PTB - Case-Study-Group 1

ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City
NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Case Scenario 3
PULMONARY TUBERCULOSIS
A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College
PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)
PRESENTED BY:
Abenido, Mary Claire Cartera, Riza June
Alayon, Hannah Marie Catubay, Jade
Anatan, Raenacet Claro, Meryll Joy
Camariosa, Shelynar B. Feliciano, Dee D Rhae
Camarista, Coleen Mae C.
(BSN III-G [GROUP 1])
SEPTEMBER 15, 2021

TABLE OF CONTENTS
I. .. .........................................................................INTRODUCTION
A. Objectives:
1. General Objective
2. Specific objectives (KSA) format
II. ................................................... NURSING HEALTH HISTORY
III . ....................................................... PHYSICAL EXAMINATION
IV. .................................... ANATOMY AND PATHOPHYSIOLOGY
V .. ...................... DIAGNOSIS AND LABORATORY PROCEDURE
VI. ................................................................. NURSING PROCESS
VII. ....................................................................... DRUG STUDY
VIII. ............................ DISCHARGE PLAN/HEALTH TEACHING
IX. ............................................................. ARTICLE/JOURNAL

I. INTRODUCTION
Tuberculosis is an infectious disease that primarily affects the lung parenchyma is most often
caused by mycobacterium tuberculosis- is an acid fast aerobic rod that grows slowly and is
sensitive to heat and ultraviolent light, it may spread to any part of the body including,
meanings, kidney, bones, and lymph nodes. (TB) is a contagious infection that usually attacks
your lungs. Tuberculosis is caused by bacteria that spread through the air, just like a cold or flu.
You can get TB if you come into contact with people who have it. The mode of transmission is
droplet nuclei through coughing, sneezing, laughing, singing and exposure to TB.
In the 20th century, TB was a leading cause of death in the United States. Today, most cases are
cured with antibiotics. But it takes a long time. You have to take medications for at least 6 to 9
months.
A TB infection doesn’t always mean you’ll get sick. There are two forms of the disease:
 Latent TB. You have the germs in your body, but your immune system keeps them from
spreading. You don’t have any symptoms, and you’re not contagious. But the infection is
still alive and can one day become active. If you’re at high risk for re-activation -- for
instance, if you have HIV, you had an infection in the past 2 years, your chest X-ray is
unusual, or your immune system is weakened -- your doctor will give you medications to
prevent active TB.
 Active TB. The germs multiply and make you sick. You can spread the disease to others.
Ninety percent of active cases in adults come from a latent TB infection.
A latent or active TB infection can also be drug-resistant, meaning certain medications don’t
work against the bacteria.
Tuberculosis Risk Factors

You could be more likely to get TB if:
 A friend, co-worker, or family member has active TB.

 You live in or have traveled to an area where TB is common, like Russia, Africa, Eastern
Europe, Asia, Latin America, and the Caribbean.
 You’re part of a group in which TB is more likely to spread, or you work or live with
someone who is. This includes homeless people, people who have HIV, people in jail or
prison, and people who inject drugs into their veins.
 You work or live in a hospital or nursing home.
 You’re a health care worker for patients at high risk of TB.
 You’re a smoker.
A healthy immune system fights the TB bacteria. But you might not be able to fend off active TB
disease if you have:
 HIV or AIDS
 Diabetes
 Severe kidney disease
 Head and neck cancers
 Cancer treatments such as chemotherapy
 Low body weight and poor nutrition
 Medications for organ transplants
 Certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis
Babies and young children also have higher chances of getting it because their immune systems
aren’t fully formed.
OBJECTIVES
A. General Objectives
This study aims to convey familiarity and to provide an effective nursing
care to a patient diagnosed with Pulmonary Tuberculosis through understanding the
patient history, disease process and management.
B. Specific Objectives
A. Knowledge
• Define the meaning of Pulmonary Tuberculosis
• Know the pathophysiological basis of the Pulmonary Tuberculosis
• Determine signs and symptoms and risk factors/causes of Pulmonary
Tuberculosis
• Determine appropriate nursing care management for client with Pulmonary
Tuberculosis
• Formulate plan of care for clients with Pulmonary Tuberculosis
• Provide accurate information about the topic
B. Skills
• Assess a woman who is experiencing a Pulmonary Tuberculosis
• Apply different assessment techniques to determine the patients need
• Evaluate the plan of care needed
• Formulate nursing diagnoses that address the needs of the client experiencing
Pulmonary Tuberculosis
• Collaborate with health team member in planning and performing client care
• Document expected outcomes for effectiveness and achievement of care.
C. Attitude
• Build rapport with the client to build trust.
• Respect client decision (race, culture, values and beliefs)
• Maintain confidentiality regarding patient records/information
• Explain the importance of follow up check-up.
• Establish therapeutic relationship with client and family

