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

Nursing Interventions for Risk for Infection

The goal of care for this nursing diagnosis is to reduce the risk of spreading tuberculosis and making sure the patient's tuberculosis is effectively treated. The following nursing activities address these goals:

Teach the patient about the infectious nature of tuberculosis and the need to prevent its spread. Place the patient in a negative pressure room and in a private room. All nurses and visitors entering the patient's room should wear an N-95 mask. Put a mask on the patient during transportation to other departments. Keep the door to the patient's room shut and place an isolation sign at a visible location near the door. Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing. Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag.

Teach the tuberculosis patient to stay in well ventilated areas and limit contact to other people while he or she is still able to spread the infection.

Nursing Interventions for Ineffective Breathing Pattern

Patients with tuberculosis may need to work harder to breathe due to coughing, nervousness or a high fever. Ineffective breathing pattern involves breathing at a faster or slower rate, use of accessory muscles to breathe and fast heart rates amongst other things. Nursing interventions for this problem are as follows:

Administer oxygen if ordered and as ordered by a physician. Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs. Position the patient in a high fowlers position to reduce the work needed to breathe. Encourage and provide rest periods so the tuberculosis patient can have energy to breathe.

Nursing Interventions to Improve Nutritional Status of TB Patients

Proper nutrition is necessary for the body to heal and fight off infections. Nursing interventions to improve the nutritional status of TB patients includes explaining the importance of a nutritious diet, monitoring the patient's weight for improvement or maintenance, administering vitamin supplements as prescribed and providing small frequent meals.

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Increase of Tuberculosis Tuberculosis and Infection Control The White Plague

Nursing Interventions to Improve Compliance with Tuberculosis Drug Regimen

It is important for tuberculosis patients to take their medications as prescribed. Failure to do this may result in drug resistant forms of tuberculosis. This would make the patients tuberculosis difficult to cure. To increase compliance with the drug regimen for tuberculosis which can be very long, the nurse does the following:

teaches the patient about the importance of taking all prescribed medications because the bacteria that causes TB grows slowly and requires a long time to be eliminated. provide the TB patient with information about expected side effects of TB drugs so that they know when to seek a doctors care and when not to be alarmed. refer patients having a hard time sticking to their drug therapy for direct observation therapy, where someone will watch them take their medication as they should.

If all the goals of care for nursing management of tuberculosis are met, the tuberculosis patient should be free of fever and able to breathe properly, practice good infection prevention strategies, maintain his or her body weight and take all medications as prescribed.

http://www.suite101.com/content/nursing-management-of-tuberculosis-a221663 http://ccn.aacnjournals.org/content/29/2/34.full

health teaching

importance of vaccination in children accomplishment of desired treatment need for follow up examination proper hygiene and sanitation

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

Isolation
Because nurses play a key role in detecting tuberculosis, they should advocate for prompt isolation of patients with suspected or confirmed M tuberculosis infection (Figure 4). Nurses should be familiar with the isolation precautions that must be implemented. Patients with suspected tuberculosis should be placed in a negative-pressure room, and appropriate particulate respiratory masks (N-95/high-efficiency particulate air filters) should be readily available outside the door for anyone entering the room.37 The number of visitors should be minimized, and children should be discouraged from visiting. Patients should be instructed to cover their nose and mouth with a tissue when sneezing or coughing. Additionally, they should wear a mask when leaving the room, and nonurgent procedures should be postponed until the infectious phase has passed. View larger version:

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Figure 4 A general plan-of-care algorithm for a patient who may have tuberculosis. Patients receiving mechanical ventilation should also be kept in a negative-pressure room, and respiratory masks should still be used by anyone who enters the room. A closed-system endotracheal suction catheter should be used for suctioning whenever feasible. In order to help reduce the risk of contaminating ventilation equipment or release of M tuberculosis organisms into the room air, a bacterial filter should be placed on the endotracheal tube or on the expiratory side of the ventilation circuit. Good oral care and strict adherence to suctioning infection control practices should be a priority, because ventilator-associated pneumonia is already a predominant nosocomial infection and would pose an enhanced threat to a patient with tuberculosis.

Nutrition
Adequate nutrition is an important feature though all stages of infection. Malnutrition appears to increase the risk for tuberculosis; persons with low body mass index are greatly more at risk for tuberculosis than are those with a high index.38 Additionally, among patients underweight at the time of diagnosis, those who increase their weight by 5% during the first 2 months of treatment have significantly less relapse than do patients who gain less than 5%.38 Nurses should take particular note of underweight tuberculosis patients, recognizing that being underweight is a risk factor for relapse and encouraging aggressive nutritional support.39 Also, because functional recovery often lags behind microbiological cure, the aim of nutritional intervention should be to restore lean tissue.23,39 Nurses should also encourage patients to engage in physical activity to counter the loss of muscle mass and subsequent fatigue. Advocating for a nutritionist and physical therapist to evaluate a patient with tuberculosis to make patient-specific recommendations would be an appropriate action for nurses.

