Nursing Diagnosis for Tuberculosis (TB): A Comprehensive Guide

Tuberculosis (TB) remains a significant global health concern, primarily affecting the lungs but capable of impacting other organs as well. Caused by the bacterium Mycobacterium tuberculosis, TB is an airborne infectious disease, spreading through microscopic droplets expelled during coughing or sneezing. While TB is both curable and preventable, it continues to pose a substantial health crisis, particularly in developing nations. Individuals with compromised immune systems, such as those with HIV/AIDS, malnutrition, or those at the extremes of age, are at heightened risk of developing TB disease.

Understanding the stages of TB infection is crucial for effective nursing care:

• Exposure: Initial contact with an individual who has TB. At this stage, the exposed person may not exhibit symptoms or test positive for TB.
• Latent TB Infection (LTBI): The TB bacteria reside in the body in an inactive state. Individuals with LTBI do not show symptoms and are not contagious, but they will test positive on a TB skin or blood test. Latent TB can progress to active TB disease.
• Active TB Disease: The TB bacteria become active and multiply, causing symptoms. Individuals with active TB are contagious and require immediate treatment.

Nurses play a pivotal role in managing TB, from prevention and early detection to treatment and patient education. This article delves into the nursing process for TB, focusing on nursing assessments, interventions, and, crucially, nursing diagnoses for TB. By understanding common nursing diagnoses for TB, healthcare professionals can deliver targeted and effective care, improving patient outcomes and controlling the spread of this infectious disease.

The Nursing Process and Tuberculosis Care

In managing tuberculosis, the nursing process is fundamental. A key responsibility for healthcare professionals is preventing the spread of this contagious disease. This involves rigorous adherence to infection control protocols, including the consistent use of personal protective equipment like masks, maintaining strict sanitation standards, and promoting optimal hygiene practices among patients and staff.

Successful TB treatment hinges on patient adherence to a prolonged medication regimen, often lasting several months. Nurses are essential in ensuring patients understand and follow their prescribed treatment plans. This includes accurate medication administration, comprehensive patient education on medication adherence, managing potential side effects, and ensuring consistent follow-up appointments to monitor treatment efficacy and patient well-being.

Nursing Assessment for Tuberculosis

The initial step in providing comprehensive nursing care is a thorough nursing assessment. This process involves gathering a broad spectrum of data – physical, psychosocial, emotional, and diagnostic – to create a holistic understanding of the patient’s condition. We will explore both subjective and objective data collection pertinent to tuberculosis.

Review of Health History

1. Document General Symptoms: Recognize and record the common presenting symptoms of TB, which may include:

• Persistent cough
• Hemoptysis (coughing up blood)
• Chest pain, especially with breathing or coughing
• Unexplained weight loss
• Persistent fatigue
• Fever, often low-grade
• Night sweats

2. Identify Risk Factors for TB: Determine the presence of factors that increase the patient’s susceptibility to TB. These risk factors include:

• Age: Very young children (under 5 years) and older adults (65 years and above) are more vulnerable.
• Immunocompromised status: Conditions such as HIV/AIDS, diabetes mellitus, organ transplantation, and immunosuppressive medications significantly elevate TB risk.
• History of positive PPD test: A previous positive purified protein derivative (PPD) or tuberculin skin test indicates prior exposure to TB bacteria.
• Prior TB treatment: Previous TB infection or treatment history needs to be documented.
• Known TB exposure: Recent contact with individuals diagnosed with active TB.
• Travel history: Travel to or residence in regions with high TB prevalence.
• Living or working conditions: Exposure risk is higher in congregate settings like homeless shelters, hospitals, correctional facilities, and nursing homes.
• Injection drug use: Substance use, particularly injection drug use, is a significant risk factor.

3. Assess Potential Exposure Routes: Understand how TB is transmitted to evaluate the patient’s possible exposure. While latent TB is not contagious, active TB spreads through airborne droplets generated by:

• Coughing
• Sneezing
• Speaking
• Singing
• Laughing

4. Analyze Medical History for Latent TB Risk: Recognize that latent TB infection is asymptomatic, as the bacteria are dormant. However, these bacteria can reactivate and cause active disease, especially if the immune system weakens. Factors that can trigger reactivation include:

• Immunosuppression (e.g., due to HIV, medications)
• Chronic diseases (e.g., diabetes, cancer)
• Malnutrition
• Advanced age

