case study miliary tb

7/27/2019 Case Study Miliary Tb

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Department of Health

Center for Health Development No.3

DR. PAULINO J. GARCIA MEMORIAL RESEARCH AND MEDICAL CENTER

Cabanatuan City

NURSING DEPARTMENT

CASE STUDY ON MILIARY TUBERCULOSIS

SUBMITTED BY:

RN HEALS IV

BERNARDEZ, DAWNERY JUANE

SANDOVAL, VHIRONICA

SANTIAGO, MICKEL

SANTA CRUZ, SHERWIN

I. Introduction


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A. Background of the study

This whole case study is about to discussed Pulmonary Tuberculosis (TB).

This case will tackle about the disease, patients health and of course nursing

intervention.

Miliary Tuberculosis (abbreviated TB for tubercle bacillus or

Tuberculosis) is a common and often deadly infectious disease caused by

mycobacteria, in humans mainly Mycobacterium tuberculosis. Tuberculosis

usually attacks the lungs (as pulmonary TB) but can also affect the central

nervous system, the lymphatic system, the circulatory system, the

genitourinary system, the gastrointestinal system, bones, joints, and even

the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium

africanum, Mycobacterium canetti, and Mycobacterium microti also cause

tuberculosis, but these species are less common in humans.

Tuberculosis is spread through the air, when people who have the

disease cough, sneeze, or spit. Most infections in human beings will result in

asymptomatic, latent infection, and about one in ten latent infections will

eventually progress to active disease, which, if left untreated, kills more thanhalf of its victims. The classic symptoms of tuberculosis are a chronic cough

with blood-tingedsputum, fever, night sweats, and weight loss. Infection of

other organs causes a wide range of symptoms.

Demographic incidence

Tuberculosis (TB) is a deadly disease. It is the worlds No. 1 cause of

death around the world; about 3 million persons die of TB every year. It isone of the 10 top killer diseases in the Philippines; 75 Filipinos die of TB

every day.
http://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Mycobacteriumhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Mycobacterium_tuberculosishttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Genitourinary_systemhttp://en.wikipedia.org/wiki/Gastrointestinal_systemhttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Jointhttp://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Mycobacterium_bovishttp://en.wikipedia.org/wiki/Mycobacterium_africanumhttp://en.wikipedia.org/wiki/Mycobacterium_africanumhttp://en.wikipedia.org/wiki/Mycobacterium_canettihttp://en.wikipedia.org/wiki/Mycobacterium_microtihttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Mycobacteriumhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Mycobacterium_tuberculosishttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Genitourinary_systemhttp://en.wikipedia.org/wiki/Gastrointestinal_systemhttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Jointhttp://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Mycobacterium_bovishttp://en.wikipedia.org/wiki/Mycobacterium_africanumhttp://en.wikipedia.org/wiki/Mycobacterium_africanumhttp://en.wikipedia.org/wiki/Mycobacterium_canettihttp://en.wikipedia.org/wiki/Mycobacterium_microtihttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Weight_loss


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B. Objective

General

The general objective of this case study is to broaden our knowledge

about the disease and develop skills on how to render the best possible care

to a patient suffering from Pulmonary Tuberculosis.

Specific

To be able to define Tuberculosis as well as on how it is acquired,

factors, signs and symptoms.

To be able to know the pathophysiology of Tuberculosis.

To be able to know the other problems that the client is suffering right

now.

To gain more information about patients condition.

To apply skills learned to actual handling and caring of a patient who

suffered from Tuberculosis.

To determine the possible nursing intervention that will be a great help

in patients prognosis.

To be able to give the appropriate health teaching and better

understanding of the disease to the patient, family and significant

others.

C. Scope and delimitation


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The scope of this study will focus on Miliary Tuberculosis. The study

covers the background of the disease, the anatomy, pathology, mode of

transmission, pathophysiology and as well as its complications.

All information needed to come up with this case study was taken from

patient, patients family (mother and sister), patients chart, laboratory

result, physical assessment, books and internet.

