TB is not underrated, honestly. It’s everywhere in nursing school and in the NCLEX, and there’s a lot to memorize: the isolation type, the RIPE drugs, the side effects, the teaching. I’m putting it all in one post so you can come back to it. Here are my notes, then a practice test.
Table of Contents
What is Tuberculosis?
Tuberculosis is an infection caused by Mycobacterium tuberculosis, an acid-fast bacillus (AFB). It mostly affects the lungs (pulmonary TB) but can spread to other organs.
- Spread through the air by droplet nuclei when a person with active TB coughs, speaks, or sings.
- Latent TB has no symptoms and isn’t contagious. Active TB has symptoms and can spread.
- Risk factors: close contact with someone who has TB, HIV or other immunosuppression, crowded living, malnutrition, diabetes, and healthcare work.
- Watch Out For: drug resistance (especially from not finishing treatment), hemoptysis, spread to other organs.
- Safety Precaution: Airborne precautions: negative-pressure room and an N95 respirator for staff.
Pathophysiology
The bacteria are inhaled and reach the alveoli, where immune cells surround them and form a granuloma (tubercle). In many people this keeps the infection under control (latent TB). If the immune system weakens, the bacteria can reactivate and cause active disease, with cavities forming in the lungs.
Assessment and Diagnostic Findings
Clinical presentation: Cough lasting 3 weeks or more, sometimes bloody sputum (hemoptysis), night sweats, low-grade fever, unintentional weight loss, fatigue, and chest pain.
Diagnostic tests
- Tuberculin skin test (TST/Mantoux): Read the induration (not the redness) at 48 to 72 hours. A positive result only shows exposure.
- IGRA (blood test) is an alternative, and not affected by BCG vaccine.
- Chest X-ray helps look for lung changes.
- Sputum tests (AFB smear, culture, NAAT) are needed to confirm active TB. Collect early morning samples.
NCLEX Tip: A positive skin test or IGRA doesn’t mean active TB. It needs a chest X-ray and sputum tests.
Medical Management
Treatment is a long course of multiple drugs to prevent resistance. A usual regimen is RIPE for 2 months, then isoniazid and rifampin for 4 more months.
- Rifampin
- Isoniazid (INH)
- Pyrazinamide
- Ethambutol
Directly observed therapy (DOT) is used to make sure the person takes every dose. Latent TB is treated with shorter regimens, such as isoniazid or rifamycin-based treatment.
Nursing Management
Nursing care focuses on isolation, medication adherence, monitoring for side effects, nutrition, and education.
- Infection control: Airborne precautions in a negative-pressure room. Staff wear an N95. The client wears a surgical mask when leaving the room. Follow facility policy for when isolation can be stopped.
- Medication teaching and side effects:
- Isoniazid: liver toxicity and peripheral neuropathy (give vitamin B6/pyridoxine).
- Rifampin: turns urine, sweat, and tears orange-red (can stain soft contact lenses). Reduces the effect of birth control pills.
- Pyrazinamide: high uric acid and liver toxicity.
- Ethambutol: optic neuritis, so check visual acuity and color discrimination.
- Avoid alcohol during treatment.
- Monitor: liver function tests, weight, and symptoms.
- Nutrition: high-calorie, high-protein diet.
- Education: Take every dose even when feeling better, cover the mouth when coughing, ventilate rooms, and go to follow-up visits. Report yellow skin, dark urine, vision changes, or numbness.
NCLEX High-Yield Notes
- Airborne precautions: negative-pressure room and N95.
- RIPE drugs for 6 months or longer.
- INH needs vitamin B6. Rifampin turns fluids orange. Ethambutol affects the eyes.
- Positive skin test = exposure, not necessarily active disease.
- Adherence prevents drug-resistant TB.
Mnemonic for side effects:
- Rifampin: Red-orange fluids
- INH: Injury to nerves and liver (give B6)
- Pyrazinamide: Pain in joints (high uric acid)
- Ethambutol: Eyes