Physical Assessment

1. Recognize Classic Clinical Signs of Active Pulmonary TB: Identify the typical signs and symptoms associated with active pulmonary tuberculosis:

• Persistent cough
• Significant, unintentional weight loss
• Anorexia (loss of appetite)
• Fever
• Night sweats
• Hemoptysis (expectoration of bloody sputum)
• Chest discomfort
• Fatigue

2. Conduct a Cephalocaudal Assessment to Detect Extrapulmonary TB: TB can affect organs beyond the lungs. Systematically assess for signs of extrapulmonary TB:

• Tuberculous Meningitis:
  • Persistent headache (lasting 2-3 weeks), often intermittent
  • Subtle changes in mental status
  • Altered levels of consciousness
  • Mild fever
• Skeletal TB:
  • Back pain
  • Stiffness
  • Lower extremity paralysis
  • Unilateral tuberculous arthritis (commonly in ankles, elbows, wrists, and shoulders)
• Genitourinary TB:
  • Flank pain
  • Dysuria (painful urination)
  • Urinary frequency
  • In males: scrotal pain, inflammation of the prostate, testicles, or epididymis
  • In females: pelvic pain mimicking pelvic inflammatory disease
• Gastrointestinal TB:
  • Persistent oral or anal ulcers
  • Dysphagia (difficulty swallowing)
  • Abdominal pain, potentially mimicking peptic ulcer disease
  • Malabsorption
  • Pain, diarrhea, or hematochezia (blood in stool)

3. Auscultate Lung Sounds: Perform lung auscultation to identify abnormal findings in patients with pulmonary TB:

• Abnormal breath sounds, particularly in the upper lobes or affected areas
• Rales (crackling sounds) upon auscultation

4. Identify Signs of Extrapulmonary TB: Based on affected tissues, extrapulmonary TB can manifest with various symptoms:

• Confusion
• Neurological deficits
• Chorioretinitis (inflammation of the choroid and retina of the eye)
• Lymphadenopathy (swollen lymph nodes)
• Cutaneous lesions (skin lesions)

5. Be Aware of Atypical Presentations in Immunocompromised and Elderly Patients: Recognize that classic TB symptoms may be absent or subtle in high-risk groups, especially those with weakened immune systems or older adults. Maintain a high index of suspicion in these populations.

Diagnostic Procedures

1. Facilitate Screening Tests: Encourage and assist patients in undergoing appropriate screening tests for TB:

• Mantoux Tuberculin Skin Test (TST): The standard initial screening test. A measured skin reaction to injected purified protein derivative (PPD) indicates potential TB infection (latent or active).
• Interferon-Gamma Release Assays (IGRAs): Blood tests (e.g., QuantiFERON-TB Gold In-Tube test) that offer higher specificity and sensitivity compared to the TST. IGRAs are less affected by prior BCG vaccination.

2. Assist with Chest X-ray: For all patients with positive screening test results, a chest X-ray is essential to rule out or confirm active pulmonary TB disease. X-rays can reveal lung abnormalities suggestive of TB.

3. Obtain Sputum Samples for AFB Smear and Culture: Collect sputum samples for acid-fast bacilli (AFB) smear and culture.

• AFB Smear: A rapid initial test to detect AFB in sputum. A positive smear suggests active TB but is not definitive.
• AFB Culture: The gold standard for TB diagnosis. Culture identifies Mycobacterium tuberculosis bacteria and allows for drug susceptibility testing. Negative smear results do not exclude active TB.

4. Conduct HIV Serology Testing: HIV testing is recommended for all TB patients with unknown HIV status due to the increased risk of TB in individuals with HIV infection.

5. Consider Blood Cultures: Blood cultures can be used to diagnose disseminated TB, especially in immunocompromised patients, but require specialized techniques for Mycobacterium tuberculosis detection.

6. Utilize New Generation Diagnostic Tools: Be aware of and utilize advanced TB diagnostic tests, such as:

• Nucleic Acid Amplification Tests (NAATs): Rapid molecular tests (e.g., Xpert MTB/RIF) that detect Mycobacterium tuberculosis DNA and rifampicin resistance in sputum samples. These tests offer faster results than traditional cultures.
• Line Probe Assays: Molecular tests that identify mutations associated with drug resistance.

Alt text: Chest X-ray revealing lung abnormalities consistent with pulmonary tuberculosis.

Nursing Interventions for Tuberculosis

Effective nursing interventions for TB are critical for patient recovery and preventing disease transmission. These interventions are broadly categorized into assisting with TB treatment and controlling transmission.

Assist TB Treatment

1. Initiate and Manage Antibiotic Therapy: Administer and manage the prescribed antibiotic regimen. Standard TB treatment involves a combination of drugs, including:

• Isoniazid (INH)
• Rifampin (RIF)
• Pyrazinamide (PZA)
• Ethambutol (EMB)
• Streptomycin (SM)

Treatment regimens typically last 6-9 months for drug-susceptible TB. Ensure patients understand the importance of completing the full course of antibiotics, even if they feel better, to prevent drug resistance and ensure TB eradication. Monitor for adverse drug reactions and provide patient education on potential side effects.

2. Emphasize Treatment Adherence: Stress the critical importance of strict adherence to the prescribed medication regimen. Non-adherence can lead to treatment failure, relapse, and the development of drug-resistant TB. Strategies to improve adherence include:

• Directly observed therapy (DOT), where a healthcare worker watches the patient swallow each dose of medication.
• Patient education and counseling.
• Simplifying medication regimens when possible.
• Addressing barriers to adherence (e.g., forgetfulness, side effects, social stigma).

3. Promote Lung Expansion: Encourage interventions to enhance lung expansion and mobilize secretions:

• Pursed-lip breathing and deep breathing exercises.
• Controlled coughing techniques.
• Aerobic exercises as tolerated.
• Incentive spirometry to encourage deep inhalation and lung volume expansion.

4. Suction Airway as Needed: Perform airway suctioning if the patient is unable to effectively expectorate secretions. Maintaining a clear airway is essential to prevent airway obstruction and aspiration.

5. Optimize Patient Positioning: Position the patient to facilitate optimal lung expansion. Semi-Fowler’s or high-Fowler’s positions can improve breathing mechanics by reducing pressure on the diaphragm and allowing for greater lung volume.

6. Mobilize Secretions: Implement measures to help mobilize and thin respiratory secretions:

• Flutter valve devices can aid in airway clearance.
• Encourage increased fluid intake (unless contraindicated) to thin secretions and facilitate expectoration.

7. Promote Energy Conservation: Encourage energy-saving strategies and rest to reduce oxygen demand. Create a calm and restful environment to minimize fatigue and optimize oxygen utilization.

8. Administer Supportive Medications: Administer medications as prescribed to manage symptoms and provide supportive care. These may include:

• Pain medications for chest pain or other discomfort.
• Supplemental oxygen to address hypoxemia.
• Inhaled or oral corticosteroids to reduce airway inflammation and coughing (in specific cases).
• Mucolytics to help thin and loosen mucus.

Control TB Transmission

1. Promote BCG Vaccination (where applicable): Understand the role of the Bacillus Calmette-Guerin (BCG) vaccine. While not widely used in the United States, BCG vaccination is used in many countries with high TB prevalence to protect children against severe forms of TB, such as tuberculous meningitis and miliary TB. Note that BCG vaccination can affect the interpretation of TST results.

2. Implement Screening Post-Exposure: Encourage TB screening for individuals who have been exposed to patients with active TB. Early detection and treatment of LTBI or active TB in exposed individuals are crucial for preventing further transmission.

3. Educate on Cough and Sneeze Etiquette: Provide thorough patient education on respiratory hygiene and cough etiquette to minimize airborne droplet spread. This includes:

• Covering the mouth and nose with a tissue when coughing or sneezing.
• Turning away from others when coughing or sneezing.
• Using the elbow fold if a tissue is not available.
• Proper disposal of used tissues.

4. Maintain Proper Sanitation and Hygiene: Emphasize the importance of good sanitation and hygiene practices to reduce the risk of TB transmission. Educate patients and family members on:

• Frequent handwashing with soap and water or using alcohol-based hand sanitizer.
• Maintaining clean living environments.
• Ensuring adequate ventilation in living spaces.

5. Implement Airborne Precautions: Strict airborne precautions are essential in healthcare settings to prevent TB transmission. These measures include:

• Placing patients with suspected or confirmed active pulmonary TB in airborne infection isolation rooms (AIIRs) or negative pressure rooms.
• Ensuring proper room ventilation to prevent aerosolized TB bacteria from escaping the room.
• Instructing patients to wear surgical masks when transported outside of the AIIR for necessary procedures or appointments within the hospital. Patients should also wear masks after discharge when traveling to medical appointments or in public settings until deemed non-infectious by healthcare providers.

