ENGLISH IN NURSING SCIENCE ASSIGNMENT

Name : Devi Setiawan

Big Five of most disease in Fatmawati Ward of Sekarwangi Hospital

1. Tuberculosis
2. Community acquired pneumonia
3. Chronic Obstructive Pulmonary Disease
4. Asthma Bronchiale
5. Pleural Effusion

I. Tuberculosis

a. Definition
Tuberculosis is a disease caused by mycobacterium tuberculosis complex.

b. Etiology
TB is caused by M tuberculosis, a slow-growing obligate aerobe and a facultative
intracellular parasite. Mycobacteria, such as M tuberculosis, are aerobic, non–spore-
forming, nonmotile, facultative, curved intracellular rods measuring 0.2-0.5 μm by 2-4
μm

c. Pathophysiology
Infection with M tuberculosis results most commonly through exposure of the lungs or
mucous membranes to infected aerosols. When inhaled, droplet nuclei are deposited
within the terminal airspaces of the lung. The organisms grow for 2-12 weeks, until
they reach 1000-10,000 in number.
When a person is infected with M tuberculosis, the infection can take 1 of a variety of
paths, most of which do not lead to actual TB. The infection may be cleared by the
host immune system or suppressed into an inactive form called latent tuberculosis
infection (LTBI), with resistant hosts controlling mycobacterial growth at distant foci
before the development of active disease. Patients with LTBI cannot spread TB.
The lungs are the most common site for the development of TB; 85% of patients with
TB present with pulmonary complaints. Extrapulmonary TB can occur as part of a
primary or late, generalized infection. An extrapulmonary location may also serve as a
reactivation site; extrapulmonary reactivation may coexist with pulmonary
reactivation.

d. Diagnostic test
 Bacteriology examination :
From sputum, pleural fluid or liquor cerebrospinal.
Sputum collection : sputum specimen collected in the spot, morning, spot
(SPS), or 3 sputum specimen from 3 consecutive days (for admitted patients)
 Radiology examination
Obtain a chest radiograph to evaluate for possible TB-associated pulmonary
findings (demonstrated in the images below). A traditional lateral and
posteroanterior (PA) view should be ordered. In addition, an apical lordotic
view may permit better visualization of the apices and increase the sensitivity
of chest radiography for indolent or dormant disease.
  Special examination
BACTEC, Polymerase chain reaction (PCR), Enzym linked immunosorbent
assay (ELISA)

e. Treatment And Medication

The purpose of tuberculosis medication is for healing the patient, prevent motality,
prevent relapse, lower the transmission rate and prevention of drug resistance

For initial empiric treatment of TB, start patients on a 4-drug regimen: isoniazid,
rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is
known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth
drug) can be discontinued. [1]
After 2 months of therapy (for a fully susceptible isolate), pyrazinamide can be
stopped. Isoniazid plus rifampin are continued as daily or intermittent therapy for 4
more months. If isolated isoniazid resistance is documented, discontinue isoniazid and
continue treatment with rifampin, pyrazinamide, and ethambutol for the entire 6
months. Therapy must be extended if the patient has cavitary disease and remains
culture-positive after 2 months of treatment.
 II. COMMUNITY ACQUIRED PNEMONIA
a. Definition
infection of the pulmonary parenchyma caused by various microorganisms
(bacteria, virus, fungal, parasite)

b. Etiology
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella
catarrhalis, Mycoplasma pneumoniae, Respiratory viruses

c. Diagnostic test
 Chest radiography
 Sputum Gram stain and/or culture
 Blood cultures
 Complete blood cell counts with differential

d. Treatment and Medication

Hospital admission, oxygen, intra fluid line for hydration, antipyretic,
analgesic and antibiotics

III. COPD
a. Definition
Chronic obstructive pulmonary disease (COPD) have symptoms of chronic
bronchitis and emphysema, but the classic triad also includes asthma or a
combination of the above (see the image below).

Chronic bronchitis is defined clinically as the presence of a chronic productive

cough for 3 months during each of 2 consecutive years (other causes of cough
being excluded).
Emphysema is defined pathologically as an abnormal, permanent enlargement
of the air spaces distal to the terminal bronchioles, accompanied by destruction
of their walls and without obvious fibrosis.
 b. Etiology
 Cigarette smoking
 Environmental factors
 Airway hyperresponsiveness
 Intravenous drug use
 Immunodeficiency syndromes
 Connective tissue disorders

c. Diagnostic test
 Lung (pulmonary) function tests.
 Chest X-ray. A chest X-ray can show emphysema, one of the main causes
of COPD. An X-ray can also rule out other lung problems or heart failure.
 CT scan. A CT scan of your lungs can help detect emphysema and help
determine if you might benefit from surgery for COPD. CT scans can also
be used to screen for lung cancer.
 Arterial blood gas analysis. This blood test measures how well your lungs
are bringing oxygen into your blood and removing carbon dioxide.
 Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they
may be used to determine the cause of your symptoms or rule out other
conditions.

d. Treatment and Medication

A diagnosis of COPD is not the end of the world. Most people have mild
forms of the disease for which little therapy is needed other than smoking
cessation. Even for more advanced stages of disease, effective therapy is
available that can control symptoms, reduce your risk of complications and
exacerbations, and improve your ability to lead an active life. Smoking
cessation, bronchodilators, antibiotics and lung therapies.

