NCLEX Review Guide: Tuberculosis

Tuberculosis Overview

• Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs but can involve any organ system.
• TB spreads through airborne droplets when infected individuals cough, sneeze, or speak, making it highly contagious in active disease.
• Risk factors include immunocompromised states (HIV/AIDS), malnutrition, crowded living conditions, substance abuse, and chronic diseases like diabetes.

Signs and Symptoms

• Classic triad includes persistent cough lasting >3 weeks, hemoptysis, and night sweats with unintentional weight loss.
• Systemic symptoms include fever, fatigue, anorexia, and chest pain that may worsen with deep breathing or coughing.
• Extrapulmonary TB may present with symptoms specific to affected organs (bone pain, neurological changes, genitourinary symptoms).

Tuberculosis Testing Methods

• Tuberculin Skin Test (TST) involves intradermal injection of PPD; results read at 48-72 hours measuring induration, not erythema.
• Interferon-Gamma Release Assay (IGRA) blood test is more specific than TST and not affected by BCG vaccination history.
• Chest X-ray may show upper lobe infiltrates, cavitation, or hilar lymphadenopathy in active pulmonary TB.
• Sputum culture remains the gold standard for diagnosis, requiring 3 consecutive morning specimens for acid-fast bacilli (AFB).

Pharmacological Treatment

1. Initial phase (2 months): Four-drug regimen including Isoniazid (INH), Rifampin (RIF), Ethambutol (EMB), and Pyrazinamide (PZA)
2. Continuation phase (4-7 months): Two-drug regimen with Isoniazid and Rifampin for drug-sensitive TB
3. Directly Observed Therapy (DOT) ensures medication compliance and prevents drug resistance development
4. Monitor for drug side effects: hepatotoxicity (INH, RIF, PZA), optic neuritis (EMB), and orange discoloration of body fluids (RIF)

Nursing Interventions

• Implement airborne precautions with negative pressure rooms, N95 respirators for healthcare workers, and patient surgical masks during transport.
• Patient remains infectious until 3 consecutive negative sputum cultures or after 2-3 weeks of effective treatment with clinical improvement.
• Contact tracing and screening of household members and close contacts is essential for preventing disease spread.
• Patient education includes medication compliance, infection control measures, and importance of completing full treatment course.