Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that spreads through the air and most often affects the lungs. Many people carry it as latent TB infection, which causes no symptoms and is not contagious; active TB disease causes cough, fever, night sweats, and weight loss and can spread to others. The nursing diagnoses used most often are Ineffective Airway Clearance, Inadequate Nutritional Intake, Ineffective Health Self-Management, and Risk for Loneliness. Nursing care centers on airborne precautions, sputum collection, safe multidrug therapy with directly observed doses, watching for drug toxicity, nutrition, and teaching the patient to finish every dose.
At a glance
- What it is
- An airborne bacterial infection. Latent TB infection means the bacteria are walled off and inactive; active TB disease means they are multiplying and causing illness, usually in the lungs.
- Who is at risk
- Close contacts of someone with active TB, people with HIV, diabetes, kidney failure, or cancer, people on steroids, TNF blockers, or transplant drugs, people who lived in countries where TB is common, and people who live or work in shelters, prisons, or long-term care.
- Key signs
- Cough lasting 3 weeks or longer, sputum that may contain blood, fever, night sweats, weight loss, fatigue, and chest pain.
- Nursing focus
- Airborne isolation in a negative-pressure room, fit-tested N95 respirators for staff, correct sputum collection, giving the four-drug regimen as ordered, monitoring for liver and vision toxicity, nutrition, and adherence teaching.
- Act now
- Report coughing up more than streaks of blood, worsening breathlessness or falling oxygen saturation, yellowing skin or eyes, dark urine, or a change in vision at once. Keep any suspected TB patient masked and isolated until the provider and infection prevention team say otherwise.
Pathophysiology of tuberculosis
TB spreads when a person with active pulmonary or laryngeal TB coughs, sings, or talks and releases tiny droplet nuclei that stay in the air for hours. Someone who breathes them in may carry bacteria down to the alveoli, where macrophages swallow them. M. tuberculosis survives inside these cells and multiplies slowly.
In most people the immune system walls the bacteria off inside a granuloma. The center of the granuloma breaks down into a cheese-like (caseous) material, and the infection becomes latent. A person with latent TB infection has no symptoms, a normal chest X-ray in most cases, and cannot spread TB, but the bacteria stay alive and can reactivate years later.
Active TB disease develops when the immune system cannot contain the bacteria, either soon after infection or when immunity falls later because of HIV, diabetes, malnutrition, kidney failure, cancer, or immune-suppressing drugs. Bacteria multiply, tissue is destroyed, and cavities form, most often in the upper lobes where oxygen is high. Cavities hold large numbers of bacteria, so a patient with cavitary disease and a positive sputum smear is highly infectious. TB can also spread through the blood to the lymph nodes, pleura, spine, kidneys, and meninges (extrapulmonary TB). Because the bacteria grow slowly and some become resistant to single drugs, treatment uses several drugs together for months.
Latent TB infection vs active TB disease
| Feature | Latent TB infection | Active TB disease |
|---|---|---|
| Bacteria | Alive but inactive | Active and multiplying |
| Symptoms | None; feels well | Cough, fever, night sweats, weight loss, fatigue |
| Skin test or blood test (IGRA) | Usually positive | Usually positive (can be negative in severe illness or HIV) |
| Chest X-ray | Usually normal | Usually abnormal in pulmonary TB (infiltrates, cavities) |
| Sputum smear and culture | Negative | Often positive |
| Can spread TB | No | Yes, when the lungs or larynx are involved |
| Treatment | A shorter regimen to prevent active disease | Several drugs together for months |
Nursing assessment
Subjective data
- Cough: how long it has lasted, sputum color and amount, and any blood in the sputum
- Fever, chills, night sweats, fatigue, loss of appetite, and unintentional weight loss
- Chest pain, especially pain with breathing, and shortness of breath
- Contact with anyone who has TB, and any past positive skin or blood test or past TB treatment
- Birth in or travel to a country where TB is common, and living or working in a shelter, prison, or long-term care facility
- HIV status, diabetes, kidney disease, cancer, and medicines that suppress immunity (steroids, TNF blockers, transplant drugs)
- Alcohol and drug use, liver disease, and other medicines, including birth control, methadone, and HIV medicines that interact with rifampin
- Housing, transportation, work, and who the patient lives with, since these affect adherence and contact tracing
Objective data
- Temperature, respiratory rate, oxygen saturation, and work of breathing
- Lung sounds: crackles or diminished sounds over the upper lobes, and signs of pleural effusion
- Weight, body mass index, and muscle wasting; enlarged lymph nodes in the neck
- Chest X-ray: upper-lobe infiltrates or cavities in reactivation TB
- Sputum for acid-fast bacilli (AFB) smear, culture, and a nucleic acid amplification test (NAAT), usually three specimens 8 to 24 hours apart with at least one early-morning sample