D. Theoretical Framework

FLORENCE NIGHTINGALE ENVIRONMENTAL THEORY

Florence Nightingale was born to a wealthy and intellectual family. She

was known as the Lady with the Lamp. She believed she was called by God

to help others to improve the well being of mankind

Nightingale is viewed as the mother of modern nursing. She

synthesized information gathered in many of her life experiences to assist

her in the development of modern nursing. Her contribution to the nursing

profession was her Environmental Theory in which the nurses role is to

place the client in the best position for nature to act upon him, thus

encouraging healing.

ENVIRONMENT

MR.ADL

VentilatiNutritio

BeddiCleanline

Ai

Light


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Nightingale viewed the manipulation of the physical environment as a

major component of nursing care. She identified ventilation and warmth,

light, noise, variety, bed and bedding, cleanliness of the rooms and walls,

and nutrition as major areas of the environment the nurse could control.

When one or more aspects of the environment are out of balance, the client

must use increased energy to counter the environmental stress. These

stresses drain the client of energy needed for healing. These aspects of

physical environment are also influenced by the social and psychological

environment of the individual.

II. Clinical summary

A. General data

Name: Mr. ADL

Age: 9 years old

Religion: Roman Catholic

Civil Status: Single

Nationality: Filipino

Ethnic Group: Aeta

Admitting Diagnosis: Miliary Tuberculosis secondary to Malnutrition

Sources of Information: Patient, Patient chart and the Significant

Others (Mother and the sister)

Reliability: 90% Reliable

B. Chief complaint


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The patient complained of difficulty of breathing.

C. History of present illness

The information that I gathered are second hand as they came from

the patient mother and sister. Due to unknown reason, the patient

refused to be interviewed even though based on my observation; he has a

capability to answer my questions.

Last two months, the family observed Mr. ADL is loosing weight and

decrease of appetite but instead of eating foods he his more on vices.

Then his condition became worsened according to familys observation.

A month prior to admission, the patient condition became more at it

worst and his cough became productive with intermittent spots of blood in

the sputum upon coughing. He also starting to have night sweat started

becoming sluggish and spending lots of time sleeping. He was advice by

the family to have a check-up and visit the nearest hospital or clinic but

he refuse everything that his familys concerned, as verbalized by Mr.

ADLs sister.

Based on the statement of his mother, two days prior to admission Mr.

ADL experience body weakness, fatigue, and on the day of admission last

April 21, 2013 in Dr. PJGMRMC, suddenly he was complaining of difficulty

of breathing, one hour after he ate his lunch.

D.Past medical history

Referring to the statements made by his sister, Mr. ADL was diagnosed

with Miliary Tuberculosis last 2012, 1 year ago. He entered a

rehabilitation program sponsored by the local government in Nueva Ecija

that will provide the beneficiates with 100% coverage on the six months

duration in curing the disease. The six months duration in curing the


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disease became successful, he was cured by the medication given by the

sponsored but due to poor nutritional intake and unsanitary environment

the disease from the past became active again.

E. Familial history

Two of his uncle died from respiratory diseases, one is from

Tuberculosis and another is from lung cancer. His sister also said that it

was Mr. ADL twice to be confined in a hospital with a serious condition.

F. Psychosocial health

1. Psychosocial Health

a. Coping Pattern

Patient used silence; he is making an observation to the student nurse

who is assigned to him.

b. Interaction Pattern

The patient ignores my kind interview due to unknown reasons but he

cooperated when I obtain Vital Signs, afternoon care, giving

medications, and physical assessment.

c. Cognitive Pattern

According to the mother, Mr. ADL knows already his condition because

he already suffered it before, last 2012, 1 year ago. But this time it is

more complicated.

d. Self Concept


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In my observation, the patient looks shy. He just mind his own self

maybe because he is still in pain.

e. Emotional Pattern

The patient looks sad and weak maybe because of the pain that he is

experiencing right now and the disease that he is suffering.

2. Socio-Cultural Health

a. Cultural Pattern

The patient was evidently proud of his ethnicity during their familys

conversation.

b. Recreation Pattern

Mr. ADL plays basketball with his friends; this is good for recreation.

He also has a good voice, according to his sister.

