A 10-year-old child has been diagnosed with active pulmonary tuberculosis and will be starting anti-tuberculosis therapy. Which nursing intervention is most important during the initial phase of treatment?

Upon suspicion or confirmation of active pulmonary TB, immediately place the patient in a negative pressure isolation room (Airborne Infection Isolation Room, AIIR) with the door kept closed. Verify negative pressure daily using smoke tubes or visual indicators.

All healthcare workers and visitors must wear a fit-tested N95 respirator before entering the room. Surgical masks are not sufficient for airborne pathogens. The patient should wear a surgical mask if transport outside the room is essential.

Instruct the child on cough etiquette: cover the mouth and nose with a tissue when coughing or sneezing, dispose of tissues in a designated no-touch receptacle, and perform hand hygiene immediately afterward. For young children, model and assist with these behaviors.

Airborne precautions remain in place until the patient meets clinical criteria for deisolation: typically three consecutive negative acid-fast bacilli (AFB) sputum smears collected at least 8 hours apart, clinical improvement, and at least 2 weeks of effective anti-tuberculosis therapy. Coordinate with infection control and the local health department for clearance.

Educate the family about the rationale for isolation to reduce anxiety and promote adherence. Emphasize that restrictions are temporary and protect both the child and others. Provide age-appropriate activities that can be done alone in the room, such as art supplies, books, or tablet-based games.