• Acknowledge client needs using holistic approach
• Display confidence in providing nursing care to the client.
• Develop teamwork and collaboration to the health care team member
II. NURSING HEALTH HISTORY
a. Biographical Data
Name: Mrs. Reyes
Age: 35 years old
Sex: Female
Civil Status: Married
b. Chief Complaint
 low grade fever, night sweats and loss of appetite.
c. Present Illness History

 A month prior to admission, She experienced easy fatigability , nocturnal sweats
and weight loss.
 She sought consultation and she was able to have an apicolordotic X-Ray result
of PTB and a Genexpert result of POSITIVE.
d. Social History
 During her teenage years she was a smoker, alcohol drinker and a drug user.
Since then she manifested a smokers cough.
 The patient works as a laborer who asks her neighbors to let her clean the house
or even wash their laundry and she also works as a street cleaner or sweeper in
their barangay.
 She is married and her husband is a jeepney driver. They had children ages 12,
9 and 5 year old.
e. Family Health History

 Her mother died of TB disease
 Her father constantly experienced chronic asthma attacks.
III. PHYSICAL EXAMINATION

Vital Signs
Temperature: 38° C
Pulse Rate: 90 bpm
Respiratory Rate: 25 cpm
Blood Pressure: N/A
Oxygen Saturation: 90% at room air
Physical Examination
 Weight: N/A
 Mrs. Reyes looks pale, with dry and flushed skin and looks older than
her age.
 Upon auscultation both lungs revealed crackles breath sound. She also
complained of chest tightness upon auscultation.
 During palpation, there are enlarged lymph nodes and she has a
distended abdomen.
IV. ANATOMY AND PATHOPHYSIOLOGY

Anatomy
Location. The lungs occupy the entire thoracic cavity except for the most central area, the
mediastinum, which houses the heart, the great blood vessels, bronchi, esophagus, and other
organs.
Apex. The narrow, superior portion of each lung, the apex, is just deep to the clavicle.
Base. The broad lung area resting on the diaphragm is the base.
Division. Each lung is divided into lobes by fissures; the left lung has two lobes, and the right
lung has three.
Pleura. The surface of each lung is covered with a visceral serosa called the pulmonary, or
visceral pleura and the walls of the thoracic cavity are lined by the parietal pleura.
Pleural fluid. The pleural membranes produce pleural fluid, a slippery serous secretion which
allows the lungs to glide easily over the thorax wall during breathing movements and causes
the two pleural layers to cling together.
Pleural space. The lungs are held tightly to the thorax wall, and the pleural space is more of a
potential space than an actual one.
Bronchioles. The smallest of the conducting passageways are the bronchioles.
Alveoli. The terminal bronchioles lead to the respiratory zone structures, even smaller conduits
that eventually terminate in alveoli, or air sacs.
Respiratory zone. The respiratory zone, which includes the respiratory bronchioles, alveolar
ducts, alveolar sacs, and alveoli, is the only site of gas exchange.
Conducting zone structures. All other respiratory passages are conducting zone structures that
serve as conduits to and from the respiratory zone.
Stroma. The balance of the lung tissue, its stroma, is mainly elastic connective tissue that allows
the lungs to recoil passively as we exhale.
V. LABORATORY AND DIAGNOSTICS

