Tuberculosis Nursing Diagnosis and Nursing Interventions
Tuberculosis NCLEX Review and Nursing Care Plans
Tuberculosis TB is an infectious disease of the lungs that is caused by the pathogen Mycobacterium tuberculosis. The disease is highly contagious as it can be transmitted via tiny air droplets from one person to another.
There are two types of tuberculosis (TB): latent and active.
Latent TB means that the person has the bacteria inside their body, but they are in a state of inactivity, rendering the infected person to be asymptomatic.
Latent or inactive TB is believed to be non-contagious. However, it can turn into an active disease so early detection and treatment are important.
In active TB, the affected person shows the signs and symptoms typical of the infection. He/she can spread the bacteria through sneezing or coughing. The bacteria can also affect other organs of the body such as lymph nodes, kidneys, central nervous system, bones, joints, and abdominal cavity, leading to a condition called extrapulmonary tuberculosis.
- Coughing – lasting for 3 or more weeks; productive with yellow or green mucus which can also be blood-tinged
- Coughing up blood (hemoptysis)
- Chest pain, or pain with breathing or coughing
- Unintentional weight loss
- Night sweats
- Loss of appetite
Extrapulmonary tuberculosis may reveal symptoms based on the affected organ/s of the body. For instance, tuberculosis of the kidneys may manifest as hematuria, or the presence of blood in the urine. Tuberculosis of the spine may be evidenced by back pain.
Tuberculosis Causes and Risk Factors
M. tuberculosis was discovered by Dr. Robert Koch in 1882 as the causative agent for the disease. Coughing, sneezing, spitting, or even speaking at short distances may cause an infected person to release microscopic droplets into the air.
The following people who are more susceptible to the infection must be screened for latent TB, according to the Centers for Disease Control and Prevention:
- Have HIV/AIDS – they are immuno-suppressed, making it hard for their body to combat the pathogen.
- Live (or are usually in contact) with an identified TB patient
- Live or travelling in countries where TB is common (e.g. some countries in Asia, Africa, Eastern Europe, and Latin America)
- Live or work in places where TB is likely to be found (e.g. nursing homes, prisons, hospitals)
- Other immunocompromised patients (e.g. diabetes, severe kidney disease, ongoing chemotherapy)
- Smoking and substance use
- Tuberculous arthritis. The bacteria can damage the joints, particularly those located on the knees and hips.
- Spinal damage. Tuberculosis can affect the spine, as evidenced by back pain and stiffness.
- Major organ issues. Tuberculosis of the kidneys and/or liver can affect how these major organs filter waste from the blood.
- Cardiac tamponade. Rare cases of tuberculosis show that the pathogen can cause inflammation and fluid buildup, reducing the heart’s ability to pump blood as normal.
Diagnostic Tests for Tuberculosis
- Mantoux / TB skin test – PPD tuberculin is injected intradermally on the forearm, which is checked after 48 to 72 hours. If the patient has a hard and raised red bump, he/she is likely to have TB infection and needs to undergo further diagnostic tests.
- Physical exam – swelling of the lymph nodes, rales/crackles heard on the upper lobes of the lungs during auscultation
- Interferon Gamma Release Assay (IGRA) – blood test specific to TB
- Imaging – chest X-ray (shows white spots in the lungs), CT scan
- Sputum culture – helps in testing for drug-resistant TB and takes 4 – 8 weeks
- Ziehl-Neelsen – acid fast stain
- If left untreated, tuberculosis puts the infected person at a fatal risk, as well as the people around him/her at high risk of contracting the disease. Early treatment is key to treating both latent and active TB.TB drugs. Latent TB treatment usually involves one or two types of TB drugs. On the other hand, active tuberculosis needs to be treated for about 6 to 9 months and requires a combination of different medications. The most common medications to treat TB include: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. Drug-resistant TB may need fluoroquinolones, amikacin, capreomycin, linezolid, and bedaquiline, which may be used for 20 to 30 months. It is important to note that all of the TB drugs puts the patient at high risk for liver toxicity, as evidenced by jaundice, nausea and vomiting, fever of unknown cause, and loss of appetite.