IV. Asthma Bronchiale

a. Definition
Asthma is complex and involves airway inflammation, intermittent airflow
obstruction, and bronchial hyperresponsiveness. See the image below.
b. Etiology
Factors that can contribute to asthma or airway hyperreactivity may include
any of the following:
 Environmental allergens (eg, house dust mites; animal allergens, especially
cat and dog; cockroach allergens; and fungi)
 Viral respiratory tract infections
 Exercise, hyperventilation
 Gastroesophageal reflux disease
 Chronic sinusitis or rhinitis
 Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity,
sulfite sensitivity
 Use of beta-adrenergic receptor blockers (including ophthalmic
preparations)
 Obesity
 Environmental pollutants, tobacco smoke
 Occupational exposure
 Irritants (eg, household sprays, paint fumes)
 Various high- and low-molecular-weight compounds (eg, insects, plants,
latex, gums, diisocyanates, anhydrides, wood dust, and fluxes; associated
with occupational asthma)
 Emotional factors or stress
 Perinatal factors (prematurity and increased maternal age; maternal
smoking and prenatal exposure to tobacco smoke; breastfeeding has not
been definitely shown to be protective)

c. Diagnostic test
You may also be given lung (pulmonary) function tests to determine how
much air moves in and out as you breathe. These tests may include:
 Spirometry. This test estimates the narrowing of your bronchial tubes by
checking how much air you can exhale after a deep breath and how fast you
can breathe out.
 Peak flow. A peak flow meter is a simple device that measures how hard
you can breathe out. Lower than usual peak flow readings are a sign your
lungs may not be working as well and that your asthma may be getting
worse. Your doctor will give you instructions on how to track and deal with
low peak flow readings.
Lung function tests often are done before and after taking a medication called
a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your
airways. If your lung function improves with use of a bronchodilator, it's
likely you have asthma.

d. Treatment and Medication

Prevention and long-term control are key in stopping asthma attacks before
they start. Treatment usually involves learning to recognize your triggers,
taking steps to avoid them and tracking your breathing to make sure your daily
asthma medications are keeping symptoms under control. In case of an asthma
flare-up, you may need to use a quick-relief inhaler, such as albuterol.
Types of long-term control medications include:
  Inhaled corticosteroids.
 Leukotriene modifiers.
 Long-acting beta agonists.
 Combination inhalers.
 Theophylline.

V. Pleural Effusion
a. Definition
A pleural effusion is collection of fluid abnormally present in the pleural
space, usually resulting from excess fluid production and decreased lymphatic
absorption.

b. Etiology
The normal pleural space contains approximately 10 mL of fluid, representing
the balance between hydrostatic and oncotic forces in the visceral and parietal
pleural capillaries and persistent sulcal lymphatic drainage. Pleural effusions
may result from disruption of this natural balance.
Presence of a pleural effusion heralds an underlying disease process that may
be pulmonary or nonpulmonary in origin and, furthermore, that may be acute
or chronic. Although the etiologic spectrum of pleural effusion can be
extensive, most pleural effusions are caused by congestive heart failure,
pneumonia, malignancy, or pulmonary embolism.

c. Diagnostic test
Useful radiological findings of pleural effusions
(1) Bilateral effusion
Bilateral pleural effusion is commonly seen in heart failure. For bilateral
effusion with a normal heart size, the differential diagnosis should include
malignancy and, less commonly, lupus pleuritis and constrictive pericarditis3.
(2) Massive effusion more than half of hemithorax
The most frequent cause of massive pleural effusions is malignancy (55%),
followed by complicated parapneumonic or empyema (22%), and tuberculosis
(TB) (12%). If massive effusions are without contralateral displacement of
 mediastinal structures, the endobronchial obstructions by lung cancer or
mediastinum fixation by mesothelioma should be considered7.
(3) Loculated effusion
The loculation of pleural space is caused by adhesions between contiguous
pleural surfaces. It occurs most frequently in conditions that cause intense
pleural inflammations, such as empyema, hemothorax, or TB pleurisy. In
patients with congestive heart failure after treatment, the loculated effusion in
fissure may simulate a mass, termed as the vanishing tumor or pseudotumor in
chest PA view1.
(4) Combined pneumonia in lower lobe
The AP, PA, and lateral chest radiographs are not sensitive methods to identify
parapneumonic effusions in patients with pneumonia, because all views
missed more than 10% of significant effusions. The existence of a lower lobe
parenchymal consolidation concealed the identification of some pleural
effusions. Therefore, such considerations should be used for obtaining
additional imaging, such as thoracic ultrasonography in patients with lower
lobe parenchymal consolidations on plain film radiographs

d. Treatment and Medication

Transudative effusions are managed by treating the underlying medical
disorder. However, regardless of whether transudative or exudative, large,
refractory pleural effusions causing severe respiratory symptoms can be
drained to provide symptomatic relief.
The management of exudative effusions depends on the underlying etiology of
the effusion. Pneumonia, malignancy, and TB cause most exudative pleural
effusions, with the remainder typically deemed idiopathic. Complicated
parapneumonic effusions and empyemas should be drained to prevent
development of fibrosing pleuritis. Malignant effusions are usually drained to
palliate symptoms and may require pleurodesis to prevent recurrence.
Medications cause only a small proportion of all pleural effusions and are
associated with exudative pleural effusions. However, early recognition of this
iatrogenic cause of pleural effusion avoids unnecessary additional diagnostic
procedures and leads to definitive therapy, which is discontinuation of the
medication. Implicated drugs include medications that cause drug-induced
lupus syndrome (eg, procainamide, hydralazine, quinidine), nitrofurantoin,
dantrolene, methysergide, procarbazine, and methotrexate.
 I. Assessment

Subjective:
“I had this recurrent cough for almost a month now and it seems that I am having difficulty in
breathing at times...” verbatim of client.

Objective:
 RR = 23 breaths/ min
 PR = 95 beats/min
 T = 37.5 degree Celsius
 Easy fatigability
 Productive cough
 Chills at night
 Loss of appetite as claimed
 Chest X- ray and sputum examination
 revealed positive for pulmonary tuberculosis

II. Nursing Diagnosis

Ineffective Airway Clearance related to presence of bronchial infection and secretion

 NURSING CARE PLAN FOR PULMONARY TUBERCULOSIS
Nursing Nursing
Assessment Inference Outcome Rationale Evaluation
Diagnosis Interventions
Subjective:
“I had this recurrent Ineffective Airway Cough is the most After 8 hours of Maintain infection PTB is transmitted After 8 hours of
cough for almost a Clearance related common symptom nursing care, client control through the via droplet nursing care, the
month now and it to presence of of will be able to use of mask and inhalation goal is partially
seems that I am bronchial infection pulmonary readily expectorate performance of so proper met
having difficulty in and secretion tuberculosis. It secretions and will hand precaution as evidenced by
breathing at times...) may have absence or washing before and should be client’s
verbatim of client. produce yellowish decrease in after contact with performed participation
or episodes of client. to avoid to breathing and
Objective: greenish colored dyspnea transmission coughing exercises
 RR= 23 breaths/ sputum especially to other clients. and ability to
min during the day. expectorate
 PR= 95 beats/min Eventually, the Place client in high Elevating the head sputum
 T= 37.5 degree sputum may be fowler’s position of the bed and upon evaluation;
Celsius streaked with and turning client still
 Easy fatigability blood. encourage every there are episodes
 Productive cough Furthermore, a reposition two hours help in of
 Chills at night person with PTB every two hours. decreasing the dyspnea as claimed
 Loss of appetite may experience pressure placed on by the client.
as claimed fatigue and loss of the diaphragm.
 Chest X- ray energy. It may
affect Maintain room or Allergen may
 sputum
his or her ability to environment free trigger more
examination
expectorate from any sorts of accumulation of
 revealed positive
secretions, too. allergen. secretion due to
for pulmonary
Aside respiratory
tuberculosis
from that, response.
difficulty
of breathing Teach and These exercises
signifies encourage deep hasten the
that there may be breathing and expulsion
an coughing exercises. of sputum and aids
accumulation of in
secretion in the maintaining
bronchial cavity of airway
the lungs. patency.

Emphasize to Fluids help loosen

increase fluid secretion in the
intake lungs.
depending on
individual
tolerability
or as indicated.

Instruct to take Warm fluids help

warm liquids in
instead loosening the
of cold ones. secretions while
cold
liquids triggers
cough more often.

Provide postural Through the aid of

drainage and gravity and
percussion. percussion
secretions
are readily
expelled.

Monitor breathing It provides

patterns and breath baseline
sounds. data for future
comparison in the
evaluation of
disease
condition.
Educate client and PTB can be
family about transmitted
disease through
condition and the droplet inhalation
need for and 6 months
compliance compliance to
with the medication is
therapeutic needed
regimen. in order to be
treated
with it.