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St.

Paul University Quezon City


College of Health and Sciences

First Semester A.Y. 2011-2012

Case Study

Pulmonary Tuberculosis Class III

Submitted by: Padaoan, Jesusa A. Submitted to: Ms. Angeline Anastacio

Objectives General objective: The purpose of this study is to provide deeper theoretical and practical knowledge and information about pulmonary tuberculosis class III. Specific objectives: y y y To provide preventive measures on how to prevent tuberculosis. To provide a framework of study regarding the subject that can serve as the foundation of future studies. List actual symptoms that can happen during the course of the disease.

Introduction Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis). You can get TB by breathing in air droplets from a cough or sneeze of an infected person. This is called primary TB. Most people who develop symptoms of a TB infection first became infected in the past. However, in some cases, the disease may become active within weeks after the primary infection. Classification Class I (TB exposure) y (+) exposure y (-) Mantoux tuberculin test y (-) Signs and symptoms suggestive of TB y (-) Chest radiograph Class II (TB infection) y () exposure y (+) Mantoux tuberculin test y (-) Signs and symptoms suggestive of TB y (-) Chest radiograph y Class III (TB disease) o Has three or more of the ff. criteria  (+) history of exposure to an adult/adolescent with active TB disease  (+) Mantoux tuberculin test  (+) signs and symptoms suggestive of TB  Cough/wheezing > 2 weeks; fever > 2 weeks  Painless cervical and/or other lymphadenopathy

Poor weight gain; failure to make a quick return to normal after an infection (measles, tonsillitis, whooping cough) or failure to respond to approriate antibiotic therapy (pneumonia, otitis media)  Abnormal Chest radiograph  Laboratory findings suggestive of TB (histological, cytological, biochemical, immunological or molecular) y Class IV (TB inactive) o A child/adolescent with or without history of previous TB and any of the ff:  () previous chemotherapy  (+) radiographic evidence of healed/calcified TB  (+) Mantoux tuberculin test  (-) signs and symptoms suggestive of TB  (-) smear/culture for M. tuberculosis


Symptoms The primary stage of TB usually doesn't cause symptoms. When symptoms of pulmonary TB occur, they may include: Cough (usually cough up mucus) Coughing up blood Excessive sweating, especially at night Fatigue Fever Unintentional weight loss Treatment
y y y y y y

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. The most commonly used drugs include:
y y y y

Isoniazid Rifampin Pyrazinamide Ethambutol

You may need to take many different pills at different times of the day for 6 months or longer. It is very important that you take the pills the way your health care provider instructed. When people do not take their TB medications as recommended, the infection becomes much more difficult to treat. The TB bacteria may become resistant to treatment, and sometimes, the drugs no longer help treat the infection.

Patient s Data Patient s Name: E. Age: 54 years old Gender: Male Civil Status: Married Nationality: Filipino Religion: Roman Catholic Ward: Isolation Room Date of Admission: August 10, 2011 Final Diagnosis: Pulmonary Tuberculosis Class III Nursing Assessment Family Health History: According to the patient, there is no history of any diseases in both the father and mother side. Past Health History: Patient E. was admitted last June 2 and was diagnosed with Partial tuberculosis with Pneumonia and Pulmonary disease. He went home against medical condition after 9 days of being admitted. Present Health History: Prior to admission, the patient s chief complaint was coughing and weight loss. He had a low grade fever and dry cough. Immunization record: The patient has a complete immunization record.

Gordon s Assessment Health Perception Before hospitalization: The patient had partial tuberculosis with pneumonia and pulmonary disease last June 2, 2011. He went home against medical advice after nine days of seeking medical help. The patient smokes everyday and drinks alcohol almost everyday. After hospitalization: The patient was brought to the hospital because the patient was showing signs of dry cough and weight loss. Interpretation: The patient has a poor health perception because when he was first admitted in the hospital last June 2, 2011 he went home against medical advice. Going against

medical advice can aggravate the condition of the patient which is what happened to patient E. Smoking and drinking alcohol can aggravate the patient s condition.