- Directly observed therapy (DOT). Compliance to the prescribed TB regimen is crucial for successful treatment of tuberculosis. This is understandably hard to achieve for the patient as the treatment can be for at least half a year, and may last longer if the TB strain is drug-resistant. Therefore, health care agencies around the globe has adopted the DOT approach, which involves a health care worker administering the TB medication in order for the patient to never miss a dose.
Prevention of Tuberculosis
- Stay at home during the first few weeks of commencing treatment for active TB.
- Keep the house or workspace well-ventilated as the bacteria spread faster in tight spaces.
- Wear a facial mask and perform handwashing frequently to protect other people.
Nursing Diagnosis for Tuberculosis
Nursing Care Plan for Tuberculosis 1
Nursing Diagnosis: Ineffective Airway Clearance related to the disease process of Tuberculosis as evidenced by crackles upon auscultation, respiratory rate of 28, SpO2 level of 85%, productive cough, greenish phlegm
Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation of at least 94%.
|Tuberculosis Nursing Interventions||Rationales|
|Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of tuberculosis.|
|Suction secretions as necessary.||To help clear thick phlegm that the patient is unable to expectorate.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician||To increase the oxygen level and achieve an SpO2 value of at least 94%.|
|Administer the prescribed TB medications, bronchodilators, steroids, mucolytics, and antipyrexial medications.||TB drugs: To treat the underlying bacterial infection.|
Antipyrexial drugs: such as Paracetamol, to alleviate fever.
Bronchodilators: To dilate or relax the muscles on the airways.
Steroids: To reduce the inflammation in the lungs.
Mucolytics: To help break down mucus and facilitate its clearance from the lungs.
|Elevate the head of the bed and assist the patient to assume semi-Fowler’s position||Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Nursing Care Plan for Tuberculosis 2
Nursing Diagnosis: Risk for Spread of Infection related to disease transmission of tuberculosis
Desired outcome: The patient will have a lower risk of spreading the tuberculosis infection through the use of techniques and interventions to reduce disease transmission.
|Tuberculosis Nursing Interventions||Rationales|
|Identify members of the household or people who are in close contact with the patient. Encourage testing for tuberculosis.||To identify if anyone who has been in close contact with the patient at home, school, or work has been infected.|
|Teach the patient to cough in a tissue and throw it away immediately, as well as to perform frequent handwashing and to wear a facial mask.||To reduce the risk of spreading the tubercle bacteria.|
|Consider isolating the patient in an airborne infection isolation room during active stages of tuberculosis.||To reduce the risk of spreading the infection in the hospital wards or in the community.|
|Facilitate Directly Observed Therapy (DOT).||Facilitate Directly Observed Therapy (DOT). To ensure that the patient is compliant with the administration of TB drugs.|
Nursing Care Plan for Tuberculosis 3
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to improper food intake secondary to pulmonary tuberculosis as evidenced by significant weight loss (10%-20% less than ideal body weight), lack of appetite, change in sensation of taste, and poor muscle tone.
Desired Outcome: The patient will exhibit weight gain toward ideal body weight and not showing signs of malnutrition, with the values of his/her laboratory tests returning normal. The patient will also be supervised towards lifestyle modification to enable the positive changes in his/her weight to be maintained.
