Scope AND DELIMITATIONS

Management in the previous hospitalization

Management between after upon admission and
the day prior to the interview.
Epidemiology of the Disease

OVERVIEW of the
presentation

overview

Health History
Physical Assessment
Anatomy and Physiology of Respiratory System
Pathophysiology of Pulmonary Tuberculosis
Disease Study

Medical Management
Nursing Management
Drug Study
Laboratory Findings
Nursing Care Plan

tuberculosis

Tuberculosis (TB) is an infectious disease that

primarily affects the lung parenchyma.

MYCOBACTERIUM TUBERCULOSIS

DEFINITION OF TERMS

ANEMIA

-a condition that develops when your blood

lacks enough healthy red blood cells or
hemoglobin

CALCIFICATION

- the accumulation of calcium salts in a body

tissue. It normally occurs in the formation of
bone, but calcium can be deposited abnormally
in soft tissue causing it to harden.

FIBROSIS

- is the formation of excess fibrous connective

tissue in an organ or tissue in a reparative or
reactive process.

GHONS COMPLEX

- a combination of pleural surface-healed granulomas,

calcifications, or scars on the middle lobe of the lung
together with hilar lymph node granulomas. The
complex is evidence that a primary tuberculosis case,
usually from a childhood infection, has healed

GHONS TUBERCLE

- calcification seen in pulmonary parenchyma (usually

midlung) resulting from earlier, usually childhood,
infection with tuberculosis; sometimes confused with a
combination of parenchymal lesion and calcified lymph
node, which is properly termed a Ranke complex.

HYPONATREMIA

- is a condition that occurs when the level of

sodium in your blood is abnormally low. Sodium is
an electrolyte, and it helps regulate the amount of
water that's in and around your cells.

HYPOXEMIA

- is a below-normal level of oxygen in your blood,

specifically in the arteries. Hypoxemia is a sign of
a problem related to breathing or circulation, and
may result in various symptoms, such as
shortness of breath.

METABOLIC ALKALOSIS

- is a metabolic condition in which the pH of tissue is

elevated beyond the normal range (7.35-7.45). This is the
result of decreased hydrogen ion concentration, leading
to increased bicarbonate, or alternatively a direct
result of increased bicarbonate concentrations.

NECROSIS

- is the death of body tissue. It occurs when

too little blood flows to the tissue

PNEUMOTHORAX

- is a collapsed lung. A pneumothorax occurs

when air leaks into the space between your
lung and chest wall. This air pushes on the
outside of your lung and makes it collapse.

THROMBOCYTOSIS

- is a disorder in which your body produces too

many platelets (thrombocytes), which play an
important role in blood clotting.

HEALTH HISTORY

BIOGRAPHICAL DATA

Name: Mr. X
Address: Panginay,Guiguinto, Bulacan
Birthday: August 17, 1984
Birthplace: Guiguinto, Bulacan

BIOGRAPHICAL DATA

Age:
31 years old
Occupation:
Garbage Collector
Civil Status:
Single
Religion:
Roman Catholic

BIOGRAPHICAL DATA

Nationality:
Filipino
Educational Attainment: Elementary
Graduate
Date of Admission: December 18, 2015
Date of Interview: January 15,2016

BIOGRAPHICAL DATA

Attending Physician: Dra. Amanda Mae Ramos

Diagnosis : Right Pneumothorax 2o Pulmonary
Tuberculosis.

HEALTH HISTORY

II. REACTION AND EXPECTATION TO ILLNESS,

HOSPITALIZATION, DIAGNOSTIC STUDY &
PERSONNEL

History of
present illness

HISTORY OF PRESENT ILLNESS

Last year, on the month of October the patient manifested

mild difficulty of breathing, intermittent fever, night sweats, body
malaise and productive cough. He described that his cough has a
thick green-colored secretions that gives him chest pain when
coughing. These clinical symptoms continue until such time that
he experienced severe difficulty of breathing that prompted him
to consult to hospital for his condition.

