Editing Medical-Surgical Nursing (section)

=== Tuberculosis ===

Tuberculosis is caused by ''Mycobacterium tuberculosis'' and spreads by the airborne route. Findings include a cough lasting more than three weeks, hemoptysis, night sweats, low-grade afternoon fever, fatigue, and unintentional weight loss.

Infection control: place the patient in an airborne infection isolation room with negative pressure, wear a fitted N95 respirator or higher, keep the door closed, and place a surgical mask on the patient during transport outside the room. Diagnosis is confirmed by sputum acid-fast bacillus smears and culture; a positive skin test indicates exposure, not active disease.

Medications: rifampin turns urine, sweat, and tears orange and reduces the effectiveness of oral contraceptives. Isoniazid is hepatotoxic and causes peripheral neuropathy, which is why pyridoxine (vitamin B6) is given with it. Pyrazinamide is hepatotoxic and raises uric acid. Ethambutol can cause optic neuritis, so the patient reports any change in vision or color discrimination. Therapy lasts many months, and adherence, often by directly observed therapy, is the central nursing concern.