Which of the following is the primary reason for emphasizing medication adherence in a patient with active tuberculosis?

B) To ensure the eradication of the bacteria and cure the patient

A) To prevent the spread of the infection to others

B) To ensure the eradication of the bacteria and cure the patient

C) To manage side effects effectively

D) To reduce the cost of long-term treatment

Which of the following is the most important initial nursing action when caring for a patient newly diagnosed with active pulmonary tuberculosis?

B) Initiate airborne isolation precautions

A) Educate the patient on the importance of medication adherence

B) Initiate airborne isolation precautions

C) Provide the patient with a balanced diet plan

D) Refer the patient to a support group for emotional support

A patient undergoing anti-tubercular treatment reports mild nausea. What is the most appropriate nursing intervention to address this side effect?

B) Suggest taking medications with food

A) Advise the patient to take medications on an empty stomach

B) Suggest taking medications with food

C) Recommend stopping the medication until nausea resolves

D) Increase the dosage of medications to build tolerance

Which statement by the patient indicates a correct understanding of the importance of completing the full course of anti-tubercular medication?

B) 'I should continue taking the medication until I finish the entire prescription, even if I feel better.'

A) 'I can stop taking the medication once my symptoms disappear.'

B) 'I should continue taking the medication until I finish the entire prescription, even if I feel better.'

C) 'It is okay to skip doses as long as I don't have any symptoms.'

D) 'I only need to take the medication when I start feeling sick again.'

Which of the following is the most important reason for the patient to complete the full course of anti-tubercular medication?

A) To prevent the development of drug-resistant strains of Mycobacterium tuberculosis.

B) To reduce the cost of future healthcare expenses.

C) To eliminate all symptoms of fatigue and nausea completely.

D) To improve the patient's immediate energy levels and appearance.

Tuberculosis - Nursing Case Study

Pathophysiology

• Primary mechanism: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which enters the body through inhaled droplets, reaching the lungs where it is engulfed by immune cells called macrophages. However, instead of being destroyed, the bacteria can survive and multiply inside these cells.

• Secondary mechanism: The immune system responds by forming granulomas, which are clusters of immune cells that wall off the bacteria to prevent spread. This containment can keep the infection inactive or latent, but if the immune response weakens, the bacteria can become active, leading to disease symptoms.

• Key complication: If active tuberculosis develops, the bacteria can destroy lung tissue, causing symptoms like a persistent cough, chest pain, and coughing up blood. This damage can complicate breathing and reduce oxygen exchange, impacting overall health.

Patient Profile

Demographics:

28-year-old female, school teacher

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Persistent cough for 3 weeks

• Key symptoms: Mild fatigue, low-grade fever, night sweats

• Vital signs: Temperature 37.5°C, Heart rate 80 bpm, Blood pressure 118/76 mmHg, Respiratory rate 18 breaths/min, Oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon conducting a thorough nursing assessment, the 28-year-old female patient presents with a persistent cough that has not improved over the past three weeks. The cough is characterized as dry, occasionally producing scant, clear sputum. On auscultation, breath sounds are slightly diminished in the right upper lung field, with no adventitious sounds such as wheezing or crackles detected. The patient reports mild fatigue that has gradually increased, but she continues to manage daily activities, including teaching. She denies any chest pain or hemoptysis at this time.

Further assessment reveals the patient has experienced night sweats, primarily affecting her sleep quality and resulting in occasional insomnia. Her low-grade fever persists, yet she remains hemodynamically stable with a blood pressure of 118/76 mmHg and heart rate of 80 bpm. Oxygen saturation remains at 98% on room air, indicating adequate oxygenation despite the ongoing symptoms. The patient appears mildly anxious about her health but is cooperative and engaged in the assessment process. Given the presentation and history, the nursing team prioritizes further diagnostic testing, including chest X-ray and sputum analysis, to confirm the presence of active tuberculosis and rule out other respiratory conditions.

Section 2

New Diagnostic Results:

Following the initial assessment, the patient undergoes a chest X-ray and sputum analysis. The chest X-ray reveals a small, localized opacity in the right upper lung field, consistent with a potential tuberculosis infection. The radiologist notes that the opacity is confined and not suggestive of widespread disease, correlating with the patient's early-stage presentation. Sputum samples are collected over three consecutive days to confirm the presence of Mycobacterium tuberculosis. The results from the acid-fast bacilli (AFB) smear test return positive, corroborating the suspicion of active tuberculosis.

Laboratory tests further reveal that the patient has a slightly elevated erythrocyte sedimentation rate (ESR), indicative of inflammation, and a normal white blood cell count, which aligns with her stable condition. Her liver function tests are within normal limits, an important consideration for potential anti-tubercular therapy. Based on these findings, the healthcare team confirms the diagnosis of pulmonary tuberculosis and plans to initiate a standard treatment regimen. The patient is educated about her condition, the importance of medication adherence, and the necessity of follow-up appointments to monitor her response to therapy and prevent complications.

