PTB Case Study

Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CASE PRESENTATION:
PULMONARY TUBERCULOSIS
In Partial Fulfilment of the Requirements for the Subject

RELATED LEARNING EXPERIENCE
CLINICAL DUTY
Prepared by:
Datu, Beverly Jane L.
De Lara, Bianca Jesmine A.
Del Rosario, Trixie DC.
BSN III-C
Mrs. Janela Galac

Clinical Instructor
Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
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Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
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CHAPTER I
General Objectives
As a level 3 NEUST-CON student nurse, the overall goal of the study was to become
acquainted with realization, understanding the constant overall disease, improve our skills, and
develop a positive attitude when dealing with various patients, as well as performing the basic
nursing skills with confidence and competence, and providing appropriate nursing management
to a patient with Pulmonary Tuberculosis.
Specific Objectives
At the end of the clinical duty the students will be able to:
1. Perform a head-to-toe assessment to the patient, formulate a nursing diagnosis and focus
on the part affected by the Pulmonary Tuberculosis;
2. Comprehend the precipitating and predisposing factors that can possibly lead to
occurrence of Pulmonary Tuberculosis;
3. Obtain, document and provide a reliable medical history related to the present condition;
4. Explain the anatomy and physiology of the respiratory system;
5. Understand the book-based pathophysiology of Pulmonary Tuberculosis in able to
correlate the mechanism of the disease to client’s health status.
6. Be aware of the different medication used, its action, and side effect in the management
of Pulmonary Tuberculosis and apply the 10 Rights in administering medications;
7. Gain knowledge about the suggested medical management and its uses;
8. Formulate a specific Nursing Care Plan;
9. Evaluate the nursing interventions rendered to the client; and
10. Provide information about the discharge and home management plan.
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Introduction
Tuberculosis is a common and often deadly infectious disease caused by
mycobacteria, in humans mainly Mycobacterium tuberculosis. Tuberculosis usually attacks the
lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system,
the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and
even the skin. Tuberculosis spread through the air, when people who have the disease cough,
sneeze, or spit. Most infections in human beings will result in asymptomatic, latent infection, and
about one in ten latent infections will eventually progress to active disease, which, if left
untreated, kills more than half of its victims. The classic symptoms of tuberculosis are a chronic
cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs
causes a wide range of symptoms. If you have latent TB, your doctor might recommend
treatment with medication if you're at high risk of developing active TB. For active tuberculosis,
you must take antibiotics for at least six to nine months. The exact drugs and length of treatment
depend on your age, overall health, and possible drug resistance and where the infection is in
your body. According to the World Health Organization, the 2020 global Tuberculosis report, the
Philippines has Asia's highest tuberculosis incidence rate, with 554 cases per 100,000 Filipinos.
Among 196 nations with a high tuberculosis infection, the mentioned country is rated ninth in the
globe.
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CLIENT’S INFORMATION
I. Patient’s Profile
Name: Client X
Age: 50 Years Old
Date of Birth: April 14, 1971
Sex: Male
Weight: 55kg
Height: 175cm
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Address: Sta Arcadia St. Cabanatuan City
Date of Admission: August 21, 2021
Attending Physician: Dr. X
II. Presenting Complaints

 Cough.
 Weight loss.
 Fever.
 Night sweats.
 Hemoptysis.
 Chest pain.
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 Fatigue.
III. Family History

No family history of any diseases related to Pulmonary Tuberculosis.
IV. Past History (History of infections)

Patient’s condition started about 6 months prior to consultation, as onset of
cough, non-productive and an intermittent fever usually in the afternoon, moderate
grade temperature which are not documented. According to him it was relieved by an
intake of paracetamol.
V. Birth History ( Postnatal History)

Birth Weight: 2.5 kg
Length : 50 cm
VI. Immunization
 Hepatitis (B)
 BCG
 Polio (IPV) (4th dose)
 Measles, mumps, and rubella (MMR) (2nd dose)
 Chickenpox (Varicella) (2nd dose)
 Influenza (Flu) (every year)
VII. DRUG HISTORY
Medication used:
 Generic Name: Paracetamol
 Brand Name: Biogesic
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 Q4h, PO
Adverse effects:
 low fever with nausea, stomach pain, and loss of appetite;
 dark urine, clay-colored stools; or
 jaundice (yellowing of the skin or eyes)
Admitting History
On August 21, 2021 at around 9:00 AM, a 50-year-old male client named X is admitted
in the medical ward of ELJH. According to the client he has a cough, experiencing weight loss,
fever, night sweats, hemoptysis, fatigue and he also experienced stabbing pain on his chest,
according to the assessment it is 6/10, and it radiates to his back. The client’s final diagnosis is
Pulmonary Tuberculosis.
Admitting Vital Signs

T: 38.1 C
P: 84 Beats/ mins
R: 36 Breaths/mins
BP: 90/70 mmHg
During the initial assessment, the client was caught onset of coughing and clarified that chest
pain is also presence.
Status of Present Illness

Upon admission, the client showed fatigue and has fever and hemoptysis. The client
stated that he is having chest pain and experiencing weight loss and night sweats. Upon taking
the vital signs, pain scale, and BMI of the client, his body temperature is 38.1° C and respiratory
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rate of 36 cpm while his pain was scored 6/10 and his weight is 55 kg and his height is 175 cm
which fall on the category of underweight. It is then confirmed the client’s condition.
Physical Assessment
The table below shows the physical assessment of the client from head to toe.
Name: Client X
Age: 50 y/o
Date of Assessment: August 21, 2021
General Appearance Normal Actual findings Interpretation and
Analysis
Mood and effect Normally calm Slightly Irritated The client has discomfort
Posture Relaxed and Uncoordinated The client has a sign of

coordinated movement noted. weakness.
movement
Hygiene and Well cleaned, He has pleasant The client has proper
Grooming presentable odor, well cut nails hygiene.
and clean haircut.
Types of clothing Accurate to the He wears polo shirt Presentable.

environment and pants.
Quantity and quality Having a good He can’t talk He possesses signs of

of speech quality of speech properly and phlegm weakness and anxious.
is presence.
Relevance and Well good, having He was slightly He was responsive but
organization of good decisions participating. cough is presence
thoughts
VITAL SIGNS
Body Temperature 36.5 0C to 37.5 0C 38.10C Intermittent fever.
Pulse Rate 60 to 100 bpm 84 bpm Normal Range of Pulse rate.
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Respiratory Rate 13 to 19 cpm 36 cpm Elevated range of

respiratory rate.
Weight
60 to 70 kg 55 kg. Underweight.
Body Parts Normal Findings Actual Findings Interpretation and

