Nursing Care Plan for Tuberculosis

Pathophysiology

Tuberculosis is caused by infection by an organism called Mycobacterium tuberculosis. This organism most often (85%) presents as a lung infection due to its airborne transmission. It causes granulomas to form in the alveolar sacs, which will create cavitation as immune cells surround it. If the host’s immune system cannot fight it off, the inflammation and infection will continue to spread, damaging more and more alveoli. The more damage to alveoli, the worse the patient’s oxygenation and gas exchange will be.

Etiology

Tuberculosis is spread via airborne aerosolization of particles. If the host’s immune system is strong enough to resist initial infection, the infection may lay dormant in the form of “Latent TB Infection” for years until the host’s immune system is compromised.  Countries with overcrowded populations or other crowded or closed environments (i.e. prisons, homeless shelters) carry higher risks, as well as history of HIV, diabetes mellitus, substance abuse, cancer, end stage renal disease, and smoking.

Desired Outcome

To fully eradicate the infection with antibiotic therapy and to optimize and restore proper oxygenation and gas exchange within the patient’s lungs

Tuberculosis Nursing Care Plan

Subjective Data:

  • Pt reports persistent cough
  • Pt reports weight loss
  • Anorexia
  • Chills
  • Fatigue
  • Chest Pain
  • Shortness of breath

Objective Data:

  • Night sweats
  • Cough
  • Hemoptysis
  • ↓ SpO2
  • ↓ PaO2

Nursing Interventions and Rationales

  1. Screen patient for symptoms and risk factors

  2. Screening for possible TB can help to identify patients who are at risk sooner rather than later. Containing the infection is a priority. As soon as you suspect TB Infection, place the patient in airborne isolation.

  3. Place and Read TB skin test (PPD) (Intradermal Injection)

  4. Evaluate 48-72 hours after placement for signs of redness and induration. The size of the induration determines if the test is positive:

    • Anyone > 15 mm
    • High Risk > 10 mm
    • Immunocompromised > 5 mm

  5. Collect Sputum Cultures

  6. Ensure the sample is entirely sputum, not saliva. You can use nasotracheal suction if necessary. Collaborate with your Respiratory Therapist to obtain this culture if needed.

  7. Place the patient in Airborne Isolation and adhere to these precautions strictly

  8. TB is spread via invisible airborne particles. The longer you are exposed to these particles, the more likely you are to develop a TB infection. Protect yourself and other patients.

  9. Monitor respiratory status and lung sounds

  10. Patients may report shortness of breath and have a persistent cough. Evaluate their respiratory effort and listen to their lungs. Coarse rhonchi or wheezing may indicate they need a breathing treatment like a bronchodilator.

  11. Monitor oxygenation (SpO2 and PaO2) and intervene as appropriate

  12. Because the alveoli are affected, the patient’s oxygenation and gas exchange will be affected. Monitor ABGs and SpO2 closely. If the patient cannot oxygenate and ventilate on their own, they may require mechanical ventilation or other supplemental oxygen support.

  13. Administer Anti-Tuberculosis Drugs as ordered:

    • Rifampin
    • Isoniazide
    • Pyrazinamide
    • Ethambutol
  14. RIPE therapy is the most common and most effective drug therapy against TB infections. In some cases, patients are resistant to isoniazide or have Multi-Drug Resistant TB. In these cases, other drugs may be given.

  15. Educate patient on importance of completing ENTIRE course of treatment

  16. This treatment can be 6-12 months long. Although they’ll feel better and no longer be contagious after about 3 weeks, they need to continue the full course. If they do not, they risk their TB laying dormant and resurfacing later OR they risk developing Multi-Drug Resistant TB.

  17. Educate patient to eat small, frequent meals

  18. Patients may be fatigued, short of breath, and have a loss of appetite. Eater smaller, more frequent meals may be more appealing and take less energy – but will allow them to still get the nutrition their body needs to heal.

  19. Cluster care and educate patient on clustering of activities

  20. This helps to conserve energy and minimize fatigue. This can also help provide extended rest periods if the patient is short of breath.


References

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