DAILY REQUIREMENTS

Name: JANNA MAE H. PATRIARCA Date: November- 16-2020 Group No. 3

Area: Isolation ward C.I: CEASARLICA S. MINGUITA, RN, MN
Case: Pulmonary tuberculosis
General Objectives (5pts):
After 8 hours of duty, the student nurse will be able to provide a comprehensive
knowledge regarding communicable disease, to describe their manifestations, management
as well as the aetiology, effective promotion of health, prevention of illness and treatment
of disease.

Specific activities (10pts):

After 8 hours of duty the student nurse will be able to :

K  To identify and analyze the aetiology of the underlying cause of
tuberculosis.
 To discuss anatomy and physiology of the related disease.
S 

Enumerate the different signs and symptoms of tuberculosis.
To establish essential nursing intervention to be implemented for
the patients wellness and recovery.

A 
To learn new skills as well as sharpen our current clinical skills
required in the management of the patient with tuberculosis.
To have an attitude that suits to different situation

Daily Plan of Activities

(10 pts)

TIME ACTIVITIES
6:30-7:00 am prayer
7:00-7:30am endorsement
7:30-8:00am Pre-conference
8:00-8:30am Initial assessment, vital signs taking , plotting and Carry out due medications
9:00-9:30am Bedside care, assessment on patient and health teachings, continuous kardex update.
9:30-10:00am Rechecking the patients chart for proper charting and carry out due meds. Kardex update after
the doctors round.
11:00-11:45 LUNCH BREAK
11:45-12:30 Vital signs taking and plotting preparing due meds
12:30 -1:30 pm Giving due meds, and taking I/O, plotting and charting, rechecking of the patients chart
1:30-2:00pm Completion of requirements
2:00-2:30 pm Endorsement
2:30- 3:00 pm Prayer
Post-conference
Score: /25
 DATA BASE AND HISTORY
Name of Client: Mrs. Bull Sex: female Age: 39 years old Religion: Roman Catholic
Civil Status: married Income: $ 48,516 per year Nationality: American
Pulse: 92 bpm BP: 146/78 mmHg Temp. 101.2 F Resp. 24 bpm Spo2: 90%

Height: 63.7 inch Weight: 100.6 pounds

Chief Complaint and History of Present Illness:

Persistent cough for the last 3 months and in the last 3 days she’s been experiencing chills and
night sweats and today she noticed she was coughing up blood.

Type of Previous Date Type of Previous Date

Illness/ Illness

Pregnancy/Delivery Pregnancy/Delivery

Fever November-10-2020 Vaginal delivery July -18-2020

headache November-2-2020

cough August -5 -2020

November-16-2020

Has received blood in the past: ___ Yes ___ No. If yes, list dates _____Reactions: ___Yes ___ No

Medication Dose/ Time of Last Medicatio Dose/ Time of Last

Name n Name
Frequency Dose Frequency Dose

Paracetamol 500 mg 1 tab PO q4 6:00 pm

Ibuprofen 300mg PO t.i.d 4:00pm

amoxicillin 500mg PO t.i.d 4:30pm

Were you admitted?_________Yes _________No If Yes, where?

Attending Physician:

Score: /20
 NURSING SYSTEM REVIEW CHART
Name: Mrs. Bulls Date: November-16-2020 Vital Signs:
Pulse: 92 bpm BP : 146/78 mmHg Temp. 101.2 F Resp. 24 bpm Spo2: 90%

Height: 63.7 inch Weight: 100.6 pounds

INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate
the location of the problem in the figure using [X].
EENT
[ ] impaired vision [ ] blind [ ] drainage NORMAL
[ ] gum infection [ ] difficulty of hearing[ ] deaf
[ ] burning [ ] edema [ ] lesion teeth
[ x ] no problem [ ] others
RESPIRATION
[ ] asymmetric [ ] tachypnea [ ] barrel chest
[ ] apnea [ x] rales [x ] cough Have rhonchi in the right upper
[ ] bradypnea [ ] shallow [ x ] rhonchi lobe of the lungs. Normal S1 and S2
[ x] sputum [ ] diminished [ ] dyspnea heart sounds heard.
[ ] orthopnea [ ] labored [ ] wheezing
[ ] pain [ ] cyanotic [ ] no problem
[ ] others
GASTROINTESTINAL TRACT
[ ] obese [ ] distention [ ] mass Active bowel sounds
[ ] dysphagia [ ] rigidity [ ] pain
[ ] abnormal bowel habits [ ] bowel sounds
[ X] no problem [ ] others
GENITO-URINARY AND GYNE
[ ] pain [ ] urine color [ ] vaginal bleeding NORMAL
[ ] hematuria [ ] nocturia [ ] odor
[ ] gyne bleeding [x ] no problem [ ] others
NEURO
[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizures She reported the she has been more
[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors fatigue lately and states a recent
[ ] confused [ ] vision [ ] grip [ ] no problem unintentional weight loss of 20Ibs in
[ x ] others the last two months .
MUSCULOSKELETAL AND SKIN
[ ] appliance [ ] stiffness [ ] itching [ ] petechiae
[ ] hot [ ] drainage [ ] prosthesis [ ] swelling Her skin appears clammy and
[ ] lesion [ ] poor turgor [ ] cool [ ] flushed somewhat pale.
[ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic moist
* assess mobility, motion, gait, alignment, joint function
skin color, texture, turgor, integrity [ ] no problem

Score: /20
 NURSING ASSESSMENT
SUBJECTIVE OBJECTIVE
COMMUNICATION: [ ]Glasses [ ] Languages
[ ]Hearing loss Comments: normal [ ]Contact lens [ ] Hearing aid
[ ]Visual changes
Can hear normal volume R L
[ ]Denied tones or words and can see Pupil Size _______
objects in the periphery. Speech Difficulties_________
Reaction _____________________________
OXYGENATION: Respiration : [ ] regular [x ] irregular
[x ]Dyspnea Comments: Describe: has rhonchi
[ ]Smoking history
Abnormal, laboured
breathing pattern related R : right upper lobe of the lungs
[x ]Cough to obstructed airway and L ____________________________________
[ x ]Sputum
decrease size of the lungs.
[ ]Denied
CIRCULATION: Heart Rhythm [ x ] regular [ ] irregular
[ ] Chest pain Comments: Ankle Edema ________ Heart_____________
[ ] Leg pain No edema, no pain Carotid Radial Dorsal Pedis Femoral
[ ] Numbness of when moved. R ____________________________________
Extremities L_____________________________________
[ ] Denied Comments: normal S1 and S2 heart sound
heard
*If Applicable __________________________
NUTRITION:
Diet: _____________________________________ [ ] Dentures [ x] None
[ ] N [ ] V Comments:
Character Full Partial
[ ] Recent change Unintentional Weight Upper [x ] [ ]
[ x ] Weight, appetite loss of 20 Ibs in the Lower [ x] [ ]
[ ] Swallowing last 2 months.
Difficulty
[ ] Denied
ELIMINATION: Comments: she has active Bowel Sounds
[ ] Usual bowel pattern [ ] Urinary ______________________________________
frequency ___________________ Abdominal Distention
___________________ ___________________ ___________________ Present [ ] Yes [ ] No
[ ] Constipation [ ] Urgency ___________________ Urine * (color,
Remedies [ ] Dyspnea consistency, odor)
___________________ [ ] Hematuria ___________________ *if foley bag catheter
Date of last BM [ ] Incontinence is in place
___________________ [ ] Polyturia
[ ] Diarrhea [ ] Foley in place
Character _________ [ ] Denied
*MGT. OF HEALTH & ILLNESS Briefly describe the patient’s ability to follow
[ ] Alcohol [ ] Denied treatments (diet, medication, etc.) for chronic
(Amount, frequency) health problems (if present)
SBE last pap smear ________________________ She was able to follow the instructions given
LMP : November-10-2020 by the physician about her condition.
 SUBJECTIVE OBJECTIVE
SKIN INTEGRITY: [ ]Dry [ ]Cold [ x ] Pale
[ ] Dry Comments: [ ]Flushed [ ] Warm
[ ]Itching Uniform colour and has no [ ] Moist [ ] Cyanotic
[ ]Others blemishes. Her skin appears *Rashes, ulcers, decubitus (Describe size,
[ ] Denied clammy and somewhat pale. location, drainage)_____________________________
_____________________________________
_____________________________________
ACTIVITY/SAFETY: LOC and Orientation ___________________
[ ]Convulsion Comments: _____________________________________
[ ] Gait [ ] Walker [ ] Care [ ] Other
[ ]Dizziness She has been more [ ] Steady [ ] Unsteady
fatigue lately. But Sensory and motor losses in face or extremities
[ ]Limited motion she can walk _____________________________________
Of joints independently. _____________________________________
Limitation of ability to [ ] ROM limitations _____________________
[ x ] Ambulate _________________________ _____________________________________
[ x] Bathe itself _________________________ _____________________________________
[ ] Other _________________________
[ ] Denied _________________________
COMFORT/SLEEP/AWAKE
[ ] Pain Comments: [x ] Facial grimaces
(Location, frequency [ x ] Guarding
Remedies) Difficulty of sleep [ ] Other signs of pain ___________________
[ ] Nocturia due to persistent ______________________________________
[ x ] Sleep difficulties cough experienced. [ ] Side rail release form signed (60+ years)
[ ] Denied ______________________________________
______________________________________
COPING:
Occupation : teacher Observed non-verbal behaviour : none
Members of the household: husband and ______________________________________
daughter. Person (Phone Number) : 09972626655
Most Supportive Person : husband ______________________________________

Score: /50
Patient’s Name: Mrs: Bulls Diagnosis; Pulmonary tuberculosis Date; 11-16-2020
ILLUSTRATIONS/TRACING OF THE PATHOPHYSIOLOGY OF THE DISEASE

Pathophysiology of Koch’s Disease

(Tuberculosis)

Predisposing Factors: Precipitating Factors:

 Age (39 years old - Occupation (e.g Health Workers)

 Immunosuppression - Repeated close contact w/ infected persons
- 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:

 Dyspnea - Fatigue
 Non-productive or productive cough - anorexia
 Hemoptysis (blood tinge sputum) - Weight loss
 Chest pain that may be pleuritic or dull - low grade fever
with chills and
 Chest tightness sweats (often at
night)
 Crackles may be present on auscultation

With Medical Intervention Without Medical intervention

 Early detection/ diagnosis of the dse Reactivation of the tubercle

bacilli
 Multi-antibacterial therapy (Due to repeated exposure to
infected
 Fixed- dose therapy Individuals,
Immunosuppression)
 TB DOTS (Direct Observed Therapy) SECONDARY
INFECTION
 BCG vaccination

