Nursing Diagnosis for Guillain-Barré Syndrome (GBS)

Pulmonary tuberculosis (TB) remains a major public health concern worldwide. As front-line caregivers, nurses play a central role in assessment, infection control, medication adherence, symptom management, and patient education. This article presents four common nursing diagnoses for patients with pulmonary TB, evidence-based nursing interventions, and clear rationales — suitable for use in clinical documentation, teaching, or a nursing care plan.

Quick overview: Pulmonary tuberculosis (brief)

Pulmonary tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis, primarily affecting the lungs. Transmission occurs via airborne droplet nuclei produced when a person with active pulmonary TB coughs, sneezes, or speaks. Classic symptoms include persistent cough (often >2–3 weeks), sputum production, hemoptysis, fever, night sweats, and weight loss. Diagnosis relies on sputum microscopy/culture, molecular tests (e.g., Xpert MTB/RIF), and chest imaging.

Important nursing priorities

• Prevent transmission (airborne precautions and community education)
• Ensure adherence to anti-tuberculosis therapy (ATT) and monitor for side effects
• Maintain adequate oxygenation and airway clearance
• Address nutritional, psychosocial, and knowledge deficits that affect recovery

Four common nursing diagnoses for pulmonary TB

1. Ineffective airway clearance related to increased sputum production, bronchial inflammation, and fatigue

Goal

Patient will maintain a patent airway with effective cough, clear breath sounds, and adequate oxygenation (SpO₂ ≥ baseline or clinician target).

Interventions & Rationale

1. Assess respiratory status: monitor respiratory rate, rhythm, effort, breath sounds, cough effectiveness, and sputum characteristics every 2–4 hours (or per unit protocol).
   Frequent assessment detects deterioration early (e.g., airway obstruction, consolidation, or need for suctioning).
2. Encourage effective coughing and deep-breathing exercises; teach controlled coughing techniques and huff coughs.
   Improves mobilization of secretions and supports alveolar ventilation, reducing atelectasis risk.
3. Provide chest physiotherapy or assisted postural drainage if indicated and available.
   Mechanical methods facilitate mucus clearance when the patient is weak or unable to cough effectively.
4. Administer humidified oxygen or nebulized saline as ordered.
   Humidity helps thin secretions and makes coughing more productive; oxygen supports tissue oxygenation when hypoxemia is present.
5. Perform suctioning (oropharyngeal/endotracheal) only when necessary using aseptic technique.
   Clears retained secretions while reducing risk of trauma and secondary infection; follow infection control precautions due to aerosol generation.

2. Impaired gas exchange related to alveolar-capillary membrane changes, inflammation, and consolidation

Goal

Patient will demonstrate improved oxygenation (PaO₂/SpO₂ within target range), decreased dyspnea, and improved activity tolerance.

Interventions & Rationale

1. Monitor oxygenation and vital signs: continuous or frequent SpO₂ monitoring, measure respiratory rate and pattern, and observe work of breathing.
   Objective data guide oxygen therapy and indicate need for escalation of care (e.g., high-flow oxygen, respiratory support).
2. Administer supplemental oxygen as prescribed and titrate to target saturation.
   Restores oxygen delivery to tissues and reduces hypoxemic complications. Avoid hyperoxia when not needed.
3. Position the patient to maximize ventilation-perfusion matching (e.g., semi-Fowler's; position affected lung up/patient lateral for unilateral disease if beneficial).
   Optimizes diaphragmatic excursion and ventilation of better-perfused lung areas, improving gas exchange.
4. Collaborate with respiratory therapy for inhaled bronchodilators, steroids, or chest physiotherapy when indicated.
   Adjunctive therapies reduce bronchospasm and inflammation, improving airflow and oxygenation.
5. Evaluate the need for escalation (noninvasive ventilation or ICU care) if signs of respiratory failure develop.
   Timely transfer and advanced support reduce morbidity and mortality in respiratory compromise.

3. Risk for infection transmission (to others) related to active, untreated pulmonary TB and airborne spread

Goal

Transmission risk is minimized through strict airborne precautions, patient and staff education, and appropriate public health reporting and follow-up.