HISTORY OF PRESENT ILLNESS

After almost 2 months of the present condition, he

went to Gregorio Hospital in Bulakan, Bulacan accompanied
by his father with chief complain of shortness of breath.
The doctor promptly ordered him to have Chest X-ray and
other therapeutic managements. After 3 days of
confinement, his doctor reffered him to Bulacan Medical
Center for further management.

HISTORY OF PRESENT ILLNESS

December 18, 2015 - 11oclock in the afternoon , he was

consequently admitted to Emergency Room in Bulacan Medical
Center with initial vital signs of:
BP: 110/80mmHg
T: 36.8o C
P: 89bpm
R: 20bpm.

HISTORY OF PRESENT ILLNESS

He was seen and examined by Dr. Ramos and diagnosed as having

Pneumothorax 2o Pulmonary Tuberculosis and immediately gave orders such
as:
IVF of D5NSS 1L x 100cc/hr
Diet of DAT with SAP
Monitor of I & O
Vital Signs every shift

HISTORY OF PRESENT ILLNESS

Diagnostic Test such as:

Chest X-ray
Complete Blood Count
Creatinine, Sodium, Potassium
Urinalysis
AST ALT
Arterial Blood Gas
Incentive Spirometry

HISTORY OF PRESENT ILLNESS

Dr. Ramos made a referral for Surgery Department for Chest Tube
Thoracotomy. For the pharmacologic therapy, his medications
were:
HRZE tab 3tabs PC
Multi-Vitamins + Budizine tab OD
Mefenamic Acid 500mg tab q8 PRN for pain

HISTORY OF PRESENT ILLNESS

On the day of the interview January 15, 2016, the

client has an IVF of PNSS1L regulated at 24gtts/min,
Oxygen Inhalation via nasal cannula at 5lpm and with
an intact CTT 3-Way bottle inserted on his right
lower chest. The client is still experiencing difficulty
of breathing and productive coughing.

HISTORY OF PRESENT ILLNESS

His diet was Diet as Tolerated. His present attending

physician was Dra. Echiverri and ordered to have
Blood transfusion of 2 units PRBC, Complete Blood
Count prior to it and made a referral to Lung Center
of the Philippines for Video-Assisted Thoracic Surgery.

History of
past illness

HISTORY OF PAST ILLNESS

The patient was previously hospitalized and diagnosed

as having Pulmonary Tuberculosis way back before but he
doesnt remember when it was. He has an ongoing
treatment for his disease with Kochs Medication and
Multivitamins as prescribed by his physician.

HISTORY OF PAST ILLNESS

As stated by his father, the patient is fully

immunized. He has no allergy in foods, medicines
and others but dust that triggers his asthma
since on his early childhood

Family health
history

FAMILY HEALTH HISTORY

Parental Side
His 54 year-old father had Pulmonary Tuberculosis when he was
in secondary education and undergone treatment for 3 months.
Maternal Side
His mother is hypertensive and has asthma.

ACTIVITIES OF
DAILY LIVING

CIRCULATION

During hospitalization, the patient has pale conjunctiva

and normal capillary refill . His blood pressure is 110/80
mmHg and pulse rate of 80bpm. Body temperature is within
normal of 36.8 degree celcius.

RESPIRATION

Prior to hospitalization, patient always experiencing difficulty

and shortness of breathing.
During the course of confinement, he is in respiratory distress
- seen and assessed as having difficulty in breathing and
shortness of breath with use of accessory muscles. He
sometimes cough and expel thick saliva.

RESPIRATION

Upon auscultation, crackle sounds was noted. His breathing

rate is 34bpm

FOOD AND FLUID

Before hospitalization, in 2 months of having clinical

symptoms he always tries to eat albeit he is not usually
in good appetite. He normally drinks 1 cup of water every
after meal and during break approximately 6 cups a day.

FOOD AND FLUID

During hospitalization, the client is on Diet as

Tolerated and eats his foods served by the
dietary department and he consumes at least a
liter of fluid every day.

ELIMINATION

The client had diarrhea for two weeks before

hospitalization, it is stated that patient
defecates 6-7 times a day of greenish-watery
stool. Urination usually takes 4-5 times a day in
yellowish color.

ELIMINATION

During hospitalization, client wears diaper

and change it twice a day. He defecates 3x a
day of semi-formed stool and urinates 6-7x a
day.

PERSONAL HYGIENE

During hospitalization, the client appears

unhygienic but his father assists him in cleaning
his body with soft clothes and soap.

EXERCISE

The client doesnt exercise.

REST AND SLEEP

Before hospitalization, the client is always

experiencing difficulty in sleeping because of his
productive cough and difficulty of breathing. He
usually sleeps 4-5 hours at bedtime with
intermittent waking up.

REST AND SLEEP

During hospitalization, he is restless because

of his condition. His sleeping pattern is always
interrupted because of difficulty of breathing.

USUAL PAIN AND DISCOMFORT

The client feels discomfort because of CTT

that is inserted to him.

COMPETENCIES

PHYSICAL

He is dependent to his relatives and he is just

lying in semi-fowlers position. He doesnt stand
because of the CTT inserted to him.

EMOTIONAL

The patient has a good relationship with his

family. He is a bit sad because he misses his
children because they cannot go to the hospital.
He is thankful because his parents help him in
their financial needs.

MENTAL

He finished studying only in grade school, can

recall past experiences and able to answer
questions coherently.

SPIRITUAL

The patient is Roman Catholic he dont

usually go to church because of his work.
Upon hospitalization, he always prays at
night.

SOCIAL

He is very cooperative albeit he is in distress.

He still maintain good eye contact during the
interview.

ENVIRONMENTAL

He is living in a crowded area in Guiguinto, Bulacan.

Their house is made of concrete and woods with 1 bed
room and a bathroom. It surrounds by an open drainage.
They are near, Rural Health Station, school and market
that takes 10 minutes ride away from their home.

ENVIRONMENTAL

During hospitalization, he is confined in

Isolation Room in Medical Ward with 6 other
patient with the same diagnosis.

PHYSICAL ASSESSMENT

General Appearance

The patient is wearing a white shirt and black short. He

has an ongoing IVF of PNSS1L at 350cc level regulated @
24gtts/min inserted on his left hand. He has an ongoing
Oxygen Inhalation via nasal cannula @ 5LPM and intact CTT 3Way bottle system on his right lower chest. He is weak in
appearance and appears untidy with body odor.

PHYSICAL ASSESSMENT

Vital Signs

Blood Pressure: 130/90mmHg

Temperature : 36.8 C
Heart Rate : 89 bpm
Respiratory Rate : 34 bpm

HEAD

The skull is normocephalic and it is

proportionate to his boy. No anomalies noted.

FACE

The client has tinea capitis on his face. No

lesions nor any problem noted.

NECK

Neck is able to perform range of motion. The

client use his sternocleidomastoid muscle when
breathing because of his dyspnea.

CHEST

The client has an intact CTT-3 Way Bottle

connected at right lower chest. There was
crackles heard upon auscultation.

ABDOMEN

The abdomen is slighty dry it is fair in color.

No anomalies noted.

GENITALIA

Not assessed.

EXTREMITIES

Upper
Both arms are symmetrical and he can move
it independently. He has a tattoo on both arms.

PHYSICAL ASSESSMENT

Lower
Both legs are symmetric in shape and length.
No problems noted.

ANATOMY AND PHYSIOLOGY

FUNCTIONS

Inhalation and Exhalation

Gas Exchange
Creation of Sound
Olfaction or Smelling

Nose

Nose
Mouth

PHARYNX
EPIGLOTIS
TRACHEA

LARYNX
TRACHEA

BRONCHIOLE
S

BRONCH
I

ALVEOLI

LARYNX
TRACHEA

BRONCHIOLE
S

BRONCH
I

ALVEOLI
DIAPHRAGM

pathophysiology

Risk factors

pathophysiology

pathophysiology

pathophysioloogy

pathophysioloogy

DISEASE STUDY

MODE OF TRANSMISSION

AIRBORNE DROPLET METHOD

Clincal symptoms

DIAGNOSTIC findings

DIAGNOSTIC TEST

COMPLETE HISTORY
AND PHYSICAL ASSESSMENT

DIAGNOSTIC TEST

CHEST X-RAY

DIAGNOSTIC TEST

MANTOUX TEST
The Mantoux method is a standardized, intracutaneous injection procedure
and should be performed only by those trained in its administration and
reading.

Video

DIAGNOSTIC TEST

SPUTUM CULTURE

MEDICAL MANAGEMENT

MEDICAL MANAGEMENT

PHARMACOLOGIC THERAPY

NURSING MANAGEMENT

NURSING MANAGEMENT

PROMOTING AIRWAY CLEARANCE

NURSING MANAGEMENT

PROMOTING ACTIVITY

NURSING MANAGEMENT

PROMOTING NUTRITION

NURSING MANAGEMENT

ADVOCATING TREATMENT TO REGIMEN

NURSING MANAGEMENT

PREVENTING SPREADING OF INFECTION

MEDICAL MANAGEMENT
(Pneumothorax)

Chest Tube Thoracostomy

is insertion of a tube into the pleural space. It is used to
drain air or fluid from the chest (eg, for large or recurrent
effusion refractory to thoracentesis, pneumothorax,
complicated parapneumonic effusions, empyema, or
hemothorax) and to do pleurodesis or fibrinolytic
adhesiolysis.

Chest tube thoracostomy

Video assisted
thoracostomy surgery

A minimal invasive surgical technique used to

diagnose and treat problems in your chest.

V.A.T.S

During surgery procedure, a tiny camera

(thoracoscope) and surgical
instruments are inserted into your
chest through several small incisions.
The thoracoscope transmits images of
the inside of your chest onto a video
monitor, guiding the surgeon in
performing the procedure.

Laboratory results

Complete blood count

It is a blood test used to evaluate your overall health and detect a wide
range of disorders, including anemia, infection and leukemia.

WBC

DECEMBE
R 21,
2015
12.6

RBC

5.20

4.50

4.08

4.09

3.99

4.005.50

Normal

HGB

123

107

96

95

95

120-160

Anemia

HCT

0.392

0.336

0.293

0.292

0.285

0.4400.540

Anemia

PLT

621

521

685

586

561

150-400

Thrombocytosis

TEST

DECEMBE JANUARY JANUARY

JANUARY
R 25,
04,
06,
08, 2016
2015
2016
2016
11.3
13.6
10.7
10.0

NORMAL
RANGE

INTERPRETATIO
N

4.0-10.0

Infection

Blood chemistry
It is testing defined simply as identifying the numerous chemical substances
found in the blood.
Test

September
10,2015

Normal Range

Interpretation

TOTAL PROTEIN

56.1 g/dl

41.0-83.0 g/dl

Normal

ALBUMIN

31.7 g/dl

34.0-53.0 g/dl

Hypoalbumenia

Test

DECEMB
ER 21,
2015

DECEMB
ER 25,
2015

JANUARY
04, 2016

JANUARY
06, 2016

JANUARY
10, 2016

Creatini
ne

59.5
umol/L

60.9
umol/L

Sodium

123.6
mmol/L

127.7
mmol/L

121.8
mmol/L

147.7
mmol/L

Potassiu
m

4.10
mmol/L

4.15
mmol/L

4.08
mmol/L

NORMA
L
RANGE
72.0127.0
umol/L
135 to
148
mmol/l
3.5 to
5.3
mmol/l

INTERPRETATI
ON
Decreased
muscle mass
Hyponatremni
a
Normal

Arterial blood gas (abg)

A test that measures the acidity (pH) and the levels of oxygen and carbon
dioxide in the blood from an artery. This test is used to check how well your
lungs are able to move oxygen into the blood and remove carbon dioxide
from the blood.
NORMAL VALUES

INTERPRETATION

Test

DECEMBER 21, 20116

pH

7.50

7.35 7.45

Alkalosis

pCO2

41.7

35 45 mmHg

Normal

pO2

111.1

80 100 mmHg

Partially
Compensated

HCO2

36.0

22 26 mEq/L

Alkalosis

B.E

11.2

+/- 2 mEq/L

Metabolic Alkalosis

O2 Sat.

98.4

97%

Over Corrected
Hypoxemia

Abdominal ultrasound
It is a type of imaging test. It is used to look at organs in the abdomen,
including the liver, gallbladder, spleen, pancreas, and kidneys.

IMPRESSION:
Diffuse liver parenchymal changes
Consider renal parenchymal disease with calietasis, bilateral
Minimal ascites
Incidental note of right pleural effusion
Unremarkable gallbladder, pancreas, spleen, urinary bladder and prostate
gland

DRUG STUDY

DRUG STUDY

MEFENAMIC ACID

Doctors Order: Mefenamic Acid 500mg tab q8*

BRAND NAME:
Ponstel

CLASSIFICATION:
Analgesic,
Nonsteroidal AntiInflammatory
Drug (NSAID)

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

NSAID
that
inhibits
COX-1
and COX2
enzymes
necessar
y for
prostagla
ndin
synthesis
.

INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

Short-term
relief of
mild to
moderate
pain.

Hypersensitivi
ty to
mefenamic; GI
inflammation,
or ulceration.

Severe
diarrhea,
nausea &
vomiting,
headache,
bleeding,
and
leukopenia
etc..

NURSING
CONSIDERATION

-Observe 10 rights
in drug
administration.
-Monitor blood
pressure during
initiation and
throughout the
course of
treatment.
-Monitor for and
report promptly S&S
of GI ulceration or
bleeding.
-Assess patients
who develop severe
diarrhea and
vomiting for
dehydration and
electrolyte
imbalance.
-Monitor lab tests:

DRUG STUDY

KETEROLAC

Doctors Order: Ketorolac 30mg TIV q12* PRN for pain

BRAND NAME:
Toradol

CLASSIFICATION:
Analgesic,
Nonsteroidal AntiInflammatory
Drug (NSAID);
Antipyretic
DRUG FORM:
Solution for
injection

ROUTE:
IV

ACTION

INDICATION

CONTRAINDICATI
ON

It inhibits
synthesis
of
prostagla
ndins by
inhibiting
both
COX-1
and COX2
enzymes.

Short-term
managemen
t of pain (up
to 5 days).

Contraindicate
d with
significant
renal
impairment,
aspirin allergy,
recent GI
bleed or
perforation.
Use cautiously
with impaired
hearing;
allergies;
hepatic
conditions.

ADVERSE
EFFECTS

Drowsiness,
nausea,
headache,
fatigue,
insomnia,
and
hemorrhage
etc..

NURSING
CONSIDERATION

-Observe 10 rights
in drug
administration.
-Assess first the
patient before
administering this
drug: know the
history (e.g.
allergies, renal
impairment, etc.)
and physical
condition of the
patient.
-Withhold drug and
notify prescriber if
S&S of
hypersensitivity
occur.
-Monitor for S&S of
GI distress or
bleeding including
nausea, GI pain,
diarrhea, melena, or
hematemesis.

DRUG STUDY

TRAMADOL

Doctors Order: Tramadol 50mg TIV q8* PRN for pain

BRAND NAME:
Ultram

CLASSIFICATION:
Analgesic, Opiate
Agonist
DRUG FORM:
Solution for
injection
ROUTE:
IV

ACTION

INDICATION

CONTRAINDICATIO
N

ADVERSE
EFFECTS

NURSING CONSIDERATION

Centrally
acting
opiate
receptor
agonist
that
inhibits
the
uptake of
norepinep
hrine and
serotonin,
suggestin
g both
opioid and
nonopioid
mechanis
ms of pain
relief.

Managemen
t of
moderate or
moderately
severe pain.

Hypersensitivit
y to tramadol,
opioids, or any
component of
the
formulation;
opioiddependent
patients.

Dizziness,
vertigo,
fatigue,
headache,
somnolence,
constipation,
and
anaphylactic
reaction etc..

-Observe 10 rights in
drug administration.
-Monitor vital signs
and assess for
orthostatic
hypotension or signs
of CNS depression.
-Assess bowel and
bladder function;
report urinary
frequency or
retention.
-Use seizure
precautions for
patients who have a
history of seizures or
who are concurrently
using drugs that
lower the seizure
threshold.
-Monitor ambulation
and take appropriate
safety precautions.

DRUG STUDY

PARACETAMOL

Doctors Order: Paracetamol 300mg TIV q4* PRN for fever

BRAND NAME:
Tylenol
CLASSIFICATION:
Non-narcotic,
Analgesic,
Antipyretic
DRUG FORM:
Solution for
injection

ROUTE:
IV

ACTION

INDICATION

CONTRAINDICATIO
N

ADVERSE
EFFECTS

Reduces
fever by
acting on
the
hypothal
amus to
cause
vasodilat
ation &
sweating.

Fever
reduction.
Temporary
relief of mild
to moderate
pain.

Contraindicate
d with allergy
to
acetaminophe
n or any
component.

Nausea,
stomach
upset, skin
rash,
constipation,
tachycardia,
and dizziness
etc..

NURSING
CONSIDERATION

-Observe 10 rights
in drug
administration.
-Assess patients
fever or pain: type
of pain, location,
intensity, duration,
temperature, and
diaphoresis.
-Assess allergic
reactions: rash,
urticaria; if these
occur, drug may
have to be
discontinued.
-Teach patient to
recognize signs of
chronic overdose:
bleeding, bruising,
malaise, fever, sore
throat.

DRUG STUDY

CEFTAZIDIME

Doctors Order: Ceftazidime 1gm TIV q6*

BRAND NAME:
Fortaz
CLASSIFICATION:
Antibiotic,
Cephalosporin
(third generation)

DRUG FORM:
Solution for
injection

ROUTE:
IV

ACTION

INDICATION

CONTRAINDICATIO
N

ADVERSE
EFFECTS

NURSING
CONSIDERATION

It inhibits
the final
stage of
bacterial
cell wall
synthesis
, leading
to cell
death.

To treat
infections of
lower
respiratory
tract

Hypersensitivit
y to
ceftazidime or
cephalosporin;
viral disease.

Nausea,
vomiting,
abdominal
pain, pain or
inflammation
at injection
site and
pseudomemb
ranous colitis
etc..

-Observe 10 rights
in drug
administration.
-Assess for liver and
renal dysfunction
-Do not mix with
aminoglycoside
solutions, administer
these drugs
separately.
-Be alert to onset of
rash, itching, and
dyspnea. Check
patients
temperature. If it is
elevated, suspect
onset of
hypersensitivity
reaction.

DRUG STUDY

FERROUS SULFATE

Doctors Order: FoSO4 325mg tab OD

BRAND NAME:
Feosol
CLASSIFICATION:
Anti-anemic, Iron
Supplement

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

INDICATION

CONTRAINDICATIO
N

Standard
iron
preparation
that corrects
erythropoiet
ic
abnormalitie
s induced by
iron
deficiency
but does not
stimulate
erythropoies
is.

Preventio
n and
treatment
of iron
deficienc
y
anemias.
-Dietary
suppleme
nt for
iron.

Patients
receiving
repeated
blood
transfusions;
anemia not
due to iron
deficiency.

ADVERSE
EFFECTS

NURSING
CONSIDERATION

Nausea,
heartburn,
constipation,
black stools,
shock, and
cardiovascul
ar collapse
etc..

- Observe 10 rights
in drug
administration.
-Give between
meals with water
but may give with
meals if
gastrointestinal
discomfort occurs.
-Avoid simultaneous
administration of
antacids or
tetracycline.
-Monitor serum iron,
total iron- binding
capacity,
reticulocyte count,
hemoglobin, and
ferritin.

DRUG STUDY

IPRATROPIUM + SALBUTAMOL

Doctors Order: Ipratropium Neb q6*

BRAND NAME:
Combivent
CLASSIFICATION
:
Anticholinergic
DRUG FORM:
Solution for
inhalation
ROUTE:
Nasal Inhalation

ACTION

INDICATION

CONTRAINDICATI
ON

The
ipratropium
ingredient is
an
anticholinerg
ic drug which
relaxes
smooth
muscle in
the lung. The
salbutamol
ingredient is
a beta-2
agonist
which
stimulates
beta-2 sites
in the lungs

Managemen
t of
reversible
bronchospas
m
associated
with
obstructive
airway
diseases in
patients
who require
more than a
single
bronchodilat
or.

Use as
primary
treatment for
acute
episodes;
hypersensitivi
ty to
atropine,
bromides,
peanut oils,
soy lecithin.

ADVERSE
EFFECTS

Dizziness,
blurred
vision,
nausea, dry
mouth,
dyspnea,
palpitations,
and chest
pain etc..

NURSING
CONSIDERATION

- Observe 10 rights
in drug
administration.
-Monitor respiratory
status; auscultate
lungs before and
after inhalation.
-Monitor the
patient's vital signs,
noting hypotension
and an irregular or
abnormal pulse.
-Maintain a quiet,
comfortable
environment to
minimize anxiety
and perhaps
decrease
palpitations.

DRUG STUDY

ACETYLCYSTEINE

Doctors Order: NAC 600mg 1 tab OD HS

BRAND NAME:
Mucomyst
CLASSIFICATIO
N:
Mucolytic

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

INDICATION

CONTRAINDICATI
ON

Mucolytic
that
reduces the
viscosity of
pulmonary
secretions
by splitting
disulfide
linkages
between
mucoprotei
n molecular
complexes.

Adjuvant
therapy in
patients with
abnormal
mucous
secretions in
acute and
chronic
bronchopulmon
ary diseases,
and in
pulmonary
complications
of cystic
fibrosis and
surgery,
tracheostomy,
and atelectasis.

Hypersensitiv
ity to
acetylcystein
e; patients at
risk of gastric
hemorrhage.

ADVERSE
EFFECTS

Dizziness,
nausea,
vomiting,
stomatitis,
burning
sensation in
upper
respiratory
passages,
and
epistaxis.

NURSING
CONSIDERATION

-Observe 10 rights
in drug
administration.
-Monitor for S&S of
aspiration of excess
secretions, and for
bronchospasm.
-Monitor lab tests:
ABGs, pulmonary
functions and pulse
oximetry as
indicated.

DRUG STUDY

AZITHROMYCIN

Azithromycin
Doctors Order: Azithromycin 500mg tab OD
.

BRAND NAME:
Zithromax

CLASSIFICATIO
N:
Macrolide,
Antibiotic

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

A macrolide
antibiotic
that
reversibly
binds to the
50S
ribosomal
subunit of
susceptible
organisms
and
consequentl
y inhibits
protein
synthesis,
causing cell
death.

INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

NURSING
CONSIDERATION

Treatment for
pneumonia,
lower
respiratory
tract
infections.

Hypersensitiv
ity to
azithromycin,
erythromycin
, or any of
the macrolide
antibiotics;
history of
cholestatic
jaundice/hep
atic
dysfunction
associated
with prior use
of
azithromycin.

Nausea and
vomiting,
headache,
dizziness,
fatigue, and
hepatotoxicit
y etc..

-Observe 10 rights
in drug
administration.
-Administer on an
empty stomach 1 hr
before or 23 hr
after meals. Food
affects the
absorption of this
drug.
-Report immediately
any S&S of
hypersensitivity;
though rare, these
reactions can be
serious.

DRUG STUDY

HREZ

RIFAMPICIN
Doctors Order: HRZE 3 tabs OD

BRAND NAME:
Crisarfam
CLASSIFICATI
ON:
Anti-infective

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

Inhibits DNAdependent
polymerase,
decreases
replication.

INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

NURSING
CONSIDERATION

Maintenance
phase
treatment of
all forms of
pulmonary and
extrapulmonary TB;
prevention of
meningococcal
meningitis.

Jaundice
associated
with reduced
bilirubin
excretion; 1st
trimester
ofpregnancy;
premature
and newborn
infants. Druginduced
liverdiseases,
impaired liver
function.

GI
disturban
ce,
nausea
and
vomiting,
diarrhea,
SOB, GI
bleeding,
liver and
kidney
dysfuncti
on etc..

-Observe 10
rights in drug
administration.
-Assess lung
sounds, character
and amount of
sputum
periodically.
-Monitor patient
compliance with
treatment
regimen.
-Inform patient
that this
medication will
discolor urine,
stool, saliva,
tears, sweat, and
otherbody fluid a
red-brown color.

ISONIAZID
Doctors Order: HRZE 3 tabs OD

BRAND NAME:
Norvit
CLASSIFICATI
ON:
Anti-infective

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

NURSING
CONSIDERATION

Inhibits RNA
synthesis,
decreases tubercle
bacilli replication.

Treatment for
pulmonary and
extrapulmonary
tuberculosis.

Should not be
given to
patients with
drug-induced
liver disease.

Various
skin
eruptions,
nausea
and
vomiting,
liver
dysfuncti
on, and GI
disturban
ce etc..

-Observe 10
rights in drug
administration.
-Monitor
renal/liver
function.
-Instruct patient
that compliance
with dosage
schedule for
duration is
necessary to gain
benefits.
-Advice patient to
report peripheral
neuritis.

PYrazinamide
Doctors Order: HRZE 3 tabs OD

BRAND NAME:
Myocovak
CLASSIFICATI
ON:
Anti-infective

DRUG FORM:
Tablet

ROUTE:
PO

ACTION

INDICATION

CONTRAINDICATIO
N

ADVERSE
EFFECTS

Mechanism is
unknown, highly
specific and
bactericidal
forMycobacterium
tuberculosis
hominis.

Treatment
for active
tuberculosis
in adults
and
selected
children.

Acuteliverdisease,
porphyria,
peripheral
neuritis, acute
gout,
hypersensitivit
y and
pregnancy.

Nausea and
vomiting,
thrombocyt
openia,
anorexia,
doserelated
hepatotoxic
ity and
increased
serum iron
concentrati
on.

NURSING
CONSIDERATION

-Observe 10
rights in drug
administration.
-Assess patients
condition before
therapy and
regularly
thereafter to
monitor drug
effectiveness.
-Regularly assess
for hepatoxicity.
-Regularly assess
renal status.
-Instruct patient
to take drug
continuously as
prescribed.

ETHAMBUTOL
Doctors Order : HRZE 3 tabs OD

BRAND NAME:
Odetol
CLASSIFICATI
ON:
Anti-infective

DRUG FORM:
Tablet
ROUTE:
PO

ACTION

It suppresses
the growth of
tubercle bacilli
however the
specific
mechanism
ofaction is
unknown.

INDICATION

CONTRAINDICATIO
N

Used with other

antituberculosis
drugs in the
primary
treatment of
pulmonary and
extra
pulmonary
tuberculosis to
suppress
emergence of
resistance to
the drugs used
in the regimen.

Patients with
optic neuritis.
Should
generally not
be used in
children below
6 years ofage.

ADVERSE
EFFECTS

Reduction
in visual
acuity,
retinal
hemorrhag
e, skin
rashes,
pruritus,
fever, and
joint pain
etc..

NURSING
CONSIDERATION

-Observe 10 rights
in drug
administration.
-Perform visual
acuity and
colordiscriminatio
n tests before and
during therapy.
-Assess liver
adrenal status and
function before
and during therapy.
-Advise patient
that compliance
with dosage
schedule and
duration is
necessary to
eradicate disease.

NURSING CARE PLAN