Nursing Care Plan (NCP) for Tuberculosis
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Outline
Lesson Objectives for Tuberculosis (TB)
- Understanding Tuberculosis:
- Define tuberculosis as an infectious disease caused by Mycobacterium tuberculosis, affecting primarily the lungs but potentially other organs, and understand its transmission and risk factors.
- Epidemiology and Global Impact:
- Explore the epidemiology of tuberculosis, including its prevalence, distribution, and the global impact of the disease on public health.
- Clinical Manifestations and Diagnosis:
- Recognize the clinical manifestations of tuberculosis, such as cough, hemoptysis, weight loss, and night sweats, and understand the diagnostic methods, including tuberculin skin testing and chest X-rays.
- Treatment and Medication Adherence:
- Understand the principles of tuberculosis treatment, including the use of antimicrobial medications such as isoniazid and rifampin, and the importance of medication adherence to prevent drug resistance.
- Infection Control and Prevention:
- Learn infection control measures to prevent the spread of tuberculosis, including the use of respiratory precautions, contact tracing, and vaccination strategies.
Pathophysiology of Tuberculosis (TB)
- Mycobacterium tuberculosis Infection:
- Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs but can also involve other organs.
- Granuloma Formation:
- The body’s immune response to M. tuberculosis involves the formation of granulomas, which are collections of immune cells, mainly macrophages, attempting to contain the infection.
- Caseous Necrosis:
- Within the granulomas, caseous necrosis occurs, resulting in a cheese-like, necrotic center. This contributes to the characteristic appearance of tuberculosis lesions.
- Spread via Airborne Transmission:
- Tuberculosis is primarily spread through airborne transmission. When an infected person with active TB coughs or sneezes, respiratory droplets containing M. tuberculosis can be inhaled by others.
- Latent and Active TB:
- Individuals may have latent tuberculosis infection (LTBI), where the bacteria are present but not causing symptoms. In some cases, the infection can become active, leading to the development of clinical symptoms and the potential for transmission.
Etiology of Tuberculosis
- Mycobacterium tuberculosis:
- The primary etiological agent is the bacterium Mycobacterium tuberculosis, which is an acid-fast, slow-growing bacterium.
*Note*
- Airborne Transmission:
- Tuberculosis is transmitted through the air when an infected person with active pulmonary TB coughs or sneezes, releasing respiratory droplets containing the bacteria.
- Close Contact with Infected Individuals:
- Close and prolonged contact with individuals who have active tuberculosis increases the risk of transmission.
- Immunocompromised Individuals:
- Immunocompromised individuals, such as those with HIV/AIDS or on immunosuppressive medications, are at higher risk of developing active tuberculosis.
- Overcrowded and Unsanitary Conditions:
- Living in overcrowded or unsanitary conditions, especially in congregate settings, increases the risk of exposure to and transmission of tuberculosis.
Desired Outcome for Tuberculosis (TB)
- Effective Treatment Response:
- Achieve a successful response to anti-tuberculosis treatment, evidenced by clinical improvement, negative sputum cultures, and resolution of symptoms.
- Prevention of Disease Transmission:
- Prevent the transmission of tuberculosis to others through adherence to infection control measures and completion of the prescribed treatment regimen.
- Adherence to Medication:
- Ensure the patient’s adherence to the prescribed medication regimen to prevent the development of drug-resistant strains of Mycobacterium tuberculosis.
- Improved Respiratory Function:
- Attain improved respiratory function, as evidenced by the resolution of cough, hemoptysis, and normalization of breath sounds on auscultation.
- Enhanced Knowledge and Self-Care:
- Increase the patient’s knowledge about tuberculosis, its transmission, and the importance of medication adherence for effective self-care and prevention.
Tuberculosis Nursing Care Plan
Subjective Data:
- Patient reports persistent cough
- Patient reports weight loss
- Anorexia
- Chills
- Fatigue
- Chest pain
- Shortness of breath
Objective Data:
- Night sweats
- Cough
- Hemoptysis
- ↓ SpO2
- ↓ PaO2
Nursing Assessment for Tuberculosis (TB)
- Health History:
- Obtain a comprehensive health history, with a focus on respiratory symptoms, previous tuberculosis exposure or treatment, and risk factors such as HIV infection or immunosuppression.
