Tuberculosis Nursing Diagnosis and Care Plan
Tuberculosis 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.
Signs and Symptoms of 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.
Cause of Tuberculosis 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-supressed, 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
Complications of Tuberculosis
- 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
Treatment for Tuberculosis
- 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 Care Plans for Tuberculosis
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%.
|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 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.
|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.|
Other possible nursing diagnoses:
• Imbalanced Nutrition Less than Body Requirements
• Impaired Gas Exchanged
• Deficient Knowledge