5 Pulmonary Tuberculosis Nursing Care Plans

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Tuberculosis is an acute or chronic infection caused by Mycobacterium tuberculosis. TB is characterized by pulmonary infiltrates, formation of granulomas with caseation, fibrosis, and cavitation. People living in crowded and poorly ventilated conditions and who are immunocompromised are most likely to become infected. In the United States, incidence is higher among the homeless, drug-addicted, and impoverished populations, as well as among immigrants from or visitors to countries in which TB is endemic. In addition, persons at highest risk include those who may have been exposed to the bacillus in the past and those who are debilitated or have lowered immunity because of chronic conditions such as AIDS, cancer, advanced age, and malnutrition. When the immune system weakens, dormant TB organisms can reactivate and multiply.

When this latent infection develops into active disease, it is known as reactivation TB, which is often drug resistant. 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. It can progress from diagnosis to death in as little as 4–6 weeks. MDR tuberculosis can be primary or secondary. Primary is caused by person-to-person transmission of a drug-resistant organism; secondary is usually the result of nonadherence to therapy or inappropriate treatment.

Nursing Care Plans

Here are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for pulmonary tuberculosis:

  1. Risk for Infection
  2. Ineffective Airway Clearance
  3. Risk for Impaired Gas Exchange
  4. Imbalanced Nutrition: Less Than Body Requirements
  5. Deficient Knowledge
  6. Other Possible Nursing Care Plans
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Risk for Impaired Gas Exchange

Nursing Diagnosis

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  • Risk for Impaired Gas Exchange

Risk factors may include

  • Decrease in effective lung surface, atelectasis
  • Destruction of alveolar-capillary membrane
  • Thick, viscous secretions
  • Bronchial edema

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

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  • Report absence of/decreased dyspnea.
  • Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within acceptable ranges.
  • Be free of symptoms of respiratory distress.
Nursing InterventionsRationale
Assess for dyspnea (using 0–10 scale), tachypnea, abnormal or diminished breath sounds, increased respiratory effort, limited chest wall expansion, and fatigue.Pulmonary TB can cause a wide range of effects in the lungs, ranging from a small patch of bronchopneumonia to diffuse intense inflammation, caseous necrosis, pleural effusion, and extensive fibrosis. Respiratory effects can range from mild dyspnea to profound respiratory distress. Use of a scale to evaluate dyspnea helps clarify degree of difficulty and changes in condition.
Evaluate change in level of mentation. Note cyanosis and/or change in skin color, including mucous membranes and nail beds.Accumulation of secretions and/or airway compromise can impair oxygenation of vital organs and tissues.
Demonstrate and encourage pursed-lip breathing during exhalation, especially for patients with fibrosis or parenchymal destruction.Creates resistance against outflowing air to prevent collapse or narrowing of the airways, thereby helping distribute air throughout the lungs and relieve or reduce shortness of breath.
Promote bedrest or limit activity and assist with self-care activities as necessary.Reducing oxygen consumption and demand during periods of respiratory compromise may reduce severity of symptoms.
Monitor serial ABGs and pulse oximetry.Decreased oxygen content (PaO2) and/or saturation or increased PaCO2 indicate need for intervention or change in therapeutic regimen.
Provide supplemental oxygen as appropriate.Aids in correcting the hypoxemia that may occur secondary to decreased ventilation/diminished alveolar lung surface.
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Recommended Resources

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See Also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to respiratory system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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