Clinical Manifestations of Tuberculosis

Tuberculosis is often called "the great imitator" is a disease that has many similarities with other diseases are also common symptoms such as weakness and fever. In some patients the symptoms are not clear so overlooked sometimes even asymptomatic.

Clinical Manifestations of pulmonary tuberculosis can be divided into 2 groups, symptoms of respiratory and systemic symptoms:

1. Respiratory symptoms, including:

a. Cough
Most cough symptoms arise early and is a disorder that most often complained. At first is non-productive, then phlegm, even mixed with blood, when there is tissue damage.

b. Coughing up blood
Blood in the sputum varied issued, may appear in the form of lines or patches of sputum, or blood clots in the amount of fresh blood very much. Coughing up blood occurs due to rupture of blood vessels. Severity of coughing up blood depends on the size of a ruptured blood vessel.

c. Shortness of breath
These symptoms are found when the damage is extensive lung parenchyma or because there are things that accompany such as pleural effusion, pneumothorax, anemia and others.

d. Chest pain
Chest pain in pulmonary TB include pleuritic pain is mild. These symptoms occur when the neural systems in the pleural exposed.

2. Systemic symptoms, include:

a. Fever
Is a common symptom that usually occur in the afternoon and evening influenza like fever, and intermittent attacks grew longer being free period shorter attack.

b. Other systemic symptoms
Other systemic symptoms are night sweats, anorexia, weight loss and malaise.
Gradual onset of symptoms is usually within a few weeks and months, but with the appearance of acute cough, heat, shortness of breath although rare can also arise resemble symptoms of pneumonia.

We must make sure that the bleeding from the nasopharynx by way of distinguishing characteristics as follows:
1. Coughing up blood

• Coughed blood with a burning sensation in the throat.
• Frothy blood mixed with air.
• Pink fresh blood.
• Blood is alkaline.
• Anemia is sometimes the case.
• Benzidine test negative.

2. Vomiting blood

• Blood spewed by nausea.
• Blood mixed with leftovers.
• Black blood, because stomach acid mixed.
• Blood is acidic.
• Anemia often occurs.
• Benzidine test positive.

3. Epistaxis

• Blood dripped from his nose.
• Cough out slowly sometimes.
• Fresh red blood.
• Blood is alkaline.
• Anemia is rare.

2 Nursing Interventions for Shock

Shock is a life-threatening medical condition in which the body suffers from insufficient blood flow throughout the body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in body tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment because the symptoms can worsen quickly.

Medical shock is a shock is different than emotional or psychological shock that can occur after a traumatic emotional event or scary.



Etiology

1. Hypovolemic shock

• Bleeding
• Loss of fluid volume
• Displacement of fluid from the vascular to the interstitial cells

2. Cardiogenic shock

• Impaired the ability of the heart pump (cardiac arrest, arrhythmia, valve disease, myocardial degeneration, systemic infection drugs.

3. Vasogenic shock

• Decrease simpatic tone, vasodilatation, increased capillary permeability

neurogenic, or chemicals (anaphylactic), severe pain, psychological stress, neurological damage, cholinergic drugs, alpha adrenergic blocker agent.

4. Septic shock

• Cause of gram-negative organisms (P. aerogenosa, Escherichia coli, Klebseilla pneomoni, Staphylococcus, Streptococcus).
• Predisiposisi: malnutrition, large open wounds, ischemia of the gastrointestinal tract (GI), immunosuppression.
• Host interactions - toxin stimulates systemic complement activity - changes in organ microcirculation, increased capillary permeability, cell injury, increased cell metabolism.

Signs of shock :

• General state: weak.
• Perfusion: pale skin, cold, wet.
• Tachycardia.
• Peripheral vein is not visible.
• Decreased blood pressure, systolic less than 90 mmHg or a fall of more than 50 mm Hg of pressure before.
• Hyperventilation.
• Peripheral cyanosis.
• Restlessness, decreased consciousness.
• Decreased urine production.

2 Nursing Interventions for Shock

1. Fluid Volume Deficit
a. Intravenous therapy (according to type of shock):
Crystalloid (to restore the liquid electrolyte).

b. Colloid (to restore plasma volume and restore the osmotic pressure): WB, PRC, plasma.

2. Decrease Cardiac Output
Goal:

• Increase the vascular fluid.
• Support the compensatory mechanisms.
• Prevent ischemic complications.

Drug therapy:

• Improve venous return.
• Improve myocardial contraction.
• Ensure adequate myocardial perfusion:
• Vasoconstrictor agents.
• Agents that increase myocardial contraction.
• Myocardial perfusion agent adds.