Interventions & Rationale

1. Place patient in airborne infection isolation (negative-pressure room) whenever available until noninfectious.
   Negative-pressure rooms reduce dissemination of droplet nuclei to other areas, protecting staff and other patients.
2. Ensure healthcare workers wear appropriate respiratory protection (e.g., fit-tested N95/FFP2 or higher) during patient contact; provide surgical mask to patient when outside room.
   Respiratory protection reduces inhalation of infectious droplet nuclei; masking the patient reduces emission during transport.
3. Teach respiratory hygiene: cover mouth/nose when coughing, dispose tissues, perform hand hygiene after handling secretions.
   Interrupts chain of transmission by reducing contaminated droplets and contact spread.
4. Coordinate rapid initiation of effective anti-TB therapy and public health notification for contact tracing and community follow-up.
   Effective treatment reduces bacillary load and infectivity; public health involvement ensures contacts are evaluated and treated if needed.
5. Limit visitors and educate household contacts on screening and preventive therapy per local guidelines.
   Reducing exposure events and ensuring contacts are screened lowers secondary transmission risk in the community.

4. Knowledge deficit regarding TB disease process, treatment regimen, and infection control

Goal

Patient (and caregivers) will verbalize understanding of TB transmission, the importance of taking medications exactly as prescribed (including DOT when used), recognize common drug side effects, and demonstrate infection-control behaviors.

Interventions & Rationale

1. Provide individualized education using simple language and teach-back techniques about TB cause, transmission, and the need for long-term treatment (typically multiple months).
   Teach-back confirms comprehension; understanding increases adherence and reduces risky behaviors that spread infection.
2. Explain the anti-TB drug regimen (names, frequency, purpose) and common adverse effects to watch for (hepatic symptoms, peripheral neuropathy with isoniazid, orange body fluids with rifampicin), advising when to seek care.
   Awareness of adverse effects leads to early reporting and management, reducing severe complications and improving adherence.
3. Encourage use of Directly Observed Therapy (DOT) or digital adherence support when available; help arrange follow-up appointments and social supports (transport, food, counseling).
   DOT and support services significantly improve treatment completion and reduce development of drug resistance.
4. Provide written materials, community resources, and contact numbers; document teaching and patient responses in the record.
   Written aids reinforce verbal teaching and are helpful for low-health-literacy patients; documentation supports continuity of care.

Additional nursing considerations

• Monitor for medication side effects (especially hepatotoxicity): baseline and periodic liver function tests per local protocol; instruct patient to report jaundice, dark urine, severe nausea.
• Address nutrition (high-protein, calorie-dense diet) and encourage weight maintenance — TB is catabolic and nutritional status affects immune response.
• Screen for comorbidities that influence TB outcomes (HIV, diabetes) and coordinate multidisciplinary care.
• Support psychosocial needs and stigma reduction; TB can cause isolation and anxiety — involve social work and counseling as appropriate.

Note: Medication specifics (doses/schedules) and local infection-control rules vary by country and facility. Always follow national TB program guidance and your institution's policies.

Sample nursing care plan summary (quick view)

Nursing Diagnosis	Primary Interventions	Expected Outcome
Ineffective airway clearance	Cough training, chest physiotherapy, suctioning, humidified O₂	Clear breath sounds; effective cough
Impaired gas exchange	O₂ therapy, monitoring SpO₂, positioning	Improved SpO₂ and decreased dyspnea
Risk for infection transmission	Airborne precautions, N95 for staff, patient masking, public health notification	No secondary cases; reduced exposures
Knowledge deficit	Teach-back education, DOT support, written resources	Adherence to therapy and correct infection-control behavior

References & further reading

The following resources were used to develop the interventions and rationales and are recommended for in-depth, up-to-date guidance:

1. World Health Organization. Tuberculosis (Fact sheets and guidelines). Available: https://www.who.int/health-topics/tuberculosis
2. Centers for Disease Control and Prevention (CDC). Tuberculosis (TB) — Diagnosis, Treatment, Infection Control. Available: https://www.cdc.gov/tb
3. National TB program guidance and local hospital protocols (consult your country's TB control guidelines for drug regimens and isolation policies).
4. American Thoracic Society / Infectious Diseases Society of America. Guidelines on TB management and infection control (see professional guideline summaries).
5. Clinical reviews on TB nursing care and adherence strategies — see PubMed for recent systematic reviews and nursing research summaries.

© Nursing Resources • This article is educational and not a substitute for clinical judgment or local protocols.

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