3. Spiritual Health

a. Religious Beliefs

Mr. ADL is a Roman Catholic, sometimes he visit the church, one ride of

jeep from their house, twice a month.

b. Values and valuing

Mr. ADL is close to his mother. He lives with his mother from the time

he was born to the time he is where right now. All good values that he

has was educated by his mother but during his adolescence stage he

became abusive in his body, he became active with many kinds of


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vices that are influenced by his friends, these is the reason why he got

the disease Tuberculosis.

G. Review of system

The data gathered are all coming from the mother as it was the patient

subjective complaint.

SYSTEMGeneral Generalized body weaknessSkin DryHeadEyes & EarsNose Runny nose, with discharges

Throat & Mouth Dry mouthNeckBreastRespiratory Difficulty of breathing, dyspnea upon

exertion. CoughCVS Dyspnea upon exertion and chest

painGIT Constipated at times, defecate every

other day.GUTExtremities Joint pain

Neurologic WeaknessHematologicEndocrine Excessive night sweatingPsychiatric Depression, Ignores kind interview

H.Physical assessment

a. General appearance/survey:

Patient appeared weak looking but was somehow coherent in a high

fowlers position. Mr. ADL ignores my kind interview but he is willing to

cooperate when it comes in taking vital signs, physical assessment and


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giving medication which is important. The patients skin was dry especially

on the lower extremities. IVF of D5NM 500 was attached to his right hand.

b. Measurement

FIDINGS NORMALVALUES

ANALYSIS/INTERPRETATION

(Ht, wt) Height: 35Weight: 25 lbs

BMI BMI below normal as aresult of malnutrition

Vital Signs Temp: 37.50 CPR: 90 bpmRR: 35 bpmBP: 90/60mmHg

Temp: 37 CPR: 60-100 bpmRR: 16-20 bpmBP: 120/80mmHg

With some abnormalfindings in therespiratory rate.Increase RR; difficultyof breathing (decreaseOxygen supply in thebody)

c. Head to toe Assessment

BODY PARTS NORMALFINDINGS

ACTUALFINDINGS

ANALYSIS/INTERPRETATI

ONA. HEAD

a. Skull

b. Hair

Rounded(normocephalic, with frontal,parietal andoccipitalprominences)

Evenlydistributed;thick hair;silky resilienthair; noinfestation orinfection;variable

Normocephalic

Evenlydistributed

Normal findings

Typical hair typeof men


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c. Face

d. Eye/vision4.1 Eyeball

4.2 Lid margins

4.3 Conjunctiva

4.4 Sclera

4.5 Pupils

4.6 Eyebrow, lashes, color,symmetry, quality of hair,placement

4.7 Eye movement in alldirections

amount ofbody hair

Symmetricfacial features,

palpebralfissures equalin size,symmetricnasolabialfolds

Shape isround; sizeequal

Protects eyes,anteriorlymeet at themedial andlateral cornersof eye.

Delicatemembrane;covers part ofthe outer

surface of theeyeball

Outermosttunic, thickwhiteconnectivetissue.

Pupilsconstrict when

looking atnear objects,pupilsconvergewhen object ismovedtowards thenose

Symmetricfacialfeatures

Round,uniform insize

Closesymmetrical

Smooth andpale

Appears

white

Normalpupilconstriction

Hair evenlydistributed,intact skin

Equalmovement

Normal findings

Normal findings

Normal findings

Undernourished,lack of vitamins

Normal findings

Normal findings

Normal findings

Normal findings


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Hair evenlydistributed,intact skin

EqualmovementB. VISION TESTING

a. Visual field

b. Visual acuity

When lookingstraight aheadclients can seeobjects inperiphery

Able to readnewspaper

Client cansee from hisperiphery

Able to readnewspaper

Normalperipheral vision

Normal visualfindings

C. EARSa. Pinna

b. External canal

c. Hearing acuity

Same color asfacial skin,pinna recoilsafter it isfolded

Dry ear waxgrayish-tancolor or sticky

wet cerumenin variousshades ofbrown/ pearlygray color;semitransparent

Responds tomoderatelyloud voice

tone

Same coloras facialskin, pinnarecoils afterit is folded

Wet andstickingcerumenwith

transparentcolor

Responds tomoderatelyloud voicetone

Normal earfeatures

Normal findings

Normal findings

D. NOSE Symmetric,normalbreathing,able toidentifyfamiliar smell

Nodeformity,(+)difficulty ofbreathing.With runnynose

(+) dyspnea,patient havecough whichreflex is not theonly way toprotect ourairways which


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causes patientto have runnynose.

