Comprehensive Nursing Care Plan for Tuberculosis

The three highest-priority NANDA-I diagnoses for pulmonary TB are Ineffective Airway Clearance, Risk for Infection Transmission, and Imbalanced Nutrition: Less Than Body Requirements. Ineffective Airway Clearance — related to thick, tenacious sputum and bronchospasm secondary to Mycobacterium tuberculosis infection, as evidenced by productive cough, abnormal breath sounds, and dyspnea — is first priority because impaired airway clearance directly threatens oxygenation and increases the risk of respiratory failure in severe cases. Risk for Infection Transmission is equally critical from a public health standpoint: TB is airborne, and a smear-positive patient can infect 10–15 people per year without proper isolation precautions. Imbalanced Nutrition is third priority because TB is a wasting disease — the infection drives a hypermetabolic state, while anorexia, nausea from antitubercular drugs, and fatigue all reduce oral intake. Additional diagnoses to include: Activity Intolerance (related to weakness, fever and dyspnea), Ineffective Health Maintenance (related to complex 6-month DOTS regimen), and Anxiety (related to stigma and prolonged treatment). In TB-specific NCP examinations, students are expected to identify infection transmission risk as a separate nursing responsibility alongside the patient's own clinical problems.

Infection control is a shared nursing and public health responsibility in TB care. The primary intervention is airborne precaution isolation: the patient should be placed in a negative-pressure single room (or in a well-ventilated room with windows open if a formal isolation room is not available). The nurse must wear an N95 respirator — not a surgical mask — when entering the room; surgical masks protect the patient, not the nurse, from airborne droplet nuclei. Teach the patient to cover the mouth and nose with a triple-layered surgical mask or a tissue when coughing or sneezing (respiratory hygiene/cough etiquette), and to dispose of sputum-soaked tissues in a sealed bag. Handle sputum specimens as biohazard material. Ensure DOTS (Directly Observed Treatment, Short-course) compliance: the nurse or a trained health worker directly watches the patient swallow each dose of antitubercular drugs (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol in the intensive phase). Non-adherence is the leading cause of drug resistance and prolonged infectiousness. Facilitate contact tracing — identify close contacts (household members, co-workers) and refer them for tuberculin skin test or IGRA testing. Document isolation precautions, sputum smear status, and every DOTS administration in the nursing record. Isolation can generally be discontinued once the patient has three consecutive negative sputum smears on separate days and has been on effective therapy for at least two weeks.

Nutritional rehabilitation is essential to TB recovery because undernutrition impairs cell-mediated immunity, which is the primary defence against Mycobacterium tuberculosis. The nurse's role is to assess nutritional status at admission (BMI, mid-upper arm circumference, serum albumin if available) and monitor weekly weight. Set a nutritional goal: TB patients should consume at least 35–40 kcal/kg/day and 1.2–1.5 g protein/kg/day to rebuild lean mass and support immune function. Advise a high-calorie, high-protein diet: pulses, legumes, eggs, fish, chicken, low-fat dairy (paneer, curd), whole grains, and fresh fruits and vegetables rich in vitamins A, C, and E. Isoniazid depletes vitamin B6 (pyridoxine), so ensure the patient is prescribed pyridoxine 25–50 mg daily alongside antitubercular therapy to prevent peripheral neuropathy. Manage common nutritional barriers: nausea and loss of appetite from Rifampicin and Pyrazinamide are worst in the first 2–4 weeks — advise taking drugs with a light snack (not a heavy meal) if nausea is severe; offer small, frequent meals every 2–3 hours rather than three large meals. Refer to a dietitian if BMI is below 17 or if the patient has comorbid diabetes (insulin requirements change as TB treatment progresses and nutrition improves). Document dietary intake and weight weekly; a patient gaining weight steadily is responding to treatment.

Discharge education is critical because TB treatment continues for 6 months (standard regimen) or longer (MDR-TB), entirely at home after the intensive phase. Cover these six areas: (1) Drug adherence — explain that stopping drugs early is the single biggest cause of MDR-TB; link the patient into the local DOTS centre or PHC for continued supervised therapy; give the DOTS worker's contact number. (2) How TB spreads and how to protect the family — open windows for ventilation, sleep in a separate room if possible, wear a mask during the infectious period (first two weeks of treatment), and avoid crowded enclosed spaces. (3) Recognition of drug side effects — yellow eyes or urine (rifampicin colours urine orange-red, which is normal, but yellow sclera means hepatotoxicity; stop drugs and report immediately), tingling hands or feet (pyridoxine deficiency from isoniazid — take B6 supplement), visual disturbance (ethambutol-related optic neuritis — report immediately). (4) Diet — high-protein, high-calorie meals; no alcohol (increases hepatotoxicity risk). (5) Follow-up schedule — sputum smear at 2 months, 5 months and 6 months; chest X-ray at 2 and 6 months; liver function test monthly in the first 2 months. (6) TB notification — inform the patient that TB is a notifiable disease; the treating facility reports to the district TB officer, which triggers contact tracing for household members.