|Tuberculosis Nursing Interventions||Rationale|
|Upon admission, document the patient’s nutritional status by taking note of the elasticity of the patient’s skin, current weight and how much weight was lost, the condition of the oral mucosa, dysphagia (if any), and gastrointestinal integrity (check for history of nausea, vomiting, or diarrhea).||The degree and extent of the problem can be measured by taking note of these conditions, which will point towards the correct nursing interventions.|
|Determine what the patient’s usual diet and choice of food include.||The dietary needs and preferences of the patient will be determined, which can help in improving the management of dietary intake.|
|Monitor input and output strictly by doing an I&O chart, food chart, and daily weight chart.||The effectiveness of supportive measures on nutrition and fluid requirements may be determined through this intervention.|
|Determine gastrointestinal symptoms (nausea, vomiting, anorexia, and the frequency, volume, and consistency of the stools). Check for possible correlation to medications.||The intake and utilization of nutrients may be helped addressed by this intervention, along with perspective on possible changes to the dietary choices.|
|Encourage rest and provide comfort measures.||Rest helps conserve energy and allows the body to recover especially on the high metabolic demand of fever.|
|Promote oral hygiene before and after administration of respiratory treatments.||Oral hygiene helps in reducing the bad taste brought by the bodily secretions or medications, which in turn helps avoid the stimulation of the vomiting center.|
|Encourage the significant other/s to bring home-made foods and to share meals with the patient.||Simulating the meal time environment that the patient is used to helps in meeting his/her personal or cultural preferences.|
|Refer the patient to a dietitian.||A dietitian should be consulted regarding the possible changes in the dietary composition of the patient. The dietitian can give plans as to how the patient can maintain the progress on his/her weight gain through meals that can meet the balance of nutritional intake, while still considering the metabolic requirements, dietary preferences, and financial resources of the patient.|
|Suggest proper scheduling before or after meals (at least one to two hours) of the treatments in relation to respiratory therapy.||Some medications may have interactions with food which may be the cause of the patient’s nausea and vomiting.|
|Monitor laboratory tests indicative of a patient’s nutritional status such as BUN, serum protein, and prealbumin, albumin.||Below normal values for the results of these laboratory tests indicates malnutrition and thus should make the clinician consider a change in the therapy being followed.|
|Administer antipyretics as needed.||Fever provides a high metabolic demand for the body and hastens the patient’s calorie consumption.|
Nursing Care Plan for Tuberculosis 4
Risk for Impaired Gas Exchange
Nursing Diagnosis: Risk for Impaired Gas Exchange related to effective lung surface area reduction, damage in the membrane of alveoli and capillary, thick and viscous secretions, and edematous bronchi secondary to pulmonary tuberculosis.
As a risk nursing diagnosis, Risk for Impaired Gas Exchange is not associated with any signs and symptoms since it still has not manifested in the patient and preventive measures will be done instead.
Desired Outcome: The patient will no longer exhibit or will exhibit dyspnea at a minimum, will exhibit better ventilation and adequate oxygenation as evidenced by acceptable values of arterial blood gas or pulse oximetry, and the patient will no longer be in respiratory distress.
|Tuberculosis Nursing Interventions||Rationale|
|Assess respiratory distress by taking note of the patient’s dyspnea (using 0-10 scale), tachypnea, adventitious breath sounds, impairment in breathing and chest wall expansion, and easy fatigability.||The degree of respiratory distress may be ascertained by taking note of the signs and symptoms related to the effects of pulmonary tuberculosis to the lungs. It should also be noted that pulmonary tuberculosis causes a variety of lesions to the lungs, such as small patches of bronchopneumonia to extensive fibrosis.|
|Monitor any changes indicative of cyanosis, such as change in skin color, mucous membranes, and the nail beds. Degree of change in mentation should also be observed.||Oxygenation of vital organs and tissues may be impaired due to blockage of the airways by secretion or due to significant respiratory compromise. Change in mentation is indicative of the effect on the patient’s brain.|
|Teach the patient on how to perform pursed-lip breathing and deep breathing exercises during exhalation, especially to the patients who have fibrosis and parenchymal destruction. Allow the patient to demonstrate these breathing exercises and encourage them to be done several times per day.||Outflowing of air can be avoided, resulting in the proper distribution of air through the lungs. With pursed-lip type of breathing, shortness of breath will be relieved or minimized.|
|Encourage enough rest periods. Encourage the patient to spread out activities of daily living throughout the day and not one after another.||Resting helps the body conserve energy and oxygen consumption and also allows recovery, thus helping in reducing the severity of symptoms.|
|Routinely check for arterial blood gas and pulse oximetry.||Arterial blood gas and pulse oximetry helps give the clinician an idea as to the oxygenation of the patient. Should it be decreased, an immediate correction or change in therapy should be done.|
|Administer oxygen as an addition to the supportive measures, if necessary.||Additional supply of oxygen helps in correcting the patient’s hypoxemia caused by impaired ventilation or decreased alveolar surface area.|
Nursing Care Plan for Tuberculosis 5
Nursing Diagnosis: Deficient Knowledge related to lack of access or understanding to the information, inability to grasp the information presented, and wrong or incomplete information presented as evidenced by asking for more information, wrong understanding of the patient’s health status, non-compliance to the instructions given for follow-up and prevention, and exhibited feelings of information overload.