E. MOUTH/LIPSa. Gums

b. Teeth

c. Tongue

d. Palate-hard/soft

e. Oropharynx/ Tonsil

Pink gums;

moist firmtexture

32 adult teethsmooth, whiteyellowishshiny toothenamel

Centralposition, pale

in color

Pink andsmooth; freelymovable

Pink andsmoothposterior wall

Dark gums

Yellowishwith fewcavities andsomemissingteeth

Centralposition,

pale in color

Pale in color

Paleposteriorwall

Gums darkened

due to smokinghistory

Needs dentalwork

No remarkablefindings



F. CHEECKS Hollow in

appearance

Indicates

malnutrition,due to weightloss

G. NECK Lymph nodesfreely movable

Lymphnodes freelymovable

Normal findings

H. CHESTa. Anteriorb. Posterior

Quiet rhythmicand effortlessrespirations;full symmetricexcursions

(+)difficulty ofbreathing,withabnormal

sound inthe rightlower lobe

Localized

Presence ofcrackles causedby fluid oftenassociated withinflammation or

infection of thealveoli.Indicatesrespiratoryproblems suchus TB,Pneumohydrothorax


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I. HEART

J. BREAST

Full andsymmetric

pain aroundthoracostomy site.

Full and

symmetric

No air leak ondrainagesystem:manageableincision pain.

Normal findings

K. ABDOMEN Flat, rounded(convex) orscaphoids

Distended,scaphoidalin shape

Client is not wellnourished.It is also due toweight loss.

L. UPPER EXTREMETIES Equal in sizeon both sidesof the body;

no muscleatrophy;normally firm;smoothcoordinatedmovements

Equal insize butmuscular

atrophyevident.

Client is not wellnourished

M. LOWER EXTREMETIES Equal in sixeon both sidesof the body;no muscleatrophy;

normally firm;smoothcoordinatedmovements

Withmuscularatrophyevident.

Client is not wellnourished

Weaknesshinder client

from activelymoving around.

I. Activities of daily living

BeforeHospitalization

DuringHospitalization

Analysis/Interpretation

a. Fluid &Nutrition

Skipping mealsmost of the time,according to thesignificant others.

His fluidpreferences arewater, softdrinks.

Moderatedecrease of theappetite; canconsume about of the foodsgiven.

Due tomedication givenas side effectssuch as;Combivent andRifampicin, thereis a decrease ofappetite.


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b. Elimination

c. Hygiene &Comfort

d. Rest &Sleep

Mr. ADL drinks 3-4 glass of water aday.

He is more onbread in themorning;vegetables andfish most of theirmeals.

Mr. ADL usuallyvoids largeamount of urine,5-7 x a day.Defecates atleast once a day.

The patient takesa bath once a day

and brushes histeeth twice a day.

The patientsleeps more orless than 5 hoursa day.

Diet as toleratedwas advised toMr. ADL

Usually voids 2-4times a day.

Mr. ADLdefecates everyother day.

Restricted onbed; the patientcant take a bath

due to weaknessAll hygienicactivities areassisted by SO.

The patientsleeps irregularly.30 minutes ofsleeps thenawake again.

The pt wastrained to takeDAT diet tosustain his

nutritional needs.

There is adecrease bowelmovement due todecreaseappetite.

Dependencerelated to

restrictedmobility due toweakness

Due toinadequate restthe patient mayhave decreasebody resistance.

J. Laboratory / Diagnostic Exam

a. Hematology report April 21,

2013


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Test Results Normal Value AnalysisHemoglobin 110 g/L 140 170 g/L Decrease

Insufficientoxygencirculating in the

bloodstream.Indicates Anemiadue tomalnutrition.

