What You Need to Know About Tuberculosis (TB) For The NCLEX Exam

Learning about Tuberculosis for nursing students

I have cared for a patient with a known diagnosis of TB and multiple “rule-out” cases. No matter the outcome of the diagnosis, we ALWAYS treat the case as though it were positive for TB infection. Making sure that you have a properly fitted N95 mask and wearing all appropriate PPE during the care of these patients is vital for your health and those that you may encounter after.

One slip-up of PPE while caring for a TB patient can result in a positive infection for you, other patients, or your family.

The last TB patient I cared for had been traveling to multiple countries over a span of 2 months and became ill. I remember having to give them a Yankhauer suction to hold so they could clear their abundant secretions to maintain an appropriate SPO2 level. They coughed continuously and the secretions were thick.

They eventually recovered, but continuous education about taking their medications after discharge was a key point in proper care. 

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Overview of Tuberculosis

1. Lung infection → pneumonitis and granulomas
2. Noncompliance → multi-drug resistance (MDR-TB)
3. Airborne transmission (infectious particles aerosolized)

Tuberculosis Risk Factors

a. Foreign travel
b. Living in tight quarters→ College, prison,homeless Shelters

Diagnostics for Tuberculosis

           a. Chest X-ray shows granulomas
            b. TB Skin Test
                    i. Anyone → 15 mm induration
                   ii. High Risk → 10 mm induration
                  iii. Immunocompromised → 5 mm induration
            c. Quantiferon Gold (gold standard)
            d. Sputum Cultures
             i. Mycobacterium tuberculosis

Assessment for Tuberculosis

1. Night sweats
2. Weight Loss
3. Chills
4. Fatigue
5. Persistent cough→ Hemoptysis (coughing up blood)
6. Chest Pain
7. Anorexia

Therapeutic Management for Tuberculosis

1. Negative Pressure Room
         a. RIPE Therapy:
                   i. Rifampin
                  ii. Isoniazid
                 iii. Pyrazinamide
                  iv. Ethambutol
          b. Treatment for 6-12 months → Risk of transmission reduced after 2-3 weeks of medication regimen

Interventions (ADPIE):

1. Screen the patient for symptoms and risk factors:
Containing the infection is the priority. Airborne isolation is necessary until diagnosis is confirmed and throughout hospitalization. TB is spread via invisible airborne particles. The longer you are exposed to these particles, the more likely you are to develop a TB infection. Protect yourself and other patients and always use appropriate PPE including a properly fitted N95 mask.  

2. Administer and Read TB skin test:
48-72 hours after placement evaluate for signs of redness and induration. The size of the induration determines if the test is positive. 

3. Collect Sputum Cultures:
Ensure that the sample is entirely sputum, not saliva. Use nasotracheal suction if necessary and collaborate with a Respiratory Therapist to obtain this culture if needed.

4. Monitor respiratory status, lung sounds, and oxygenation (SpO2 and PaO2): Patients often report shortness of breath and present with a persistent cough. Evaluate their respiratory effort (are they using accessory muscles? Is breathing labored?) and listen to their lungs. Coarse rhonchi or wheezing may indicate they need a breathing treatment like a bronchodilator. The alveoli are affected,  therefore, the patient’s oxygenation and gas exchange will also be affected. Monitor ABGs and SpO2 closely. If the patient cannot oxygenate and ventilate on their own, they may require mechanical ventilation or other supplemental oxygen support. 

5. Administer Anti-Tuberculosis Drugs as ordered:
RIPE therapy is the most effective drug therapy against TB infections and the most common form of treatment. Some  patients are resistant to isoniazide or have Multi-Drug Resistant TB. In these cases, other drugs may be given, always communicate with the provider about the treatment plan. 

6. Educate the patient on the importance of completing the ENTIRE course of treatment: 
This is EXTREMELY important as treatment can be 6-12 months long. Although the patient will  feel better and no longer be contagious after about 3 weeks, they need to continue the full course of treatment. If they do not, they risk their TB lying dormant and resurfacing later OR they risk developing Multi-Drug Resistant TB. 

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Happy Nursing!