Although many still believe it to be a problem of the past, pulmonary tuberculosis (TB) is on the rise. Most frequently seen as a pulmonary disease, TB can be extrapulmonary and affect organs and tissues other than the lungs.
Multidrug-resistant tuberculosis (MDR-TB) is also on the rise, especially in large cities, in those previously treated with antitubercular drugs, or in those who failed to follow or complete a drug regimen.
Nursing Care Plan for Pulmonary Tuberculosis (TB)
Here is a Sample of Nursing Care Plan for Pulmonary Tuberculosis.
Nursing Care Plan for Pulmonary Tuberculosis: Nursing Diagnosis
Nursing Diagnosis of Pulmonary Tuberculosis: Infection, risk for [spread/reactivation]
Risk factors may include
- Inadequate primary defenses, decreased ciliary action/stasis of secretions
- Tissue destruction/extension of infection
- Lowered resistance/suppressed inflammatory process
- Malnutrition
- Environmental exposure
- Insufficient knowledge to avoid exposure to pathogens
Nursing Care Plan for Pulmonary Tuberculosis: Nursing Intervention & Rationale
Nursing Care Plan for Pulmonary Tuberculosis: Nursing Intervention & Rationale
Nursing Interventions of Pulmonary Tuberculosis with Rationale
Infection Control (NIC)
Nursing Interventions of Pulmonary Tuberculosis with Rationale: Independent
- Review pathology of disease (active/inactive phases; dissemination of infection through bronchi to adjacent tissues or via bloodstream/lymphatic system) and potential spread of infection via airborne droplet during coughing, sneezing, spitting, talking, laughing, singing.
- Identify others at risk, e.g., household members, close associates/friends.
- Instruct patient to cough/sneeze and expectorate into tissue and to refrain from spitting. Review proper disposal of tissue and good handwashing techniques. Encourage return demonstration.
- Review necessity of infection control measures, e.g., temporary respiratory isolation. Note: AFB can pass through standard masks; therefore, particulate respirators are required.
- Monitor temperature as indicated. Rationale: Febrile reactions are indicators of continuing presence of infection.
- Identify individual risk factors for reactivation of tuberculosis, e.g., lowered resistance associated with alcoholism, malnutrition/intestinal bypass surgery; use of immunosuppression drugs/corticosteroids; presence of diabetes mellitus, cancer; postpartum. Rationale: Knowledge about these factors helps patient alter lifestyle and avoid/reduce incidence of exacerbation.
- Stress importance of uninterrupted drug therapy. Evaluate patient’s potential for cooperation. Rationale: Contagious period may last only 2–3 days after initiation of chemotherapy, but in presence of cavitation or moderately advanced disease, risk of spread of infection may continue up to 3 months. Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.
- Review importance of follow-up and periodic reculturing of sputum for the duration of therapy. Rationale: Aids in monitoring the effects of medications and patient’s response to therapy.
- Encourage selection/ingestion of well-balanced meals.
Infection Control (NIC)
Nursing Care Plan for Pulmonary Tuberculosis
Nursing Interventions of Pulmonary Tuberculosis with Rationale: Collaborative
- Administer anti-infective agents as indicated, e.g.:
- Primary drugs: isoniazid (INH), ethambutol (Myambutol), rifampin (RMP/Rifadin), rifampin with isoniazid (Rifamate), pyrazinamide (PZA), streptomycin , rifapentine (Priftin); Rationale: Initial therapy of uncomplicated pulmonary disease usually includes four drugs, e.g., four primary drugs or combination of primary and secondary drugs. INH is usually drug of choice for infected patient and those at risk for developing TB.
- Second-line drugs: e.g., ethionamide (Trecator-SC), para-aminosalicylate (PAS), cycloserine (Seromycin), capreomycin (Capastat).
Nursing Care Plan for Pulmonary Tuberculosis
Nursing Interventions of Pulmonary Tuberculosis with Rationale: Collaborative
- Monitor laboratory studies, e.g., sputum smear results; Rationale: Patient who has three consecutive negative sputum smears (takes 3–5 mo), is adhering to drug regimen, and is asymptomatic will be classified a nontransmitter.
- Liver function studies, e. g., AST/ALT. Rationale: Adverse effects of drug therapy include hepatitis.
- Notify local health department. Rationale: Helpful in identifying contacts to reduce spread of infection and is required by law. Treatment course is long and usually handled in the community with public health nurse monitoring.
Nursing Care Plan for Pulmonary Tuberculosis: Overview; Nursing Care Plan for Pulmonary Tuberculosis: Nursing Priorities & Discharge Goals; Nursing Care Plan for Pulmonary Tuberculosis: Nursing Diagnosis; Nursing Care Plan for Pulmonary Tuberculosis: Nursing Intervention with Rationale. Nursing Care Plan for Pulmonary Tuberculosis (TB).