Nutritional-Metabolic Pattern Before hospitalization: The patient eats at least three times a day and he usually prefers vegetables with his meals. He eats his vegetables with a cup and a half of rice. He drinks at an estimate of 700 ml of water per day.

After hospitalization: The patient eats what the hospital provides for him and the occasional food brought by his family members. He usually finishes the food served for him. He drinks at around 1,400 ml of water. Interpretation: The patient s nutritional intake is almost the same before and after he was admitted in the hospital. His fluid intake increased. Patient E should add more protein to his diet.

Elimination Pattern Before hospitalization: Patient E defecates at least two times every day. His stool is usually brown in color (depends on what he ate that day). He urinates at least four times a day and the color of his urine is from clear to amber yellow (depends on what he drank that day). After hospitalization: The patient still defecates two times a day and his stool color is still brown. He still urinates at least four times a day but the color of his urine changed to orange because of his medications. Interpretation: One of the side effects of TB medications is the change in urine color which is normal for patient E because he is taking medications for TB.

Exercise-Activity Pattern Before hospitalization: Patient E still works at the age of 54. He mentioned that he exercise at least everyday for 15-30 minutes. After hospitalization: The patient has not gone to work for almost two weeks. He still manages to exercise by moving his arms around in a circular motion. Interpretation: The patient is able to move and exercise. His good exercise pattern is good for his health because blood can easily flow when exercising.

Sleep-rest pattern Before hospitalization: The patient mentioned that he used to sleep for at least 8 hours a day. He would be in bed at around 7 pm and he ll wake up at around 3. He doesn t take a nap in the afternoon. After Hospitalization: The patient is having a difficult time sleeping because nurses would interrupt his sleep and his not comfortable in the hospital. Interpretation: The patient has a normal sleeping pattern when before he was hospitalized. He doesn t get enough sleep when he was hospitalized which he needs in order to get better.

Cognitive-Perceptual Pattern Before hospitalization: Since patient E is the head of the family, he makes the decisions in his house. He was alert and active and can take action when problems arise. After hospitalization: The patient understands his situation the reason why he is seeking medical care and why he needs it. He was alert when I conducted an interview with him and he is well-oriented. Interpretation: The patient has a normal mental status. Even though he s still in the hospital he can still makes decisions and can cooperate and understand well.

Self-Perception Pattern Before hospitalization: The patient has a positive view of himself. He is contented with what he has. After hospitalization: When the patient was confined, he feels insecure of himself because he doesn t like getting sick. He sometimes thinks of committing suicide because of his insecurity. Interpretation: The patient has a low self-perception at the moment. He feels insecure because of the illness that he currently has.

Role-Relationship Pattern Before hospitalization: The patient lives with his wife and four children. He is the head of the family and he makes decisions for their betterment.

After hospitalization: Patient E s family members visit him all the time. They take turns on who will take care of him. They always bring him pasalubong like pastries. Interpretation: The patient has a very supportive family. He has a good relationship with every member of the family.

Coping/Stress Tolerance Before hospitalization: Whenever the patient is experiencing stress, he usually sits in a quiet place and rests and tries to forget all his problems. After hospitalization: The patient still feels insecure about his illness. He still sits on his hospital bed and he still tries to forget all his problems. Interpretation: Patient E is in an emotional state because of his illness.

Sexuality-Reproductive Pattern Before hospitalization: The patient is married and has four children. The patient has a normal sexual functioning. After hospitalization: The patient is unable to make sexual contact with his wife because of his current illness. Interpretation: The patient is feeling unsatisfied sexually because he hasn t made sexual contact with his wife because of his illness.

Value-Belief Pattern Before hospitalization: Patient E is a Roman Catholic, he also rarely goes to church. But he mentioned that his faith is only with God and he prays everyday. After hospitalization: Patient E continues to pray everyday. He even reads the bible during his alone time in the hospital Interpretation: Patient E has a strong faith in God.

