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pulmonary Tubercurosis - Coggle Diagram
pulmonary Tubercurosis
Pathological
It is a respiratory complication that is found in pregnant women. It is found mainly in pregnant women with HIV in the bloodstream, caused by mycobacterium tuberculosis, which is transmitted from person to person by breathing. We remove germs caused by coughing, sneezing and using the patient's voice
The incubation period is 4-12 weeks. From first exposure to positive tuberculin test, TB is classified as an acute infectious disease or a chronic infectious disease after the body has been previously infected. Most of the infection is calm in the organs. From the first spread for a long time without showing symptoms If the body has a weak immune system Will make tuberculosis easily aggravated
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Signs and symptoms
- Weakness, loss of appetite, weight gradually decreases, pale
- There may be an overabundance or fever in the afternoon. Some have had a fever for months without knowing why.
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- There is a cough in the early stages There will be a dry cough. Then there is phlegm Looks like a mucus with pus (mucopurulent), then coughing heavily when going to bed or waking up in the morning or after meals And the cough usually persists for more than 3 weeks, but some people do not have a cough at all.
- The patient may feel fullness or chest pain without coughing.
- In a very large case May have asthma symptoms Or a black or red blood clot, coughing up blood (hemoptysis)
- In some cases, there may not be any symptoms. And is often detected accidentally by seeing a spot in the lungs on an X-ray photo.
Diagnosis
- History taking of signs and symptoms
- tuberculin skin test is a test that the body is immune to tuberculosis. If the test result is positive Showing that there is an infection in the body But it cannot be classified as being infected with a disease in the sedative stage or being sick with tuberculosis
- X-ray of the lungs This is the detection of lesions in the lungs. It is necessary to be aware of the effects of radiation on the fetus. Therefore, it is necessary to use a lead shield (abdominal shield) and should be examined after the first trimester.
- Sputum testing for tuberculosis It is a test to confirm the diagnosis, there are 3 methods.
4.1 Staining test for tuberculosis (acid fast bacilli standing) This test is specific to tuberculosis. But has low sensitivity The sputum must be collected for 3 consecutive days and takes a short hour.
4.2 culture for mycobacterium tuberculosis is sensitive and specific. But it takes about 2 months to grow the infection. Used to test in patients with recurrence Patients with an irregular history of treatment
4.3 Detection of genetic material in which tuberculosis (PCR or polymerase chin reaction) is highly sensitive and specific. But the cost is very high It is used in diagnosis rather than monitoring treatment. It takes 1-2 days for the examination.
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Treatment
From drug safety data Therefore, it was concluded that the 6-month standard short-term regimen (2HRZE / 4HR) should be chosen because it is a very effective formulation in the treatment of tuberculosis.
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However, in the first trimester of pregnancy where the mother may experience pregnancy nausea and vomiting, they may consider avoiding pyrainamide using the 9-month regimen (2HRE / 7HR), which is also very effective in the Cure tuberculosis
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How to take the drug should be taken every dose once a day on an empty stomach, before bedtime or 30 minutes before breakfast. So that the drug can be absorbed well into the body And give the best treatment results
Nursing Care
Antepartum
- Strictly focus on how to take medication according to the doctor's treatment plan, do not stop the medication itself, 2. Recommend eating foods rich in protein, focus on fish, milk, eggs, add foods rich in vitamins and iron, fruits, 3. Recommend rest. Enough for 6-8 hours a night, 1 hour a day to reduce energy consumption, 4. Abstain from drugs such as alcohol, cigarettes will make the symptoms of the disease worsen, 5. Do not use personal items (handkerchiefs, towels) with others. , 6. It is recommended to sputum sputum into a container with a closed lid. Or with Lysol disinfectant and then be destroyed by pouring into the toilet or digging a bury
- Recommend family members to have a health check to look for risks, 8. Suggest a way to count fetal flexion. Usually, each day the fetus struggles at least 10 times in 12 hours, indicating the health condition of the fetus, 9. Emphasize the doctor's appointment. To assess the growth of the fetus And assess the health of the fetus as well
Intrapartum
- Take care of the maternity rest as much as possible, 2. Care for the maternity to receive water and medication according to the doctor's treatment plan, 3. If the birth is given sedative and analgesic Take care of the cough reflex in the birth. This reaction is reduced. The maternity is unable to cough to drain phlegm, 4. periodically listen to the fetal heart sounds,
- periodically assess the progress of labor. If the birth has progressed well As the water moved downward well The doctor will deliver the birth by forceps extaction to help deliver the birth to avoid the force of force in the second stage and will not have an abdominal caesarean if there is no obstetric indication, 6. After placenta birth Take care of the uterus to contract and tighten. Prevent bleeding
Postpartum
- After birth, the baby should be separated from the mother. Until the maternal sputum culture was negative, in practice, the result was very slow. But the principle is that after 2 weeks of treatment, the infection is likely not already established. Therefore, 2 weeks of separation of the infant from the mother is sufficient, 2. In the event that the infant cannot be separated from the mother, Recommend mothers not to cough, sneeze or breathe in the face of the baby. Should always wear a mask to prevent transmission to infants, 3. Mothers can expose their babies with breast milk. If the culture results were negative because the amount of TB drugs passed through the milk was very small. And this drug does not harm the baby, 4. Take care of the mother after birth, as well as the mother after birth. Eating
- family planning Contraception is recommended to leave the child at least 2 years for the body to return to its original state as much as possible. In the case of having enough children Sterilization is recommended.6. Advise relatives or people with symptoms that show a risk of TB to approach or hold or speak to the baby. To prevent transmission to infants, 7. All newborns should have tuberculin skin test at birth and isoniazid immediately after birth for 3 months to prevent maternal infection and repeat tuberculin skin test. Again, at 3 months of age, if effective is less than 5 mm, isoniazid can be discontinued. BCG vaccination can be administered in a tuberculin skin test greater than 5 mm indicating tuberculosis infection. Until 6-9 months and no need for BCG vaccination, 8. BCG vaccine that newborn babies receive is useful in preventing invasive tuberculosis. And cortical tuberculosis But does not prevent tuberculosis in adults
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