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Tuberculosis Nursing Guide

Content revised by: Kathleen Koopmann, RN, BSN, PCCN

Tuberculosis Overview: 

This content is intended as a Quick Reference for tuberculosis and will cover an overview as well as nursing considerations utilizing the nursing process.

 

Tuberculosis Etiology and Epidemiology

Tuberculosis (TB) is an infectious disease that is caused by a bacterium. The bacteria is called Mycobacterium tuberculosis. It is spread from person-to-person by droplets in the air. TB usually infects the lungs but can infect anywhere within the body, such as:

  • Pleural space
  • Genitourinary tract
  • Bone and joints
  • Abdomen
  • Pericardium
  • Brain

TB can be an active infection or remain latent within the body. TB can be effectively treated with a 6-month drug regimen. This regimen has an 85% cure rate (DynaMed, 2018).

TB can affect anyone at any time or place, but most people with active disease are adults. TB infects men more often than it infects women and is more prevalent in impoverished countries. Over 10 million people worldwide are infected with TB annually (Suarez et al., 2019). Mycobacterium tuberculosis is among the 10 leading causes of death worldwide. According to the World Health Organization (2020), approximately 25% of the world population is infected with latent Mycobacterium tuberculosis. Worldwide, TB is the leading cause of death from a single infectious agent.

Risk factors for TB include:

  • Close contact with an infected person
  • Recent immigration from a country with high rates of TB
  • People with HIV infection
  • Injection drug users
  • Homeless persons

People at risk for TB include anyone who works or resides in a facility with a high risk for TB, such as:

  • Hospitals
  • Residences of individuals with HIV infection
  • Homeless shelters
  • Correctional facilities
  • Long-term care facilities

Other individuals at risk include:

  • Weakened immune system
  • HIV infection
  • Treatment with immunosuppressive medications
  • Diabetes mellitus
  • Malignancy
  • Silicosis
  • Substance use disorder
  • Severe kidney disease

TB is transmitted through airborne particles released into the air as droplet nuclei when an infected person coughs (DynaMed, 2018). Infection occurs when a susceptible person inhales the airborne bacteria. Transmission risk is higher indoors than it is outdoors due to the change in concentrations of droplets in the air. The droplets can filter down to the terminal alveoli because of their small size. Once the droplets reach the alveoli, they are spread deeper into the lung tissue by infected macrophages.

The symptoms of TB can be vague, but the diagnosis should be considered for anyone who has had a productive cough for > 2 weeks. There may be other respiratory symptoms present such as dyspnea, hemoptysis, or chest pain. Additional symptoms of tuberculosis are:

  • Loss of appetite
  • Fever
  • Night sweats
  • Weight loss

Complications from tuberculosis can be:

  • Pleural effusion
  • Tuberculosis pneumonia
  • Spread to other organs
  • Reactions to medication therapy

Tuberculosis Diagnosis

Diagnosing and rapid treatment of Mycobacterium tuberculosis is essential to preventing the transmission (Suarez et al., 2019). Respiratory expectorate specimens will confirm the diagnosis of pulmonary Mycobacterium tuberculosis. Performing an acid-fast bacillus (AFB) smear microscopically on the expectorate will detect the presence of Mycobacterium tuberculosis.

Additional testing can be done if tuberculosis is suspected (DynaMed, 2018). These tests include:

  • Chest X-ray for abnormalities
  • Urine specimen to determine lipoarabinomannan (LAM) in urine
  • Tuberculin skin test for positive immune response
  • Bronchoscopy

Inquire about the person’s past medical history. Focus on anything that would make them more prone toTB, such as:

  • HIV infection
  • Diabetes mellitus
  • Silicosis
  • Malignancies
  • Immunosuppressive medication

A thorough social history should include questions about:

  • Living with a person with active TB
  • Travel to areas with a high rate of TB
  • Homelessness
  • Incarceration
  • Malnutrition

Tuberculosis Management

All suspected TB cases must be reported to the local health department for management and follow-up (DynaMed, 2018). Individuals suspected of TB must be isolated in an airborne infection isolation room (AIIR) on airborne isolation precautions as soon as possible.