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

Score: /20
 Patient’s Name: Mrs. Bulls Diagnosis: Pulmonary tuberculosis Date: November-16-2020

DIAGNOSTIC EXAMS

DIAGNOSTIC TEST W/ NORMAL VALUES RESULT INTERPRETAT SIGNIFICANCE NURSING RESPONSIBILITY RE

ION MA
RKS

A. BLOOD A.BLOOD CHEMISTRY

CHEMISTRY
Sodium 138-140mmoL/L 143.3 Above normal High levels of sodium  Prepare the patient for the
mmoL/L range in the blood. procedure.
potassium 3.5-4.9 mmoL/L 3.32 mmol/L Above normal Having too much  Explain and educate the
range potassium in your patient about the result of the
blood can be test.
dangerous.
B. HEMATOLOGY C. HEMATOLOGY
Hematocrit 37%-49% 35.6% Below normal Patient has too few of  Use of standard precautions or
range red blood cells that sterile technique.
results to anaemia.
Haemoglobin 12-16g/dL 11.7 Below normal Associated with a  Providing support to the
range disease or condition patient and monitoring the
that causes the body patients response during the
to have few RBC. procedure
MCV 80-100fL 83.8 Within normal normal  Ensuring the correct
range translation of specimen.
MCH 31-37pg 27.5 Below normal Low amount of  Compare the previous and
range haemoglobin present current test result.
per RBC
31-36 g/dl 32.8 Within normal normal  Reporting the result to the
MCHC range patient to appropriate
members of the health care
team.
RDW 11-16% 12.4 Within normal Normal
 range
WBC 4.0-10.0 x 10/L 8,490 Within normal No increased or
range decreased production
of wbc.
Platelet count 150-450x10/L 281,000 Within normal No detection of
range disorders.
PPD tuberculin skin test <15 17 mm for 48 positive Patient has positive Facilitate the procedure in injecting
hours result of TB. tuberculin and reading the results to
the patient.

C. DIRECT SPUTUM SMEAR MICROSCOPY

Specimen: sputum
specimen 1 2
Visual appearance Muco-purulent Muco -purulent
Reading +2 +2
Laboratory result positive positive

Result: the patient has tuberculosis.

D. CHEST X-RAY:
 Reticular and nodular densities scattered diffusely in both lungs-more in the left lung.
 There is also cavity damage in the right upper lobe.
 The heart and great vessels are normal in size and configuration
 Diaphragm and visualized bones are intact

Score: /20
Patient’s Name: Mrs. Bulls Diagnosis: Pulmonary tuberculosis Date: November-16-2020