Hematocrit 0.33 0.40 0.50 DecreaseInsufficientoxygencirculating in thebloodstream.Indicates Anemiadue to

malnutrition.WBC 15.2 x 10 5.0 10.0 x 10 Increase

LeukocytosisIndicatesinfection

Neutrophils 0.78 0.45 0.65 IncreaseAcute bacterialinfection

Lymphocytes 0.21 0.25 0.40 Decreaselow absolutelylymphocyte

concentration,associated withincrease rates ofinfection

Monocytes 0.01 0.02 0.06 DecreaseDepleted inoverwhelmingbacterial infection

Platelets 320 150 - 450 Normal

b. Chest X-ray April 21,

2013


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Impression: Miliary Tuberculosis

c.Urinalysis April 21,

2013

Color: YellowTransparency: S/I Fubid

Chemical Strips

Reaction: 5.2Specific Gravity: 1.025 (above normal) dehydration

and contaminationAlbumin: Trace

Microscopic

WBC 8-12RBC 1-3Epithelial Cells RareMucus treads Moderate

Amorphous Urates Plentyc. Urinalysis April 22, 2013

Color: Yellowish brownConsistency: SoftMicroscopic: No Ova, parasite seenWBC 4-8

RBC 0-1Bacteria Plenty bacterial infection

d. Radiological Report April 23,

2013

Impression: Miliary Tuberculosis

N.Course in the ward


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Date/Time Focus Data, Action, ResponseApril 21, 2013

2pm

7pm

Admission Admitted a 9 years old male

accompanied by relatives with a

complained of difficulty of breathing.

Vital signs are taken and recorded with a

BP: 90/60 mmHg, HR: 81 bpm, RR: 35

bpm

Seen and examined by Dra. Olay

Consent signed and secured

IVF of D5NM 500 inserted and regulated

with 31 gtts/min

Laboratory requested

To radiology department on the way to

pedia ward accompanied by undersigned

Endorsed

7:30pm

8pm

11pm

Post transfer

Elevated

body

temperature

In from ER per wheelchair cuddled by

mother with an IVF of D5NM @ 400ml

level

Conscious and coherent

Vital signs are taken and recorded with

blood pressure of 90/60 mmHg

D febrile 38.5

A : tepid sponge bath done

R : temperature subsided to 37.5

NPO was advice

Endorsed

11pm

Received on bed with an IVF @ 300cc

level

Vital signs taken and recorded BP: 90/60

mmHg, PR: 90 bpm, RR: 29 bpm

Temperature: 36.6 CWith abnormal RR: 29 bpm

Diet as tolerated maintained

Due medication given and recorded

Cefuroxime 100mg TIV after negative

skin test

Rifampicin 1 tablet before dinner


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7 am Vital signs recheck with no significance

finding

Needs attended

EndorsedApril 22, 2013

7am

3 pm

Received on bed alert, coherent,

cooperative.

With an IVF of D5NM

Vital signs taken and recorded

Afternoon care rendered

Health teaching done

Medication given

Needs attended

No other complaints

Endorsed


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III. Clinical discussion of the diseaseA. Anatomy and physiology

UPPER RESPIRATORY TRACT

Respiration is defined in two ways. In common usage, respiration refersto the act of breathing, or inhaling and exhaling. Biologically speaking,respiration strictly means the uptake of oxygen by an organism, its use inthe tissues, and the release of carbon dioxide. By either definition,respiration has two main functions: to supply the cells of the body with theoxygen needed for metabolism and to remove carbon dioxide formed as awaste product from metabolism. This lesson describes the components of theupper respiratory tract.

The upper respiratory tract conducts air from outside the body to thelower respiratory tract and helps protect the body from irritating substances.

The upper respiratory tract consists of the following structures:

The nasal cavity, mouth, pharynx, piglottis, larynx, and upper trachea;the oesophagus leads to the digestive tract.

One of the features of both the upper and lower respiratory tracts isthe mucociliary apparatus that protects the airways from irritatingsubstances, and is composed of the ciliated cells and mucus-producing
http://nursingcrib.com/wp-content/uploads/respiratory-system.gif


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glands in the nasal epithelium. The glands produce a layer of mucus thattraps unwanted particles as they are inhaled. These are swept toward theposterior pharynx, from where they are swallowed, spat out, sneezed, orblown out.

Air passes through each of the structures of the upper respiratory tracton its way to the lower respiratory tract. When a person at rest inhales, airenters via the nose and mouth. The nasal cavity filters, warms, andhumidifies air. The pharynx or throat is a tube like structure that connectsthe back of the nasal cavity and mouth to the larynx, a passageway for air,and the esophagus, a passageway for food. The pharynx serves as acommon hallway for the respiratory and digestive tracts, allowing both airand food to pass through before entering the appropriate passageways.

