DISCHARGE PLAN FOR TUBERCULOSIS

Treatment for Pulmonary Tuberculosis
 A combination of drugs to which the organisms are susceptible is given to destroy viable bacilli as rapidly as
possible and to protect against the emergence of drug-resistant organisms.
 Current recommended regimen of uncomplicated, previously untreated Pulmonary Tuberculosis TB is an
initial phase of 2 months of bactericidal drugs, including isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA),
and ethambutol (EMB). This regimen should be followed until the results of drug susceptibility studies are
available, unless there is little possibility of drug resistance.
1. If drug susceptibility results are known and organism is fully susceptible, EMB does not need to be
included.
2. For children whose visual acuity cannot be monitored, EMB is not normally recommended except with
increased likelihood of INH resistance or if the child has upper lobe infiltration and/or cavity formation
Pulmonary Tuberculosis TB.
3. Due to increasing frequency of global streptomycin resistance, streptomycin is not considered
interchangeable with EMB unless organism is known to be susceptible to streptomycin.
4. PZA may be withheld for severe liver disease, gout and possibly, pregnancy.
5. Adverse effects including liver injury have been noted with rifampin and pyrazinamide in a once daily or
twice weekly combination, therefore this combination is not recommended for the treatment of
latentPulmonary Tuberculosis TB infection.
 Follow with 4 months of isoniazid and rifampin. Six months of therapy is usually effective for killing the
three populations of bacilli: those rapidly dividing, those slowly dividing, and those only intermittently dividing.
 Sputum smears may be obtained every 2 weeks until they are negative; sputum cultures do not become
negative for 3 to 5 months.
 Rifabutin (Mycobutin) is used as a substitute for rifampin if the organism is susceptible to rifabutin and for
patients taking medications that may interact with rifampin.
 Second-line drugs, such as cycloserine (Seromycin), ethionamide (Trecator-SC), streptomycin, Amikacin
(Amikin), kanamycin (Kantrex), capreomycin (Capastat),
para-aminosalicylic acid, and some fluoroquinolones, are used in patients with resistance, for retreatment, and in
those with intolerance to other agents. Patients taking these drugs should be monitored by health
providers experienced in their use.
 For people suspected of having latent Pulmonary Tuberculosis TB infection (LTBI), treatment should begin
after active TB has been ruled out.

Continue medication as Prescribe by the Doctor:

1. Zectin 1cap 30 mg bid

2. Rosvastatin 1 tab 10 mg after super
3. Allupurinol 100 mg 1 tab bid
4. Flixotide 1 neb q12h
5. Combevent 1 neb q4h

HEALTH TEACHING

 Tuberculosis is a problem
1. Get vaccinated and avoid socializing with people who have a persistent cough.
2. Make sure that you eat well and enjoy plenty of sunlight and exercise.
3. Seek medical attention if you develop a cough that persists for more than three weeks.
4. Drink warm fluids and avoid cold fluids
5. Avoid cold weather as much as you can
6. Eat healthy food that contain essential nutrients
7. Stop smoking is very important
8. Take the medications regularly in very strict way
9. DIET:

 Before antibiotics were used to treat tuberculosis, cod liver oil was a mainstay. Studies suggest that the
Vitamin A found in cod liver oil may have helped treat the disease by boosting the immune systems
response to the bacteria. Consume an adequate amount of fruit and vegetables but stay within the
correct calorie level for a healthy weight. On a 2000-calorie diet, eat 2 cups of fruit and 2 and half cups of
vegetables per day. Eat more or less according to your calorie needs.
 Eat a variety of fruit and vegetables each day. Choose from all five vegetable sub-groups (dark green,
orange, legumes, starchy vegetables, and other vegetables) several times a week.
 Consume 3 or more ounce-equivalents of whole-grain foods each day, with the rest of the recommended
grains coming from enriched or whole-grain products. At least half your grains should come from whole
grains. Eating at least 3 ounce-equivalents of whole grains per day can reduce the risk of heart disease,
may help with weight maintenance, and will lower your health risk for other chronic diseases.
 Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. Adults and children can
consume milk and milk products without worrying that these foods lead to weight gain. There are many
fat-free and low-fat choices without added sugars that are available and consistent with an overall healthy
dietary plan. If a person has difficulty drinking milk ...choose alternatives within the milk food group, such
as yogurt or lactose-free milk, or consume the enzyme lactase prior to the consumption of milk products.
For people who must avoid all milk products (e.g. individuals with lactose intolerance, vegans), non-dairy
calcium-containing alternatives may be chosen to help meet calcium needs.