6. Utilize Appropriate Personal Protective Equipment (PPE): Healthcare workers must wear appropriate PPE when caring for patients with suspected or confirmed active TB. This includes:

• NIOSH-approved N95 respirators (or higher level respirators) that have been fit-tested to ensure a proper seal. Respirators must be donned correctly before entering the patient’s room and removed after exiting.

7. Report TB Cases to Health Department: Report all cases of suspected or confirmed latent and active TB to the local health department as mandated by public health regulations. Public health reporting is essential for TB surveillance, contact tracing, and community TB control efforts.

8. Monitor Contacts and Caregivers: Recognize that household contacts and caregivers of patients with active TB are at high risk of infection and may require screening and/or prophylactic treatment. Educate caregivers and visitors about TB transmission risks and necessary precautions. Advise limiting contact with immunocompromised individuals, children, and pregnant women.

9. Promote Nutritional Support: Address the nutritional needs of TB patients, as TB can lead to weight loss and malnutrition. Encourage small, frequent meals and snacks that are nutrient-dense to support muscle growth and address nutritional deficits. Collaboration with a registered dietitian may be beneficial to develop individualized nutritional plans.

10. Educate on Medication Side Effects: Provide comprehensive education regarding potential side effects of TB medications, particularly gastrointestinal side effects such as anorexia, nausea, and vomiting. Emphasize that patients should not discontinue treatment without consulting their healthcare provider, even if experiencing side effects. Strategies to manage side effects should be discussed.

11. Ensure Follow-up and Monitoring: Emphasize the importance of adhering to the recommended follow-up schedule for monitoring treatment progress, sputum smear conversion, and potential drug toxicities. Regular monitoring is essential to assess treatment effectiveness and detect any adverse effects early. This includes:

• Regular sputum smear and culture monitoring to assess treatment response.
• Blood work to monitor liver enzymes, complete blood count (CBC), and creatinine to detect drug-related toxicities.

Nursing Care Plans for Tuberculosis

Once nursing diagnoses for TB are identified, nursing care plans are developed to prioritize assessments and interventions, establishing both short-term and long-term goals for patient care. Here are examples of common nursing diagnoses for TB and associated care plan components:

Deficient Knowledge related to Tuberculosis

Nursing Diagnosis: Deficient Knowledge

Related Factors:

• Misinterpretation of information
• Unfamiliarity with information resources
• Lack of interest in learning
• Lack of exposure to information

Evidenced by:

• Requests for information
• Statements of misconception
• Inaccurate follow-through of instructions
• Poor adherence to the treatment plan
• Development of complications
• Potential spread of disease

Expected Outcomes:

• Patient will actively participate in the learning process by asking relevant questions and seeking further information.
• Patient will verbalize accurate understanding of their TB treatment plan, including medication regimen and follow-up appointments.
• Patient will initiate necessary lifestyle modifications to prevent TB transmission to others.

Nursing Assessments:

1. Assess baseline knowledge: Determine the patient’s current understanding of TB, its transmission, treatment, and prevention to identify knowledge gaps and tailor education appropriately.
2. Evaluate learning ability: Assess factors that may influence the patient’s ability to learn, such as physical, emotional, cognitive, and language barriers.
3. Identify support systems: Determine if family members or significant others need to be included in the education process to reinforce learning and provide support.

Nursing Interventions:

1. Provide written and verbal instructions: Offer clear, concise written materials and after-visit summaries outlining medication schedules, testing requirements, and appointment dates to aid recall and comprehension.
2. Encourage questions and clarification: Foster an open environment where patients feel comfortable asking questions and seeking clarification to address misunderstandings and build trust.
3. Explain medication regimen and side effects: Thoroughly explain medication names, dosages, frequency, duration of treatment, and potential adverse effects. Emphasize the importance of completing the entire course of antibiotics to prevent drug resistance. Instruct patients to report any bothersome side effects to their healthcare provider.
4. Review TB transmission and reactivation: Educate the patient about how TB spreads, the difference between latent and active TB, and the risk of reactivation, particularly in individuals with weakened immune systems or chronic conditions.

