Nursing care plan pulmonary tuberculosis TB

I. Pathophysiology
a. Bacterial infection by Mycobacterium tuberculosis bacilli
i. Primarily affects the lungs (70% per Centers for Disease
Control and Prevention [CDC], 2004) although it can
invade other body systems
ii. Airborne droplets are inhaled, with the droplet nuclei
deposited within the alveoli of the lung.
b. Primary infection followed by a latent or dormant phase, or
by active disease in some individuals
c. When the immune system weakens, dormant TB organisms
can reactivate and multiply (reactivation TB).

II. Classifications
a. Latent: Body’s immune system has encapsulated the bacteria
into tiny capsules called tubercles, infection not transmissible
to others.
b. Active: Infection is spreading in the body and can be transmitted
to others.

III. Etiology
a. Following exposure, the bacilli may (1) be killed by the
immune system, (2) multiply and cause primary TB,
(3) become dormant and remain asymptomatic, or
(4) proliferate after a latency period (reactivation disease)
(Herchline & Amorosa, 2007).
b. Multidrug-resistant tuberculosis (MDR-TB)
i. Primary: caused by person-to-person transmission of a
drug-resistant organism
ii. Secondary: usually the result of nonadherence to
therapy or inappropriate treatment
iii. On the rise especially in large cities, in those previously
treated with antitubercular drugs, or in those who failed
to follow or complete a drug regimen
iv. Can progress from diagnosis to death in as little as 4 to
6 weeks
c. Risk factors: individuals with weakened immune systems
due to chronic conditions, advanced age, and malnutrition;
higher among persons with HIV infection, the homeless,
drug-addicted, and impoverished populations, as well as
among immigrants from or visitors to countries in which
TB is endemic

IV. Statistics (Centers for Disease Control and Prevention
[CDC], 2005, 2007)
a. Morbidity: In 2005, 14,903 cases of TB were reported in
the United States (down from a peak of 25,287 cases in
1993), with foreign-born individuals accounting for a
steadily increasing proportion (54%) of all reported TB
cases (Herschline, 2007); globally, 9.2 million new cases
reported annually.
b. Morbidity: Globally, 1.7 million deaths from TB occurred
in 2006, of which 0.2 million deaths were in HIV-positive
individuals (World Health Organization [WHO], 2008).
Care Setting
Most clients are treated in community clinics, but may be
hospitalized for diagnostic evaluation or initiation of therapy,
adverse drug reactions, or severe illness or debilitation.
This plan of care is intended to reflect care of the person
with active (rather than latent) TB, although if latent, when
TB is diagnosed, treatment will be initiated.

Related Concerns
Extended care
Psychosocial aspects of care

Nursing Priorities
1. Achieve and maintain adequate ventilation and oxygenation.
2. Prevent spread of infection.
3. Support behaviors and tasks to maintain health.
4. Promote effective coping strategies.
5. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Respiratory function adequate to meet individual need.
2. Complications prevented.
3. Lifestyle and behavior changes adopted to prevent spread
of infection.
4. Disease process, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.

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