Analysis
Skin The skin normally uniform, He has smooth, brown Abnormal
whitish pink or brown in color and lesion free skin but
depending on the race of the warm to touch.
client. No strong odor should be
evident and the skin should be Intermittent fever
lesion free
Head The head should be He has smooth, non- Normal

normocephalic and symmetrical,
normal skull is smooth, non- tender and without
tender and without masses and masses and depression
depression.
Eyes The eyes are normally aligned, His eyes are aligned; his Abnormal
there should not have excessive pupils are equally round
discharge from lacrimal duct. and reactive to light.
Pupils are normal and reacted to Found hollowness Volume deficiency of
light fat within the orbit
(the space inside of
the bony eye
socket). This
condition of the
patient is related to
his nutritional
status, she is
malnourished.
Ears Should be position centrally in No discharges noted Normal
proportion to the head.
Nose It is located symmetrically in the His nose is symmetric Abnormal
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middle of the face and must not and straight; Uniform
have presence of lesion and color with nasal flaring.
masses; no discharge or flaring. Nasal flaring
suggests airway
obstruction. Nasal
discharge shows the
presence of mucus
secretions in the air
tract.
Mouth The lips and membranes should Bluish-black in color, dry Abnormal
be pink and moist and to show and cracked lips;
no evidence of lesions and
inflammation. The color of the lips
were result of
smoking and may
suggest have cellular
dehydration.
Neck Neck is straight The client’s neck is Normal
No visible mass or lumps straight.
No jugular venous distention No visible mass or lumps;
no presence of jugular
venous distention.
Chest Symmetrical. Bronchovesicular Chest is symmetrical, Abnormal
sounds and unblemished skin decreased breath sound;
Good capillary refill. Ronchi is presence It has appeared
tachypnea and
adventitious sounds
were heard during
auscultation.
Nails/Fingers Symmetrical. Absence of blue Cyanosis is presence Abnormal
/Toes
finger nails, no lesion and
The findings were
tenderness.
related to present
condition.
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Table 1. Physical Examinations
CHAPTER II
Definition of the Case
The microbe Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a
contagious, airborne infection that destroys body tissue. It is spread by tiny droplets spread by
coughing and sneezing, with the droplet remaining suspended in the air for several hours.
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Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread
from there to other organs.
Furthermore, transmission occurs when a person inhales tuberculosis bacteria-containing
droplet nuclei, which then enter the upper respiratory tract via the mouth or nasal passages. They
then make their way to the bronchi, then to the lungs and alveoli.
There is a distinction between being infected with the tuberculosis bacterium and having
active tuberculosis disease. The stages of tuberculosis are exposure, which occurs when a person
comes into contact with or is exposed to another person who has TB, latent TB infection, which
occurs when a person has TB bacteria in his body but is asymptomatic of the disease, and TB
disease, which occurs when a person exhibits signs and symptoms of an active infection.
Moreover, those with a weakened immune system and those who have recently been
infected with TB are at a higher risk of developing tuberculosis. Pulmonary tuberculosis is
curable if diagnosed early and treated with antibiotics. However, if the disease is left untreated or
not fully treated, it can be fatal. Untreated pulmonary tuberculosis can cause long-term damage
to the lungs, brain, liver, heart, or spine.
Cases of Pulmonary Tuberculosis in the Philippines

According to the World Health Organization's (WHO) 2020 global tuberculosis report,
the Philippines has the highest tuberculosis incidence rate in Asia, with 554 cases per 100,000
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Filipinos. The said country is ranked ninth in the world among 196 countries with a high TB
burden.
TB is the sixth leading cause of death in the Philippines. Every day, 73 Filipinos die as a
result of tuberculosis. There are approximately 200,000 - 600,000 Filipinos with active
tuberculosis. This condition causes the person to become ill and contagious to others. Active
tuberculosis can develop within a few weeks of being infected with the bacteria. Cough, phlegm
with blood, unexplained weight loss, fatigue, afternoon fever, night sweats, chills, and loss of
appetite are all signs and symptoms of active tuberculosis.
Tuberculosis is caused by Mycobacterium tuberculosis and can be transmitted to others
via tiny droplets spread by coughing and sneezing. Bacteria will be expelled in respiratory
droplets, and people in close proximity may inhale them. The body's natural defense system will
initially fight the bacteria, but as the immune system deteriorates, the bacteria may attack the
lungs and other parts of the body.
The internationally recommended strategy for tuberculosis control is the Directly
Observed Therapy Short Course (DOTS). DOTS simply means asking a relative or a health
worker to observe the patient taking anti-TB medications on a daily basis. DOTS treatment
success in the Philippines is around 88 percent, which is higher than the WHO target of 85
percent.
Tuberculosis is curable, and treatment is free in public health facilities across the country.
According to the 2016 National Tuberculosis Prevalence Survey, only 19% of people with TB
symptoms sought treatment and care. The others would either do nothing or self-medicate. These
behaviors are likely to persist today, as COVID-19 mobility restrictions continue.
Anatomy and Physiology
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[ CITATION Ana191 \l 1033 ]
The primary functions of the respiratory system are to obtain oxygen from the
surrounding environment and deliver it to the cells, as well as to remove carbon dioxide from the
body produced by cellular metabolism.
The respiratory system consists of the lungs, the conducting airways, the central nervous
system components that control the respiratory muscles, and the chest wall. The chest wall
consists of the muscles of respiration—such as the diaphragm, the intercostal muscles, and the
abdominal muscles—and the rib cage.
UPPER RESPIRATORY TRACT