The pharynx contains a specialised flap-like structure called theepiglottis that lowers over the larynx to prevent the inhalation of food and

liquid into the lower respiratory tract.

The larynx, or voice box, is a unique structure that contains the vocalcords, which are essential for human speech. Small and triangular in shape,the larynx extends from the epiglottis to the trachea. The larynx helpscontrol movement of the epiglottis. In addition, the larynx has specialisedmuscular folds that close it off and also prevent food, foreign objects, andsecretions such as saliva from entering the lower respiratory tract.

LOWER RESPIRATORY TRACT

The lower respiratory tract begins with the trachea, which is just belowthe larynx. The trachea, or windpipe, is a hollow, flexible, but sturdy air tubethat contains C-shaped cartilage in its walls. The inner portion of the tracheais called the lumen.

The first branching point of the respiratory tree occurs at the lower endof the trachea, which divides into two larger airways of the lower respiratorytract called the right bronchus and left bronchus. The wall of each bronchuscontains substantial amounts of cartilage that help keep the airway open.Each bronchus enters a lung at a site called the hilum. The bronchi branchsequentially into secondary bronchi and tertiary bronchi.

The tertiary bronchi branch into the bronchioles. The bronchiolesbranch several times until they arrive at the terminal bronchioles, each ofwhich subsequently branches into two or more respiratory bronchioles.

The respiratory bronchiole leads into alveolar ducts and alveoli. Thealveoli are bubble-like, elastic, thin-walled structures that are responsible forthe lungs most vital function: the exchange of oxygen and carbon dioxide.


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Each structure of the lower respiratory tract, beginning with thetrachea, divides into smaller branches. This branching pattern occursmultiple times, creating multiple branches. In this way, the lower respiratorytract resembles an upside-down tree that begins with one trachea trunkand ends with more than 250 million alveoli leaves. Because of this

resemblance, the lower respiratory tract is often referred to as therespiratory tree.

IV. Nursing problem list

Ineffective Airway Clearance

Ineffective Breathing Pattern

Risk for Infection

Imbalanced Nutrition; less than Body Requirements

Activity Intolerance

Impaired Physical Mobility

Anxiety

Nursing Priority:

1. Ineffective Airway Clearance

2. Risk for infection

3. Impaired Physical Mobility


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VI. Drug Study

Generic Name: CEFUROXIME 200 mg TIV q8 hours ANST (-)Brand Name:CEFTINClassification Action Indication Adverse Effect Nursing

Consideration

2ND generationcephalosporin

A 2nd generationcephalosporin that

binds to bacterial cellmembranes andinhibits cell wallsynthesis.

Treatment of susceptibleinfection due to group B

streptococcus, E. coli, H.influenza etc.

Allergic reaction, oralcandidiasis, mild

diarrhea, mildabdominal cramping.

Ask the patient if hehas a history of

allergies to drugs,particularly tocephalosporin andpenicillin.

Generic Name:IPRATROPIUM BROMIDE q4 hoursBrand Name:COMBIVENT, DOUNEBClassification Action Indication Adverse Effect Nursing

ConsiderationAnti-cholinergicbronchodilator

An anti-cholinergicthat blocks the actionof acetylcholine atparasympathetic sitesin bronchial smooth

muscles.

Maintenance treatment ofbronchospasm due tochronic obstructionpulmonary disease(COPD), bronchitis,

emphysema, asthma.

Hypotension,insomnia, metallic orunpleasant taste,palpitations, urinereaction.

Monitor Vital signsMonitor intake andoutput

Generic Name:RIFAMPICIN 2 Tablets before lunch and 1 tablet before dinnerBrand Name:MYRIN-P FORTEClassification Action Indication Adverse Effect Nursing

Consideration

Antituberculosis Inhibits RNA synthesis,decreases tuberclebacilli replication

Initial phase treatment andretreatment of all forms of

TB in category I and IIpatients caused bysusceptible strains ofmycobacterium.

Disorder of theblood and lymphaticsystem, immunesystem, metabolismand nutrition, CNS,eye, GI, skin andtissues, renal, fever,dryness of mouth.

Explain to the patientto expect a orangecolor of urine.

Monitor I & O.


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Nursing Care PlanA s s e s s m

e n tD i a g n o s

i sP l a n n i

n gIntervent i

onE v a l u a t i

o n

Lack of energyWeaknessPoor oral intake

Fatigue related tomalnutrition anddisease process

After a week ofconfinement, thepatient will be ableto report/ exhibitstrength.

Asse ss v i t a ls i g n s

Provide supplementoxygen asindicated.

Referred tocomprehensiverehabilitationprogramor nutritionist

The patient stillhavingbody weakness

Helps reducefatigue

Due to patientstatus,PEG (percutaneousendoscopicgastrostomy)

was not done


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A s s e s s me n t

D i a g n o si s

P l a n n in g

Intervent ion

E v a l u a t io n

Difficulty ofbreathingRR of 24rpm

Oxygen saturation of94 %

Ineffect ivebreathingpattern

A f t e r a w e e ko fconfinement, the

patientwill be able to exhibitimproved ventilationandadequateoxygenation.

Note rate anddepth ofrespiration and use of

accessory muscles

Auscultate chest

Elevate head of bedorclient appropriately

Administernebulization asordered

OxygenAdministration

Suction secretions asneeded

Difficulty of breathingwaslessen

Crackles heard inbreathSounds



Oxygen saturation

increasedClears airway


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A s s e s s me n t

D i a g n o si s

P l a n n in g

Intervent ion

E v a l u a t io n

Limitation ofmovementUncoordinatedmovementsof upper extremitiesImmobility of lowerextremities

Self care deficit,bathing/hygiene; dressing/grooming

After a week ofconfinement, thepatientsrelatives or watcherswillbe able to performskillsand activities thatarenecessary for thepatient.

Perform hygienepractices(bathing,shampooing, etc.)

.

Teach relatives alsoonhow to performhygieneto their patient

Encouraging familytoshow physical andemotional support for

thepatient in a way thatthepatient canunderstand

The relatives wereable todemonstrate theteachingsgiven to them.


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VII. Discharge Plan (METHODS)

M- Medications

Medications should be taken as ordered and prescribed by thephysician to avoid complications and help mange the condition of the

patient. There are a lot of main anti-Tuberculosis medications such us:

Isoniazid, Fifampicin, Ethambutol and Pyrazinamide.

E- Exercise

Instruct the patient to have a time for deep breathing exercise

everyday for several times at home to helps achieved maximal lung

expansion and for relaxation.

Start with exercises that you are already comfortable doing. Starting

slowly makes it less likely that you will injure yourself.

Immediately stop any activities that might causes undue fatigue,

increased shortness of breath or chest pain.

T- Treatment

Remind the importance of taking the medication in the right time and

dose.

Sleep in a room with good ventilation.

Limit your activity to avoid fatigue. Frequent rest is advice.

Maintained wound integrity on the surgical site.

H- Health Teachings

Advise to take the medication on time and with the right dosage.

Semi-fowlers position is advice most of the time for breathing

relaxation.


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Avoid close contact with others until the doctor finds it Okay.

Advise the client to turn your head when coughing. Keep tissues with

you and cover your mouth when you cough then throws the tissues

used in the plastic bag.

Keep your hands clean. Maintain proper hygiene.

Isolate techniques is one of the best way to prevent the speared of

the bacteria; separation of dining ware.

Advise the relatives to clean the environment regularly since it is one

of the factor that contribute to the speared of bacteria.

Discuss to the client and significant others the cardinal signs of

infection such as; redness, heat, induration, swelling and separation

of drainage.

O- Out- patient follow- up

Most of the treatment to cure Pulmonary Tuberculosis can be given at

home but must be taken as explained by the health care worker. The family

has the responsibility to check the status of the patient and the progress of

it.

D- Diet

Diet as tolerated is advice by the attending physician, to sustain his

nutritional needs.

High protein diet for tissue repair - meat and green leafy vegetables.

S- Spiritual practice

Mr. ADLs religion is Catholic, encourage the patient pray daily, go to

church regularly and increase his faith with God Almighty.

case study miliary tb

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