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 normal

(+) dry hair
(+) normocephalic

Skin (-) jaundice normal

(+) moist skin

Ears (+) lumps/lesions normal

Eyes (+) pupillary reflex normal

(+) pupils equal
(-) discharge noted
(-) periorbital edema
 Nose (-) discharge normal
(-)lesions

Mouth (+) dry lips Poor oral hygiene

(-) foul smell Good oral hygiene
(-) tartar

Face (-) edema normal

(-) rounded/moon face
(-) scars

Neck (+) enlarged lymph nodes in lymphadenopathy

cervical area

Shoulder (+) symmetry normal

Chest (-) palpable mass normal

(+) rales during inspiration

Abdomen (-) skin discoloration normal

(-) scars
(+)Normal bowel sounds

Arms ( ) mucle mass noted

(+) active motion

Legs (-) superficial lesions normal

(-) palpable mass

Bladder Elimination (+) orange- brown colored Normal side effect of

urine medication

Bowel Elimination (+) regular, daily hard normal

brownish stool
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 Normal

Reaction 7-5
Albumin (-) Normal
Sugar (-) Normal
Specific gravity 1.005 decreased
Epithelial cells few
Amorphous substance few
Pus Cells 1-3
RBC 0-2
Hematology:

Test Normal Values Findings Significance

Hemoglobin M: 140-170 g/L 100 g/L Anemia

F:120-150 g/L

WBC 5-10 x 10 g/L 12.5 x 10 g/L Infection

Hematocrit M: 40-50 vol. % .36 Hemodilution, Acute

F:37-47 vol. % 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 Sneeze
individual talk,

Mycobacterium Mucus d
tuberculosis remains released
suspended in the air infected in

Entry of
pathogen
Inhaled by susceptible
person
 Infectious Inflammation of
process small area in the
(4-12 wks) lung usually self
limiting

Reaction to pathogen
Primary
infection

Remaining bacteria ar
cell-mediated resolved into a
immune response calcified lesion and
housed during latent
period.
 Reactivation of secondary
bacteria tuberculosis
infection
occurs

Secondary TB
not self-
limiting 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.