For Deficient Knowledge, you first need to assess the client's level of consciousness (alert, oriented X 4), his or her education level, and his or her reading level (usually 2 years below education level). Most of the American public require printed material on a 5th grade reading level. Next you need to determine the client's preferred learning style: one-on-one instruction, pamphlet or printed material, video, or a combination of these? One-on-one instruction with combination of printed material (on 5th grade reading level with lots of pictures) is preferred.
Teaching is vitally important for the client with active tuberculosis. This will help ensure the client completes the medication regimen and help avoid the emergence of multidrug resistant TB and spread of the TB in society. Areas of teaching:
Medications/ side effects.
Combination drug therapy: use of multiple oral medications. The use of multiple-drug regimens destroys organisms as quickly as possible and minimizes the emergence of drug-resistant organisms and transmission of the TB pathogen.
Isoniazid (INH) and Rifampin throughout therapy (most effective).
Pyrazinamide is added for 1st 2 months.
Ethambutol is also added for the 1st 4-6 weeks, until sensitivities received. If the other three medications are cleared by the sensitivities, then this drug will be dropped. These four are the standard part of initial treatment.
Streptomycin may be added for multidrug resistant TB or in the case of hepatotoxicity.
The duration of drug therapy with this combination is approximately 6 -12 months. TB drugs have multiple side effects, most notably liver toxicity, loss of vision, and loss of hearing. Teach patient the side effects and observe patient closely during therapy.
Patients are monitored during the course of drug treatment. Strict adherence to the prescribed drug regimen is crucial for suppressing the disease and preventing the emergence of multidrug resistance tuberculosis strains. A strain of MDR TB develops when a case of drug-susceptible tuberculosis is improperly or incompletely treated. The nurse's major role is teaching the client about drug therapy, monitoring for side effects from these powerful drugs, and directly observing the client take the medications. All active tuberculosis cases in North Carolina, require Direct Observation Therapy. The community health nurse must go to the client’s residence to give client medication—must watch client swallow the pills (this is called Direct Observation Therapy). Direct Observation Therapy occurs every day for the first two weeks of therapy, and then twice weekly for the next 5-1/2 months of therapy.
Isolation/ Preventing Disease Spread:
The hospitalized client with active TB is placed under airborne precautions in a well-ventilated room. The room should have at least 6 exchanges of fresh air per minute and should be ventilated to the outside. Nurse wears an N-95 or HEPA respirator when caring for the patient, or in room. When there is a risk of hand and clothing contamination, standard precautions are implemented by using appropriate barrier protection (gowns and gloves). Thorough hand-washing, of course, before and after client care.
The risk of transmission of TB is greatly decreased after 2-3 consecutive weeks of effective drug therapy with clinical improvement. The client cannot be taken off of isolation, however, until he or she has three negative sputum cultures (usually about 2-3 months). The client must then continue with the prescribed drugs for 6 months or longer as prescribed.
Precautions are discontinued after the client is no longer considered infectious (after three negative sputum cultures, while on antibiotic therapy). All procedures possible should be performed on the client in the negative pressure room, during the time the client is still considered infectuous. Clients at home must stay in their home until there are three negative sputum cultures with antibiotic therapy.
Well-balanced diet, rich in iron, protein, vitamin C. Vitamin B-6 (pyridoxine) must be used concurrently with Isoniazid.