{
  "name": "Pulmonary Tuberculosis",
  "slug": "pulmonary-tuberculosis",
  "url": "https://nursingplex.com/care-plans/pulmonary-tuberculosis",
  "category": "Infectious Diseases",
  "summary": "Airborne infection needing negative-pressure isolation and long multidrug adherence.",
  "nursing_diagnoses": [
    "Risk for infection transmission",
    "Ineffective airway clearance",
    "Imbalanced nutrition"
  ],
  "overview": [
    "Pulmonary tuberculosis (TB) is caused by Mycobacterium tuberculosis, an acid-fast bacillus spread via airborne droplet nuclei when an infected person coughs, sneezes, or talks. Primary infection is often asymptomatic and contained by the immune system within a granuloma (Ghon complex), producing latent TB infection — a positive skin/blood test with no active disease and no ability to transmit. Latent infection can reactivate, particularly with immunosuppression, into active disease characterized by productive cough lasting more than three weeks, hemoptysis, night sweats, low-grade fever, and unintentional weight loss.",
    "TB disproportionately affects immunocompromised individuals (HIV, malnutrition, diabetes, chronic steroid use), people in congregate settings (correctional facilities, shelters, long-term care), and those with limited healthcare access, and multidrug-resistant strains are a growing global concern. Diagnosis combines tuberculin skin testing or interferon-gamma release assays, chest imaging showing characteristic upper-lobe cavitary lesions, and sputum acid-fast bacilli smear/culture, which also confirms when a patient is no longer infectious.",
    "Nursing management centers on airborne isolation precautions to prevent transmission, supporting adherence to the prolonged multidrug regimen (typically 6+ months) since nonadherence drives drug resistance, monitoring for hepatotoxicity and other medication side effects, and nutritional/psychosocial support, since stigma and treatment duration are major barriers to completion."
  ],
  "key_facts": [
    {
      "label": "Transmission",
      "text": "Airborne droplet nuclei; requires airborne (negative pressure) isolation with N95 respirator use."
    },
    {
      "label": "First-line regimen",
      "text": "RIPE therapy — Rifampin, Isoniazid, Pyrazinamide, Ethambutol — for 2 months, followed by rifampin/isoniazid for 4 more months."
    },
    {
      "label": "Infectious until",
      "text": "Three consecutive negative sputum AFB smears and clinical improvement on effective therapy."
    },
    {
      "label": "Key toxicity",
      "text": "Hepatotoxicity from isoniazid, rifampin, and pyrazinamide requires baseline and periodic liver function monitoring."
    },
    {
      "label": "DOT",
      "text": "Directly observed therapy is standard of care to ensure adherence and prevent drug-resistant TB."
    }
  ],
  "nursing_priorities": [
    "Implement and maintain airborne isolation precautions until non-infectious status is confirmed.",
    "Support and monitor adherence to the full multidrug regimen.",
    "Monitor for medication side effects, especially hepatotoxicity and visual changes.",
    "Manage respiratory symptoms and monitor for hemoptysis or respiratory compromise.",
    "Support nutritional status given the catabolic effects of chronic infection.",
    "Educate to prevent transmission to household/close contacts.",
    "Address the psychosocial impact of stigma, isolation, and prolonged treatment."
  ],
  "assessment": {
    "subjective": [
      "Chronic cough lasting more than three weeks, often productive",
      "Reports of night sweats, fatigue, and unintentional weight loss",
      "Low-grade fever, especially in the afternoon/evening",
      "Chest pain or discomfort, particularly with breathing or coughing",
      "Coughing up blood-tinged sputum",
      "Feelings of isolation, fear, or embarrassment related to diagnosis and precautions"
    ],
    "objective": [
      "Positive tuberculin skin test (induration) or interferon-gamma release assay",
      "Chest X-ray showing upper lobe infiltrates, cavitation, or Ghon complex",
      "Positive sputum acid-fast bacilli smear and/or culture",
      "Crackles or diminished breath sounds on auscultation",
      "Cachexia, pallor, and generalized weakness",
      "Elevated liver enzymes if on hepatotoxic anti-TB medications",
      "Low-grade fever pattern documented on vital sign trends"
    ],
    "related_factors": [
      "Close contact with a person with active, untreated pulmonary TB",
      "Immunosuppression from HIV, chronic corticosteroid use, malnutrition, or diabetes",
      "Living in congregate settings with poor ventilation (shelters, correctional facilities)",
      "Limited access to healthcare, delaying diagnosis and treatment",
      "Nonadherence to previous TB treatment, increasing drug-resistance risk",
      "Advanced age or comorbid chronic illness reducing immune competence"
    ]
  },
  "goals": [
    "The client will demonstrate improved gas exchange with decreasing cough and clearing chest imaging over the treatment course.",
    "The client will complete the full prescribed course of anti-TB therapy without interruption.",
    "The client will remain free of significant medication toxicity, or toxicity will be identified and managed promptly.",
    "The client will demonstrate three consecutive negative sputum smears, confirming non-infectious status.",
    "The client will verbalize understanding of transmission prevention and identify all close contacts for testing.",
    "The client will maintain or regain adequate nutritional status and body weight."