- Drug susceptibility results, HIV test, blood glucose or HbA1c, and baseline liver function tests before treatment
- Baseline visual acuity and red-green color vision before ethambutol
Nursing diagnoses used with tuberculosis
- Ineffective Airway Clearance — thick sputum, cough, and secretions from lung inflammation and cavities
- Inadequate Nutritional Intake — poor appetite, fever, and weight loss
- Ineffective Health Self-Management — a long, multidrug regimen that is hard to fit into daily life
- Risk for Loneliness — weeks of airborne isolation and stigma
- Impaired Gas Exchange — extensive disease or pleural effusion with low oxygen saturation
- Fatigue — chronic infection, fever, and poor nutrition
- Hyperthermia — fever and night sweats from active infection
- Anxiety — fear of the diagnosis, of infecting family, and of losing work or housing
Worked care plans
Four plans in the same ADPIE shape. The scenario is a 52-year-old man who has stayed in a shelter for the past year. He has had a cough for 6 weeks, night sweats, and a weight loss of about 5 kg (11 lb). He is admitted to an airborne infection isolation room. Temperature is 38.2 °C (100.8 °F), heart rate 98, respiratory rate 22, blood pressure 124/78, and oxygen saturation 94% on room air. Weight is 58 kg with a BMI of 18.9. The chest X-ray shows a cavity in the right upper lobe. His first sputum AFB smear is positive and the NAAT detects M. tuberculosis with no rifampin resistance. HIV test is negative, HbA1c is normal, and baseline liver tests are within normal limits. The provider orders rifampin, isoniazid, pyrazinamide, and ethambutol with pyridoxine, given by directly observed therapy, and the case is reported to the health department.
1. Ineffective Airway Clearance
Problem-focusedSubjective: “I cough all night and can’t get the phlegm up.” “Sometimes there’s a little blood in it.”
Objective: Frequent, weak cough with thick yellow sputum streaked with blood; coarse crackles over the right upper lobe; respiratory rate 22; oxygen saturation 94% on room air; temperature 38.2 °C.
Ineffective Airway Clearance related to excessive mucus and retained secretions from pulmonary tuberculosis, as evidenced by ineffective cough, thick sputum, adventitious breath sounds, and an increased respiratory rate.
- Patient coughs up secretions effectively into tissues and disposes of them safely
- Breath sounds improve and respiratory rate and oxygen saturation stay in the range the provider sets
- Any increase in blood in the sputum is recognized and reported at once
- Assess respiratory rate, effort, lung sounds, and oxygen saturation at the frequency your unit sets, and more often if breathing worsens
- Raise the head of the bed and teach controlled and huff coughing
- Encourage fluids unless restricted, to thin secretions
- Teach him to cover his mouth, cough into tissues, and put tissues in a closed bag in the room
- Collect sputum specimens as ordered, ideally early in the morning, with the door closed in the isolation room or a sputum booth; wear a fit-tested N95 respirator if you are in the room during coughing
- Record the amount and color of blood in the sputum and report anything more than streaks right away
- Give oxygen as ordered to the target saturation set by the provider
By day 5 he coughed up sputum with less effort, blood streaking had stopped, crackles were fewer, respiratory rate was 18, and oxygen saturation was 96% on room air. He used tissues and the closed bag every time. Goal met.
2. Inadequate Nutritional Intake
Problem-focusedSubjective: “I’m just not hungry anymore.” “My pants are falling off.” Eats about one meal a day at the shelter.
Objective: Weight 58 kg, about 5 kg lost in 6 weeks; BMI 18.9; temporal wasting; eating less than half of each meal tray; low-grade fevers and night sweats.
Inadequate Nutritional Intake related to poor appetite and the increased metabolic demands of chronic infection, as evidenced by weight loss, eating less than half of meals, and muscle wasting.
- Patient eats most of each meal and snack, with the calorie and protein goals the dietitian sets
- Weight stops falling and then rises steadily over the treatment period
- Patient names high-protein foods he can get after discharge
- Weigh him on the same scale at the same time of day on the schedule ordered, and record intake
- Refer to the dietitian for calorie and protein goals and supplements
- Offer small, frequent, high-protein meals and the foods he prefers
- Give pyridoxine (vitamin B6) as ordered with isoniazid to prevent peripheral neuropathy, which is more likely with poor nutrition
- Ask about nausea or stomach upset with the TB pills and report it; ask the pharmacist or prescriber whether the doses can be taken with food rather than skipping them
- Provide oral care before meals and treat fever as ordered, since both improve appetite
- Work with the case manager on food access after discharge
After one week he ate 75% or more of meals plus two supplements a day, and his weight was stable at 58.4 kg. He listed eggs, beans, peanut butter, and milk as foods he could get at the shelter. Goal partly met; continue weekly weights through the TB clinic.