 Nose
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It is the body’s primary organ of smell and also functions as part of the body’s respiratory
system. Air comes through the nose.
 Nostril/Nasal Cavities
The nasal cavity refers to the interior of the nose, or the structure which opens exteriorly at
the nostrils. The cavity is entirely lined by the nasal mucosa which form the physical barriers of
the body’s immune system. These barriers provide mechanical protection from the invasion of
infectious and allergenic pathogens. During inhalation, air enters the nostrils and passes into the
nasal cavities where foreign bodies are removed, the air is heated and moisturized before it is
brought further into the body.
 Sinuses
The sinuses are small cavities that are lined with mucous membrane within the bones of the
skull. Their main function is to produce a mucus that moisturizes the inside of the nose.
 Pharynx
The pharynx is a tube-like passage that connects the posterior nasal and oral cavities to the
larynx and esophagus. Air enters the superior portion, the nasopharynx, from the nasal cavity and
then descends through the oropharynx and laryngopharynx to enter the larynx below.
LOWER RESPIRATORY TRACT
 Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location of the
Adam’s apple which in reality is the thyroid gland and houses the vocal cords. It also serves as a
sphincter by transmitting air from oropharynx and nasopharynx to trachea.
 Epiglottis
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It is a small flap of tissue that covers the air-only passage when we swallow, preventing food
and liquid from entering the lungs. It is also known as the "guardian of the airways" because it
protects the superior opening of the larynx.
 Trachea
The trachea or windpipe is a tube that connects the larynx to the upper part of the chest and
transports air between the larynx and the lungs. The trachea is lined with ciliated mucosa that
beats continuously and in the opposite direction of the incoming air, propelling mucus loaded
with dust particles and other debris away from the lungs and into the throat, where it can be
swallowed or spat out.
 Lungs
The lungs are the organ where gas exchange takes place. The lungs are made up of silicate
tissues that are extremely thin. The bronchi subside at the lungs, becoming progressively smaller
as they branch through the lung tissue until they reach the tiny air sacks of the lungs known as
the alveoli.
 Bronchi
The right and left main (primary) bronchi are formed by the division of the trachea. Each
main bronchus runs obliquely before it plunges into the medial depression of the lung on its own
side. The right main bronchus is wider, shorter, and straighter than the left.
 Bronchioles
The bronchi subside creating a network of smaller branches, with the smallest one being the
bronchioles. There are more than one million bronchioles in each lung that represent the
conducting system for air to travel from the trachea to the alveolar ducts and alveoli.
 Alveolar ducts
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Alveolar ducts are tiny ducts that connect the respiratory bronchioles to alveolar sacs, each of
which contains collection of alveoli. They are the end ducts of the branching airways that fill the
lungs.
 Alveoli
Alveoli are small mucus-lined pouches made of flattened epithelial cells where the lungs and
blood exchange oxygen and carbon dioxide during the process of breathing in and breathing out.
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Book-Based Pathophysiology
Susceptible person inhaled mycobacterium

tuberculosis through droplets
(Sneezing, coughing, etc.)
Becomes infected
Bacteria are transmitted through the airways to the

alveoli then transported via lymph system and
bloodstream to other parts of the body
Immune system reacts.
Phagocytosis and inflammatory responds through

macrophages engulfing many bacteria.
TB-specific lymphocytes produced a T-lytic enzyme

which lyses the bacilli and normal tissue.
Macrophages surrounds the TB bacteria and forms a

granuloma.
Granuloma turns into fibrous tissue mass called

Ghon Tubercle
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Bacteria and macrophages turn into a cheesy mass.
Ghon Tubercle is calcified and walled off by the

immune system but it formed a collagenous scar.
No further progression of active disease.
For immunocompromised and has inadequate

immune system response:
Active disease may develop after initial exposure

and infection.
Spread of Mycobacteria outside the original

granuloma.
Formation of caseating granulomas necrotized and

become cavitary granulomas.
Cavitary granulomas erode into bronchioles and

generate sputum with M. tuberculosis or it can erode
in blood vessels resulting from hemoptysis.
Sources: Tierney, D, Nardell, E. (2018). Tuberculosis (TB). Msdmanuals.

https://www.msdmanuals.com/professional/infectious-diseases/mycobacteria/tuberculosis-tb
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Explanation:
Tuberculosis is caused by inhaling mycobacteria and becoming infected. Bacteria enter

the body via the airways and travel to the alveoli, as well as the lymph system and bloodstream.
The immune system responds by launching an inflammatory response, and phagocytes engulf
many of the bacteria, while TB-specific lymphocytes lyse the bacilli and normal tissue.
Granulomas are new tissue masses made up of both live and dead bacilli that are surrounded by
macrophages, which form a protective wall. They are then transformed into a fibrous tissue
mass, with the central portion known as a Ghon tubercle. Bacteria and macrophages combine to
form a cheesy mass that can calcify and form a collagenous scar. At this point, the bacteria go
dormant, and no further active disease progression occurs. Active disease may develop after
initial exposure and infection due to a weakened or insufficient immune system response.
Reactivation occurs typically in apices and upper poles of lower lobes where the V/Q
ratio is high. The Mycobacteria spreads outside the original granuloma which resulted in the
formation of caseating granulomas that can necrotized and become a cavitary granuloma.
Cavitary granuloma erode into bronchioles and generate sputum with M. tuberculosis but it can
also erode into blood vessels, causing hemoptysis.
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Client-Based Pathophysiology
Precipitating Factor:
Predisposing Factor:
 Occupation
 Age
 Repeated close contact with
 Immunosuppression infected person
Inhalation
Transmission
Defense
Protection
Ghon’s
tubercle Signs and Symptoms
 Cough
Scarring  Weight loss

 Fever
 Night sweats
Dormacy
 Hemoptysis
 Chest pain
Activation
 Fatigue
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Explanation:
Tuberculosis begins when a susceptible person inhales mycobacteria and becomes

infected. The bacteria are transmitted through the airways to the alveoli, and are also
transported via lymph system and bloodstream to other parts of the body. The body’s
immune system responds by initiating an inflammatory reaction and phagocytes
engulf many of the bacteria, and TB-specific lymphocytes lyse the bacilli and normal
tissue. Granulomas new tissue masses of live and dead bacilli, ate surrounded by
macrophages, which form a protective wall. They are then transformed to a fibrous
tissue mass, the central portion of which is called a Ghon tubercle. The bacteria and
macrophages turns into a cheesy mass that may become calcified and form a
collagenous scar. At this point, the bacteria become dormant, and there is no further
progression of active disease. After initial exposure and infection, active disease may
develop because of a compromised or inadequate immune system response. As the
disease developed it will shows signs and symptoms such as Cough, Weight loss,
Fever, Night sweats, Hemoptysis, Chest pain and Fatigue.
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Risk Factors
Risk factors for pulmonary tuberculosis include:

 Immunosuppressive Conditions- HIV coinfection is the most potent
immunosuppressive risk factor for developing active TB disease.
 Malnutrition- Studies have shown that malnutrition (both micro- and macro-deficiency)
increases the risk of TB because of an impaired immune response. TB disease can itself
lead to malnourishment because of decreasing appetite and changes in metabolic
processes.
 Young Age- Children are at higher risk of contracting TB infection and disease. Studies
have shown that 60–80% exposed to sputum smear-positive case became infected
compared to only 30–40% who are exposed to a sputum smear-negative source case.
 Diabetes- Diabetes has been shown to increase the risk of active TB disease.
 Social Workers- Social workers are one that has increased risk of exposure to TB.
 Tobacco Smoke- The association between smoking and TB has been studied in several
systematic reviews the effects of smoking on TB, showed that the relative risk of TB
disease was high among smokers in comparison to nonsmokers and that there was clear
evidence that smoking causes remained a risk factor for TB infection and disease, with
additional risk of death in persons with active TB.
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Clinical Manifestation
BOOK-BASED CLIENT-BASED
 Cough up Phlegm  Cough
 Malaise  Weight loss
 Consistent Fever  Fever
 Weight loss  Hemoptysis
 Sweats  Chest pain
 Anorexia  Fatigue
 Sore throat
Table 2. Clinical Manifestation

Source: Heemskerk D, Caws M, Marais B, et al. (2015). Tuberculosis in Adults and Children
https://www.ncbi.nlm.nih.gov/books/NBK344404/?
fbclid=IwAR2_izifKDj82QNePFNavJFTy5qYNu9Qvpam_DfDu7ne__7
gETfdf8bMJDw
Medical Management
Pulmonary tuberculosis is treated primarily with antituberculosis agents for 6 to 12 months.
 First line treatment. First-line agents for the treatment of tuberculosis are isoniazid
(INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide.
 Active TB. For most adults with active TB, the recommended dosing includes the
administration of all four drugs daily for 2 months, followed by 4 months of INH and
RIF.
 Treatment guidelines. Recommended treatment guidelines for newly diagnosed cases of
pulmonary TB have two parts: an initial treatment phase and a continuation phase.
 Initial phase. The initial phase consists of a multiple-medication regimen of INH,
rifampin, Pyrazinamide, and ethambutol and lasts for 8 weeks.
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 Continuation phase. The continuation phase of treatment includes INH and rifampin or
INH and rifapentine, and lasts for an additional 4 or 7 months.
 Prophylactic isoniazid. Prophylactic INH treatment involves taking daily doses for 6 to
12 months.
 DOT. Directly observed therapy may be selected, wherein the assigned health care
provider directly observes the administration of the drug.
NURSING MANAGEMENT
Nursing Management for the patient include:
 Promoting airway clearance. The nurse instructs the patient about correct positioning to
facilitate drainage and to increase fluid intake to promote systemic hydration.
 Adherence to the treatment regimen. The nurse should teach the patient that TB is a
communicable disease and taking medications is the most effective means of preventing
transmission.
 Promoting activity and adequate nutrition. The nurse plans a progressive activity
schedule that focuses on increasing activity tolerance and muscle strength and a
nutritional plan that allows for small, frequent meals.
 Preventing spreading of tuberculosis infection. The nurse carefully instructs the patient
about important hygienic measures including mouth care, covering the mouth and nose
when coughing and sneezing, proper disposal of tissues, and handwashing.
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 Disposal. Place a covered trash can nearby or tape a lined bag to the side of the bed to
dispose of used tissues.
 Monitor adverse effects. Be alert for adverse effects of medications.
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CHAPTER III
Laboratories
The signs and symptoms of pulmonary tuberculosis are often nonspecific and vary widely
based on the ranging age and how the infectious organisms were involved. Laboratory
medicine covers an essential role in the monitoring of these physiological changes.
A complete blood count (CBC) is a blood test used to evaluate the health and detect a
wide range of disorders. This test measures several components and features of the blood
including: red blood cells, white blood cells, hemoglobin, hematocrit, the proportion of
red blood cells to the fluid component, or plasma, in the blood and platelets.
A Chest X-ray is an imaging test that uses small amounts of radiation to produce pictures
of the organs, tissues, and bones of the body. When focused on the chest, it can help spot
abnormalities or diseases of the airways, blood vessels, bones, heart, and lungs. Chest X-
rays can also determine if fluid is presence in lungs, or fluid or air surrounding of lungs.
A sputum culture (SC) is a test for the gooey substance that often comes up from the
chest when it has a presence of infection in lungs or airways. It is mostly made up of
white blood cells that fight infection mixed with germs.
A urinalysis is a simple test that looks at a small sample of your urine. The test detects a
certain sugar that coats the surface of TB bacteria, which usually ends up in infected
people's urine in low concentrations. The test uses tiny molecular cages embedded with a
special dye that can catch and trap these sugar molecules.
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Here are findings of the laboratory tests that can be performed for diagnosed with PTB client:
 Complete blood count

Complete Blood Count (CBC)
Normal Results Interpretation Clinical
Significance
WBC 5.00 - 11.00 g/L 12.00 g/L Not Normal Elevated WBC
count to fight
infection
RBC 4.50 – 5.20 L 4.00 L Not Normal Risk of anemia
and nutritional
deficiency
Hgb 13.5 – 17.5 g/L 12.6 g/L Not Normal Risk of anemia
No risk of
Platelet 200 – 400 g/L 351 10 g/L Normal thrombocytopenia
Test Purpose
RBC An RBC count is a blood test that measures how many red blood cells (RBCs) you have.
WBC A WBC count is a blood test to measure the number of white blood cells (WBCs) in the
blood. WBCs are also called leukocytes.
HGB The hemoglobin test is often used to check for anemia, usually along with a hematocrit or as part
of a complete blood count (CBC)
HCT A hematocrit test measures how much of your blood is made up of red blood cells. Red blood cells
contain a protein called hemoglobin that carries oxygen from your lungs to the rest of your body.
Platelet A platelet blood count is a blood test that measures the average number of platelets in
the blood. Platelets help the blood heal wounds and prevent excessive bleeding. High or
low platelet levels can be a sign of a severe condition.
Table 1. CBC Test Result Of The Client.
Table 2. Purposes of the CBC Test.
 Chest X-Ray
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Figure 1. Presence of Pulmonary Tuberculosis
Presence of Bronchopneumonia
The chest x-ray (figure 1) showed the rounded opacity to be persistent. A 50-year-old male
client with fever and productive cough has a focal opacity in the left lower lobe that looks like
pneumonia. This is a primary case of pulmonary tuberculosis in an adult. The clinical findings of
fever, cough and elevated WBC count raise infection to the top of our differential. Familiarity of
pulmonary condition is necessary for accurate interpretation of chest radiographs. Features on
chest x-ray are a non-segmental, homogenous consolidation predominantly involving one lobe with
air Broncho grams.
Table 3. Purposes of Chest X-ray.
Test Purpose
 Sputum
x-ray Culture To serve as a noninvasive medical test that helps
physicians diagnose and treat medical conditions.
Imaging with x-rays involves exposing a part of the body
to a small dose of ionizing radiation to produce pictures
of the inside of the body.
Table 4. Sputum Culture test result of the client.
RESULT RESULT
POSITIVE NEGATVE
M. pneumonia ✔
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S. pneumonia ✓
Grp. A steptococcus ✓
S. aureus ✓
M. tuberculosis ✔
Mycobacteriaceae ✔
Table 5. Purpose of Sputum Culture