Physical Assessment

Assessment

Findings

Interpretation

Appearance and mental status Body built, height and weight Posture and gait, standing, sitting and walking Overall hygiene and grooming

Well-oriented and not drowsy Proportional, low weight Positive limping gait

Normal Due to excessive coughing Due to Polio Normal

Clean, neat

Body and breath odor Facial expression Quantity of speech, quality, and organization

No body odor; no breath odor No distress noted Understandable, moderate pace; clear tone and inflection; exhibits thought association 36.8

Normal Normal Normal

Temperature Skin Skin turgor

Normal

Skin snaps back after 3-4 Seconds

Normal

Texture Nails Fingernail plate shape Color Capillary refill

Smooth

Normal

Convex curature Pink Returns to pink when pressure is released 3-4 sec

Normal Normal Normal

Hair

Distribution Evenly distributed Texture Smooth and straight Skull and Face Size, shape and symmetry Rounded, smooth skull contour Symmetric facial feature Symmetric facial movements

Normal

Normal

Normal

Facial feature Facial movements Eyes Eyelashes

Normal Normal

Equally distributed; curved slightly outward Hair evenly distributed

Normal Normal

Eyebrows

Eyelids Conjunctiva

Skin intact; no discoloration Transparent with light pink color White

Normal Normal Normal

Sclera

Cornea

Transparent, shiny

Normal

Pupils

Brown, constricts briskly

Normal

Iris Ears Ear Canal opening Nose

Brown

Normal

Free of lesions

Normal

Shape, size, color

Smooth, symmetric with same color as the face

Normal

Nares Oval, symmetric Mouth Lips Pink, moist, symmetric Gums Slightly red in color, moist and slightly loose fit against each tooth Tongue Moist, slightly rough on dorsal surface medium or dull red Normal Due to smoking Normal Normal

Teeth Shiny and yellow of enamel Neck Symmetric, muscles, alignment of trachea Neck, slightly hyper extended, without masses or asymmetry

Due to smoking habits.

Normal

Neck rolls Thyroid gland

Neck moves free without discomfort Neck moves freely without discomfort

Normal Normal

Trachea

Rises freely with swallowing

Normal

Thorax and Lungs Shape and symmetry of the thorax Chest symmetric Normal

Spinal alignment

Spine vertically aligned

Normal Due to pulmonary tuberculosis

Breathing patterns

Adventitious breath sounds (crackles)

Abdomen Skin integrity Symmetry Palpation of the abdomen Unblemished skin, uniform color Rounded No tenderness Normal Normal Normal

Bladder Upper extremities (right and left) Radial pulse

Not palpable

Normal

Equal pulsation

Normal

Skin integrity

Intact condition of the skin in the right arm, with no bruises at the mid-arm on both arms, no presence of edema on the left arm

Normal

Lower extremities(right and left) Symmetry Bilaterally symmetrical and equal Normal

Skin integrity Skin color

Right and left legs to feet with no presence of edema, no lesions Same as the other part of the body

Normal

Normal

Anatomy and Physiology The Respiratory System

Overview Cells in the body require oxygen to survive. Vital functions of the body are carried out as the body is continuously supplied with oxygen. Without therespiratory systemexchange of gases in the alveoli will not be made possible and systemic distribution of oxygen will not be made possible. The transportation of oxygen in the different parts of the body is accomplished by the blood of the cardiovascular system. However, it is the respiratory system that carries in oxygen to the body and transports oxygen from the tissue cells to the blood. Thus, cardiovascular system and respiratory system works hand in hand with each other. A problem in the cardiovascular system would affect the other and vice versa. Functional Anatomy of the Respiratory System Nose