- Respiratory Assessment:
- Perform a thorough respiratory assessment, including auscultation of breath sounds, assessment of cough characteristics, and documentation of any hemoptysis.
- Physical Examination:
- Conduct a complete physical examination, with attention to signs such as weight loss, night sweats, and lymphadenopathy.
- Tuberculin Skin Test (TST) or Interferon-Gamma Release Assay (IGRA):
- Administer and interpret a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to assess for latent tuberculosis infection.
- Sputum Analysis:
- Collect sputum samples for acid-fast bacilli (AFB) smear microscopy and culture to confirm the diagnosis and assess the infectiousness of the patient.
- Psychosocial Assessment:
- Perform a psychosocial assessment, considering factors such as housing stability, social support, and mental health, as these can impact treatment adherence.
- Educational Needs:
- Assess the patient’s educational needs regarding tuberculosis, treatment expectations, potential side effects of medications, and the importance of completing the full course of treatment.
- Infection Control Assessment:
- Evaluate the patient’s understanding and adherence to infection control measures, including respiratory hygiene, ventilation, and minimizing contact with vulnerable individuals.
Implementation for Tuberculosis (TB)
- Medication Administration:
- Administer anti-tuberculosis medications as prescribed, ensuring adherence to the prescribed regimen to prevent the development of drug-resistant strains.
- Patient Education:
- Provide comprehensive education to the patient regarding tuberculosis, including transmission, importance of medication adherence, potential side effects, and the duration of treatment.
- Adherence Support:
- Establish a supportive environment to enhance medication adherence, addressing any barriers or concerns the patient may have. Consider the use of directly observed therapy (DOT) if necessary.
- Infection Control Measures:
- Implement and reinforce infection control measures, including respiratory hygiene, proper ventilation, and educating the patient on minimizing close contact with others, especially vulnerable populations.
- Collaboration with Public Health:
- Collaborate with public health authorities to facilitate contact tracing, monitoring, and support for individuals exposed to tuberculosis, contributing to community health.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Screen patient for symptoms and risk factors | 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. |
| Place and Read TB skin test (PPD) (Intradermal Injection) | 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 |
| Collect Sputum Cultures | 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. |
| Place the patient in Airborne Isolation and adhere to these precautions strictly | 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. |
| Monitor respiratory status and lung sounds | 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. |
| Monitor oxygenation (SpO2 and PaO2) and intervene as appropriate | 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. |
| Administer Anti-Tuberculosis Drugs as ordered:
Rifampin Isoniazid Pyrazinamide Ethambutol |
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. |
| Educate the patient on the importance of completing the ENTIRE course of treatment | 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 lying dormant and resurfacing later OR they risk developing Multi-Drug Resistant TB. |
Evaluation for Tuberculosis (TB)
- Treatment Response:
- Assess the patient’s response to treatment by monitoring clinical improvement, resolution of symptoms, and consecutive negative sputum cultures.
- Medication Adherence:
- Evaluate the patient’s adherence to the prescribed medication regimen through self-reporting, pill counts, or directly observed therapy (DOT) as applicable.
- Prevention of Transmission:
- Monitor the effectiveness of infection control measures in preventing the transmission of tuberculosis to others, both within healthcare settings and the community.
- Educational Effectiveness:
- Evaluate the effectiveness of patient education by assessing the patient’s understanding of tuberculosis, treatment plan, and the importance of adherence.
- Psychosocial Well-being:
- Assess the patient’s psychosocial well-being, including mental health, social support, and coping mechanisms, as these factors can influence treatment adherence and outcomes.
