Virgen Milagrosa University Foundation Martin P. Posadas Ave. San Carlos City, Pangasinan College of Nursing
A Case study on Pulmonary Tuberculos T uberculosis is Presented to: Mr. Nino J. Gonzales,RN, RM
Prepared by: Cudal, Ma. Charisse Joy E. De Mesa, Robertito De Vera, Feme De Vera, Judilyn De Vera Ronalyn Delos Santos, Jica Relene Domantay, Grace Fiesta, Ma. Elena (BSN III-G)
I.Personal Data Name: Mrs.A.C.L. Age: 31 yrs.old Address: Poblacion, Bugallon Pangasinan Date of birth: November 30, 1978 Civil Status: Married Sex: Female Occupation: Housewife Religion: Roman Catholic Nationality: Filipino Date of admission: April 15, 2010 Time of Admission: 7:45 PM Chief Complaint: Coughing out of blood Initial Diagnosis: PTB with hemoptysis Final Diagnosis: PTB with hemoptysis Attending Physician: Dr. Emilio Sison
Social and Demographic Factors:
Rurban Residence Low Socio-economic status Uses Charcoal for cooking
Educational
Attainment:
High school graduate
II.Health History
Personal Persona l History:
Past Health History
Family History
(-) Smoker
(-) smoker
(-) Smoker
(-) alcohol drinker
(-) alcohol drinker
(+) alcohol drinker
(-) Asthma
(-) Asthma
(-) Asthma
(-) HPN
(-) HPN
(-) HPN
(-) DM
(-) DM
(+) DM
Two months prior to admission, Mrs. A.C.L. suffered from from persistent productive coughing which later persists to coughing out of blood. On the 15 th of April, she was rushed to the hospital (Don Mariano Verzosa Memorial Memorial Hospital) with the chief complaint of coughing out of blood. She also suffered from severe chest pain. Her vital signs upon admission was: BP: 90/70mmHg
RR: 45 breaths/min.
PR: 70bpm
Temp: 38.2oC
III. Physical Assessment
Area of Assessmen Assessmentt
Findings
Interpretations Interpretatio ns
Head
(-) wounds (+) dry hair (+) normocephalic
normal
Skin
(-) jaundice (+) moist skin
normal
Ears
(+) lumps/lesions lumps/lesio ns
normal
Eyes
(+) pupillary pupillar y reflex refl ex (+) pupils equal (-) discharge noted (-) periorbital edema
normal
Nose
(-) discharge (-)lesions
normal
Mouth
(+) dry lips (-) foul smell (-) tartar
Poor oral hygiene Good oral hygiene
Face
(-) edema (-) rounded/moon face (-) scars
Neck
(+) enlarged lymph nodes in cervical area
Shoulder
Chest
Abdomen Abdome n
Arms
normal
lymphadenopathy
(+) symmetry
normal
(-) palpable mass (+) rales during inspiration
normal
(-) skin discoloration (-) scars (+)Normal bowel sounds
normal
( ) mucle mass noted
(+) active motion
Legs
Bladder Elimination Eliminatio n
Bowel Elimination Eliminati on
(-) superficial lesions (-) palpable mass (+) orange- brown colored urine (+) regular, daily hard brownish stool
normal
Normal side effect of medication normal
IV. Diagnostic Procedures I.Chest X-ray Result: -Reticular and nodular densities scattered diffusely in both lungsmore lungsmore in the left lung. -There is also a cavity damage in the right upper lobe. -The heart and great vessels are normal in size and configuration. -Diaphragm and visualized bones are intact.
II. Urinalysis Result
Color
Yellow
Transparency
slightly turbid
Reaction
7-5
Albumin
Sugar
(-)
Specific gravity
1.005
Epithelial cells
few
Amorphous substance
Significance Normal (-)