The nose is the only external part of the respiratory system and is the part where the air passes through. During inhalation and exhalation, air enters the nose by passing through the external nares or nostrils. Nasal cavity is found inside the nose and is divided by a nasal septum. The receptors for the sense of smell, olfactory receptors are found in the mucosa of the slit-like superior part of the nasal cavity which is located beneath the ethmoid bone. Respiratory mucosa lines the rest of the nasal cavity and rests on a rich network of thin-walled veins that warms the air passing by. Pharynx The pharynx is a 13 cm long muscular tube that is commonly called the throat. This muscular passageway serves as a common food and air pathway. This structure is continuous with the nasal cavity anteriorly via the internal nares. Parts of pharynx: 1. Nasopharynx the superior portion of the pharynx. The pharyngotympanic tubes that drain the middle ear open in this area. This is the main reason why children who have otitis media may follow a sore throat or other tyoes of pharyngeal infections since the two mucosae of these regions are continuous. 2. Oropharynx middle part 3. Laryngopharynx part of pharynx that enters the larynx. When food enters the oral cavity, it travels to the oropharynx and laryngopharynx. However, instead of entering the larynx, the food is directed into the esophagus and not to the larynx. Tonsils clusters of lymphatic tissues found in the pharynx. Larynx The larynx is the one that routes the air and food into their proper channels. Also termed as the voice box, it plays an important role in speech. Glottis the slit-like passageway between the vocal folds. Trachea Also called the windpipe, the trachea is about 10 to 12 cm long or about 4 incheas and travels dwon from the larynx to the fifth thoracic vertebra. This structure is reinforced with C-shaped rings of hyaline cartilage and these rings are very important for the following purposes: 1. The open parts of the rings abut the esophagus that allows the structure to expand anteriorly when a person swallows a large size of food. 2. The solid portions of the C-rings are supporting the walls of the trachea to keep it patent or open even though pressure changes during breathing. The trachea is lined with ciliated mucosa that primarily serves for this purpose: To propel mucus loaded with dust particles and other debris away from the lungs towards the throat where it can either be swallowed or spat out. Main Bronchi The main bronchi, both the right and the left, are both formed by tracheal divisions. There is a slight difference between the right and left main bronchi. The right one is wider, shorter and straighter than the left. This is the most common site for an inhaled foreign object to become lodged. When air reaches the bronchi, it is already warmed, cleansed of most impurities and well humidified. Lungs

The lungs are fairly large organs that occupy the most of the thoracic cavity. The most central part of the thoracic cavity, the mediastinum, is not occupied by the lungs as this area houses the heart. Apex the narrow superior portion of each lung and is located just below the clavicle Base the resting area of the lung. This is a broad lung area that rests on the diaphragm. Divisions of the Lungs The lungs are divided into lobes by the presence of fissures. The left lung has two lobes while the right lung has three. Pleural Layers Visceral pleura also termed as the pulmonary pleura and covers each surface of the lings. Parietal pleura covers the walls of the thoracic cavity. Pleural fluid a slippery serous secretion that allows the lungs to slide along over the thorax wall during breathing movements and causes the two pleural layers to cling together. Bronchioles smallest air-conducting passageways. Bronchial tree or respiratory tree a network formed due to the branching and rebranching of the respiratory passageways within the lungs. Alveoli air sacs. This is the only area where exchange of gases takes place. Millions of clustered alveoli resembles bunches of grapes and these structures make up the bulk of the lungs. Respiratory Zone this part includes the respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli. Physiology of Respiration The respiratory primarily supplies oxygen to the body and disposes of carbon dioxide through exhalation. Four events chronologically occur, for respiration to take place. 1. Pulmonary ventilation this process is commonly termed as breathing. With pulmonary ventilation, air must move out into and out of the lungs so that the alveoli of the lungs are continuously drained and filled with air. 2. External respiration this is the exchange of gases or the loading of oxygen and the unloading of carbon dioxide between the pulmonary blood and alveoli. 3. Respiratory gas transport this is the process where the oxygen and carbon dioxide is transported to the and from the lungs and tissue cells of the body through the bloodstream. 4. Internal respiration in internal respiration the exchange of gases is taking place between the blood and tissue cells. Mechanics of Breathing Breathing, also called pulmonary ventilation is a mechanical process that completely depends on the volume changes occurring in the thoracic cavity. Thus, a when volume changes pressure also changes, and this would lead to the flow of gases equalizing with the pressure. Inspiration also called inhalation. This is the act of allowing air to enter the body. Air is flowing into the lungs with this process. Inspiratory muscles are involved with inspiration which includes: 1. The diaphragm 2. External intercostals These muscles contract when air is flowing in and thoracic cavity increases. When the diaphragm contracts it slides inferiorly and is depressed. As a result the thoracic cavity

increases. The contraction of the external intercostal muscles lifts the rib cage and thrusts the sternum forward. This increases the anteroposterior and lateral dimensions of the thorax. Expiration also called expiration. It the process of breathing out air as it leaves the lungs. This process causes the gases to flow out to equalize the pressure inside and outside the lungs. Under normal circumstances, the process of expiration is effortless. Laboratory Results Blood Chemistry Glucose BUN Creatinin Uric Acid Triglycerides Total Cholesterol HDL Result 5.02 3.78 108.4 232.1 0.95 4.52 2.52 Reference 3.85-6.4 mmol/L 2.86-7.20 mmol/L 80-115 umol/L M 210-420 umol/L T 150-350 umol/L 0.0-2.30 mmol/L 0.0-5.20 mmol/L 0.78-2.21 mmol/L Interpretation Normal Normal Normal Normal Normal Normal Normal HDL-cholesterol is good cholesterol, in that risk of cardiovascular disease decreases with increase of HDL.
Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia and infection.

LDL

1.81

2.5-4.5 mmol/L

VLDL SGOT SGPT

0.19 24.66 11.0

0.0-0.46 mmol 0-35 u/L 0-42 u/L

Normal Normal Normal

Radiographic Findings FF- up study since 02 June 11 shows both lungs are still hyper aerated, progression of the previous varisized thin walled cystic lucencies are seen in the entire left lung, right upper to midlungs. The tracheal air column is tracted to the right. Heart is not enlarged Aorta is not dilated Diaphragm & Left sular are intact The rest of the visualized chest structures are unremarkable. Interpretation: Hyperaerated lungs mean that lung area is less dense than normal. This may be indicative of COPD if
it includes a flattened diaphragm. This is because with COPD the airways collapse thus trapping air behind them causing the lungs then to dilate, become hyperinflated. Urinalysis Interpretation Color: Yellow Transparency: Clear Specific Gravity:1.015 Reaction to: Albumin: (-) Sugar: (-) RBC: 0-2/hpf WBC:0-2/hpf Urates: fair Epithelial Cells: fair Normal Normal Normal Normal Normal Normal Normal Normal Normal

Hematology Interpretation Hemoglobin No. Of conc. 107g/L Hematorcrit 34X10/L Leukocytes 9.7X10/L Thrombocytes 298X10L Neutrophils- 0.76 (0.55-0.65) Normal Normal Normal Normal An increased percentage of neutrophils may be due to:
y y

Acute infection Acute stress

y y y y y y y

Eclampsia Gout Myelocytic leukemia Rheumatoid arthritis Rheumatic fever Thyroiditis Trauma

Lymphocytes - ) 0.24 (0.25-0.35)

A decreased percentage of lymphocytes may be due to:


y y y y y

Chemotherapy HIV infection Leukemia Radiation therapy or exposure Sepsis

Pathophysiology Pulmonary Tuberculosis


Predisposing Factors: y y y Age Life style Immunosuppression infected persons o Prolonged corticosteroid therapy Systemic Infection: o Diabetes Mellitus o End-stage Renal Disease o HIV or AIDS infection Precipitating Factors:

- Occupation (e.g Health Workers) - Repeated close contact w/ - Indefinite substance abuse via IV - recurrence of infection

Exposure or inhalation of infected Aerosol through droplet nuclei (exposure to infected clients by coughing, sneezing, talking)

Tubercle bacilli invasion in the apices of the

Lungs or near the pleurae of the lower lobes

Bronchopneumonia develops in the lung tissue (Phagocytosed tubercle bacilli are ingested by macrophages)  bacterial cell wall binds with macrophages arrest of a phagosome which results to bacilli replication

Necrotic Degeneration occurs (production of cavities filled with cheese-like mass of tubercle bacilli, dead WBCs, necrotic lung tissue)

drainage of necrotic materials into the tracheobronchial tree (eruption of coughing, formation of lesions) PRIMARY INFECTION

Lesions may calcify (Ghon s Complex) and form scars and may heal over a period of time

Tubercle bacilli immunity develops (2 to 6 weeks after infection) (maintains in the body as long as living bacilli remains in the body)

