Tuberculosis (TB), is an infection caused by Mycobacterium tuberculosis bacteria. Pulmonary TB is spread through these airborne bacteria. Symptoms are persistent cough, fever, and weight loss. It is a growing and serious public health, social, and economic problem with approximately 8 million cases world wide each year. 95% of the cases are in developing countries but more are occurring in crowded urban settings in developed countries recently, too. Treatments are effective and readily available in developed countries, however, poor access to health care and inadequate health care coverage along with a reluctance to report suspected TB due to stigma, immigration issues, and misunderstanding of current therapy, has made it more and more difficult to identify, treat, and prevent.

Cure rates can be low because of interrupted treatment, since the course of treatment is a long 6-8 months of medication therapy until the patient is verified as negative by sputum testing. Sputum checks are done at about two month intervals.

It is critical that treatment is not interrupted to prevent development of drug-resistant TB which is far more difficult and costly to treat. For the patient, remembering to take the drugs for 6 to 8 months can be a problem. Education by nursing professionals is a key intervention.

To answer the question about nursing interventionsin this condition, an assumption will be made that the question is about pulmonary TB (TB can affect other areas of the body) and that the setting is outpatient or home care.

Each Nursing Plan of Care must be individualized to a specific patient's needs. Ethnic, social, and economic differences, as well as education and living conditions are just some of the variables that play a role in the approach to care.

Some common Nursing Diagnoses and interventions for this condition would be:

Risk for infection

* Monitor sputum for changes indicating infection * Monitor vital signs * Teach patient and family the purpose and techniques for infection control such as hand washing, patient covering mouth when coughs, maintaining isolation if necessary * Teach patient the purpose, importance and how to take medications as prescribed consistently over the long term therapy

Deficient knowledge

* Determine who will be the learner, patient or family * Assess ability to learn * Identify any existing misconceptions about the material to learn * Assist the learner to integrate the information into daily life * Give clear thorough explanations and demonstrations Noncompliance

* Determine if there has been past noncompliance and the reasons * Ask to see prescription drugs periodically and count the remaining pills * If economics are a reason for noncompliance, explore community resources * Increase the amount of supervision provided, follow up visits, phone calls, etc. Ineffective therapeutic regimen management

* Assess prior efforts to follow regimen * Assess patient's perceptions of their health problem * Assess other factors that may affect success in a negative way * Inform patient of the benefits of conforming with the regimen * Concentrate on the behaviors that will make the most difference to the therapeutic effect * Include family, support system in teachings and explanations * Instruct patient on the importance of ordering refills of medications several days ahead of running out. Activity intolerance

* Assess patient's level of mobility * Observe and document response to activity * Assess emotional response to change in physical status * Anticipate patient's needs to accommodate * Teach energy conservation techniques * Refer to community resources as needed Ineffective airway clearance

* Auscultate lungs for wheezing, decreased breath sounds, coarse sounds * Use universal precautions if secretions are purulent even before culture reports

* Assess cough for effectiveness and productivity * Note sputum amount, color, odor, consistency * Send sputum specimens for culture as prescribed or prn * Institute appropriate isolation precautions if cultures are positive * Use humidity to help losen sputum * Administer medications, noting effectiveness and side effects * Teach effective deep breathing and coughing techniques Ineffective health maintenance * Assess patient's knowledge of health maintenance behaviors * Assess to what degree environmental, social, intrafamilial disruptions, or changes have correlated with poor health behaviors * Determine patient's motives for failing to report symptoms reflecting changes in health status * Assess whether economic problems present a barrier to maintaining health behaviors * Provide patient with a means to contact health care providers * Involve family and friends in health planning conferences

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