Test Purpose
M. pneumonia To know the attaches to the respiratory
epithelium, inhibits ciliary action " cellular
destruction and inflammatory response in the
submucosa “and airway obstruction.
S. pneumonia Presence of local edema that aids in proliferation
of organisms and spread to adjacent portion "
focal lobar involvement.
Grp. A streptococcus Presence of diffuse infection with
interstitialpneumonia; necrosis of the
tracheobronchial mucosa " exudation,edema, local
hemmorhage, with extension into alveolar
septa,lymphatics, pleural involvement.
S. aureus Confluent bronchonecrosis and irregular
pneumonia, unilateral, p resence of extensive
areas of hemorrhagic areas ofcavitation of the lung
parenchyma " pneumatocele,
empyema,bronchopumonary fistulas.
M. tuberculosis Primarily a pathogen of the mammalian
respiratory system, it infects the lungs. The most
frequently used diagnostic methods for
tuberculosis are the tuberculin skin test, acid-fast
stain, culture, and polymerase chain reaction.
Mycobacteriaceae The most important species is Mycobacterium
tuberculosis, which causes tuberculosis in
humans. Tuberculosis in cattle and humans is also
caused by Mycobacterium bovis, whilst
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Mycobacterium africanum is a rare cause of
human tuberculosisayusin
 Urinalysis
Specimen Free catch
Color Yellow
Appearance Cloudy
Specific Gravity 1.038
pH 7.0
Protein Negative
Glucose Negative
Ketones Negative
Bilirubin 1+
Blood Bacteria
Bacteria Few
Table 6. Purposes of Urinalysis.
Test Purpose
Urinalysis A urinalysis is a simple test that looks at a small sample of your urine. It can
help find problems that need treatment, including infections or kidney
problems. A urine test for tuberculosis could make it much easier to identify
the disease and treat it before it kills.
Diagnostic examination:
A diagnostic examination identifies an individual's specific areas of weakness and strength

in order determines a condition, disease or illness. The tests are involved in acquiring a sample of
the blood, the phlegm, urine, and upper body scan. The samples are then sent away and examined
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in a laboratory for checking upon the condition. Diagnostic tests are the ways to know the client if
there is a presence of illness such as pulmonary tuberculosis. It is the outcome of determining the
health of each individual and identifying other health concerns or underlying issues for the client.
CHAPTER IV
NURSING CARE PLAN
Assessment Diagnosis Outcome Planning Intervention Evaluation
identification
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Subjective: Ineffective After the SHORT TERM: Independent: Promoted
airway nursing airway
“Nahihirapan After 4 hours of Establish rapport
clearance interventions, clearance.
na akong nursing
related to the patient will - Building rapport aims to
huminga at retained interventions,
demonstrate the get the client’s trust and
parang pagod secretions and the client will
following: cooperation to render an The client
na pagod pa fatigue as demonstrate
effective nursing care performed
ako kahit -Maintain behaviors of
evidence by expectoration
walang patent airway. improve or Assess respiratory function
abnormal without
ginagawa maintain clear noting breath sounds, rate,
respiratory -Expectorate assistance.
kaya airway. rhythm, and depth, and use
rate, rhythm, secretions
nagpadala na of accessory muscles.
depth, without
ako sa
abnormal assistance. -To determine accumulation Demonstrated
hospital.” LONG TERM:
breath sounds of secretions and behaviors in
-Demonstrate
Objective: (wheezes), After 5 days of respiratory distress. improving or
behaviors to
dyspnea, and nursing maintaining
Fatigue improve or Teach the patient the proper
hemoptysis. interventions, clear airway.
maintain clear ways of coughing and
Hemoptysis the client will
airway. breathing.
demonstrate
Dyspnea
-Participate in absence or -The most convenient way Adhered to
Wheezing treatment reduction of to remove most secretions is treatment
breath sound regimen within congestion with coughing. Deep breathing, regimen.
the level of breath sounds on the other hand, promotes
Respiratory ability/situation. clear, oxygenation before
rate: 36 cpm respirations controlled coughing. Promoted
-Identify
noiseless, and activity and
potential
improved adequate
complications
oxygen Note ability to expectorate nutrition.
and initiate
exchange. mucus and cough
appropriate
action. effectively; document
character, amount of Prevented
sputum, presence of spread of
hemoptysis tuberculosis
infection.
-To determine ability to
protect airway.
Place patient in semi or Goal was
high-Fowler’s position. partially met.
Assist patient with coughing
and deep-breathing
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exercises.
- Positioning helps
maximize lung expansion
and decreases respiratory
effort. Maximal ventilation
may open atelectatic areas
and promote movement of
secretions into larger
airways for expectoration.
Clear secretions from mouth

and trachea; suction as
necessary
- Prevents obstruction and
aspiration. Suctioning may
be necessary if patient is
unable to expectorate
secretions.
Encourage patient to
increase fluid intake to 3
liters per day within the
limits of cardiac reserve and
renal function.
- Fluids help minimize
mucosal drying and
maximize ciliary action to
move secretions.
Provide well ventilated
environment.
-To improve comfort and
breathing pattern.
Observe for signs of
respiratory distress.
-For timely intervention.
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Dependent:
Maintain humidified
oxygen as prescribed.
- Increasing humidity of
inspired air will reduce
thickness of secretions and
aid their removal.
Give medications as
prescribed, such as
antibiotics, mucolytic
agents,
bronchodilators, expectorant
s, noting effectiveness and
side effects.
- A variety of medications
are prepared to manage
specific problems. Most
promote clearance of
airway secretions and may
reduce airway resistance.
Source: Vera, M. (2019). 5 Pulmonary Tuberculosis Nursing Care Plans. Nurseslabs.