SUMMARY OF DOCTOR’S ORDER

DATE DOCTORS ORDER RATIONALE

11-12-2020 refer admit to isolation room >For Proper monitoring management and
9:00 am evaluation,
Secure consent >Patient has the right to be consented in all
procedures to be done.
V/S q4 >To have a baseline data
PNSS 1L @ 20 gtts/min >to maintain fluid and electrolyte balance.
For ECG >A test that records the electrical activity of
the heart.
DAT >Diet as tolerated to maintain nutritional
status of patient.
Labs : blood test , sputum culture test, >It is used as a broad screening test to check
for such disorders as anaemia, infection, and
much other disease.
11-13-2020 For sputum examination >to identify bacteria or fungi that infect the
1:00 pm lungs or breathing
CXR reviewed To check and clarify the result
Meds:
Rifampin 600 mg PO daily >Antitubercular Agents
Isoniazide 300mg PO daily
Pyrazinamide 1500 mg PO daily
Ethambutol 1200 mg PO daily
Continue present management
> For continues management
11-14-2020 Refer accordingly
10am For the continuity of care refer any
unusualties and progress.
IVF to followPNSS 1L X 20 gtts/min >To hydrate the patient prevents hypovolemic
shock or hypotension.
Place in moderate to high back rest >To promote lung expansion
Maintain O2 >To support oxygen in the body
For STAT post-op x-ray >Test that involves exposing the chest briefly
to radiation to produce and image of the chest
and the internal organs of the chest.
Deep breathing exercises >To controlled
Monitor I and O every shift >To monitor patients fluid status
Place patient in semi-fowler position >To promote lung expansion
Continue meds > for compliance
11-16-20
10:00am
May go home > for continues management at home
May resume regular diet >to improve healthy condition
Continue medication >for compliance of medication
Score: /20
 DRUG STUDY (1)
Name of Classifi Dose/ Mechanism Specific Contra- Side Effects/ Nursing
Drug cation Freque Of Action Indication Indication Toxic Effects Precaution
Genetic ncy (Why drug is
(Brand) Ordered)
GENERIC 600 Inhibits RNA Active Hypersensit CNS: Administer on an empty stomach, 1 hr
NAME : Antitub mg/da synthesis by tuberculosis ivity; ataxia,confusion,drows before or 2 hr after meals.
Rifampicin y
ercular blocking (with other Concurrent iness,fatigue,headache,
Agents RNA agents). indinavir, weakness. Administer in a single daily dose.
BRAND transcription Elimination nelfinavir, Derm:
NAMES :
Routes in susceptible of pyrazinamid rash,pru-ritus. Consult pharmacist for
of
Rifadin, organisms. meningococc e, or  EENT: rifamoin suspension for patients
admini
Rimacta Therapeutic al carriers. saquinavir.  red discoloration of tears. unable to swallow capsules.
stratio
ne, n: PO Effects: Unlabeled  GI: abdominal pain,
Rofact Bactericidal Use: diarrhea, Prepare patient for the reddish-orange
action against Prevention of flatulence,heartburn, coloring of body fluids (urine, sweat,
susceptible disease nausea, vomiting,q sputum, tears, feces, saliva);
organisms. caused by liver enzymes, red soft contact lenses may be
Haemophilus discoloration of saliva. permanently stained; advise patients
influenza  GU: not to wear them during therapy.
type B in  reddiscoloration of urine.
close contacts Hemat: Warning: arrange for follow-up visits
hemolytic for liver and renal function tests, CBC,
anemia, thrombocytopenia and ophthalmic examination.
.
MS:arthral-
gia,muscleweakness,m
yalgia.
Misc:
flu-likesyndrome
 DRUG STUDY (2)
Name of Classifi Dose/ Mechanism Specific Contra- Side Effects/ Nursing
Drug cation Freque Of Action Indication Indicatio Toxic Effects Precaution
Genetic ncy (Why drug is n
(Brand) Ordered)
GENERIC antitub 300mg . Inhibits First-line therapy of Hyperse CNS: pyschosis Assess laboratory examinations.
NAME : ercular /day mycobacteria active tuberculosis, nsitivity; seizure
Isoniazi s l cell wall in combination with Acute Monitor liver/renal function.
d Routes synthesis and other agents. liver EENT: visual
of interferes Prevention of disease; disturbances Instruct patient that compliance with
admini with tuberculosis in Previous dosage schedule for duration is
stratio GI: drug induced
BRAND metabolism. patients exposed to hepatitis necessary to gain benefits.
n: PO hepatitis, nausea,
NAMES : Therapeutic active disease (alone from vomiting
INH Effects: isoniazid Caution patient in alcohol while in
Bacteriostatic NEURO: peripheral therapy may increase risk of liver
or neuropathy damage.
bactericidal
action against MISC : fever Tell patient to report peripheral neuritis.
susceptible
mycobacteria
 DRUG STUDY (3)
Name of Classifi Dose/ Mechanism Specific Contra- Side Effects/ Nursing
Drug cation Freque Of Action Indication Indicatio Toxic Effects Precaution
Genetic ncy (Why drug is n
(Brand) Ordered)
GENERIC Anti- Mechanism Used in combination Hyperse MILD: allergic Assess patient’s condition before
NAME : tuberc 15OOm not known. with other agents in nsitivity; reactions, loss of therapy and regularly thereafter to
Pyrazin ulotic g/day Therapeutic the treatment of Cross- appetite, nausea, monitor drug effectiveness.
amide Effects: active tuberculosis sensitivit vomiting, increased
Bacteriostatic y with uric acid, joint pain. Monitor serum uric acid which may be
BRAND
action against ethionam elevated and cause gout symptoms.
SERIOUS:
NAMES : susceptible ide,
Routes sideroblastic anemia,
Zynapha of
mycobacteria isoniazid pellagra, seizures, low
Regularly assess for hepatoxicity.
r admini , niacin, platelet count,
stratio or nephritis, gouty Regularly assessrenal status.
n: PO nicotinic arthritis, drug induced
acid may hepatitis Instruct patient to take drug
exist; continuously as prescribed.
Severe
liver Remind patient to report with follow-up
impairm schedule.
ent.
 DRUG STUDY (4)
Name of Classifi Dose/ Mechanism Specific Contra- Side Effects/ Nursing
Drug cation Frequen Of Action Indication Indication Toxic Effects Precaution
Genetic cy (Why drug is
(Brand) Ordered)
GENERIC antitub 1200mg/d Inhibits the Active tuberculosis Hypersensit Dizziness, fatigue, Perform visual acuity and
NAME : ercular ay growth of or other ivity; Optic or headache, loss of color discrimination tests before and
Ethambu mycobacteria mycobacterial neuritis appetite, upset during therapy.
tol . Therapeutic diseases (with at stomach, vomiting,
Effects: least one other numbness and Assess liver and renal status and
Tuberculostat drug). tingling in the function before and during therapy.
BRAND hands or fee and
NAMES : ic effect
optic neuritis-
Myambu against blurring of vision.
Assess patient for visual disturbance
tol susceptible that may indicate optic neuritis.
organisms.
Routes of Advise patient that compliance with
administr dosage schedule and duration is
ation: PO necessary to eradicate disease.

Remind patient to come for follow up

consultations including ophthalmic
appointments.

