- Tuberculosis patients may need oxygen therapy. - Ronnieb
Tuberculosis or TB is caused by bacteria and is an infectious disease. It is transmitted from person to person through the air. Though it affects the lung more often, it can affect other parts of the body. Symptoms of TB include:
- fatigue
- anorexia
- low grade fever
- night sweats
- fever and chills
- cough
- and chest pain
Nursing management of this disease involves assessing the TB patient and care planning.
Nursing Assessment of Tuberculosis Patients
A patient with tuberculosis may show certain signs and symptoms of the disease. During a nursing assessment, the nurse tries to find out the following:
- if the patient has been exposed to someone who has tuberculosis;
- if the patient has any symptoms of tuberculosis by asking questions and performing a physical exam. The nurse looks for signs of a productive cough, night sweats, temperature elevation during the day, unintentional weight loss and chest pain. The nurse also listens to the patient's lungs for abnormal breath sounds.
- If the patient is on drug therapy for tuberculosis, the nurse assesses for signs of liver abnormalities such as fatigue, joint pain, fever, tenderness in the liver area, clay colored stools, dark urine, vision changes, and loss of feeling in the hands and legs. The nurse also does this by monitoring the patient's liver function lab tests.
Nursing Diagnoses For Tuberculosis
A nursing diagnosis is a statement that describes a patient's response to his medical problem which in this case is tuberculosis. Nursing diagnoses for tuberculosis are as follows:
- risk for infection related to pulmonary TB disease
- ineffective breathing pattern related to decreased lung volumes and pulmonary infection
- ineffective therapeutic regimen related to long term treatment and lack of motivation
- imbalanced nutrition; less than body requirements related to fatigue, poor appetite, and productive cough.
Nursing Interventions for Risk for Infection
The goal of care for this nursing diagnosis is to reduce the risk of spreading tuberculosis and making sure the patient's tuberculosis is effectively treated. The following nursing activities address these goals:
- Teach the patient about the infectious nature of tuberculosis and the need to prevent its spread.
- Place the patient in a negative pressure room and in a private room.
- All nurses and visitors entering the patient's room should wear an N-95 mask.
- Put a mask on the patient during transportation to other departments.
- Keep the door to the patient's room shut and place an isolation sign at a visible location near the door.
- Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing.
- Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag.
- Teach the tuberculosis patient to stay in well ventilated areas and limit contact to other people while he or she is still able to spread the infection.
Nursing Interventions for Ineffective Breathing Pattern
Patients with tuberculosis may need to work harder to breathe due to coughing, nervousness or a high fever. Ineffective breathing pattern involves breathing at a faster or slower rate, use of accessory muscles to breathe and fast heart rates amongst other things. Nursing interventions for this problem are as follows:
- Administer oxygen if ordered and as ordered by a physician.
- Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs.
- Position the patient in a high fowlers position to reduce the work needed to breathe.
- Encourage and provide rest periods so the tuberculosis patient can have energy to breathe.
Nursing Interventions to Improve Nutritional Status of TB Patients
Proper nutrition is necessary for the body to heal and fight off infections. Nursing interventions to improve the nutritional status of TB patients includes explaining the importance of a nutritious diet, monitoring the patient's weight for improvement or maintenance, administering vitamin supplements as prescribed and providing small frequent meals.
Nursing Interventions to Improve Compliance with Tuberculosis Drug Regimen
It is important for tuberculosis patients to take their medications as prescribed. Failure to do this may result in drug resistant forms of tuberculosis. This would make the patient’s tuberculosis difficult to cure. To increase compliance with the drug regimen for tuberculosis which can be very long, the nurse does the following:
- teaches the patient about the importance of taking all prescribed medications because the bacteria that causes TB grows slowly and requires a long time to be eliminated.
- provide the TB patient with information about expected side effects of TB drugs so that they know when to seek a doctors care and when not to be alarmed.
- refer patients having a hard time sticking to their drug therapy for direct observation therapy, where someone will watch them take their medication as they should.
If all the goals of care for nursing management of tuberculosis are met, the tuberculosis patient should be free of fever and able to breathe properly, practice good infection prevention strategies, maintain his or her body weight and take all medications as prescribed.
References:
World Health Organization: Tuberculosis
"Lippincott Manual of Nursing Practice"; Sandra M. Nettina ANP-BC.; 2009.
"Nursing care Plans: Nursing Diagnosis and Intervention"; Meg Gulanick, PhD, APRN, FAAN., et. al.; 2007.
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