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Assessment Diagnosis Outcome Planning Intervention Evaluation

identification
SUBJECTIV Hyperthermia After 30- 40 SHORT INDEPENDENT SHORT
E: related to minutes of TERM: TERM
nursing Establish rapport
inflammatory
“Naku hindi interventions, After 30- 40 After 30-40
na nawala ang response as the client’s minutes of - Building rapport aims to minutes of
lagnat ko, evidenced by nursing get the client’s trust and
body nursing
pabalik-balik warm to touch temperature will interventions, cooperation to render an intervention,
na lang” as skin and the client’s effective nursing care
be able to the client’s
verbalized by temperature decrease from body body
of 38.1 C Identify underlying cause
the client. 38 C to less temperature will
(in our case it is due to temperature
than 37.7 C in be able to
inflammatory response decreases from
OBJECTIVE cooperation of: decrease from
cause by the disease 38 C to less
: 38 C to less
process) than 37.7 C in
-Flushed skin;  Assessing than 37.7 C
warm to touch for the cooperation of:
-To know for the right
-Increase causative/c
treatment to be given.  Assessing
body ontributing
for the
temperature factor/s
causative/
higher than and be Do tepid sponge bath to
contributi
normal range able to lower the client’s body
ng
-Increased participate temperature factor/s
respiration , in one
- To facilitate the body in and be
RR= 36 cpm interventio
cooling down and provide able to
-The patient is n.
participate
sweating  Assist with comfort.
in one
-T: 38.1˚C measures
Eliminate excess clothing or interventi
to reduce on.
body covers.
 Assist
temperatur -Exposing skin to room air with
e and decreases warmth and measures
participate increases evaporative to reduce
in
cooling. body
interventio
temperatu
ns. Promote oral fluid intake. re and
 Promoting participate
health care - Without proper nutrition
and hydration, the oral in
wellness. interventi
mucosa is more vulnerable
ons.
to damage and this will
 Promoting
prevent dehydration health
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Advice the client to make a care
gargle with warm water and wellness.
salt. All of the
following
- This relieves the client’s intervention
sore throat although this is helps in
only short-lived. decreasing
patient’s body
Educate the client regarding temperature,
the possible causes of PTB. maintaining it
-The information will be in normal range
and monitoring
able to help in preventing
in progress of
PTB to reoccur.
the condition.
Goal was met.
DEPENDENT
Administer antipyretics as
orederd; paracetamol 500
mg/tab 1 tab q4 prn T>37.8
- To reduce fever. Follow
the frequency of medication
because temperature may
rise again due to infection
Provide high-calorie diet, or

parenteral nutrition.
-To meet increased
metabolic demands.
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CHAPTER V
NAME OF MECHANISM OF DOSAGE INDICATIONS CONTRAINDIC ADVERSE NURSING
THE DRUG ACTION ATIONS EFFECT CONSIDERATION
Generic to inhibit Adult: 10 contraindicated -Headache Before:
Name: bacterial DNA- mg/kg For the in patients with -loss of
dependent RNA treatment of a history of consciousness. -Observe the 12
 Rifam polymerase, Tuberculosis hypersensitivity -yellowing of rights of drug
pin which appears to Route: and to rifampin or the skin or eyes administration
occur as a result Tuberculosis- any of the - reddish brown During:
of drug binding Oral related components, or discoloration of
in the mycobacterial to any of the the skin, saliva, -Administer drug
Brand polymerase infections. rifamycins. urine, feces, orally.
Name: subunit deep Frequency sweat, and
: -Ensure that the
Rifadin within the tears.
client will drink
DNA/RNA
OD his medication.
channel,
Classificatio facilitating -Make the client
n: direct blocking take the
of the elongating medication on an
Antitubercula RNA. This empty stomach.
r Agents effect is thought
Take at least 1
to be
hour before or 2
concentration
related. hours after meals.
After:
-Advise the client
to continue taking
the medication
until the full
prescribed
amount is
finished.
-Disposed
container of drug
properly
-Monitor any
adverse effects.
DRUG STUDY
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NAME OF MECHANISM OF
COLLEGE
DOSAGE
OF NURSING
INDICATIONS CONTRAINDIC ADVERSE NURSING
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Generic Isoniazid is a Adult:5 For the Isoniazid is -Peripheral Before:
Name: prodrug and mg/kg up treatment of contraindicated neuropathy
Isoniazid must be to 300 mg all forms of in patients who -Loss of -Observe the 12
activated by tuberculosis develop severe appetite rights of drug
bacterial in which hypersensitivity -Nausea administration
Brand catalase. Route: organisms are reactions, -Vomiting -Explain the
Name: Specficially, susceptible. including drug- -Stomach importance and
activation is Oral induced pain causative factors
associated with hepatitis; -Weakness of the medication.
Isonarif, reduction of the previous
Isotamine, mycobacterial Frequency isoniazid-
Isotamine B, ferric KatG :OD associated
Rifamate, During:
catalase- hepatic injury;
Rifater peroxidase by severe adverse -Ensure that the
hydrazine and reactions to client will drink
reaction with isoniazid such his medication.
oxygen to form as drug fever,
Classificatio an oxyferrous chills, arthritis; - Take this
n: enzyme and acute liver medication by
complex. Once disease of any mouth on an
Antimycobac empty stomach (1
activated, etiology.
terials hour before or 2
isoniazid
inhibits the hours after meals)
synthesis of as directed by the
mycoloic acids, doctor.
an essential After:
component of
the bacterial cell -Disposed
wall. container of drug
properly
-Monitor any
adverse effects
- Advise the client
not to stop the
medication until
prescribed by the
doctor.
-Instruct the client
not to take this
medicine in larger
or smaller
amounts or for
longer than
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recommended.
-Keep isoniazid in
the container that
it came in and
keep the container
tightly closed.