Norma Normal
few
Pus Cells
1-3
RBC
0-2
decreased
Hematology: Test
Hemoglobin
WBC
Hematocrit
Normal Values
Findings
Significance Signifi cance
M: 140-170 g/L F:120-150 g/L
100 g/L
Anemia
5-10 x 10 g/L
12.5 x 10 g/L
Infection
M: 40-50 vol. % F:37-47 vol. %
.36
Hemodilution, Acute massive blood loss
V. Pathogenecity What is Pulmonary tuberculosis?
Pulmonary tuberculosis tuberculosis (TB) is a contagious bacterial infection that mainly involves the lungs, but may spread to t o other organs. Causative Organism
Pulmonary TB is caused by M. tuberculosis which is a rod-shaped bacteria with a waxy capsule. It is non-motile (requires external forces, such as coughing for example, to move from place to place), does not form spores, and is aerobic. R isk isk Factors y y y y y y y y y y
Old Age Infants Children Alcoholism Low Socio economic Status Drug addicts HIV positive People with weakened immune systems Severely malnourished People with frequent contact to the infected individual individual
y y y
Have poor nutrition Live in crowded or unsanitary living conditions Healthcare workers
Symptoms: y y y y y y y y y y
Cough (sometimes producing phlegm) Coughing up blood Excessive sweating, especially at night Fatigue Fever Unintentional weight loss Pallor: Breathing difficulty Chest pain Wheezing
Transmission Mycobacterium tuberculosis is spread by small airborne droplets, called droplet nuclei, generated by the t he coughing, sneezing, talking, or singing of a person with pulmonary or laryngeal tuberculosis. These minuscule droplets can remain airborne for minutes to hours after expectoration.
Stages of Tuberculosis: Latent Tuberculosis Mycobacterium tuberculosis organisms can be enclosed, as previously described, but are difficult to completely eliminate.Persons eliminate.Persons with with latent tuberculosis have no signs or symptoms of the disease, do not feel sick, and are not infectious, however viable bacilli can persist in the necrotic material for years or even a lifetime, and if the t he immune system later becomes compromised, as it does in many critically ill patients, the t he disease can be reactivated.
Primary Disease Primary pulmonary tuberculosis tuberculosis is often asymptomatic, so that the results of diagnostic tests. are the only evidence of the disease.. Associated paratracheal lymphadenopathy lymphadenopathy may occur may occur because the bacilli spread from the lungs through the lymphatic system. If the t he primary lesion enlarges, pleural effusion develops,
because the bacilli infiltrate the pleural space from an adjacent area. The effusion may remain small and resolve spontaneously, or it may become large enough to induce symptoms such as fever, pleuritic chest pain, and dyspnea.
Primary Progressive Tuberculosis When a patient progresses to active tuberculosis, early signs and symptoms are often nonspecific. nonspecific. Manifestations often include progressive fatigue, malaise, weight loss, and a low-grade fever accompanied by chills and night sweats. a classic feature of tuberculosis, is due to the lack of appetite and the altered metabolism associated with the t he inflammatory and inflammatory and immune responses. Wasting involves the loss of both fat and lean tissue; the decreased muscle mass contributes to the t he fatigue. Although the cough may initially be nonproductive, it advances to a productive cough of purulent sputum.. Hemoptysis can be due to destruction of a patent vessel located in the wall of the cavity, the rupture of a dilated vessel dilated vessel in a cavity, or the formation of an aspergilloma in an old cavity. Hematologic studies might reveal anemia, which is the t he cause of the weakness and fatigue.
Diagnostic Tests: y y y y y y y
Biopsy of the affected tissue (rare) Bronchoscopy Chest CT scan Chest x-ray Sputum examination and cultures Thoracentesis Tuberculin skin test
Treatment: y y y y y
Isoniazid Rifampicin Pyrazinamide Ethambutol Steptomycin
Possible Complications: Pulmonary TB can cause permanent lung damage if not treated early.
extrapulmonary extrapulmonary tuberculosis (TB spread to areas of the body outside of the lungs) tuberculosis pneumonia (massive lobular or lobar pneumonia) pneumonia) pleuritis (infection & inflammation of tissue covering the lungs.
Nursing Implications of this study to:
Nursing Process: In the practice of nursing, we have been vested with the opportunity to convey to our patients the attitude, skills, and the knowledge that we assimilated from school. In contemplating to this kind of disease, our knowledge and understanding relevant to it, the medications, actions, and interventions to be made, became a vest. Thus, it assists us to deliver proficient, apt, and most notably, a safe nursing care.
Nursing R esearch: esearch: This case will serve as a deviation for researchers in the coming days to pursuit better methods to care for patients. This may be used as a future foundation for clinical conventions and presentations. This also lays a cornerstone of interpersonal and clinical excellence of the students wherein they could fortify their knowledge about their professional professional field.
Nursing Education: This case has instituted a vast force on nursing education. Through this case study, a vivid comprehension about the disease became material to us. Furthermore, we were handed with the capability and appropriate management management and nursing interventions asked for such disease.