Acquired immunity leads to further growth Of bacilli and development of ACTIVE INFECTION

SIGNS AND SYMPTOMS Pulmonary Symptoms: General Symptoms:

y y y y

Dyspnea Non-productive or productive cough Hemoptysis (blood tinge sputum) Chest pain that may be pleuritic or dull chills and y Chest tightness y Crackles may be present on auscultation

- Fatigue - anorexia - Weight loss - low grade fever with sweats (often at night)

With Medical Intervention

Without Medical intervention

y y y y y

Early detection/ diagnosis of the dse Multi-antibacterial therapy infected Fixed- dose therapy TB DOTS (Direct Observed Therapy) BCG vaccination

Reactivation of the tubercle bacilli (Due to repeated exposure to Individuals, Immunosuppression) SECONDARY INFECTION

Severe occurrence of lesions in the lungs No Recurrence Recurrence

Cavitation in the lungs occurs Good Prognosis Bad Prognosis

Active infection is spread throughout the body systems (infiltration of tubercle bacilli in other organs)    TB of the Bones Pott s Disease Renal TB

SEVERE OCCURRENCE OF INFECTION Client becomes clinically ill

BAD PROGNOSIS

DEATH

Drug Study Drug 1.INH 15 + RIF 15+ PZA 400+ Ethambutol (2 tabs OD before breakfast) Indication -Adjunctive treatment for tuberculosis when primary and secondary anti tuberculotic can t be used or have failed. Contraindication -Contraindicated to patients hypersensitive to drug an in those with severe hepatic disease or acute gout. Nursing Responsibilities -instruct the patients to take drug as prescribed, exactly as directed, even after feeling better -tell patient that drug may cause orange brown stain in the urine, feces, sputum and saliva. -Advise client to take the medication 30 minutes before breakfast.

2.Ferrous Sulfide (2 tabs OD prebreakfast)

-For patients with iron - Contraindicated to patients who are deficiency anemia receiving blood transfusion and anemia not due to iron deficiency.

-Advise client that drug is best taken on an empty stomach. -Use cautiously when using in long term basis. -GI upset may be related to dose.

3.Paracetamol 500mg/tab (q4 PRN for fever T>= 37.8C)

- Mild pain or fever

- Contraindicated to patients with hypersensitivity to drugs.

-Use cautiously in patients with chronic alcohol use. -Use liquid form for children and patients

who have difficulty in swallowing. -May produce false positive reading in glucose blood levels

4.Multi-vitamins (Appebon) 1 tab OD after breakfast

- Treatment and prevention of vitamin deficiencies.

-Patient who are hypersensitive to the drug.

-Assess patient s signs of nutrition deficiency -instruct to notify physician if side effect occurs -Encourage to comply with the medications.

5.Heraclene (at bedtime)

- poor appetite in infant, children & adult, adjuvant to treatment of TB & other chronic ailments, convalescence from acute infection or surgery, faulty nutrition in older people.

-Contraindicated to patients that is hypersensitive to drugs.

- May Administer drug with regards to meal.

Nursing Care Plan Assessment Subjective: The patient verbalized, Ubo ako ng ubo pero wala naming plemang lumalabas. Objective: Diagnosis Ineffective airway clearance related to retained secretions secondary to bacterial infection as evidenced by crackles Inference
Bacterial infection of the respiratory system.

Inflammato ry response

Retained

Planning After 8 hours of nursing interventio n, the patient will be able to maintain a patent airway through

Implementation Rationale
-Check Vital signs
-Baseline data

-Monitor respirations and breath sounds.

-May indicate respiratory distress or accumulati on of secretions

Evaluation After 8 hours of nursing interventio n, the patient was able to maintain an effective airway

-Crackles heard upon heard upon auscultation auscultation . . -has wide shallow eyes.

secretions in the respiratory tract.

the mobilizatio n of secretions as evidenced by productive cough

-Encourage deep breathing and coughing exercises. -Increase fluid intake.

-to maximize breathing effort.

-Hydration
can help liquefy viscous secretions. And improve secretion clearance.

clearance as evidenced by expectorati on of yellow secretions.

-Support reduction or cessation of smoking.

-to improve lung function.

-Auscultate breath sounds

-To
ascertain status and note progress.

Assessment Subjective: Nagtataka lang ako kung bakit ang payat ko kahit ang lakas ko kumain. As verbalized by the patient. Objective:

Diagnosis Imbalanced Nutrition: Less than Body Requirement s related to inability to ingest food because of prolonged cough as evidenced by

Planning After 8 hours of nursing intervent Causes dry ion, the cough patient will be Body obtains energy in a able to demonstr form of ate protein, calories and progressi fat. ve weight
Pulmonary Tuberculosis

Inference

Implementation -Assess weight

-Evaluate total food intake

-Use flavouring

Rationale Evaluation -Baseline After 8 data hours of nursing -Changes interventio could be n, the made in patient the was able client s demonstra diet. te progressive weight gain -To toward

-Weight: 46kg -Appears weak -Minimal subcutaneou s fat.

decreased BMI.

Weight loss

gain toward goal.

agents

enhance food satisfacti on. Maximize s nutrient intake without undue energy expendit ure from eating large meals.

goal.

-Encourage small, frequent meals, with foods high in protein and carbohydrates.

-Weigh regularly

-To monitor effective ness of efforts. Rationale -To note ability to self help Evaluation After 8 hours of nursing interventio n, the patient was able to (plan) adopt lifestyle changes.

Assessment Subjective: Madals akong umiinom at nag-yoyosi ako. As verbalized by the patient Objective: -Yellowstained teeth -Gums are slightly red

Diagnosis Ineffective health maintenan ce related to inability to make appropriat e judgments as evidenced by smoking.

Planning Smoking After 8 and alcohol hours of abuse nursing interventio n, the Vasoconstri patient will ction of the be able to veins (plan) adopt lifestyle Accumulatio changes.
n of secretions

Inference

Implementation -Evaluate for substance use

-Discuss with client beliefs about health and reasons for not following prescribed plan of care.

-Determine client s view about current situation and potential for change. -Ability to adapt and organize

-Slightly loose gums.

-Develop a plan for self care

care activities.

-Provide participatory guidance

-To maintain and manage effective health practices. -For future reference/r evision as appropriat e.

-Help client plan realistic goals

Problem List 1. Ineffective airway clearance related to retained secretions in the respiratory tract secondary to bacterial infection as evidenced by crackles upon auscultation 2. Imbalanced Nutrition: Less than Body Requirements related to inability to ingest food because of prolonged cough as evidenced by decreased BMI. 3. Ineffective health maintenance related to inability to make appropriate judgments as evidenced by smoking. Discharge Planning y y Continue Taking the Anti-TB drugs. Practice deep breathing exercise and coughing exercises. Resume previous activities. Prevent extraneous work. Have a regular physical exercise like brisk walking for 30 minutes daily Follow faithfully the regimen for tuberculosis, especially the medications. Have a regular sputum test, as ordered by the doctor You should practice hand washing regularly. Always cover the mouth and the nose when exposed to person who coughs or sneezes. You should not spit anywhere, instead spit in a single container to prevent transfer of M. Tuberculosis. Always have a regular check up at your nearest health center, at least once a week to monitor the progress of the treatment. The client should report immediately to the physician if there is difficulty of breathing, there is

y y

productive cough more than 5 days and there is chest pain and experiencing fatigue The diet should be high caloric. Always drink a lot of water. Also eat fruits and vegetables. Don t escape meals. If there are any food supplements available, consult it with the doctor. Eat vitamin c rich food to strengthen immune systems. Always pray for the guidance of the Lord. Spiritual health affects the wellness of an individual greatly. Strengthen relationship with Lord by showing love and respect to the people around you.

Recommendation The patient should stop smoking and drinking alcohol because it will only aggravate his condition. Reference: http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm http://www.slideshare.net/crisbertc/pulmonary-tuberculosis-1062451 http://nursingcrib.com/anatomy-and-physiology/anatomy-and-physiology-of-respiratorysystem/
http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm