decreased vital capacity, increased dead space, increased resido air ratio and total lung capacity and decrease in oxygen saturation parenkhim secondary to infiltration / fibrosis, loss of lung tissue and pleural disease (chronic pulmonary TB area).
Assessment
- Activity / rest.
Symptoms :- General fatigue and weakness.
- Short breath because of work.
- Difficulty sleeping at night or in the evening fever, and chills or sweating.
- A bad dream.
Signs :- Tachycardia, tachipnoe, / dispnoe at work.
- Muscle fatigue, pain and shortness (in the advanced stage).
- Ego Integrity
Symptoms :- The long stress factor.
- Economic problems, household.
- Feeling helpless / hopeless.
- Population culture.
Signs :- Denial. (especially during the early stages).
- Ancietas, frightened, easily offended.
- Food / liquids.
Symptoms :- Anorexia.
- Unable to digest food.
- Weight loss.
Signs :- Poor skin turgor.
- Loss of subcutaneous fat in the muscle.
- Pain / comfort
Symptoms :- Chest pain increased as recurrent cough.
Signs :- Take care of the sick area.
- Behavior distraction, anxious.
- Respiration
Symptoms :- Cough productive or unproductive.
- Short breath.
- History of tuberculosis / individuals exposed to the injection site.
Signs :- Increased frequency of breath.
- Development of respiratory not symmetrical.
- Percussion and vocal fremitus reduction, decreased breath sounds bilaterally or not unilaterally (effusi pleural / pneomothorax) tubuler breath sounds and / or a whisper above the pectoral area of the lesion, were recorded over the apex krekels diving inspiration lung rapidly after a short cough (krekels - posttusic).
- Characteristics of sputum; purulent green, yellow or mixed mukoid blood.
- Deviation trakeal (bronkogenik distribution).
- No interest, real inflammable, mental changes (advanced stage).
- Security
Symptoms :- The condition of immune suppression, for example; AIDS, cancer, HIV tests positive (+)
Signs :- A low fever or acute fever.
- Social interaction.
Symptoms :- Feelings of isolation / rejection due to infectious diseases.
- Changes in normal patterns tangguang jaawab / change the physical capacity to perform the role.
- Guidance / learning
Symptoms :- Family history of TB.
- General inability / poor health status.
- Failure to improve / recurrence of TB.
- Not participating in therapy.
Nursing Care Plan Patients Pulmonary Tuberculosis
Airway clearance is not effectively connected with a thick secretions / blood.
Destination: Jalan breath effectively.
Result Criteria :
Intervention :
Airway clearance is not effectively connected with a thick secretions / blood.
Destination: Jalan breath effectively.
Result Criteria :
- Finding a comfortable position that allows increased air exchange.
- Demonstrated effective cough.
- Stating a strategy to reduce the viscosity secretion.
Intervention :
- Explain the client about the effective use of cough and why there is accumulation of secretions in the airway.
Rational : Knowledge is expected to help develop a client adherence to the plan teraupetik. - Teach the client about the proper method of controlling cough.
Rational : Uncontrollable cough is exhausting and ineffective, causing frustration. - Breath deeply and slowly when sitting as straight as possible.
Rational : Allows greater lung expansion. - Perform diaphragmatic breathing.
Rational : Respiratory diaphragm lower frequency. breathing and increased alveolar ventilation. - Hold your breath for 3 - 5 seconds and then slowly, remove as much as possible through the mouth. Make a second breath, hold and cough from the chest by doing a short 2 and a strong cough.
Rational : Increasing the volume of air in the lung secretions facilitate secretion of expenditure. - Auscultation of lung before and after the client cough.
Rational : Review This helps evaluate the effectiveness of cough effort clients. - Teach the client action to reduce the viscosity of secretions: maintain adequate hydration; increase fluid input 1000 and 1500 cc / day if no contraindications.
Rational : Secretion is difficult to dilute thick and can cause blockage of mucus, which leads to atelectasis. - Encourage or provide good mouth care after coughing.
Rational : Hiegene good mouth increase the sense of well-being and prevent bad breath. - Collaboration with other health team: With the doctor: the provision expectoran, of antibiotics, consul-ray photo.
Rational : Expextorant to facilitate mucus and evaluation of client improvement of lung development.
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