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NCLEX Readiness Diagnostic
Fifty questions with a written rationale on every option, scored by section so you can see which content area is weakest. Sent as a PDF.
3. Ineffective Health Self-Management
Problem-focusedSubjective: “Six months of pills? I’ll take them until the cough goes away.” “I don’t have a phone, and I move around a lot.” “My pee turned orange, so I think the pills are bad for me.”
Objective: Unstable housing, no phone, no regular source of care, and four TB drugs plus pyridoxine to take. Unable to explain why treatment must continue after symptoms improve.
Ineffective Health Self-Management related to a complex treatment regimen, insufficient knowledge of the regimen, and perceived barriers (unstable housing, no phone), as evidenced by stated plans to stop medicines when symptoms improve and difficulty fitting the regimen into daily life.
- Patient explains in his own words why every dose must be taken for the whole course
- Patient names the side effects that are expected and the ones he must report
- A directly observed therapy plan and a follow-up appointment with the TB program are in place before discharge
- Ask what he already knows and believes about TB, and use plain language and an interpreter if needed
- Explain that the cough improves weeks before the bacteria are gone, and that stopping early can cause relapse and drug-resistant TB
- Explain that orange-red urine, tears, and sweat from rifampin are expected and harmless, and that it can stain soft contact lenses
- Teach him to report yellow skin or eyes, dark urine, nausea, vomiting, or belly pain, vision changes, numbness or tingling, and rash
- Give each dose by directly observed therapy, and coordinate in-person or video DOT with the health department
- Work with the case manager and TB program on housing, transport, a phone, and incentives the program offers
- Use teach-back and give written instructions at his reading level
He said, “If I stop when I feel better, the germs come back stronger.” He named the orange urine as expected and yellow eyes and vision changes as reasons to call. The TB program arranged DOT at the shelter and a clinic visit. Goal met.
4. Risk for Loneliness
RiskSubjective: “Everybody who comes in here is wearing a mask. I feel like a leper.” “My friends at the shelter won’t want me back.”
Objective: In an airborne infection isolation room with the door closed; staff and visitors wear N95 respirators; few visitors; spends long periods in bed looking at the TV.
Risk for Loneliness; risk factors: physical isolation (airborne precautions) and social isolation (stigma and limited contact with his support network).
Risk diagnosis: risk factors only, because loneliness has not been reported yet.
- Patient has daily social contact by phone, video, or visits that follow precautions
- Patient states he understands why isolation is needed and when it is expected to end
- Patient takes part in activities he chooses while isolated
- Explain that precautions protect others from the infection, not from him as a person, and that most patients come off isolation once treatment is working
- Plan care so you spend unhurried time in the room, and introduce yourself since your face is partly covered
- Help him use a phone or tablet for video calls, and teach visitors how to wear the respirator your facility provides
- Offer activities: reading material, radio, puzzles, and a chaplain or social work visit if he wishes
- Explain that he can tell the health department who his contacts are and that they will be tested confidentially
- Watch for withdrawal, low mood, or refusal of care, and report it
He talked with his sister by video every evening, met with the social worker, and said, “I get why the door stays shut. It won’t be forever.” No signs of withdrawal. Goal met.
Interventions and rationales
Key TB drugs and nursing teaching
| Drug | Watch for | Teach the patient |
|---|---|---|
| Isoniazid (INH) | Liver injury; peripheral neuropathy | Avoid alcohol; take vitamin B6 if prescribed; report numbness, tingling, yellow eyes, or dark urine |
| Rifampin | Liver injury; many drug interactions | Orange-red urine, sweat, and tears are expected; it can stain soft contacts; hormonal birth control may not work, so use a backup method; tell every provider you take it |
| Pyrazinamide | Liver injury; high uric acid and gout | Report joint pain or swelling, and liver symptoms |
| Ethambutol | Optic neuritis | Report blurred vision or trouble telling red from green at once |
Regimens, doses, and treatment length are set by the prescriber and the TB program based on drug susceptibility results, HIV status, how extensive the disease is, and how the patient responds. A common regimen for drug-susceptible pulmonary TB is these four drugs for an initial phase followed by isoniazid and rifampin; shorter regimens are used for some patients.
