Download - 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
No remarkablefindings
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
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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
Difficulty of breathingwaslessen
Difficulty of breathingwaslessen
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.