Guide — Infection Control
Tuberculosis Nursing Care
Tuberculosis is the classic airborne disease, and almost every TB exam question turns on two things: protecting everyone else from an airborne pathogen, and getting a patient through months of multi-drug therapy without quitting or being poisoned by it.
8 min read · Infection Control
Educational use only. TB drug regimens, treatment duration, and discontinuation of isolation are determined by the provider and public health authorities; follow current facility and CDC guidance. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Mycobacterium tuberculosis spreads through airborne droplet nuclei — particles small enough to stay suspended and travel on air currents, which is why TB needs airborne (not droplet) precautions. Inhaled bacilli usually lodge in the lungs, though TB can seed bone, kidney, meninges, and elsewhere.
The crucial distinction is latent vs active. Latent TB infection (LTBI): the organism is walled off, the person is asymptomatic and not infectious, with a positive skin test or IGRA but a normal chest film. Active TB disease: symptomatic, contagious, abnormal chest X-ray, positive sputum. Latent disease is treated to prevent progression; active disease is treated to cure and to stop transmission.
Key Concepts
Airborne precautions — the bundle
Negative-pressure (airborne infection isolation) room with the door closed; staff wear a fit-tested N95 (or PAPR); the patient wears a surgical mask when transport is unavoidable and during any time out of the room. The N95 protects the wearer from inhaling nuclei; the patient’s surgical mask contains their own.
Testing nuances
A TST (PPD) is read at 48–72 hours by measuring induration, not redness, with risk-based cut-offs (e.g., ≥5 mm in HIV or recent contacts, ≥10 mm in higher-risk groups, ≥15 mm in low-risk). IGRA blood tests aren’t confounded by prior BCG vaccination. A positive test means infection, not active disease — chest X-ray and sputum confirm activity.
RIPE drug therapy
Active TB is treated with multiple drugs for months — classically Rifampin, Isoniazid, Pyrazinamide, Ethambutol. Multiple drugs prevent resistance; the long course is what cures. Stopping early is how multidrug-resistant TB is created.
When can isolation stop?
Generally after clinical improvement on effective therapy plus three negative sputum smears on different days (per protocol). It is not based on how the patient feels alone.
Assessment Findings
Active pulmonary TB classically presents with a chronic productive cough (often three or more weeks), hemoptysis, drenching night sweats, low-grade afternoon fevers, anorexia, fatigue, and weight loss — the historical name “consumption” captures the wasting. Symptoms are insidious, so any patient with a weeks-long cough plus risk factors (immunosuppression, homelessness, incarceration, recent immigration from high-prevalence regions, close contact) deserves a TB thought and prompt masking.
Drug Toxicities to Teach and Monitor
| Drug | Key Toxicity / Teaching |
|---|---|
| Rifampin | Harmless orange-red discoloration of urine, sweat, tears (stains contacts); potent enzyme inducer — reduces oral contraceptive and many drug levels |
| Isoniazid (INH) | Hepatotoxicity (avoid alcohol; report dark urine, jaundice, RUQ pain); peripheral neuropathy prevented with pyridoxine (vitamin B6) |
| Pyrazinamide | Hepatotoxicity; raises uric acid — can precipitate gout; push fluids |
| Ethambutol | Optic neuritis — report any change in vision or color discrimination; baseline and periodic eye exams |
Nursing Priorities
Containment first
Place the patient in airborne isolation immediately on suspicion, mask the patient, don your N95, keep the door closed, and limit transport. Do not wait for confirmation to start precautions.
Adherence and DOT
Directly observed therapy (a worker watches each dose) is standard for active TB precisely because months of pills defeat unsupported patients. Support adherence relentlessly — it protects the patient and the public.
Monitor for toxicity
Baseline and periodic liver function tests, vision checks for ethambutol, and active questioning about neuropathy, vision change, and hepatitis symptoms.
Public health partnership
TB is reportable; contact tracing and follow-up belong to public health. Coordinate, don’t freelance.
Patient Education
Take every dose for the full course even after feeling well — quitting early breeds resistant TB. Expect orange-red body fluids on rifampin (harmless) and use a backup contraceptive method. Avoid alcohol. Report vision changes, numbness or tingling, and signs of liver trouble (yellow skin or eyes, dark urine, nausea, right-upper-quadrant pain). Cover coughs, ventilate the home, and keep public-health follow-up appointments.
NCLEX Pearls
- ✦TB = airborne precautions: negative-pressure room, N95 for staff, surgical mask on the patient for transport.
- ✦Read a PPD at 48–72 hours by induration (not redness); a positive test = infection, not necessarily active disease.
- ✦Rifampin turns body fluids orange-red (expected) and weakens oral contraceptives; INH needs B6 and an alcohol warning.
- ✦Ethambutol → optic neuritis: any vision or color change gets reported.
- ✦Stop isolation only after clinical improvement plus three negative sputum smears — and finishing the full regimen is the resistance-prevention answer.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →