PULMONARY TUBERCULOSIS

Tuberculosis is a bacterial infection that can pass through the air between people. Its bacteria mainly grow in the lungs, but they can
infect other parts of the body. Miliary TB is an advanced form of the disease that develops when the bacteria spread through the
bloodstream to infect organs beyond the lungs.
Symptoms of TB can develop slowly and may vary. The main symptoms of pulmonary TB include:

 a bad cough that lasts for at least 3 weeks.

 chest pain
 coughing up blood or phlegm from the lungs
 breathlessness
More general symptoms of TB can include:

 weight loss
 a loss of appetite
 nausea and vomiting
 low energy or fatigue
 fever and chills
 night sweats
 NURSING CARE PLAN
NURSING
ASSESSMENT DESIRED OUTCOME NURSING INTERVENTIONS IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective: Ineffective After 24 hours of Independent: After 24 hours of
The wife Airway comprehensive nursing comprehensive nursing
verbalized that Clearance r/t interventions, the  Assess respiratory Assessing and interventions, the
his husband retained patient will be able to: function noting breath sounds, determining the patient is able to:
has been secretions as rate, rhythm, and depth, and condition of
coughing with manifested  Display stable use of accessory muscles. respiratory function  Display stable
blood streaked by thick, vital signs using the flat disc vital signs as
sputum for viscous and Rationale: Abnormal breath sounds diaphragm of manifested by T
more than 2 bloody may indicate respiratory distress and/or stethoscope. = 36.5C to
weeks and has sputum and accumulation of secretions. 37.4C, PR = 60-
on and off dyspnea 100 bpm, RR =
fever.  Note ability to expectorate Noting the patient’s 12-20 bpm, and
mucus and cough effectively; ability to expectorate O2 Sat. = 95%
Objective: document character, amount of mucus and cough
V/S  Maintain airway sputum, presence of effectively by  Maintain airway
-T= patency. hemoptysis. instructing him on patency as
38.9C how to do it. manifested by
- PR = Rationale: Expectoration may be Document the absence of signs
101 difficult when secretions are very thick character, amount of and symptoms
bpm as a result of infection and/or sputum and presence of obstructive
- RR = 28 inadequate hydration. Blood -tinged or of hemoptysis on a airway.
bpm frankly bloody sputum results from chart.
- O2 Sat.  Expectorate tissue breakdown (cavitation) in the  Expectorate
= 94% secretions lungs or from bronchial ulceration and secretions
Patient weighs without may require further evaluation or without
52kg assistance. intervention. assistance such
(malnourished) as drinking
Lethargic  Place patient in semi or high- plenty of fluids,
Productive Fowler’s position. Assist patient Placing the patient in keeping head
Cough with coughing and deep- semi or high-Fowler’s elevated, use
(Red/blood breathing exercises. position and saline nasal
streaked instructing the patient spray or rinse,
sputum) Rationale: Positioning helps maximize with coughing and and taking the
Presence of lung expansion and decreases deep breathing right
Dyspnea respiratory effort. exercises. medication.

 Verbalize  Maintain fluid intake of at least  Verbalize

understanding 2500 mL/day unless Administer 2500 ml or understanding
of cause/s and contraindicated. 2.5 L (8-oz glasses of of cause/s and
therapeutic water) to the patient therapeutic
management Rationale: High fluid intake helps thin to help thin management
regimen. secretions, making them easier to secretions. regimen.
expectorate.
 Participate in  Participate in
treatment Dependent: treatment
regimen, within regimen, within
the level of  Administer medications as the level of
ability/situation. indicated; Administer the ability/situation.
- Analgesics: to improve cough medications according
when pain is inhibiting effort. to the doctor’s order
(Caution: overmedication can to avoid
depress respirations and cough complications.
effort.)
- Mucolytic agents: acetylcysteine
(Mucomyst): Reduces the
thickness and stickiness of
pulmonary secretions to
facilitate clearance.
- Bronchodilators: oxtriphylline
(Choledyl), theophylline (Theo-
Dur): Increases lumen size of the
tracheobronchial tree, thus
decreasing resistance to airflow
and improving oxygen delivery.
- Corticosteroids (prednisone):
May be useful in presence of
extensive involvement with
profound hypoxemia and when
inflammatory response is life-
threatening.

DRUG STUDY
 Drug Mechanism of Indication/ Nursing responsibilities
action/Side effects Contraindication

Brand name: Action Indication  Observe the 10 rights to administration of

drugs:
Myrin P Forte They work impacting the Initial phase 1. Right patient
synthesis or transcription of treatment and re- 2. Right medication
Generic name: mycobacteria RNA or treatment of all forms 3. Right dosage
inhibiting the synthesis of of tuberculosis 4. Right route
mycolic acids in the cellular
Pyrazinamide/Ethambutol category I and II 5. Right time
wall. Mycobacteria can
patients caused by 6. Right documentation
develop resistance to
HCl/Rifampicin/Isoniazid susceptible strains of
antitubercular medications; 7. Right client education
therefore, strict compliance mycobacteria.  8. Right to refuse
Classification: to drug regimen must be
Category I: cases of 9. Right assessment
emphasized.
An Antituberculous agent smear-positive  Right evaluation
pulmonary  Monitor vital signs
that contains Pyrazinamide, Side Effects tuberculosis and  Educate the patient about the significance of
other newly continuing drug therapy even after
Ethambutol HCl, Rifampicin The following is a list of symptoms have resolved to prevent the
possible side effects that diagnosed seriously ill
patients with severe spread of disease. 
and Isoniazid may occur from all
constituting ingredients of forms of  Educate the patient about the side effects of
Route: Oral Myrin P Forte Tablet. This is tuberculosis.  the medication
not a comprehensive list.  Instruct the patient to take the medicine 1
These side-effects are Category II: Relapse hour before breakfast
Dosage:
possible, but do not always or treatment failure  Provide thorough teaching including drug
occur. Some of the side- patients.
- 3 tablets name and prescribed dosage measurement
effects may be rare but
to help avoid adverse effects, warning signs
serious. Consult your doctor
Pyrazinamide 400mg if you observe any of the Contraindication that may indicate problems and the need for
following side-effects, periodic monitoring and evaluation to
Ethambutol HCl 275mg especially if they do not go Hypersensitivity. enhance patient knowledge about the drug
away. Alcoholism, optic therapy and promote compliance
Rifampicin 150mg neuritis, impaired  Monitor patient’s response to the drug
 Skin sensitivity to hepatic function and
Isoniazid 75mg sunlight  Evaluate effectiveness of the teaching plan
severe renal
 Loss of appetite insufficiency,  Document and record any findings.
Frequency: OD 1 hour  Headache hyperuricemia and/or
 Pain gouty arthritis,
before breakfast  Skin reactions jaundice, or in
 Vomiting patients with known
 Appetite loss retrobulbar neuritis.
 Rifampin produces Patients who are
brownish-red or orange unable to appreciate
coloration of the urine and report visual side
 Itchy skin rashes effects or changes in
 Abdominal vision (example:
discomfort young children and
patients with mental
illness or mental
deficiency).