Score: /20

NURSING CARE PLAN

 Diagnosis: PULMONARY TUBERCULOSIS Date: November-16-2020

Cues Nursing Objective Intervention Rationale Evaluation

Diagnosis
1. After 8 hours  Assess respiratory o Diminished breath sounds may After 8 hours of
Ineffecti nursing function noting breath reflect atelectasis. Rhonchi, nursing
Subjective ve intervention sounds, rate, rhythm, wheezes indicate accumulation of intervention the
Data: clearanc the Patient and depth, and use of secretions and inability to clear client was able to
 Pt e airway will: accessory muscles. airways that may lead to use of display patency
reports related  Maintain of airway as
accessory muscles and increased
persistent to manifested by:
patent airway. work of breathing.
cough Thick,
 Expectorate  Note ability to o Expectoration may be difficult 
 Pt viscous, Clients
secretions expectorate mucus when secretions are very thick as a respirato
reports or
without and cough effectively; result of infection and/or ry rate is
weight loss bloody
 Anorexi assistance. document character, inadequate hydration. Blood-tinged within
secretio
a  Demonstrat amount of sputum, or frankly bloody sputum results normal
ns.
 Chills e behaviors to presence of from tissue breakdown (cavitation) range.
 Fatigue improve/maint hemoptysis. in the lungs or from bronchial
 Chest ain airway ulceration and may require further  Secretion
Pain clearance. evaluation or intervention. s
 Shortne  Participate o Positioning helps maximize lung decrease.
ss of breath in treatment expansion and decreases  Clients
regimen,  Place patient in semi
Objective respiratory effort. Maximal restlessn
within the or high-Fowler’s
Data: level of position. Assist ventilation may open atelectatic ess was
 Night areas and promote movement of alleviate
ability/situatio patient with coughing
sweats d and
n. and deep-breathing secretions into larger airways for
 Cough remained
 Hemopt  Identify exercises. expectoration. calm.
ysis potential
 ↓ SpO2 complications o Prevents obstruction and aspiration.
↓ PaO2 and initiate Suctioning may be necessary if
 appropriate  Clear secretions from patient is unable to expectorate
actions. mouth and trachea; secretions.
BP: 146/78 suction as necessary.
HR: 92bpm  Maintain fluid intake o High fluid intake helps thin
RR: 24 bpm of at least 2500 secretions, making them easier to
TEMP: mL/day unless expectorate.
101.2F contraindicated.
SPO2: 90% o Prevents drying of mucous
 Humidify inspired air membranes and helps thin
and oxygen secretions.

 Administer o Reduces the thickness and

medications as stickiness of pulmonary secretions
indicated: Mucolytic to facilitate clearance.
agents: acetylcysteine
(Mucomyst);
 Bronchodilators: oxtri o Increases lumen size of the
phylline (Choledyl), tracheobronchial tree, thus
theophylline (Theo- decreasing resistance to airflow and
Dur); improving oxygen delivery.
 Corticosteroids
(prednisone). o May be useful in presence of
 Be prepared for/assist extensive involvement with
with emergency profound hypoxemia and when
intubation. inflammatory response is life-
threatening.
o Intubation may be necessary in rare
cases of bronchogenic TB
accompanied by laryngeal edema
or acute pulmonary bleeding.

Score: /20
Subjective 2. Risk for -Assess for dyspnea (using 0–  Pulmonary TB can cause a wide After 8 hours of
Data: impaired gas After 8 hours 10 scale), tachypnea, range of effects in the lungs, ranging nursing
 Pt exchange of nursing abnormal or diminished from a small patch of bronchopneumonia intervention the
reports related to intervention breath sounds, increased to diffuse intense inflammation, caseous patient was able
persistent decrease in Patient will: respiratory effort, limited necrosis, pleural effusion, and extensive to Report
cough effective chest wall expansion, and fibrosis. Respiratory effects can range absence
 Pt lung surface of/decreased
fatigue. from mild dyspnea to profound
reports dyspnea,
weight loss  Report respiratory distress. Use of a scale to
absence -Evaluate change in level of evaluate dyspnea helps clarify degree of Demonstrate
 Anorexi
of/decrease mentation. Note cyanosis difficulty and changes in condition. improved
a
d dyspnea. and/or change in skin color,  Accumulation of ventilation and
 Chills
 Fatigue  Demonstrat including mucous membranes secretions and/or airway compromise adequate
 Chest e improved and nail beds. can impair oxygenation of vital organs oxygenation of
Pain ventilation and tissues. tissues by ABGs
 Shortne and  Creates resistance against within
ss of breath adequate -Demonstrate and encourage outflowing air to prevent collapse or acceptable
oxygenation pursed-lip breathing during narrowing of the airways, thereby ranges and Be
Objective exhalation, especially for helping distribute air throughout the free of
of tissues
Data: patients with fibrosis or lungs and relieve or reduce shortness of symptoms of
by ABGs
 Night respiratory
within parenchymal destruction. breath
sweats distress.
acceptable  Reducing oxygen consumption and
 Cough
 Hemopt ranges. demand during periods of respiratory
ysis  Be free of -Promote bedrest or limit compromise may reduce severity of
 ↓ SpO2 symptoms activity and assist with self- symptoms.
↓ PaO2 of care activities as necessary.  Decreased oxygen content (PaO2)
respiratory and/or saturation or increased
BP: 146/78 distress. -Monitor serial ABGs and PaCO2 indicate need for intervention or
HR: 92bpm pulse oximetry. change in therapeutic regimen.
RR: 24 bpm  Aids in correcting the hypoxemia
TEMP: -Provide supplemental oxygen that may occur secondary to decreased
101.2F as appropriate. ventilation/diminished alveolar lung
SPO2: 90% surface.
Score: /20
Subjective Data: 3.  Document patient’s -Useful in defining After 8 hours of
 Pt reports imbalance After 8 hours of nutritional status on degree or extent of nursing
persistent cough nutrition: nursing intervention admission, noting skin problem and appropriate intervention the
 Pt reports less than Patient will turgor, current weight choice of interventions. patient was able to
weight loss body Demonstrate
and degree of weight
 Anorexia requireme progressive
 Demonstrate loss, integrity of oral
 Chills nts related weight gain
to progressive mucosa, ability or
 Fatigue toward goal with
 Chest Pain Frequent weight gain inability to swallow,
toward goal presence of bowel normalization of
 Shortness of cough/spu
tum with tones, history of nausea laboratory values
breath
productio normalization and vomiting or and be free of
Objective Data: n; of laboratory diarrhea. signs of
 Night sweats dyspnea values and be  Ascertain patient’s -Helpful in identifying malnutrition and
 Cough free of signs usual dietary pattern. specific needs and Initiate
 Hemoptysis of Include in selection of strengths. Consideration behaviors/lifestyle
 ↓ SpO2 malnutrition. food. of individual preferences changes to regain
↓ PaO2 may improve dietary and/or to maintain
 Initiate intake. appropriate
BP: 146/78 behaviors/lifes weight.
HR: 92bpm tyle changes  Monitor I&O and -Useful in measuring
RR: 24 bpm to regain weight periodically. effectiveness of
TEMP: 101.2F and/or to nutritional and fluid
SPO2: 90% maintain support.
appropriate
weight.  Investigate anorexia -May affect dietary
and nausea and choices and identify
vomiting, and note areas for problem
possible correlation to solving to enhance
medications. Monitor intake and utilization of
frequency, volume, nutrients.
consistency of stools.
 Encourage and -Helps conserve energy,
provide for frequent rest especially when
periods. metabolic requirements
are increased by fever.
 Provide oral care
before and after -Reduces bad taste left
respiratory treatments. from sputum or
medications used for
respiratory treatments
that can stimulate the
vomiting center.
 Encourage small,
frequent meals with -Maximizes nutrient
foods high in protein intake without undue
and carbohydrates. fatigue/energy
expenditure from eating
large meals, and reduces
gastric irritation.
 Encourage SO to
bring foods from home -Creates a more normal
and to share meals with social environment
patient unless during mealtime, and
contraindicated helps meet personal,
cultural preferences
 Refer to dietitian for
adjustments in dietary -Provides assistance in
composition. planning a diet with
nutrients adequate to
meet patient’s metabolic
requirements, dietary
 preferences, and
financial resources post
 Consult with discharge.
respiratory therapy to
schedule treatments 1–2 -May help reduce the
hr before or after meals. incidence of nausea and
vomiting associated with
medications or the
 Monitor laboratory effects of respiratory
studies: BUN, serum treatments on a full
protein, and stomach.
prealbumin, albumin.
- values reflect
malnutrition and indicate
 Administer need for intervention
antipyretics as and change in
appropriate. therapeutic regimen.

-Fever increases
metabolic needs and
therefore calorie
consumption.

Score: /20
Subjective Data: After 8  Assess patient’s ability Learning depends on emotional After 8 hours of
 Pt reports 4. hours of to learn. Note level of fear, and physical readiness and is nursing
persistent cough Knowledge nursing concern, fatigue, achieved at an individual pace. intervention the
 Pt reports deficient interventi participation level; best patient was able
weight loss related to on Patient environment in which Written information relieves to Verbalized
 Anorexia Inaccurate/ understanding of
will: patient can learn; how patient of the burden of having
 Chills incomplete disease
much content; best media to remember large amounts of
 Fatigue process/prognosis
informatio Verbalize and language; who should information. Repetition
 Chest Pain
n understan be included. strengthens learning. and prevention,
 Shortness of
presented ding of  Provide instruction and Initiate
breath
as disease specific written Provides opportunity to correct behaviours
Objective Data: evidenced process/pr information for patient to misconceptions and alleviate /lifestyle changes
 Night sweats by Lack of ognosis refer to schedule for anxiety. Inadequate finances or to improve
 Cough or and medications and follow-up prolonged denial may affect general well-
 Hemoptysis inaccurate prevention sputum testing for coping and managing the tasks being and reduce
 ↓ SpO2 follow- . documenting response to necessary to regain health. risk of
↓ PaO2 through of  Initiate therapy. reactivation of
instruction behaviors/  Encourage patient and May indicate progression or TB., Identify
BP: 146/78 s/behaviors lifestyle SO to verbalize fears and reactivation of disease or side symptoms
HR: 92bpm . changes to concerns. Answer effects of medications, requiring requiring
RR: 24 bpm improve questions factually. Note further evaluation evaluation
TEMP: 101.2F general prolonged use of denial. /intervention,
SPO2: 90% well-being  Identify symptoms that Meeting metabolic needs helps Describe a plan
and should be reported to minimize fatigue and promote for receiving
reduce healthcare provider: recovery. Fluids aid in adequate follow-
risk of hemoptysis, chest pain, liquefying or expectorating up care, and
reactivatio fever, difficulty breathing, secretions. Verbalize d
n of TB. hearing loss, vertigo. understanding of
 Identify  Emphasize the Enhances cooperation with therapeutic
symptoms importance of maintaining therapeutic regimen and may regimen and
requiring high-protein and prevent patient from rationale for
evaluation carbohydrate diet and discontinuing medication before actions.
 /interventi adequate fluid intake. cure is truly affected. Directly
on.  Explain medication observed therapy (DOT) is the
 Describ dosage, frequency of treatment of choice when
e a plan administration, expected patient is unable or unwilling to
for action, and the reason for take medications as prescribed.
receiving long treatment period.  May prevent or
adequate Review potential reduce discomfort
follow-up interactions with other associated with
care. drugs and substances. therapy and enhance
 Verbali  Review potential side cooperation with
ze effects of treatment regimen.
understan (dryness of mouth, Combination of INH and
ding of constipation, visual alcohol has been linked with
therapeuti disturbances, headache, increased incidence of hepatitis.
c regimen orthostatic hypertension)
and and problem-solve Major side effect is reduced
rationale solutions. visual acuity; initial sign may be
for  Stress need to abstain decreased ability to perceive
actions. from alcohol while on green.
INH.
 Refer for eye Excessive exposure to silicone
examination after starting dust enhances risk of silicosis,
and then monthly while which may negatively affect
taking ethambutol. respiratory function and cause
 Evaluate job-related risk bronchitis.
factors, working in foundry
or rock quarry, Although smoking does not
sandblasting. stimulate recurrence of TB, it
 Encourage abstaining does increase the likelihood of
from smoking. respiratory dysfunction or
 Review how TB is bronchitis.
transmitted (primarily by
 inhalation of airborne Knowledge may reduce risk of
organisms, but may also transmission/reactivation.
spread through stools or Complications associated with
urine if infection is present reactivation include cavitation,
in these systems) and abscess formation, destructive
hazards of reactivation emphysema, spontaneous
 Refer to public health pneumothorax, diffuse
agency. interstitial fibrosis, serous
effusion, empyema,
bronchiectasis, hemoptysis, GI
ulceration, bronchopleural
fistula, tuberculous laryngitis,
and miliary spread

DOT by community nurses is

often the most effective way to
ensure patient adherence to
therapy. Monitoring can include
pill counts and urine dipstick
testing for presence of
antitubercular drug. Patients
with MDR-TB may be
monitored with monthly sputum
specimens for AFB smear and
culture. Note:In some states,
there are legal means for
involuntary confinement for
care if efforts to ensure patient
adherence are ineffective.
Score: /20
 HEALTH TEACHINGS
Name of Client: MRS: BULLS

 Take medicine exactly as directed. Continue taking it even if you start to feel better.
Take medicine for at least 6 months and maybe longer. Not taking your medicine for
the full course may lead you to sick again. It also increases the chance of drug-resistant
TB. Drug-resistant TB means that one or more of the usual medicines for TB don’t
MEDICATIONS work.

 If you are taking birth control pills, use an additional backup method of birth control.
Some TB medicines may interfere with the pills effectiveness.

 Check with your healthcare provider before taking any over-the counter medicines.

 Limit your activity to avoid feeling tired. Plan frequent rest periods.

 It is recommended that you aim 30 minutes every day for five days of the week,
EXERCISE however you should only ever exercise as much as you feel that you are physically able
to especially during your recovery time.

 Advise patient to watch out for adverse effects of medications and to report them to
the physician immediately.
TREATMENT  Follow faithfully the regimen for tuberculosis, especially the medications . have
regular sputum test as ordered by doctor.

 Always have regular check-up at your nearest health centre at least once a week to
monitor the progress of the treatment. The client should report immediately to the
OUT PATIENT physician if there is difficulty of breathing , there is productive cough more than 5 days
(Check-up) and there is chest pain and experiencing fatigue.

 Foods like banana, cereal porridge, peanut chikki, wheat and ragi are quite beneficial
for TB patients. Fruits and vegetables like orange, mango, sweet pumpkin and carrots ,
guava, amla, tomato, nuts, and seeds are an excellent source of vitamin A,C and E.
DIET
 Avoid caffeine, refined sugar and flour, sodium, and bottled sauces. Foods containing
saturated and transs fats worsen the TB symptoms of diarrhea and abdominal
cramping and fatigue. Additionally, alcohol and tobacco are a definite no-no during
disease treatment and cure phase.

Score: /20
Patient’s Name: Mrs: Bulls

Diagnosis: Pulmonary tuberculosis Date: November-16-2020

NURSES NOTES

DATE/ TIME DAR

SHIFT
11-16-2020 7:30 am D >Received awake in supine position with IVF # 1 PNSS 1L @ 30
gtts/min. she reported of a persistent cough for the last 3 months and
in the last 3 days she’s been experiencing chills and night sweats and
today she noticed she was coughing up blood. Facial grimacing and
guarding behaviour noted.
8:00 am >c vital signs of Temp : 101.2 F , HR : 92 bpm, RR: 24 bpm , BP:
146/78 mmHg, Spo2: 90%
8:30 am A> IVF regulated to desired rate.
> Vital signs were monitored and recorded.
>medications were administered as per doctor’s order. The right of
medication administration were followed.
> explain about dietary management to the patient.
> Knowledge given about disease condition.
>steam inhalation given to the patient.
> breathing exercise taught to the patient with demonstration.
>uses of medication explained to the patient and family members.
>explain the dietary management and disease condition to the patient
and family members.
2:30 pm R> endorsed to NOD with latest v/s of Temp : 97 F , HR : 86 bpm, RR:
18 bpm , BP: 120/80 mmHg, Spo2: 97%
>ongoing IVF # 1 of PNSS IL with 30 gtts/min level left 20ml.
>reported cough was relieved.