Desired Outcome: The patient will express thorough understanding of the disease process/prognosis and preventive and therapeutic measures against it, knows what the signs and symptoms of the disease are for prompt diagnosis and mitigation, exhibit lifestyle modifications for overall well-being and for prevention of tuberculosis recurrence or worsening, and describe plans for receipt of follow-up care.
|Tuberculosis Nursing Interventions||Rationale|
|Assess the receptiveness of the patient to new information. The fear and concerns of the patient should be eased; the best kind of media to use for the communication of information should be determined; and those who should be included in the communication of the information should also be known.||Learning is dependent on a patient’s acceptance of new information measured by his/her physical, mental, or emotional readiness. Each individual also has a different pace when it comes to learning.|
|Provide clear and specific instructions to the patient verbally and also in written form. It should indicate the schedule for medications and follow-up.||Written instruction provides ease of access and remembering to the patient in contrast to verbally communicated instruction.|
|Include the patient’s significant other/s and caregiver/s in the patient’s learning process and health education sessions.||The patient’s caretaker should help voice out the concerns and inhibitions of the patient.|
|Educate the patients on how to determine the symptoms such as hemoptysis and fever that the patient may manifest, which should be reported to the clinician.||The classical symptoms of tuberculosis are indicative of worsening or reactivation of disease or may also indicate adverse effects from the medications being taken.|
|Emphasize proper nutrition and fluid intake to the patient.||Better and faster recovery is expected through the improvement in the patient’s metabolic and fluid intake.|
|Discuss the rationale why the drug is to be taken for a prolonged period of time and the explanations for the dosage, frequency of administration, and expected action.||Better compliance from the patients will be expected should they understand the rationale behind their treatment. Directly observed therapy (DOT) should be considered if compliance is still not observed from the patient.|
|Determine and address any adverse effects of the treatment.||Increased compliance will be expected should the patient experience less side effects since they are resolved by the clinician.|
|#Emphasize abstinence from alcohol especially when isoniazid is part of the drug regimen of the patient.||Known side effect of isoniazid is hepatotoxicity, which will be exacerbated when the patient takes in alcohol.|
|Refer the patient for eye examination after explaining why it should be started when taking ethambutol and gaining the patient’s consent for referral.||Ethambutol is known to decrease visual acuity in patients, which typically manifests initially with reduced color perception.|
|Discuss any occupational hazards with the patient.||Exposure to silicone or other minerals may cause impaired respiratory function.|
|Encourage abstinence from smoking.||Smoking should be discouraged to avoid respiratory dysfunction and bronchitis associated with smoking, which may make the patient more susceptible to pulmonary tuberculosis.|
|Review and discuss transmission and hazards of reactivation of pulmonary tuberculosis.||The risk of transmission and reactivation may be reduced if the patient is aware of the mechanisms behind these.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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