Nursing Care Plan (NCP) for Tuberculosis

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Outline

Pathophysiology

Tuberculosis is caused by infection by an organism called Mycobacterium tuberculosis. It causes granulomas to form in the alveolar sacs, which will create cavitation as immune cells surround it. If the host’s immune system cannot fight it off, the inflammation and infection will continue to spread, damaging more and more alveoli. The more damage to alveoli, the worse the patient’s oxygenation and gas exchange will be.

Etiology

Tuberculosis is spread via airborne aerosolization of particles. If the host’s immune system is strong enough to resist initial infection, the infection may lay dormant in the form of “Latent TB Infection” for years until the host’s immune system is compromised.  Countries with overcrowded populations or other crowded or closed environments (i.e., prisons, homeless shelters) carry higher risks, as well as a history of HIV, diabetes mellitus, substance abuse, cancer, end-stage renal disease, and smoking.

Desired Outcome

To fully eradicate the infection with antibiotic therapy and to optimize and restore proper oxygenation and gas exchange within the patient’s lungs.

Tuberculosis Nursing Care Plan

Subjective Data:

  • Patient reports persistent cough
  • Patient reports weight loss
  • Anorexia
  • Chills
  • Fatigue
  • Chest pain
  • Shortness of breath

Objective Data:

  • Night sweats
  • Cough
  • Hemoptysis
  • ↓ SpO2
  • ↓ PaO2

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Screen patient for symptoms and risk factors Screening for possible TB can help to identify patients who are at risk sooner rather than later. Containing the infection is a priority. As soon as you suspect TB Infection, place the patient in airborne isolation. 
Place and Read TB skin test (PPD) (Intradermal Injection) Evaluate 48-72 hours after placement for signs of redness and induration. The size of the induration determines if the test is positive:

Anyone > 15 mm

High Risk > 10 mm

Immunocompromised > 5 mm

Collect Sputum Cultures Ensure the sample is entirely sputum, not saliva. You can use nasotracheal suction if necessary. Collaborate with your Respiratory Therapist to obtain this culture if needed. 
Place the patient in Airborne Isolation and adhere to these precautions strictly 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. 
Monitor respiratory status and lung sounds Patients may report shortness of breath and have a persistent cough. Evaluate their respiratory effort and listen to their lungs. Coarse rhonchi or wheezing may indicate they need a breathing treatment like a bronchodilator.
Monitor oxygenation (SpO2 and PaO2) and intervene as appropriate Because the alveoli are affected, the patient’s oxygenation and gas exchange will 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.
Administer Anti-Tuberculosis Drugs as ordered:

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

RIPE therapy is the most common and most effective drug therapy against TB infections. In some cases, patients are resistant to isoniazide or have Multi-Drug Resistant TB. In these cases, other drugs may be given. 
Educate the patient on the importance of completing the ENTIRE course of treatment This treatment can be 6-12 months long. Although they’ll feel better and no longer be contagious after about 3 weeks, they need to continue the full course. If they do not, they risk their TB lying dormant and resurfacing later OR they risk developing Multi-Drug Resistant TB. 

Writing a Nursing Care Plan (NCP) for Tuberculosis

A Nursing Care Plan (NCP) for Tuberculosis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hi everyone. Today, we’re going to be creating a nursing care plan for tuberculosis. So, let’s get started. First, we’re going to go over the pathophysiology. So, tuberculosis is caused by an infection by an organism called mycobacterium tuberculosis. It causes granulomas that form in the alveoli sacs that cause an immune response in the cells surrounded. If the host’s immune system cannot fight off the inflammation, the infection will spread damaging more and more alveoli, and the worse the patient’s oxygenation and gas exchange will be. Nursing considerations: TB screening, airborne precautions, sputum culture, respiratory assessment, TB skin testing, administering medications, and educating the patient on the treatment plan. Desired outcome: to fully eradicate the infection with antibiotic therapy and to optimize and restore proper oxygenation and gas exchange within the patient’s lungs. 

So, we’re going to go ahead and get started on our care plan, writing out some subjective data and some objective data. So, what are we going to see in the patient with TB? Some subjective data you’re going to see that they’re going to have a persistent cough. They may all also have some shortness of breath and complain of some fatigue. Some of the objective data that we’re going to see in these patients are night sweats, decrease in SpO2, decrease PaO2. So, a patient may also report some weight loss, anorexia, chills, shortness of breath, and chest pain. So, some interventions: we want to make sure we’re screening the patient for symptoms and risk factors of TB. So, risk factors. So, screening for possible TB can help to identify patients who are at risk sooner rather than later, containing the infection is a priority. As soon as you suspect a TB infection, make sure you’re placing the patient in airborne isolation. The longer you are exposed to these particles, the more likely you are to develop a TB infection. So, to protect yourself and other patients, use proper PPE. Another intervention is we’re going to place, and we’re going to read TB skin test. So PPD is an intradermal injection; they evaluate these 48 to 72 hours after placement for signs of any sort of redness and the size of the induration determines if the test is positive. So, anyone above 15 millimeters, and above10 millimeters for high risk, and above five millimeters for the immunocompromised. Another intervention we’re going to do, we’re going to collect a sputum culture. So, we’re going to ensure the sample is entirely sputum. Not saliva is important. Okay? Sputum not saliva. You can use nasal tracheal suction, if necessary, or you can collaborate with your respiratory therapist to obtain the culture. Another intervention we’re going to do, we’re going to monitor their respiratory status. So, we’re going to be listening to their lung sounds. We’re going to look at their O2 sats, and the patients may report shortness of breath. You might hear some crackles or wheezing that may indicate that they need some breathing treatments like a bronchodilator, because the alveoli are affected. The patient’s oxygenation and gas exchange will be affected. So, you want to monitor their ABGs and their SpO2 closely. If the patient cannot oxygenate and ventilate on their own, they may require some mechanical ventilation or other supplemental oxygen support. Another intervention that we’re going to be doing is we’re going to be administering antitubercular drugs as ordered. And it goes with the acronym RIPE. So that is going to be rifampin, isoniazid, pyrazinamide, and ethambutol. So, this therapy is the most common and the most effective drug therapy against TB infections. In some cases, patients are resistant or have multiple or multi drug resistant TB. In these cases. Other drugs may be given. Lastly, we want to educate the patient on the importance of completing the entire course of this treatment. So, you want to make sure they’re completing the course treatment – 6 to 12 months. So, although they’ll feel better, and they no longer are contagious. After about three weeks, they need to continue taking the full course. If they don’t, they will be at risk for the TB lying dormant and resurfacing later on, or they’ll risk developing multi-drug resistant TB. 

All right, so we’re going to go over some key points. So, TB is caused by the organism called mycobacterium Tuberculosis, which causes granulomas to form in the alveoli sacs, which creates capitation as immune cells surround it. Some subjective objective data you’re going to see with these patients: they’re going to have a persistent cough, anorexia, chills, shortness of breath, night sweats, decreased SpO2, and decreased PaO2. We’re going to do a TB test, culture, and assessment screen for possible TB. Make sure you’re initiating airborne precautions, place and read TB tests, collect sputum cultures, and assess respiratory function and their O2 sats. You’re going to be giving medication and you’re going to make sure you’re educating the patient on the meds and educate the importance of making sure they’re taking the entire course of treatment. And that is the end of this care plan. 

You guys did awesome. We love you guys. Go out, be your best self today and as always happy nursing.

 

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