Generic Pyrazinamide Adult: 15 For the initial Pyrazinamide is nausea, Before:
Name: diffuses into to 30 treatment of contraindicated
active M. mg/kg active in persons: with -Observe the 12
upset stomach,
Pyrazinamide tuberculosis that tuberculosis severe hepatic rights of drug
express in adults and damage; who administration
Brand vomiting,
Name: pyrazinamidase Route: children when have shown -Monitor client’s
enzyme that combined hypersensitivity loss of appetite, vital signs
converts Oral with other to it; with acute
Rifater, pyrazinamide to antituberculo gout. mild muscle or -Explain the
Tebrazid the active form us agents. joint pain, or. importance and
pyrazinoic acid. Frequency fatigue causative factors
Pyrazinoic acid :OD of the medication.
Classificatio can leak out under
-Check the
n: acidic conditions
patient's medical
to be converted to
Antitubercula record for an
the protonated
r Agents. allergy or
conjugate acid,
which is readily
contraindication
diffused back into
to the prescribed
the bacilli and
medication.
accumulate During:
intracellularly.
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-Administer drug
orally.
-Ensure that the
client will drink
his medication.
-Make the client
take this
medication by
mouth with or
without food as
directed by the
physician.
After:
-Disposed
container of drug
properly
-Monitor any
adverse effects
-Advise the client
to take the
medicine at the
same time.
to continue taking
this medication
until the full
prescribed
amount is
finished.

to notify their
physicians
promptly if they
experience any
adverse effects of
the drug.
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Generic Ethambutol Adult: 25 Ethambutol is Ethambutol is Headache, loss Before:
Name: diffuses into mg/kg indicated in contraindicated of appetite,
combination upset stomach, -Observe the 12
Ethambutol Mycobacterium in patients who rights of drug
cells. Once with other are known to be or
anti- nausea/vomitin administration
Brand inside the cell, Route: hypersensitive
Name: ethambutol tuberculosis to this drug. It g -Monitor client’s
Oral drugs in the vital signs
Myambutol inhibits the is also
treatment of
arabinosyltransf contraindicated -Explain the
pulmonary
erases Frequency tuberculosis. in patients with importance and
Classificatio preventing : OD Ethambutol is known optic causative factors
n: formation of the commonly neuritis unless of the medication.
cell wall used in clinical
Antimycobac -Check the
components combination judgment patient's medical
terial
arabinogalactan with determines that record for an
antibiotics.
and isoniazid, it may be used. allergy or
lipoarabinomann rifampin, and contraindication
pyrazinamide. to the prescribed
an, and
preventing cell medication.
division.
Decreased
concentrations During:
of -Ensure that the
arabinogalactan client will drink
in the cell wall his medication.
reduces the
-Take the
number of
medication with
binding sites for food to avoid
mycolic acid, upsetting the
leading to the stomach.
accumulation of
mycolic acid, -Ensure that the
client take the
trehalose
medication
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monomycolate, exactly as
and trehalose directed by the
dimycolate. physician.
After:
-Disposed
container of drug
properly
-Monitor any
adverse effects
-Advise the client
to take the
medicine at the
same time.

to continue taking
this medication
until the full
prescribed
amount is
finished.

to notify their
physicians
promptly if they
experience any
adverse effects of
the drug.
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CHAPTER VI
Evaluation and Findings
After conducting this study, the nursing students were able to understand the
importance of utilizing a nursing process by providing clinical care and management for the
patient. The results of the laboratory testing revealed that the client's health issues were
Pulmonary Tuberculosis. The study has benefited in improving the quality of nursing care and
patient management.
The study was conducted by making it possible to understand the conditions that trigger
Pulmonary Tuberculosis. The researchers become aware that Pulmonary Tuberculosis is a
common and often deadly infectious disease caused by mycobacteria, in humans mainly
Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect the
central nervous system, the lymphatic system, the circulatory system, the genitourinary system,
the gastrointestinal system, bones, joints, and even the skin. fortunately, Pulmonary TB is
curable with treatment, but if left untreated or not fully treated, the disease often causes life-
threatening concerns. Moreover, the Treatment for tuberculosis usually involves taking
antibiotics for several months.
Accurate and early identification is essential for improving patient care. The correct
treatment will only be provided if the health care provider has the right knowledge, abilities, and
attitude for the management of Pulmonary Tuberculosis. Understanding the reason or factors of
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pulmonary tuberculosis, as well as the process that the client is going through, enables nurses to
provide holistic care and relieve the client's concerns and worries.
RECOMMENDATION
From the foregone conclusions the following recommendations are drawn.
Medication
Medications should be taken as ordered and prescribed by the physician to avoid
complications and help manage the condition of the patient. There are a lot of main anti-
Tuberculosis medications such as Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide.
Exercise
 Instruct the client to have a time for deep breathing exercise daily for several times at
home to help achieved maximal lung expansion and for relaxation.
 Advise the client to start with exercises that the client is already comfortable doing.
Starting slowly makes it less likely that the client will injure himself.
 Caution the client to immediately stop any activities that might cause undue fatigue,
increased shortness of breath, or chest pain.
Treatment
 Remind the client about the importance of taking the medication in the right time and
dose.
 Sleep in a room with good ventilation.
 Frequent rest is advised.
Health Teaching
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 Advice the client to take the medication on time and with the right dosage.
 Avoid close contact with others until the doctor agrees.
 Advice the client to cough and sneeze into tissues and to dispose of all secretions in a
separate trash can.
 Advice the client to perform hand washing frequently. Proper hygiene must be exercised.
 Isolation is the best technique to prevent the spread of bacteria. Wear a mask when going
outside of the room and separate dining wares to be used.
 Advice the relatives of the client to clean the room regularly and provide a good
ventilation.
 Discuss to the client and significant others the cardinal signs of infection such as redness,
heat, induration, swelling and separation of drainage.
OPD Check-up
 Keep all follow-up appointments. It’s important to have doctor monitor the client’s
progress.
 Advised the client to consult a physician. Advise the client to watch out for adverse
effects of medications and to report them to the physician immediately.
 Discuss to the relatives of the client to check the status of the client and its progress.
Diet
 Diet as tolerated is advice by the attending physician, to sustain his nutritional needs.
 High protein diet for tissue repair like meat and green leafy vegetables.
Spiritual
 Encourage the client to read the Bible on a regular basis. So that his soul can be fed and
nurtured. Pray to God when you're feeling down, anxious, and hopeless
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REFERENCES:
Introduction
Domingo, L. (2021). Tuberculosis Updates in the Philippines. Pharexmedics.
https://www.pharexmedics.com/studies/tuberculosis-updates-in-the-philippines
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Definition of the Case