  ],
  "interventions": [
    {
      "title": "1. Preventing transmission",
      "points": [
        "Place the patient in an airborne infection isolation room with negative pressure and the door closed at all times.",
        "Wear a fit-tested N95 or higher-level respirator whenever entering the room; instruct the patient to wear a surgical mask when leaving the room for necessary procedures.",
        "Limit room entries and cluster care to reduce staff exposure while still meeting patient needs.",
        "Teach the patient to cover the mouth/nose when coughing and to dispose of tissues properly.",
        "Maintain isolation until the patient has completed at least two weeks of effective therapy and has three consecutive negative sputum AFB smears (or per facility/public health protocol)."
      ]
    },
    {
      "title": "2. Supporting adherence to therapy",
      "points": [
        "Administer directly observed therapy (DOT) per protocol to ensure medications are taken correctly and completely.",
        "Educate on the importance of completing the full 6+ month regimen even after symptoms improve, since premature discontinuation drives relapse and drug resistance.",
        "Simplify the regimen where possible with fixed-dose combination pills to improve adherence.",
        "Address barriers to adherence such as cost, transportation, side effects, or housing instability, and connect with public health resources.",
        "Coordinate with the public health department for case management and contact tracing."
      ]
    },
    {
      "title": "3. Monitoring for medication toxicity",
      "points": [
        "Monitor liver function tests at baseline and periodically throughout treatment; hold hepatotoxic drugs and notify the provider if enzymes rise significantly or jaundice develops.",
        "Assess for peripheral neuropathy with isoniazid and administer pyridoxine (vitamin B6) prophylactically as ordered.",
        "Monitor visual acuity and color discrimination with ethambutol, since optic neuritis is a known risk.",
        "Educate that rifampin causes harmless orange-red discoloration of body fluids (urine, tears, sweat) and can reduce efficacy of oral contraceptives and other drugs.",
        "Assess for hyperuricemia and joint pain associated with pyrazinamide."
      ]
    },
    {
      "title": "4. Managing respiratory status",
      "points": [
        "Monitor respiratory rate, oxygen saturation, and breath sounds regularly.",
        "Assess sputum characteristics and report increasing hemoptysis immediately.",
        "Encourage deep breathing exercises and adequate hydration to help mobilize secretions.",
        "Position for comfort and optimal lung expansion, and provide supplemental oxygen if indicated."
      ]
    },
    {
      "title": "5. Supporting nutrition and psychosocial needs",
      "points": [
        "Encourage small, frequent, high-protein and high-calorie meals to counteract the catabolic effects of chronic infection.",
        "Monitor weight trends over the treatment course as an indicator of clinical improvement.",
        "Address feelings of isolation and stigma related to airborne precautions through consistent, compassionate communication and by involving family per facility guidelines.",
        "Provide information in the patient's preferred language and account for cultural beliefs about TB that may affect trust or adherence.",
        "Refer to social work for assistance with housing, financial, or legal concerns related to isolation and prolonged treatment."
      ]
    }
  ],
  "patient_teaching": [
    "Take all TB medications exactly as prescribed for the full duration, even after feeling better, to prevent relapse and drug resistance.",
    "Cover your mouth and nose when coughing or sneezing and dispose of tissues properly until cleared as non-infectious.",
    "Attend all scheduled sputum tests and follow-up appointments to confirm treatment response.",
    "Report side effects such as yellowing skin/eyes, vision changes, numbness/tingling, or persistent nausea immediately.",
    "Ensure household and close contacts are tested for TB infection.",
    "Maintain good ventilation in living spaces and avoid crowded indoor settings until cleared by the provider.",
    "Eat a well-balanced, high-protein diet to support recovery and immune function.",
    "Avoid alcohol during treatment, since it increases the risk of medication-related liver toxicity."
  ]
}