Tuberculosis : Nursing implementation

Nursing implementation

• Health Promotion
  • Ultimate goal in the United States is eradication
  • Selective screening programs in high-risk groups to detect TB
  • Treatment of LTBI
  • Follow-up positive TST results
  • Reportable disease
  • Address social determinants of TB
• Acute Care
  • Airborne isolation
    • Single-occupancy room with 6-12 airflow exchanges/hour
    • Health care workers wear high-efficiency particulate air (HEPA) masks
  • Immediate medical workup
  • Appropriate drug therapy
  • Teach patient to prevent spread
    • Cover nose and mouth with tissue when coughing, sneezing, or producing sputum
    • Hand washing after handling sputum-soiled tissues
  • Patient wears mask if outside of negative-pressure room
  • Identify and screen close contacts
• Ambulatory Care
  • Can go home even if cultures positive
  • Monthly sputum cultures
  • Teach patient how to minimize exposure to others
  • Ensure that patient can adhere to treatment
  • Negative cultures are needed to declare the patient not infectious
  • Notify health department
  • Teach symptoms of recurrence
  • Instruct about factors that could reactivate TB
  • Smoking cessation

Evaluation

• Expected Outcomes
  • Resolution of disease
  • Normal pulmonary function
  • Absence of any complications
  • No further transmission of TB

Patient teaching

• Emphasize the importance of complying with his medication regimen.
  • Teach him how to minimize exposure to close contacts.
  • They should open windows and ventilate rooms in which he is living.
    • Until their sputum is negative for AFB,
    • Should sleep alone
    • Spend as much time as possible outdoors, and minimize time in close proximity with other people and on public transportation.
  • Emphasize importance of treatment compliance.
• Strategies to improve adherence to drug therapy include
  • Teaching and counseling
  • Reminder systems
  • Incentives or rewards
  • Contracts and DOT