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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Deficient Knowledge

Nursing Diagnosis

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May be related to

  • Lack of exposure to/misinterpretation of information
  • Cognitive limitations
  • Inaccurate/incomplete information presented

Possibly evidenced by

  • Request for information
  • Expressed misconceptions about health status
  • Lack of or inaccurate follow-through of instructions/behaviors
  • Expressing or exhibiting feelings of being overwhelmed

Desired Outcomes

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  • Verbalize understanding of disease process/prognosis and prevention.
  • Initiate behaviors/lifestyle changes to improve general well-being and reduce risk of reactivation of TB.
  • Identify symptoms requiring evaluation/intervention.
  • Describe a plan for receiving adequate follow-up care.
  • Verbalize understanding of therapeutic regimen and rationale for actions.
Nursing InterventionsRationale
Assess patient’s ability to learn. Note level of fear, concern, fatigue, participation level; best environment in which patient can learn; how much content; best media and language; who should be included.Learning depends on emotional and physical readiness and is achieved at an individual pace.
Provide instruction and specific written information for patient to refer to schedule for medications and follow-up sputum testing for documenting response to therapy.Written information relieves patient of the burden of having to remember large amounts of information. Repetition strengthens learning.
Encourage patient and SO to verbalize fears and concerns. Answer questions factually. Note prolonged use of denial.Provides opportunity to correct misconceptions and alleviate anxiety. Inadequate finances or prolonged denial may affect coping and managing the tasks necessary to regain health.
Identify symptoms that should be reported to healthcare provider: hemoptysis, chest pain, fever, difficulty breathing, hearing loss, vertigo.May indicate progression or reactivation of disease or side effects of medications, requiring further evaluation.
Emphasize the importance of maintaining high-protein and carbohydrate diet and adequate fluid intake.Meeting metabolic needs helps minimize fatigue and promote recovery. Fluids aid in liquefying or expectorating secretions.
Explain medication dosage, frequency of administration, expected action, and the reason for long treatment period. Review potential interactions with other drugs and substances.Enhances cooperation with therapeutic regimen and may prevent patient from discontinuing medication before cure is truly affected. Directly observed therapy (DOT) is the treatment of choice when patient is unable or unwilling to take medications as prescribed.
Review potential side effects of treatment (dryness of mouth, constipation, visual disturbances, headache, orthostatic hypertension) and problem-solve solutions.May prevent or reduce discomfort associated with therapy and enhance cooperation with regimen.
Stress need to abstain from alcohol while on INH.Combination of INH and alcohol has been linked with increased incidence of hepatitis.
Refer for eye examination after starting and then monthly while taking ethambutol.Major side effect is reduced visual acuity; initial sign may be decreased ability to perceive green.
Evaluate job-related risk factors, working in foundry or rock quarry, sandblasting.Excessive exposure to silicone dust enhances risk of silicosis, which may negatively affect respiratory function and cause bronchitis.
Encourage abstaining from smoking.Although smoking does not stimulate recurrence of TB, it does increase the likelihood of respiratory dysfunction or bronchitis.
Review how TB is transmitted (primarily by inhalation of airborne organisms, but may also spread through stools or urine if infection is present in these systems) and hazards of reactivation.Knowledge may reduce risk of transmission/reactivation. Complications associated with reactivation include cavitation, abscess formation, destructive emphysema, spontaneous pneumothorax, diffuse interstitial fibrosis, serous effusion, empyema, bronchiectasis, hemoptysis, GI ulceration, bronchopleural fistula, tuberculous laryngitis, and miliary spread.
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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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