Dietary Fat

 Eat less than ten percent of calories from saturated fats and less than 300 mg/day of cholesterol, and eat
as few trans-fats (hydrogenated fat) as possible.
 Maintain your total intake of fats/oils at between 20-35 percent of calories, with most fat coming from
polyunsaturated and monounsaturated fat, such as oily fish, nuts, and vegetable oils.
 Regarding meat, poultry, dry beans, and milk or milk products, choose lean, low-fat, or fat-free options.

Carbohydrates

 Eat fiber-rich fruits, vegetables, and whole grains as often as possible.

 Consume foods and drinks with little added sugars or caloric sweeteners.

Protein

 Eat lean meats and poultry.

 Bake, broil, or grill food.
 Eat a variety of protein rich foods, with more fish, beans, peas, nuts and seeds.

Sodium and Potassium

 Eat less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.
 Choose low-sodium foods, and do not add salt when cooking. Also, eat potassium-rich foods, such as
fruits and vegetables.

Patient teaching discharge and home healthcare guidelines for Patient with Pulmonary Tuberculosis. Be sure the
patient understands all medications, including the dosage, route, action, and adverse effects. Instruct the patient
to abstain from alcohol while on INH, and refer for eye examination after starting, then every month while taking,
 ethambutol. Teach the patient to recognize symptoms such as fever, difficulty breathing, hearing loss, and chest
pain that should be reported to healthcare personnel.
Patient Teaching & Home Health Guidance for Patient with Pulmonary Tuberculosis

 Improve ventilation by opening windows in room of affected person, and keeping bedroom door closed as
much as possible.
 Instruct patient to cover mouth with fresh tissue when coughing or sneezing and to dispose of tissues
promptly in plastic bags.
 Discuss Tuberculosis TB testing of people residing with patient.
 Investigate living conditions, availability of transportation, financial status, alcohol and drug abuse, and
motivation, which may affect compliance with follow-up and treatment. Initiate referrals to a social worker for
interventions in these areas.
 Report new cases of Tuberculosis TB to public health department for screening of close contacts and
monitoring.
 Review possible complications: hemorrhage, pleurisy, symptoms of recurrence (persistent cough, fever, or
Hemoptysis).
 Instruct patient on avoidance of job-related exposure to excessive amounts of silicone (working in
foundry, rock quarry, sand blasting), which increases risk of reactivation.
 Encourage patient to report at specified intervals for bacteriologic (smear) examination of sputum to
monitor therapeutic response and compliance.
 Instruct patient in basic hygiene practices and investigate living conditions. Crowded, poorly ventilated
conditions contribute to development and spread of Tuberculosis TB.
 Encourage regular symptom screening and follow-up chest X-rays for rest of life to evaluate for
recurrence.
 Show the patient and family how to perform postural drainage and chest percussion. Also teach the
patient coughing and deep-breathing exercises. Instruct him to maintain each position for 10 minutes and then to
perform percussion and cough.
 Instruct patient on prophylaxis with isoniazid for people infected with the tubercle bacillus without active
disease to prevent disease from occurring, or to people at high risk of becoming infected.
 Educate asymptomatic people about PPD testing and treatment of latent Tuberculosis TB for positive
results, based on risk grouping.

PREVENTION

The most important step is to find, isolate and treat all disease carriers until they are no longer an infective risk to
others.
It is always advisable not to get too close to people who are coughing; equally, people with a cough should be
aware of those around them and try not to cough near them.