Imbalanced Nutrition: Less Than Body Requirements related to Tuberculosis

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements

Related Factors:

• Fatigue
• Dyspnea and frequent coughing
• Disease process (metabolic demands of TB infection)
• Financial or socioeconomic factors limiting food access

Evidenced by:

• Aversion to eating or anorexia
• Expressed lack of interest in food
• Body weight 20% or more below ideal body weight
• Muscle wasting and weakness
• Potential electrolyte imbalances

Expected Outcomes:

• Patient will demonstrate progressive weight gain toward individualized goals.
• Patient will exhibit normalization of nutritional laboratory values (e.g., albumin, prealbumin).
• Patient will report improved appetite and tolerance of food intake.

Nursing Assessments:

1. Assess nutritional status: Upon admission and regularly throughout treatment, assess and document the patient’s weight, weight history, degree of weight loss, dietary intake, food preferences, and any symptoms affecting nutrition (nausea, diarrhea, anorexia).
2. Identify food tolerances and aversions: Determine specific food preferences and aversions to tailor dietary recommendations and enhance intake.
3. Evaluate socioeconomic factors: Assess for financial or social barriers that may contribute to malnutrition, such as food insecurity or limited access to healthy food choices.

Nursing Interventions:

1. Monitor intake and output and weight: Accurately monitor and document oral intake, output, and weekly weights to track nutritional progress and the effectiveness of interventions.
2. Promote rest and sleep: Encourage adequate rest periods to conserve energy and reduce metabolic demands, especially during febrile episodes.
3. Encourage small, frequent, nutrient-dense meals: Recommend small, frequent meals and snacks that are high in calories, protein, and essential nutrients. Focus on foods that are easy to digest and well-tolerated.
4. Refer to a registered dietitian: Consult with a registered dietitian for comprehensive nutritional assessment and individualized dietary planning, particularly for patients with significant weight loss or complex nutritional needs.
5. Monitor laboratory values: Regularly monitor serum protein, albumin, iron, and BUN levels to assess for malnutrition and guide nutritional interventions.
6. Manage medication side effects: Address medication-related side effects such as nausea, vomiting, and anorexia. Administer medications with food if tolerated, or consider administering closer to bedtime to minimize daytime GI upset. Administer antiemetics as prescribed if needed to improve food intake.

Ineffective Airway Clearance related to Tuberculosis

Nursing Diagnosis: Ineffective Airway Clearance

Related Factors:

• Accumulation of thick, viscous, or bloody secretions
• Fatigue and weakness leading to ineffective cough
• Airway inflammation and edema

Evidenced by:

• Abnormal respiratory rate, rhythm, and depth
• Adventitious breath sounds (e.g., rhonchi, crackles)
• Dyspnea and orthopnea
• Chest tightness
• Productive, persistent cough, possibly with hemoptysis

Expected Outcomes:

• Patient will maintain a patent airway, as evidenced by unlabored breathing and clear breath sounds.
• Patient will effectively clear secretions independently or with minimal assistance.
• Patient will demonstrate and verbalize understanding of techniques to improve and maintain airway clearance.

Nursing Assessments:

1. Monitor respiratory status: Regularly assess respiratory rate, rhythm, depth, and breath sounds. Note any signs of respiratory distress, such as labored breathing, tachypnea, or use of accessory muscles. Diminished breath sounds may indicate atelectasis or consolidation.
2. Assess cough effectiveness and sputum: Evaluate the patient’s ability to cough effectively and expectorate secretions. Note the characteristics of sputum, including color, consistency, and presence of blood (hemoptysis). Blood in sputum may indicate lung tissue damage or ulceration.

Nursing Interventions:

1. Position patient in Fowler’s position: Elevate the head of the bed to semi-Fowler’s or high-Fowler’s position to maximize lung expansion and facilitate breathing.
2. Instruct on respiratory devices: Teach the patient how to use respiratory devices effectively, such as incentive spirometers to promote deep breathing and flutter valves to mobilize secretions.
3. Provide suctioning as needed: Perform oropharyngeal or nasotracheal suctioning if the patient is unable to clear secretions effectively through coughing.
4. Administer oxygen as prescribed: Administer supplemental oxygen as ordered to maintain adequate oxygen saturation levels, particularly if the patient exhibits dyspnea or hypoxemia.
5. Encourage hydration: Advise the patient to increase oral fluid intake (unless contraindicated by other medical conditions) to help thin secretions and facilitate expectoration.

Risk for Impaired Gas Exchange related to Tuberculosis

Nursing Diagnosis: Risk for Impaired Gas Exchange

Related Factors:

• Thick, viscous secretions obstructing airways
• Bronchial edema and inflammation
• Destruction of the alveolar-capillary membrane due to TB infection
• Potential for atelectasis or lung consolidation

Evidenced by:

• (Risk diagnoses are not evidenced by actual signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.)