Client and family teaching
- TB is caught by breathing the air near someone with active TB in the lungs; it does not spread through sharing dishes, shaking hands, or touching bedding
- Take every dose, even after you feel better; stopping early can bring TB back in a form that is much harder to treat
- Your nurse or health worker will watch you take your pills (directly observed therapy), in person or by video
- Orange-red urine, sweat, and tears from rifampin are normal
- Do not drink alcohol, and check with your pharmacist before starting any new medicine, supplement, or birth control
- Call right away for yellow skin or eyes, dark urine, nausea or vomiting, belly pain, rash, vision changes, or numbness in your hands or feet
- Until your provider says you are no longer contagious, stay home from work, school, and group settings, cover your cough, and keep your home well ventilated
- Tell the health department who you live and work with so they can be tested; latent TB in contacts can be treated before it becomes active disease
- Keep every clinic visit and sputum test, and eat well to help your body heal
NurseStudyPrep.com
You’ve read the care plan. Now answer one.
A priority item in the NCLEX format. On Prep, every option gets a written rationale — including the three that are wrong.
A client with active pulmonary tuberculosis is in week 3 of treatment with rifampin, isoniazid, pyrazinamide, and ethambutol. Which finding should the nurse report to the prescriber first?
Why B. Nausea, dark urine, and jaundice point to drug-induced liver injury from isoniazid, rifampin, or pyrazinamide, which can become severe. The next dose is usually held and the prescriber notified at once. Option A is an expected, harmless effect of rifampin. Option C is common early in treatment; smears often stay positive for several weeks, and the client simply stays on airborne precautions. Option D reflects a known effect of pyrazinamide that is reported routinely but is not urgent without symptoms. Prep also explains why each wrong option looks reasonable.
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Frequently asked questions
What is the priority nursing diagnosis for tuberculosis?
Airway and breathing come first, so Ineffective Airway Clearance is often the priority in active pulmonary TB, with Impaired Gas Exchange if oxygen saturation falls. Preventing spread through airborne precautions is a top nursing priority alongside it, and Ineffective Health Self-Management is the key long-term diagnosis because treatment lasts months.
What precautions are used for tuberculosis?
Airborne precautions: a negative-pressure airborne infection isolation room with the door closed, a fit-tested N95 or higher respirator for anyone entering, and a surgical mask on the patient during transport.
Is latent TB contagious?
No. A person with latent TB infection has no symptoms and cannot spread TB. Treating latent infection lowers the chance it becomes active disease later.
When can a TB patient come off airborne isolation?
Generally when the patient is on effective treatment, is improving, and in most cases has three consecutive negative sputum smears, per CDC guidance. The provider, infection prevention team, and health department make the final decision.
Why is tuberculosis treated with several drugs?
TB bacteria grow slowly and some are naturally resistant to a single drug. Using several drugs together kills both active and slow-growing bacteria and prevents resistance from developing.
What are the main side effects of TB medicines?
Liver injury (isoniazid, rifampin, pyrazinamide), numbness and tingling (isoniazid), orange body fluids and drug interactions (rifampin), gout (pyrazinamide), and vision changes (ethambutol).
References
- Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know (7th ed.). 2021.
- Nahid, P., Dorman, S. E., Alipanah, N., et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: Treatment of drug-susceptible tuberculosis. Clinical Infectious Diseases, 2016;63(7):e147–e195.
- Carr, W., Kurbatova, E., Starks, A., et al. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis. MMWR, 2022;71(8):285–289.
- Lewinsohn, D. M., Leonard, M. K., LoBue, P. A., et al. Official ATS/IDSA/CDC clinical practice guidelines: Diagnosis of tuberculosis in adults and children. Clinical Infectious Diseases, 2017;64(2):111–115.
- Sterling, T. R., Njie, G., Zenner, D., et al. Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recommendations and Reports, 2020;69(1):1–11.
- Jensen, P. A., Lambert, L. A., Iademarco, M. F., & Ridzon, R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recommendations and Reports, 2005;54(RR-17):1–141.
- World Health Organization. Global Tuberculosis Report. 2024.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. Thieme.
- Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (13th ed.). Elsevier, 2023.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. F.A. Davis.
- Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.
- Silvestri, L. A. Saunders Comprehensive Review for the NCLEX-RN Examination. Elsevier, 2023.
Skin test cut-offs, sputum collection schedules, isolation and discontinuation criteria, respirator requirements, drug regimens, doses, treatment length, laboratory and vision monitoring schedules, and reporting rules vary by patient, by provider, by facility, and by health department. Follow the provider’s written orders, current CDC, ATS, and IDSA guidance, your TB program, and your own institution’s policies. This page supports study and does not replace course instruction or clinical judgment.