 In the first, people with TB and their contacts are identified and then treated. Identification of infections often
involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB
(BCG). Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine.
DISCHARGE GOALS

1. Respiratory function adequate to meet individual need.

2. Complications prevented.
3. Lifestyle/behavior changes adopted to prevent spread of infection.
4. Disease process/prognosis and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
PROGNOSIS

Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and
begin to multiply. In primary TB disease—1–5% of cases—this occurs soon after infection. However, in the majority
of cases, a latent infection occurs that has no obvious symptoms.[

 These dormant bacilli can produce tuberculosis in 2–23% of these latent cases, often many years after
infection. The risk of reactivation increases with immunosuppressant. In patients co-infected with M. tuberculosis,
the risk of reactivation increases to 10% per year. Studies utilizing DNA fingerprinting of M. tuberculosis strains
have shown that reinfection contributes more substantially to recurrent TB than previously thought, with between
12% and 77% of cases attributable to reinfection (instead of reactivation).

STAGE OF DISEASE

ACTIVITY/REST

Generalized weakness and fatigue

Shortness of breath with exertion
Difficulty sleeping, with evening or night fever, chills, and/or sweats
Tachycardia, tachypnea/dyspnea on exertion
Muscle wasting, pain, and stiffness

EGO INTEGRITY

Recent/long-standing stress factors

Financial concerns, poverty

Cultural/ethnic populations: Filipina

Anxiety, apprehension

FOOD/FLUID

Loss of appetite
Indigestion
Poor skin turgor, dry/flaky skin
Muscle wasting
 AIN/DISCOMFORT

Chest pain aggravated by recurrent cough

Guarding of affected area
Distraction behaviors, restlessness

RESPIRATION

Cough, productive
Shortness of breath
History of tuberculosis/exposure to infected individual
Increased respiratory rate (extensive disease or fibrosis of the lung parenchyma and pleura)
Asymmetry in respiratory excursion (pleural effusion)
Dullness to percussion and decreased fremitus (pleural fluid or pleural thickening)
Breath sounds diminished or unilaterally (pleural effusion/pneumothorax); tubular breath sounds and/or
whispered pectoriloquies over large lesions; crackles may be noted over apex of lungs during quick inspiration after
a short cough (posttussive crackles)

Sputum characteristics green/purulent, yellowish mucoid, or blood-tinged

Tracheal deviation (bronchogenic spread)

Inattention, change in mentation

SAFETY

Low-grade fever or acute febrile illness

SOCIAL INTERACTION

Feelings of isolation because of communicable disease

Change in usual patterns of responsibility/change in physical capacity to resume role

TEACHING/LEARNING

May report: Familial history of TB

General debilitation/poor health status
Failure to improve/reactivation of TB
Nonparticipation in therapy

Discharge plan DRG projected mean length of inpatient stay: 6.3–8.3 days

KIND OF DISEASE

Pulmonary Tuberculosis TB
 Ineffective Airway Clearance
 Risk for impaired Gas Exchange
 Imbalanced Nutrition: Less than Body Requirements
 Risk for Infection [spread/reactivation]
 Deficient Knowledge [Learning Need] regarding condition, treatment, prevention, self-care, and discharge
needs

Tuberculosis is a disease caused by an infection with the bacteria Mycobacterium tuberculosis. (short

for tubercles  bacillus) is a common and in some cases deadly infectious disease caused by various strains of
mycobacterium, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also
affect other parts of the body. It is spread through the air when people who have active MTB infection cough,
sneeze, or spit.  Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent
infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims.

The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss (the last
giving rise to the formerly prevalent colloquial term "consumption"). Infection of other organs causes a wide range
of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as
microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long
courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a
growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs
and vaccination, usually with Bacillus Calmette-Guérin vaccine.

RESPONSE TO TREATMENT

Immune responses to Mycobacterium tuberculosis antigens could serve as surrogate markers of treatment

response.

GENERAL STATE OF HEALTH