Tuberculosis - Complete Notes With MCQs Practice For NORCET Exams

UNITY MEDICAL ACADEMY

MEDICAL-SURGICAL NURSING

TUBERCULOSIS (TB)

Complete Nursing Notes | Clinical Concepts | NORCET Preparation

BSc Nursing GNM NORCET

1. Definition

Tuberculosis (TB) is a communicable infectious disease caused by Mycobacterium tuberculosis. It most commonly affects the lungs (pulmonary TB), but it can also involve other organs.

TB is primarily transmitted through the air.
It is a major cause of preventable illness and death worldwide.
TB can be active or latent.
Early diagnosis, appropriate treatment, and infection-control measures help prevent transmission and complications.

2. Causative Organism

Organism: Mycobacterium tuberculosis
It is a slender, rod-shaped bacillus.
It is an acid-fast bacillus (AFB) because of its waxy, mycolic-acid-rich cell wall.
It is an obligate aerobe, which helps explain its preference for oxygen-rich lung regions.
It grows slowly compared with many common bacteria.

Exam Point: The causative organism of tuberculosis is Mycobacterium tuberculosis, an acid-fast bacillus.

3. Types of Tuberculosis

A. Based on Disease Activity

Latent TB infection (LTBI): TB bacteria are present in the body, but the person has no symptoms and is not infectious. It may progress to active disease.
Active TB disease: TB bacteria are multiplying and causing illness. Pulmonary or laryngeal TB may be infectious.

B. Based on Site

Pulmonary TB: Involves the lungs.
Extrapulmonary TB: Involves sites outside the lungs, such as lymph nodes, pleura, bones, kidneys, meninges, or abdomen.
Miliary TB: Disseminated TB that spreads through the bloodstream and may affect multiple organs.

C. Based on Drug Susceptibility

Drug-susceptible TB
Drug-resistant TB, including rifampicin-resistant and multidrug-resistant TB (MDR-TB)

4. Mode of Transmission

TB spreads mainly through the air when a person with infectious pulmonary or laryngeal TB coughs, speaks, sings, or sneezes, releasing infectious particles.

Another person may inhale these particles and become infected.
Transmission risk is higher in crowded, poorly ventilated indoor spaces.
Not everyone infected with TB develops active disease.
TB is not usually spread by sharing food, utensils, clothing, or casual touching.

Infection-Control Point: Suspected infectious pulmonary TB requires prompt airborne precautions according to facility protocol.

5. Risk Factors

Close contact with a person who has infectious TB
HIV infection or other immunosuppressive conditions
Diabetes mellitus
Malnutrition and undernutrition
Smoking and harmful alcohol use
Chronic kidney disease
Immunosuppressive therapy, including certain biologic drugs or prolonged corticosteroid use
Overcrowding and poor ventilation
Silicosis
Previous untreated or inadequately treated TB infection/disease

6. Pathophysiology

Infectious TB particles are inhaled into the respiratory tract.
The bacilli reach the alveoli and are taken up by macrophages.
The bacteria may survive and multiply inside macrophages.
The immune system responds and may form granulomas containing infected cells.
In many people, the immune response controls the infection, resulting in latent TB infection.
If immune control fails, bacteria may multiply and cause active TB disease.
Progressive pulmonary disease may cause tissue destruction, caseation, and sometimes cavitation.
Bacilli may spread through lymphatic or blood routes to extrapulmonary sites.

Remember: Latent TB infection is not the same as active TB disease. Latent infection does not cause symptoms or transmit TB.

7. Clinical Manifestations

Pulmonary TB

Persistent cough, often lasting 2 weeks or longer
Cough with sputum
Hemoptysis (blood in sputum) in some cases
Chest pain
Shortness of breath in advanced disease
Fever, often low-grade
Night sweats
Unintentional weight loss
Loss of appetite
Fatigue and weakness

Extrapulmonary TB

Lymph node TB: Enlarged lymph nodes
TB meningitis: Headache, fever, altered mental status, neck stiffness
Bone/spinal TB: Persistent back pain or deformity
Renal TB: Urinary symptoms, sometimes blood in urine
Pleural TB: Pleuritic chest pain and breathlessness

Urgent Assessment: Severe breathlessness, significant hemoptysis, altered consciousness, or signs of sepsis require immediate clinical assessment.

8. Diagnostic Investigations

Investigation	Purpose / Key Point
Sputum AFB smear microscopy	Detects acid-fast bacilli; a negative smear does not rule out TB.
Rapid molecular test (NAAT, e.g., Xpert MTB/RIF)	Detects TB genetic material and may identify rifampicin resistance.
Mycobacterial culture	Confirms viable organisms and supports drug-susceptibility testing; results may take weeks.
Chest X-ray	May show infiltrates, nodules, cavities, or other abnormalities; it does not confirm TB alone.
Tuberculin Skin Test (TST/Mantoux)	Assesses immune response to TB antigens; does not distinguish latent from active TB.
Interferon-Gamma Release Assay (IGRA)	Blood test for TB infection; cannot by itself distinguish latent from active disease.
Drug-susceptibility testing	Helps guide treatment, especially when resistance is suspected or detected.

Important: A positive TST or IGRA indicates TB infection, but further assessment is needed to rule out active disease.

9. Medical Management

Treatment depends on whether TB is active or latent, drug susceptibility, disease site, patient factors, and national guidelines.

Common First-Line Anti-TB Drugs

Drug	Important Adverse Effects / Nursing Points
Isoniazid (H)	Hepatotoxicity, peripheral neuropathy. Pyridoxine (vitamin B6) may be prescribed to reduce neuropathy risk.
Rifampicin (R)	Hepatotoxicity, drug interactions; orange-red discoloration of urine, tears, and other body fluids may occur.
Pyrazinamide (Z)	Hepatotoxicity, hyperuricemia, joint pain.
Ethambutol (E)	Optic neuritis; assess visual acuity and color vision as indicated.

Drug-Susceptible TB

A common regimen for drug-susceptible pulmonary TB is an initial phase of isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a continuation phase of isoniazid and rifampicin.
The exact regimen and duration depend on current national guidelines, resistance results, disease site, and clinical circumstances.
Some eligible patients may receive shorter, guideline-approved regimens.
Drug-resistant TB requires specialist-guided treatment based on susceptibility results and current protocols.

Never self-prescribe or stop anti-TB medicines. Incomplete or irregular treatment can lead to treatment failure, relapse, and drug resistance.

10. Nursing Management

A. Assessment

Assess respiratory rate, SpO₂, temperature, pulse, and blood pressure.
Assess cough, sputum, hemoptysis, chest pain, and breathlessness.
Monitor weight, nutritional status, appetite, and fatigue.
Review prescribed investigations and medication adherence.
Assess for adverse effects of anti-TB drugs.

B. Infection Prevention

Initiate airborne precautions for suspected or confirmed infectious pulmonary/laryngeal TB as per facility policy.
Place the patient in an airborne infection isolation room when available and indicated.
Healthcare workers should use a fit-tested N95 or equivalent respirator as required by policy.
Educate the patient on cough etiquette and respiratory hygiene.
Use patient source control, such as a surgical mask during transport, according to facility protocol.
Maintain appropriate ventilation and limit unnecessary transport.

C. Medication Administration

Administer anti-TB drugs exactly as prescribed.
Reinforce adherence and explain the importance of completing treatment.
Monitor liver function and other investigations as ordered.
Ask about jaundice, dark urine, persistent nausea, abdominal pain, rash, numbness, or visual changes.
Report suspected serious adverse drug reactions promptly.

D. Nutrition and Rest

Encourage a balanced, energy- and protein-adequate diet.
Monitor weight and nutritional intake.
Plan rest periods and gradually increase activity as tolerated.
Provide emotional support and address stigma or anxiety.

E. Patient Education

Explain the disease, prescribed treatment, and follow-up plan.
Emphasize that symptoms may improve before treatment is complete.
Teach cough etiquette, ventilation, and infection-prevention measures.
Encourage contact evaluation as recommended by the TB program.
Explain how to access the treating team if doses are missed or adverse effects occur.

11. Complications of Tuberculosis

Pulmonary fibrosis and permanent lung damage
Hemoptysis
Pleural effusion
Respiratory failure in severe disease
Disseminated or miliary TB
TB meningitis
Spinal TB and neurological complications
Relapse or drug-resistant TB after inadequate treatment

12. Prevention and Control

Early identification and appropriate treatment of infectious TB.
Airborne infection-control precautions in healthcare settings.
Good ventilation and respiratory hygiene.
Screening and evaluation of close contacts according to guidelines.
Preventive treatment for eligible people with TB infection after active disease is excluded.
BCG vaccination is used in many countries to protect children against severe forms of TB; it does not guarantee prevention of all TB infection or pulmonary TB.
Community education and support to improve treatment completion.

India: Follow current National TB Elimination Programme (NTEP) guidance and local TB-unit instructions for diagnosis, treatment, notification, and follow-up.

13. High-Yield NORCET Revision

Causative organism: Mycobacterium tuberculosis
Organism type: Acid-fast bacillus (AFB)
Main route of transmission: Airborne
Common symptoms: Persistent cough, fever, night sweats, weight loss
Rapid molecular test: Xpert MTB/RIF or other NAAT
Common first-line drug combination: HRZE during the initial phase of many standard regimens
Rifampicin: Orange-red discoloration of body fluids
Isoniazid: Peripheral neuropathy; pyridoxine may be prescribed
Ethambutol: Optic neuritis; monitor vision
Priority infection precaution: Airborne precautions for infectious pulmonary/laryngeal TB
Latent TB: No symptoms and not infectious
Key nursing responsibility: Support adherence, monitor toxicity, and prevent transmission

📝 Tuberculosis – MCQ Practice Test

25 Clinical & Scenario-Based Questions | 25 Marks | 20 Minutes

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Educational Disclaimer: These notes are for nursing education and exam preparation. TB diagnosis and treatment should follow current national guidelines, drug-susceptibility results, and the treating clinician's instructions.

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