Score: /20
 LEARNING FEEDBACK DIARY
LEARNINGS FEELINGS PROBLEMS MET SOLUTIONS REMARKS
Self I have learned a lot from the case study I feel sad because I have problems on While doing my I realized that there are
that was assigned by our instructor to doing this case was making the requirements easy things that I need to learn
us. As I picture it out to my mind having not in actual requirements and quick I do more and understand well
a patient in actual scenario it means a lot scenario. Also caring complete because searching online and especially when caring the
to me. I’ve learned what are the dos and a patient with TB there is a big most especially patient with TB. I need to
don’ts when taking care of a patient with will help me to difference in actual trying to imagine study in advance, read and
tuberculosis. enhance my learning assessing the patient that I was caring a read to gain more ideas so
about the disease in than understanding patient with TB in that when times about to
actual. the case scenario in the hospital. assess the patient I am
the paper. confidently do my job.
Activity The activity was very hard but I’ve I feel so tired making I have difficulties on I Do self study , After I’ve finished the
learned so much. I understand the the activities but it answering the searching on the activities I realized that I
importance of doing patient details in really helps me to activities because I internet and also need to be knowledgeable
accurate and correct information just gain knowledge on wasn’t able to meet imagining I was and smart to finish my
like on the chart. the case study. the patient. assessing the patient requirements correct and
on the actual easy.
scenario
Case/To I have known that the case about the TB The case/topic was I was got confused I still do my best in The tuberculosis(TB) is an
pic is a serious disease caused by a type of very interesting. I some important doing self study and infectious disease being a
bacteria that is spread through the air. It feel so happy and sad things to learn on the searching online. health care provider I think I
is easily spread from person to person while learning on topic. have an obligations to
through coughs and sneezes. And it this case. I wish it educate people all the
usually occurs in the lungs, but it can was on the actual important things they need to
spread to other parts of the body. scenario. know to become aware of
their health.
Clinical Though this case was not in actual I feel happy while None so far Do my job as a Our instructor teaches us to
Instruct scenario but still I’ve learnt and learning with my student. become productive. She do
or understand the topic. Our clinical instructor. She is her job well.
instructor was very amazing she tried very smart and
her best to become us productive even responsible.
they are not here to guide us because of
this type of learning but still her
presence in giving us task to worked
and I’ve learned a lot.

Score: /20
 JOURNAL READING
Assessment of Knowledge and Attitude of Tuberculosis Patients in Direct Observation Therapy Program
towards Multidrug-Resistant Tuberculosis in Addis Ababa, Ethiopia: A Cross-Sectional Study

Abstract

Background. Multidrug-resistant tuberculosis (MDR-TB) is becoming a major challenge of tuberculosis (TB)

control program globally but more serious in developing countries like Ethiopia. In 2013, a survey result showed
that in Ethiopia, tuberculosis patients from new cases and retreatment cases had resistance to at least isoniazid and
rifampicin with a significant increase over time. Inadequate knowledge and wrong perception about MDR-TB by
patients were detrimental to TB control programs. The study aimed at assessing the knowledge and attitude of TB
patients of direct observation therapy program towards multidrug-resistant tuberculosis in health centres of Addis
Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 health centres of Addis Ababa which
were selected by simple random sampling technique. A total of 422 TB patients were included in the study, and
participants from each health centres were taken proportional to the number of clients in each health centres. Data
was entered and analyzed using SPSS version 20. Association between outcome and independent variables was
explored using logistic regression. Results. The level of knowledge of TB patients about MDR-TB was poor and
only 55.0% of TB patient’s attained good overall knowledge. A significant association was found between good
knowledge and attending tertiary level of education (, , 9.8), gender (, , 2.4), income of respondents’ family
(, , 0.9), and sleeping practice (, , 15.7). Nearly three-fourths (73.5%) of TB patients had a favorable attitude
towards MDR-TB. Occupational status (,  , 7.6) and sleeping practices (, , 5.0) were significantly associated with
the attitude of the TB patients. 

INSIGHTS/ REACTION:
Tuberculosis (TB) is a leading cause of morbidity and mortality of worldwide. The lack of knowledge about the
Cause, mode of transmission and symptoms as well as appropriate treatment of TB within communities also
Contribute to poor adherence to TB treatment and or long delay in diagnosis. furthermore, the study was identified
That the knowledge of TB patient toward MDR-TB was poor, one third of TB patients was never heard about MDR-
TB and two third of TB patients heard from health workers and the number of studied patients showed unfavourable
Attitude towards MDR-TB in addis ababa, Ethiopia. On the other hand, there are different factors which affect the
Knowledge and Attitude of TB patients about MDR-TB including the occupational status, average monthly income
Sleeping practices, educational status and others. Overall , it is essential to improve the living condition of TB
Patients and efforts should be made to implement health education to improve awareness of TB patients about MDR-TB.
Score: /25
CASE CONCLUSION: (minimum of 250 words)

Therefore I conclude that tuberculosis (TB) is a widespread highly infectious disease

primarily affecting lung parenchyma that most often caused by mycobacterium tuberculosis and is
curable. It may spread to any part of our body including, kidney, bones and lymph nodes. It is an air
borne droplet infection caused by the ingestion of the bacterium when the infected person
coughing, sneezing etc. TB disease will make person sick. People with TB disease may spread the
bacteria to people with whom they spend many hours it is Characterized by the persistent cough,
cough with sputum, sudden weight loss, loss appetite, chest tightness and pain. It is very important
that people who have TB disease are treated, finish the medicine, and take the drugs exactly as
prescribed. Overall, As a health care provider especially treating patient who had TB disease we
need to educate them by giving them instructions to stop the spread of TB including taking all the
medicines as prescribed until the doctor takes you off, keep all doctor’s appointments, always cover
mouth with a tissue when cough or sneeze, wash hands after coughing or sneezing and don’t visit
other people or invite them to visit you.

Score: /20