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:

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 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

RR: 45 breaths/min.

PR: 70bpm

Temp: 38.2oC

III. Physical Assessment

Area of Assessment

Findings

Interpretations

Head

(-) wounds
(+) dry hair
(+) normocephalic

normal

Skin

(-) jaundice
(+) moist skin

normal

Ears

(+) lumps/lesions

normal

Eyes

(+) pupillary reflex

(+) 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

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

Bowel Elimination

(-) 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 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

Significance

Transparency

slightly turbid

Reaction

7-5

Albumin

(-)

Normal

Sugar

(-)

Normal

Specific gravity

1.005

Epithelial cells

few

Amorphous substance

few

Pus Cells

1-3

RBC

0-2

Normal

decreased

Hematology:
Test
Hemoglobin

WBC

Hematocrit

Normal Values

Findings

Significance

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 (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.

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.