The next steps involve tailoring a treatment plan that includes the first-line anti-tubercular medications, such as isoniazid, rifampin, ethambutol, and pyrazinamide. The nursing team focuses on providing the patient with clear instructions on medication administration and potential side effects, emphasizing the importance of regular monitoring to prevent adverse reactions. The patient is encouraged to maintain a balanced diet and adequate rest to support her recovery, and she is provided with resources for emotional support and stress management to address her mild anxiety. With a comprehensive care plan in place, the patient expresses understanding and readiness to begin her treatment journey.

Section 3

Response to Interventions:

Two weeks into the anti-tubercular treatment regimen, the patient returns for a follow-up appointment to assess her response to the prescribed medications. During this visit, the nursing team conducts a thorough evaluation, noting that the patient reports feeling slightly fatigued but otherwise stable. She mentions experiencing mild nausea, a common side effect of her medication, but it has not significantly impacted her daily activities. She denies any other adverse symptoms, such as vision changes or joint pain, which are important to monitor given the potential side effects of ethambutol and pyrazinamide.

The nursing assessment reveals stable vital signs: her temperature is 37.2°C (99°F), pulse is 78 beats per minute, respiratory rate is 18 breaths per minute, and blood pressure is 118/76 mmHg. These findings, along with her normal respiratory effort and clear lung sounds upon auscultation, suggest that her condition remains stable. Recent lab results show a slight decrease in her erythrocyte sedimentation rate (ESR) to 28 mm/hr, indicating a reduction in inflammation, while liver function tests remain within normal limits, suggesting she is tolerating the medication well without hepatic complications.

The nursing team reinforces the importance of medication adherence and addresses the patient's mild nausea by suggesting she take her medications with food. They also encourage her to continue maintaining a balanced diet and adequate rest. Additionally, they provide reassurance and emotional support, recognizing that the psychological aspect of managing a chronic infectious disease can be challenging. The patient expresses relief at her stable progress and confidence in her ability to continue with the treatment plan. The team schedules her next follow-up appointment and arranges for routine lab monitoring to ensure continued safety and efficacy of the therapy.

Section 4

Three weeks following the last appointment, the patient returns for another routine follow-up. During this visit, the nursing team focuses on assessing any new diagnostic results and monitoring the ongoing response to the anti-tubercular treatment. The patient continues to report mild fatigue, but her nausea has diminished significantly after taking her medications with food as previously recommended. She has been diligent in adhering to her medication schedule and maintaining a balanced diet, both of which are evident in her overall appearance and energy levels.

New diagnostic results include a chest X-ray, which shows slight improvement in the previously noted pulmonary infiltrates, indicating a positive response to the treatment. The patient’s sputum test, conducted to assess the presence of Mycobacterium tuberculosis, returns negative, suggesting effective bacterial suppression. Her vital signs remain stable, with a temperature of 36.9°C (98.4°F), pulse at 76 beats per minute, respiratory rate at 16 breaths per minute, and blood pressure at 116/74 mmHg. These findings, combined with clear lung sounds and normal respiratory effort, reinforce her stable status.

The nursing team explains the new diagnostic results to the patient, highlighting the importance of continued adherence to her treatment plan to achieve full recovery. They emphasize the significance of completing the entire course of medication despite the absence of symptoms, to prevent relapse and resistance. The patient expresses understanding and commits to following the advised regimen. The team schedules her next appointment in four weeks and reiterates the importance of regular lab monitoring, particularly liver function tests, to ensure continued tolerance to the medications. The patient leaves feeling encouraged by her progress and the support from the healthcare team.

Section 5

Four weeks later, the patient returns for her scheduled follow-up appointment, looking visibly more energetic and reporting a noticeable decrease in her overall fatigue. During the initial assessment, the nursing team observes that her weight has stabilized, and she appears well-nourished, a testament to her adherence to the dietary recommendations. Her vital signs remain within normal limits: her temperature is 36.8°C (98.2°F), pulse is steady at 74 beats per minute, respiratory rate is 15 breaths per minute, and blood pressure is 118/76 mmHg. These stable vital signs, coupled with clear lung auscultation, indicate that she is maintaining her positive trajectory.

The patient reports that she has been able to resume light physical activities such as walking and gentle yoga, which have contributed to her improved energy levels and mood. She mentions experiencing occasional mild headaches, which the nursing team attributes to slight dehydration, as her recent lab work shows a slightly elevated hematocrit level. The team advises increasing her fluid intake and monitoring the frequency and intensity of the headaches. They also review her liver function tests, which remain within normal parameters, reassuring both the patient and the healthcare providers of her continued tolerance to the anti-tubercular medications.

The nursing team commends the patient for her commitment to the treatment plan and reinforces the importance of maintaining her medication schedule. They discuss the next steps, which include continuing her current regimen and scheduling another follow-up appointment in six weeks. The patient expresses gratitude for the support and guidance she has received and feels optimistic about her continued recovery. This ongoing collaboration and patient engagement set the stage for a successful outcome and the eventual conclusion of her treatment journey.