References
- https://my.clevelandclinic.org/health/diseases/11301-tuberculosis
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/tuberculosis-tb
- https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
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Transcript
Hi everyone. Today, we’re going to be creating a nursing care plan for tuberculosis. So, let’s get started. First, we’re going to go over the pathophysiology. So, tuberculosis is caused by an infection by an organism called mycobacterium tuberculosis. It causes granulomas that form in the alveoli sacs that cause an immune response in the cells surrounded. If the host’s immune system cannot fight off the inflammation, the infection will spread damaging more and more alveoli, and the worse the patient’s oxygenation and gas exchange will be. Nursing considerations: TB screening, airborne precautions, sputum culture, respiratory assessment, TB skin testing, administering medications, and educating the patient on the treatment plan. 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.
So, we’re going to go ahead and get started on our care plan, writing out some subjective data and some objective data. So, what are we going to see in the patient with TB? Some subjective data you’re going to see that they’re going to have a persistent cough. They may all also have some shortness of breath and complain of some fatigue. Some of the objective data that we’re going to see in these patients are night sweats, decrease in SpO2, decrease PaO2. So, a patient may also report some weight loss, anorexia, chills, shortness of breath, and chest pain. So, some interventions: we want to make sure we’re screening the patient for symptoms and risk factors of TB. So, risk factors. So, 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 a TB infection, make sure you’re placing the patient in airborne isolation. The longer you are exposed to these particles, the more likely you are to develop a TB infection. So, to protect yourself and other patients, use proper PPE. Another intervention is we’re going to place, and we’re going to read TB skin test. So PPD is an intradermal injection; they evaluate these 48 to 72 hours after placement for signs of any sort of redness and the size of the induration determines if the test is positive. So, anyone above 15 millimeters, and above10 millimeters for high risk, and above five millimeters for the immunocompromised. Another intervention we’re going to do, we’re going to collect a sputum culture. So, we’re going to ensure the sample is entirely sputum. Not saliva is important. Okay? Sputum not saliva. You can use nasal tracheal suction, if necessary, or you can collaborate with your respiratory therapist to obtain the culture. Another intervention we’re going to do, we’re going to monitor their respiratory status. So, we’re going to be listening to their lung sounds. We’re going to look at their O2 sats, and the patients may report shortness of breath. You might hear some crackles or wheezing that may indicate that they need some breathing treatments like a bronchodilator, because the alveoli are affected. The patient’s oxygenation and gas exchange will be affected. So, you want to monitor their ABGs and their SpO2 closely. If the patient cannot oxygenate and ventilate on their own, they may require some mechanical ventilation or other supplemental oxygen support. Another intervention that we’re going to be doing is we’re going to be administering antitubercular drugs as ordered. And it goes with the acronym RIPE. So that is going to be rifampin, isoniazid, pyrazinamide, and ethambutol. So, this therapy is the most common and the most effective drug therapy against TB infections. In some cases, patients are resistant or have multiple or multi drug resistant TB. In these cases. Other drugs may be given. Lastly, we want to educate the patient on the importance of completing the entire course of this treatment. So, you want to make sure they’re completing the course treatment – 6 to 12 months. So, although they’ll feel better, and they no longer are contagious. After about three weeks, they need to continue taking the full course. If they don’t, they will be at risk for the TB lying dormant and resurfacing later on, or they’ll risk developing multi-drug resistant TB.
All right, so we’re going to go over some key points. So, TB is caused by the organism called mycobacterium Tuberculosis, which causes granulomas to form in the alveoli sacs, which creates capitation as immune cells surround it. Some subjective objective data you’re going to see with these patients: they’re going to have a persistent cough, anorexia, chills, shortness of breath, night sweats, decreased SpO2, and decreased PaO2. We’re going to do a TB test, culture, and assessment screen for possible TB. Make sure you’re initiating airborne precautions, place and read TB tests, collect sputum cultures, and assess respiratory function and their O2 sats. You’re going to be giving medication and you’re going to make sure you’re educating the patient on the meds and educate the importance of making sure they’re taking the entire course of treatment. And that is the end of this care plan.
You guys did awesome. We love you guys. Go out, be your best self today and as always happy nursing.
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