Carey, E. (2018). Pulmonary Tuberculosis. Healthline.
https://www.healthline.com/health/pulmonary-tuberculosis
DOH.(2020). Decline in reported tb cases an effect of the pandemic. DOH.gov.ph.
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DOH.(2021). DOH Partners Aim to get TB Care Back on Track. DOH.gov.ph.
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Anatomy and Physiology
Anatomy Note. (2020). Respiratory System. Anatomy
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Archer, S. et al. (2021). Nasal Physiology. Medscape.
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Chernaik, N. et al. (2020). Human respiratory system.
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Hoffman, M. (2020). Pictures of the Sinuses. Webmd.
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myVMC. (2015). Anatomy and Physiology of Nasal Cavity (Inner nose) and Mucosa. MYVMC.
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Belleza, M. (2021). Respiratory System Anatomy and Physiology. Nurseslabs.
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Tierney, D, Nardell, E. (2018). Tuberculosis (TB). Msdmanuals.
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Belleza, R. M. N. (2021a, February 11). Pulmonary Tuberculosis. Retrieved August 21, 2021,
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Laboratory
Subahi E A, Alawad M J, Abdelmahmuod E A, et al. (June 27, 2021) Pulmonary Tuberculosis With Saddle
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U#a2
(044) 600-3970
www.neust.edu.ph
www.neust.edu.ph
COLLEGE OF NURSING
Nursing Care Plan
Nurse Study. Tuberculosis nursing diagnosis care plan. Nurse Study.
https://nursestudy.net/tuberculosis-nursing-diagnosis-care-plan/
Vera, M. (2019). 5 Pulmonary Tuberculosis Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/5-pulmonary-tuberculosis-nursing-care-plans/2/
Drug study
Isoniazid (isoniazid): Uses, Dosage, Side Effects, Interactions, Warning. (2021, April 12).
Retrieved August 21, 2021, from https://www.rxlist.com/isoniazid-drug.htm#side_effects
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Rifampin: Side Effects, Dosages, Treatment, Interactions, Warnings. (2017, June 6). Retrieved
August 23, 2021, from https://www.rxlist.com/consumer_rifampin/drugs-condition.htm
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https://medlineplus.gov/druginfo/meds/a682403.html
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27). Retrieved August 23, 2021, from https://www.rxlist.com/pyrazinamide-drug.htm
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Recommendation
Nursing Ce. Tuberculosis Nursing CE Course. Nursing Ce.https://www.google.com/url?
sa=t&source=web&rct=j&url=https://www.nursingce.com/ceu-
courses/tuberculosis&ved=2ahUKEwixmvPfvcLyAhUW7WEKHYmOAC0QFnoECAsQAQ&u
sg=AOvVaw3gnitG4_oAS3SPrpG6tjan&cshid=1629563151060
Belleza, M. (2021). Pulmonary Tuberculosis. Nurseslabs. https://www.google.com/url?
sa=t&source=web&rct=j&url=https://nurseslabs.com/pulmonary-
tuberculosis/&ved=2ahUKEwixmvPfvcLyAhUW7WEKHYmOAC0QFnoECAUQAg&usg=AO
vVaw2Xz2YepUPveSPq829_ibt3&cshid=1629563151060
Nurse Study. Tuberculosis nursing diagnosis care plan. Nurse Study.
https://nursestudy.net/tuberculosis-nursing-diagnosis-care-plan/
(044) 600-3970
www.neust.edu.ph
www.neust.edu.ph
COLLEGE OF NURSING
(044) 600-3970
www.neust.edu.ph
www.neust.edu.ph

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Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND

In Partial Fulfilment of the Requirements for the Subject

Mrs. Janela Galac

Tuberculosis is a common and often deadly infectious disease caused by

mycobacteria, in humans mainly Mycobacterium tuberculosis. Tuberculosis usually attacks the

Age: 50 Years Old

Date of Birth: April 14, 1971

Civil Status: Single

Religion: Roman Catholic

Address: Sta Arcadia St. Cabanatuan City

Date of Admission: August 21, 2021

Attending Physician: Dr. X

II. Presenting Complaints

III. Family History

IV. Past History (History of infections)

V. Birth History ( Postnatal History)

VII. DRUG HISTORY

 low fever with nausea, stomach pain, and loss of appetite;

 dark urine, clay-colored stools; or

 jaundice (yellowing of the skin or eyes)

Admitting Vital Signs

Status of Present Illness

Posture Relaxed and Uncoordinated The client has a sign of

Types of clothing Accurate to the He wears polo shirt Presentable.

Quantity and quality Having a good He can’t talk He possesses signs of

Body Temperature 36.5 0C to 37.5 0C 38.10C Intermittent fever.

Pulse Rate 60 to 100 bpm 84 bpm Normal Range of Pulse rate.

Respiratory Rate 13 to 19 cpm 36 cpm Elevated range of

Body Parts Normal Findings Actual Findings Interpretation and

Head The head should be He has smooth, non- Normal

Nose It is located symmetrically in the His nose is symmetric Abnormal

Table 1. Physical Examinations

Cases of Pulmonary Tuberculosis in the Philippines

Anatomy and Physiology

[ CITATION Ana191 \l 1033 ]

UPPER RESPIRATORY TRACT

LOWER RESPIRATORY TRACT

Susceptible person inhaled mycobacterium

Bacteria are transmitted through the airways to the

Immune system reacts.

Phagocytosis and inflammatory responds through

TB-specific lymphocytes produced a T-lytic enzyme

Macrophages surrounds the TB bacteria and forms a

Granuloma turns into fibrous tissue mass called

Bacteria and macrophages turn into a cheesy mass.

Ghon Tubercle is calcified and walled off by the

No further progression of active disease.

For immunocompromised and has inadequate

Active disease may develop after initial exposure

Spread of Mycobacteria outside the original

Formation of caseating granulomas necrotized and

Cavitary granulomas erode into bronchioles and

Sources: Tierney, D, Nardell, E. (2018). Tuberculosis (TB). Msdmanuals.

Tuberculosis is caused by inhaling mycobacteria and becoming infected. Bacteria enter

Scarring  Weight loss

Tuberculosis begins when a susceptible person inhales mycobacteria and becomes

Risk factors for pulmonary tuberculosis include:

Table 2. Clinical Manifestation

(INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide.

 Treatment guidelines. Recommended treatment guidelines for newly diagnosed cases of

 Initial phase. The initial phase consists of a multiple-medication regimen of INH,