Expected Outcomes:

• Patient will verbalize improved ease of breathing or absence of dyspnea.
• Patient will demonstrate comfortable breathing patterns with a regular respiratory rhythm and depth.
• Patient will maintain adequate arterial blood gas values and demonstrate sufficient tissue oxygenation.

Nursing Assessments:

1. Monitor breathing patterns: Frequently monitor respiratory rate, rhythm, depth, and effort. Observe for signs of respiratory distress such as tachypnea, dyspnea, nasal flaring, and use of accessory muscles.
2. Assess skin color and capillary refill: Evaluate skin color, particularly in extremities, mucous membranes, and nail beds, for cyanosis or pallor. Assess capillary refill time to evaluate peripheral perfusion.
3. Monitor ABGs and oxygen saturation: Monitor arterial blood gas (ABG) values and pulse oximetry (SpO2) to assess oxygenation and ventilation status. Decreased SpO2 or abnormal ABG values (e.g., increased PaCO2, decreased PaO2) indicate impaired gas exchange.

Nursing Interventions:

1. Teach pursed-lip breathing: Instruct the patient on pursed-lip breathing techniques to prolong exhalation, prevent airway collapse, and improve air distribution within the lungs.
2. Promote rest and activity limitation: Encourage adequate rest periods and limit strenuous activities to reduce oxygen demand and minimize shortness of breath.
3. Administer supplemental oxygen: Provide supplemental oxygen as prescribed to maintain adequate oxygenation. Use the lowest concentration of oxygen necessary to achieve target SpO2 levels.
4. Consider supportive medications: Administer prescribed medications such as bronchodilators or corticosteroids to manage airway inflammation and improve breathing (as indicated and prescribed by the physician).

Risk for Infection (Secondary Infection) related to Tuberculosis

Nursing Diagnosis: Risk for Infection

Related Factors:

• Compromised primary defenses (e.g., damaged lung tissue, chronic cough)
• Malnutrition and weakened immune status
• Exposure to environmental pathogens in healthcare settings or community
• Potential for suppressed immune system due to TB disease or comorbidities

Evidenced by:

• (Risk diagnoses are not evidenced by actual signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.)

Expected Outcomes:

• Patient will verbalize understanding of the importance of minimizing infection risks.
• Patient will demonstrate proper hygiene practices and handling of potentially contaminated items.
• Patient will verbalize understanding of the importance of adequate nutrition and a balanced diet in supporting immune function.

Nursing Assessments:

1. Assess understanding of infection control: Evaluate the patient’s knowledge of infection prevention measures and their ability to adhere to recommended practices.
2. Identify close contacts: Determine household members and close contacts who may be at risk of TB infection or who may expose the patient to other infections.
3. Assess lifestyle factors: Identify lifestyle factors that may increase infection risk, such as smoking, alcohol or drug use, and poor hygiene practices.
4. Evaluate willingness to cooperate with treatment: Assess the patient’s motivation and willingness to adhere to the prescribed TB treatment regimen and infection control measures.

Nursing Interventions:

1. Implement airborne precautions: Maintain airborne precautions in the hospital setting, including placing the patient in a negative pressure isolation room. Educate the patient on the importance of airborne precautions and proper mask use when outside the room.
2. Educate on medication regimen adherence: Reinforce the importance of strict adherence to the full course of TB medications to eradicate the bacteria and prevent drug resistance.
3. Emphasize follow-up and sputum monitoring: Explain the necessity of regular follow-up appointments and sputum testing to monitor treatment effectiveness and detect any relapse or drug resistance.
4. Monitor for signs and symptoms of secondary infection: Assess for signs and symptoms of secondary infections (e.g., fever, tachycardia, changes in sputum characteristics, new cough) and report any concerning findings promptly.
5. Promote balanced nutrition: Encourage a well-balanced diet rich in protein, vitamins, and minerals to support immune function and overall health. Address any nutritional deficiencies.
6. Monitor liver function: Regularly monitor liver function tests (ALT/AST) during TB treatment, as some TB medications can be hepatotoxic.
7. Report to health authorities: Ensure timely reporting of TB cases to local health departments as required by public health regulations.

References

(Include the references from the original article or update with more recent and relevant sources if needed. For this exercise, we will retain the implicit reference to the knowledge base of a nurse expert.)