Virgen Milagrosa University Foundation Martin P. Posadas Ave.

San Carlos City, Pangasinan College of Nursing

A Case study on Pulmonary Tuberculosis

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 History: (-) Smoker (-) alcohol drinker Past Health History (-) smoker (-) alcohol drinker Family History (-) Smoker (+) alcohol drinker

(-) Asthma (-) HPN (-) DM

(-) Asthma (-) HPN (-) DM

(-) Asthma (-) HPN (+) DM

Two months prior to admission, Mrs. A.C.L. suffered from persistent productive coughing which later persists to coughing out of blood. On the 15th of April, she was rushed to the hospital (Don Mariano Verzosa 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 PR: 70bpm RR: 45 breaths/min. Temp: 38.2oC

III. Physical Assessment

Area of Assessment

Findings

Interpretations

Head

(-) wounds (+) dry hair (+) normocephalic (-) jaundice (+) moist skin (+) lumps/lesions (+) pupillary reflex (+) pupils equal (-) discharge noted (-) periorbital edema

normal

Skin

normal

Ears Eyes

normal normal

Nose

(-) discharge (-)lesions (+) dry lips (-) foul smell (-) tartar (-) edema (-) rounded/moon face (-) scars (+) enlarged lymph nodes in cervical area (+) symmetry

normal

Mouth

Poor oral hygiene Good oral hygiene

Face

normal

Neck

lymphadenopathy

Shoulder

normal

Chest

(-) palpable mass (+) rales during inspiration (-) skin discoloration (-) scars (+)Normal bowel sounds
( ) mucle mass noted

normal

Abdomen

normal

Arms

(+) active motion

Legs

(-) superficial lesions (-) palpable mass (+) orange- brown colored urine (+) regular, daily hard brownish stool

normal

Bladder Elimination

Normal side effect of medication normal

Bowel Elimination

IV. Diagnostic Procedures

I.Chest X-ray Result: -Reticular and nodular densities scattered diffusely in both 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 Transparency Reaction Albumin Sugar Specific gravity Epithelial cells Amorphous substance Pus Cells RBC

Yellow slightly turbid 7-5 (-) (-) 1.005 few few 1-3 0-2

Significance Normal

Normal Normal decreased

Hematology:
Test Hemoglobin Normal Values M: 140-170 g/L F:120-150 g/L 5-10 x 10 g/L Findings 100 g/L Significance Anemia

WBC

12.5 x 10 g/L

Infection

Hematocrit

M: 40-50 vol. % F:37-47 vol. %

.36

Hemodilution, Acute massive blood loss

V. Pathogenecity
What is Pulmonary tuberculosis? Pulmonary tuberculosis (TB) is a contagious bacterial infection that mainly involves the lungs, but may spread to 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. Risk Factors 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

Have poor nutrition Live in crowded or unsanitary living conditions Healthcare workers

Symptoms:

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 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 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 immune system later becomes compromised, as it does in many critically ill patients, the disease can be reactivated.

Primary Disease
Primary pulmonary tuberculosis is often asymptomatic, so that the results of diagnostic tests. are the only evidence of the disease.. Associated paratracheal lymphadenopathy may occur because the bacilli spread from the lungs through the lymphatic system. If the 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. 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 inflammatory and immune responses. Wasting involves the loss of both fat and lean tissue; the decreased muscle mass contributes to the 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 in a cavity, or the formation of an aspergilloma in an old cavity. Hematologic studies might reveal anemia, which is the cause of the weakness and fatigue.

Diagnostic Tests:

Biopsy of the affected tissue (rare) Bronchoscopy Chest CT scan Chest x-ray Sputum examination and cultures Thoracentesis Tuberculin skin test

Treatment:

Isoniazid Rifampicin Pyrazinamide Ethambutol Steptomycin

Possible Complications:
Pulmonary TB can cause permanent lung damage if not treated early.

extrapulmonary tuberculosis (TB spread to areas of the body outside of the lungs) tuberculosis pneumonia (massive lobular or lobar pneumonia) pleuritis (infection & inflammation of tissue covering the lungs.

Infected individual

Sneeze talk,

Mycobacterium tuberculosis remains suspended in the air

Mucus d released infected in

Entry of pathogen Inhaled by susceptible person

Infectious process (4-12 wks)

Inflammation of small area in the lung usually self limiting

Primary infection

Reaction to pathogen

cell-mediated immune response

Remaining bacteria ar resolved into a calcified lesion and housed during latent period.

Reactivation of bacteria

secondary tuberculosis infection occurs

Secondary TB not selflimiting

More problem terms of fur complicatio

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 Research:

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 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 and nursing interventions asked for such disease.