Risk for Infection — Pulmonary Tuberculosis Nursing Care Plan (NCP)

NURSING DIAGNOSIS: 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

Possibly evidenced by

[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

• Identify interventions to prevent/reduce risk of spread of infection.
• Demonstrate techniques/initiate lifestyle changes to promote safe environment.

Risk for Infection — Pulmonary Tuberculosis Nursing Care Plan (NCP): Nursing Interventions & Rationale

Nursing Interventions	Rationale
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.	Helps patient realize/accept necessity of adhering to medication regimen to prevent reactivation/complication. Understanding of how the disease is passed and awareness of transmission possibilities help patient/SO take steps to prevent infection of others.
Identify others at risk, e.g., household members, close associates/friends.	Those exposed may require a course of drug therapy to prevent spread/ development of infection.
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.	Behaviors necessary to prevent spread of infection.
Review necessity of infection control measures, e.g., temporary respiratory isolation.	May help patient understand need for protecting others while acknowledging patient’s sense of isolation and social stigma associated with communicable diseases.Note: AFB can pass through standard masks; therefore, particulate respirators are required.
Monitor temperature as indicated.	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.	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.	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.	These second-line drugs may be required when infection is resistant to or intolerant of primary drugs or may be used concurrently with primary antitubercular drugs. Note: MDR-TB requires minimum of 18–24 mo therapy with at least three drugs in the regimen known to be effective against the specific infective organism and which patient has not previously taken. Treatment is often extended to 24 mo in patients with severe symptoms/HIV infection.
Encourage selection/ingestion of well-balanced meals. Provide frequent small “snacks” in place of large meals as appropriate.	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.	Adverse effects of drug therapy include hepatitis.
Notify local health department.	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.
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);                        Second-line drugs: e.g., ethionamide (Trecator-SC), para-aminosalicylate (PAS), cycloserine (Seromycin), capreomycin (Capastat).	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. Short-course chemotherapy, including INH, rifampin (for 6 mo), PZA, and ethambutol or streptomycin, is given for at least 2 mo (or until sensitivities are known or until serial sputums are clear) followed by 3 more months of therapy with INH. Ethambutol should be given if central nervous system (CNS) or disseminated disease is present or if INH resistance is suspected. Extended therapy (up to 24 mo) is indicated for reactivation cases, extrapulmonary reactivated TB, or in the presence of other medical problems, such as diabetes mellitus or silicosis. Prophylaxis with INH for 12 mo should be considered in HIV-positive patients with positive PPD test.