Emotional Support and Education

In addition to the direct responsibilities of nursing, many nurses are also a key source of emotional support for patients and patients families during times of illness. Perceived emotional support from nursing staff can improve adherence to therapy. Many patients with tuberculosis experience feelings of guilt and face stigma, and patients family members often fear associating with the patients.40 Nurses can provide education to patients and patients families about transmission and treatment to help reduce misconceptions and can elicit conversations to communicate concerns. Encouragement combined with education can affect a patients adherence to therapy, as well as improve the patients mood and perception of the illness.

Nursing Management 1. Address emotional and psychosocial needs.

Women with trophoblastic disease may experience the same feeling of loss after its evacuation that she would have experienced after the loss of a true

pregnancy. In addition, she is faced with the possibility that a malignancy may develop. Encourage the patient and her family to express their feelings. Offer emotional support and help them through the grieving process. Help the patient and her family develops effective coping strategies, referring them to a mental health professional, if needed.

2. Ensure physical well being of the client through accurate assessment and interventions.

Obtain baseline vital signs. Preoperatively observe the patient for signs of complications, such as hemorrhage, uterine infection, and vaginal passage of vesicles. Save any expelled tissue for laboratory analysis. Prepare the patient physically and emotionally for surgery, if indicated. Postoperatively, monitor vital signs and fluid intake and output, and assess for signs of hemorrhage.

3. Provide client and family teaching. Ensure appropriate follow-up and self-care by explaining that frequent possibility of recurrence of the problem or progression to choriocarcinoma. Also explain that hCG levels should be monitored for 1 year. Discuss the need to prevent pregnancy for at least 1 year after diagnosis and treatment. Describe and emphasize signs and symptoms that must be reported (i.e., irregular vaginal bleeding, persistent secretion from the breast, hemoptysis, and severe persistent headaches). These symptoms may indicate spread of the disease to other organs.

Maintain respiratory isolation until patient responds to treatment or until the patient is no longer contagious. Administer medicines as ordered. Always check sputum for blood or purulent expectoration. Encourage questions and conversions so that the patient can air his or her feelings.

Teach or educate the patient all about PTB. Encourage the patient to stop smoking. Teach the patient to cough or sneeze into tissue paper and dispose secretions properly. Advise patient to have plenty of rest and eat balanced meals. Be alert for signs of drug reaction. If the patient is receiving ethambutol, watch for optic neuritis. If it develops, discontinue the drug. If the patient receives rifampicin (Rifampin), watch for hepatitis and purpura. Also observe the patient for complications like hemoptysis. Emphasize the importance of regular follow-up examinations and instruct the patient and his family about the signs and symptoms of recurring TB.

NURSING INTERVENTION 1. Ensure physical well being of the patient through accurate assessment and interventions. Obtain baseline vital signs.

Monitor sputum for changes indicating infection Send sputum specimens for culture Administer medications, noting for effectiveness and side effects Teach effective deep breathing and coughing techniques Administer oxygen if ordered and as ordered by a physician. Give the TB patients fluids to loosen up secretions for easier expulsion from the lungs.

2. Institute appropriate isolation precautions

Place the patient in a negative pressure room. Respiratory masks (N-95) should be readily available outside the door for anyone entering the room. Put a mask on the patient during transportation to other departments. Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing. Instruct patient to cover their nose and mouth with a tissue when sneezing or coughing. The number of visitors should be minimized, and children should be discouraged from visiting.

3. Maintain adequate nutrition

Monitor the patient's weight for improvement Administer vitamin supplements as prescribed Encourage intake of fruits and vegetables Provide healthy diet high in protein, calcium and pyridoxine to wall off organisms in lung tissue

4.

Improve compliance with Tuberculosis Drug Regimen

Provide the patient with information about expected side effects of PTB drugs so that they know when to seek a doctors care and when not to be alarmed. Refer patients having a hard time sticking to their drug therapy for direct observation therapy where someone will watch them take their medication as they should.

Inform patient of the benefits of conforming with the regimen Ask to see prescription drugs periodically and count the remaining pills Instruct patient on the importance of ordering refills of medications several days ahead of running out

HEALTH TEACHING As a nurse educator, nurses must provide health teaching to the patient and their family to promote better outcome and recovery. Nurses should teach the patient and family:

Purpose and techniques for infection control such as hand washing, patient covering mouth when coughs, maintaining isolation if necessary. Purpose, importance and how to take medications as prescribed consistently over the long term therapy. Effective deep breathing and coughing techniques. About the infectious nature of tuberculosis and the need to prevent its spread. About the importance of taking all prescribed medications because the bacteria that causes TB grows slowly and requires a long time to be eliminated. Importance of the need for follow up examination.
Importance of receiving regular immunization in children. Provide proper hygiene and environmental sanitation.