Treatment medications should follow the Centers for Disease Control and Prevention (2020a) guidelines. The Centers for Disease Control and Prevention (CDC) recommends combination doses of the following medications for the treatment of active TB:

  • Isonicotinic acid hydrazide (Isoiazid®)
  • Rifampin (Rifadin®)
  • Ethambutol (Myambutol®)
  • Pyrazinamide (Tebrazid®)

The CDC recommends that all four medications be administered for the first 8 weeks of treatment (CDC, 2020a). After 8 weeks, a combination of only two drugs will be given for the next 18 weeks. The completion of treatment is based on the total number of doses administered within a certain period of time.

Medications recommended by the CDC (2020b) for latent TB:

  • Isonicotinic acid hydrazide (Isoiazid®)
  • Rifampin (Rifadin®)
  • Ethambutol (Myambutol®)
  • Pyrazinamide (Tebrazid®)
  • Rifapentine (Priftin®)

The CDC recommends either a combination of two medications for 3 months or a single drug for 4 to 9 months depending upon which medication is used to treat latent TB.

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for TB are listed below.

Assessment

  • Assess signs and symptoms, such as:
  • An exposure to TB
  • Signs and symptoms of active TB disease such as:
    • Productive cough
    • Night sweats
    • Fever
    • Unintentional weight loss
    • Pleuritic chest pain
  • Listen to lung sounds for the presence of crackles
  • Breathing patterns for dyspnea, tachypnea
  • Liver dysfunction during treatment phase:
    • Loss of appetite
    • Fatigue
    • Joint pain
    • Fever
    • Tenderness in liver region
    • Clay-colored stools
    • Dark, tea-colored urine
    • Vision changes
  • Adequate intake and output
  • Height and weight

Tuberculosis Nursing Diagnosis/Risk For

  • Potential for ineffective breathing pattern as related to (Phelps, 2021a):
    • Pulmonary infection
    • Long-term scarring with decreased capacity
  • Potential risk for infection of staff and other patients related to (Phelps, 2021b):
    • The highly contagious nature of the disease
  • Potential for imbalanced nutrition: Less than body requirements related to (Phelps, 2021c):
    • Disease process
    • Symptoms including weight loss

Interventions

  • Monitor for results of liver function studies
  • Monitor and record lung sounds and respiratory rate and depth at least every 4 hours
  • Administer oxygen as ordered
  • Assist the individual with activities of daily living to conserve energy
  • Encourage the individual to ambulate when stable
  • Monitor and record vital signs at least every 8 hours
  • Monitor white blood cell count for changes or trends
  • Encourage frequent oral hygiene
  • Encourage individual cough and deep breath every 4 hours and use inspiratory spirometry as ordered
  • Encourage the individual to change position at least every 2 hours
  • Monitor intake and output
  • Place the individual on strict airborne precautions
  • Allow only staff who are fit tested to wear an N95 mask into the room

Expected Outcomes

  • Breathing pattern returns to normal for the individual
  • Expresses feeling comfortable when breathing
  • Maintains stable vital signs
  • Performs activities of daily living at previous level
  • Decrease in respiratory secretions
  • Maintains a stable weight

Individual/Caregiver Education

  • Condition, treatment, and expected outcome
  • Proper nutrition for body requirements
  • Report loose stools or diarrhea immediately
  • How to cough and deep breathe and to use the inspiratory spirometer
  • Importance of strict medication regime for prevention of reoccurrence of TB
  • Infection prevention and control interventions to prevent the spread of TB
  • Notify healthcare provider or seek immediate medical care for:
    • Medication side effects that are intolerable
      • Nausea, vomiting, or loss of appetite
      • Tingling or numbness in hands or feet
      • Itchy skin, rashes, or bruising
      • Changes in eyesight or blurred vision
      • Jaundice or yellowish skin or eyes
      • Dark or cola-colored urine
      • Fatigue, weakness, or fever for three or more days
  • Increased cough or bloody sputum
    • Inability to take your medication
  • Recommended follow-up with healthcare provider

 

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Overview of Tuberculosis CE Course

1.0 Contact Hour

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

Content Contributor

The content was revised by Kathleen Koopmann, RN, BSN, PCCN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.

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