Learning Center Articles

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