Med-Surg · chapter 11 · Gas Exchange, Airway Management, and Respiratory System Disorders
Disorders of the Lower Respiratory System: Tuberculosis
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
TB transmission particles
Tiny particles called droplet nuclei are expelled from an infected person during talking, coughing, or singing, and these droplets remain airborne for several hours.
Inhaled bacilli path
Once inhaled, the droplet nuclei bring the tubercle bacilli to the lungs, where they eventually reach the alveoli.
Latent infection formation
In other cases, the initial infection persists but becomes latent. The tubercle bacilli become walled off into a capsule called a granuloma, which prevents spread.
Granuloma cavity spread
Granulomas can develop cavities. They are filled with a lipid-rich substance, which can accelerate the spread throughout the lungs and body via the lymphatic or circulatory systems.
Major U.S. risk factors
In the United States, major risk factors include immunosuppression (including HIV), substance abuse, and malnutrition.
High-density living risk
Due to TB spreading by close contact, the risks of TB infection increase in high-density living situations, including incarceration and other congregate living settings.
Systemic TB symptoms
Patients with active TB infection typically present with systemic symptoms. These can include fever, chills, night sweats, weight loss, weakness, fatigue, and decreased appetite.
Cough and sputum symptoms
A chronic cough, lasting longer than three weeks, can be present, along with bloody or purulent sputum.
Blood and skin test limits
The utility of both blood and skin tests is limited because they are unable to differentiate an active infection from a latent one.
Conclusive TB diagnosis
The conclusive way to diagnose TB is by obtaining a sputum sample and examining it for the presence of tubercle bacilli.
Initial nursing care
Nursing care of the patient with TB begins with screening, symptom assessment, and infection prevention.
Infection spread priority
In patients with suspected or confirmed TB, prevention of the spread of the infection is a high priority.
Airflow room and masking
The nurse should facilitate placement into a negative airflow private room. If a negative airflow room is not available, the patient should always wear a surgical mask and be moved to a location away from others.
Treatment duration rationale
TB generally requires at least six months of treatment. Most of the bacteria are eradicated within the first eight weeks of treatment, but persistent organisms can remain and must be treated to prevent ongoing illness, infectious spread, and antibiotic resistance.
Terms to know
- Tuberculosis
- Tuberculosis is caused by the airborne bacterium Mycobacterium tuberculosis (M. tuberculosis).
- droplet nuclei
- Tiny particles called droplet nuclei are expelled from an infected person during talking, coughing, or singing, and these droplets remain airborne for several hours.
- granuloma
- The tubercle bacilli become walled off into a capsule called a granuloma, which prevents spread.
- pleuritic chest pain
- Patients may report shortness of breath, and pleuritic chest pain can occur; this type of pain is severe, sudden, and happens with inhalation and exhalation.
- disseminated tuberculosis
- An additional treatment goal is to prevent the development of disseminated tuberculosis, where mycobacteria has spread to distant body parts.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 09:00, a patient with suspected TB needs placement, but no negative airflow private room is available. Which entry best documents the interim infection-prevention plan?
- Keep the patient wearing a surgical mask in the shared waiting area until a negative airflow room becomes available.
- Move the patient away from others; patient masking is unnecessary when staff wear fit-tested respirators.
- Move the patient away from others and have the patient wear a surgical mask during coughing episodes.
- Keep a surgical mask on the patient and move the patient to a location away from others.
Answer: Keep a surgical mask on the patient and move the patient to a location away from others.
When a negative airflow room is unavailable, the section calls for both continuous patient masking and placement away from others. Remaining in a shared waiting area or masking only during coughing does not meet those instructions, and staff respirators do not replace patient masking.
At 14:00, a nurse uses teach-back after explaining how a patient receiving TB treatment can reduce transmission at home. Which statements should the nurse document as demonstrating understanding? Select all that apply.
- I will isolate when possible and sleep alone.
- I will cover my nose and mouth when I sneeze or cough.
- I will avoid having visitors.
- I can have visitors as long as their visits are brief.
- I can share a bed again when my cough becomes less frequent.
Answer: I will isolate when possible and sleep alone., I will cover my nose and mouth when I sneeze or cough., I will avoid having visitors.
The section recommends isolating when possible, sleeping alone, avoiding visitors, and covering the nose and mouth during sneezing and coughing. Brief visits still conflict with avoiding visitors. Less frequent coughing is not identified as a reason to stop sleeping alone.
At a 10:00 follow-up after eight weeks of TB treatment, a patient reports an improved cough and asks whether treatment can end. Which entry best documents appropriate counseling?
- Discussed stopping treatment once the cough resolves and restarting if symptoms return.
- Explained that treatment can end after eight weeks because most bacteria have been eradicated.
- Reviewed that treatment generally requires at least six months because persistent organisms can remain after the first eight weeks.
- Explained that follow-up imaging showing improvement is sufficient to end treatment early.
Answer: Reviewed that treatment generally requires at least six months because persistent organisms can remain after the first eight weeks.
The section states that TB generally requires at least six months of treatment because organisms can persist beyond the first eight weeks. Eradication of most bacteria does not mean treatment is complete, and neither symptom resolution nor improved imaging is presented as sufficient justification for ending therapy early.
Where every quote comes from
Section 11.8 Disorders of the Lower Respiratory System: Tuberculosis of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.