Laboratory tests for diagnosis of active tuberculosis
Diagnostic tests for active TB
Test type Principal WHO policy Advantages Limitations

commercial recommendatio
tests n
Smear Non- Recommended Inexpensive, simple, rapid, Cannot

microscopy commercial specific differentiate
NTMa and M
.
tuberculosis
LED Recommended Inexpensive, simple, rapid Cannot

microscopy differentiate
NTMa and M
.
tuberculosis
Automated GeneXpert Recommended Rapid (2 h to result). Detects Higher cost

real-time MTB/RIF smear-negative TB. Also detects than smear
nucleic acid RIF resistance
amplificatio
n
Loop- LAMP assay Not Rapid, simple Subjective

mediated recommended. interpretatio
isothermal Under further n and poor
amplification development specificity
test kit for TB
Rapid Recommended For rapid differentiation of Expensive

speciation NTMa and M. tuberculosis
strip
technology

tests n
Serodiagnosti Over 20 Not recommended Poor

c tests commercial sensitivity
variants and
specificity
Interferon- QuantiFERON Not recommended for diagnosis of active TB Complex to

Gamma -TB perform and
release assays Gold In-Tube indeterminat
test, T-Spot e results
test relatively
common
Drug susceptibility tests
Test type Principal WHO policy Drugs tested Advantages Limitations

Commercial recommendation
tests
Phenotypic Non- Recommended All drugsb Gold-standard Extremely

DST on solid commercial for USE long time to
or liquid result (6–12
media weeks)
Commercial Bactec MGIT Recommended STR, INH, RIF, Faster than Expensive
liquid for USE EMB, PZA solid culture
culture and media. Ten
DST systems days if direct
testing
Line probe MTBDR-Plus; Recommended RIF, INH Result in 2 Expensive

assay first- INNO LiPA- for USE on days
line RIF TB

tests n
smear-positive
samples
Line probe MTBDRsl Not yet Fluoroquinolone Result in 2 Low

assay second- recommended s, days sensitivity
line due to aminoglycosides for
insufficient and EMB ethambutol
evidence
Automated GeneXpert Recommended RIF Result in 2 h Cartridge

real-time MTBRIF for USE price
nucleic acid reductions
amplificatio only
n available in
low middle
income
countries
Microscopic Non- Recommended RIF, INH Low-tech. Subjective

observation commercial for USE 10–14 days interpretatio
drug for result n.
susceptibility Laborious
(MODS) manual plate
readingc
Colometric Non- Not yet RIF, INH Low-tech. Subjective

redox commercial recommended 10–14 days interpretatio
indicator due to for result n
(CRI) insufficient
evidence
Nitrate Non- Not yet RIF, INH Low-tech 10– Subjective

reductase commercial recommended 14 days for interpretatio
assays (NRA) due to result n

tests n
insufficient
evidence
Phage assays FASTplaque, Not RIF, INH N/a Poor

lucerferase recommended specificity
reporter phage
assay
Sequencing Non- No policy Depends on gene Can provide Requires

commercial regions information specialist
sequenced on multiple interpretatio
drugs n. Not
simultaneousl generally
y available
outside
research
centres
VI. NURSING CARE PLAN

DEFINING
NURSING NURSING
CHARACTERISTI PLANNING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
CS
Subjective:  Risk for Short Term: Independent: After 1 week of
Chief infection After 24 hours - monitor - To have a nursing
complaint related to of nursing respiratory baseline intervention,
experiencing inadequate intervention status, vital data patient will be
hemoptysis as primary the patient will signs, able to display
accompanied defences and be able to breath patency of
by low grade lowered sustain sound and airway
fever, night resistance as respiratory rate skin color evidenced by:
sweats and loss evidenced by within normal
of appetite. expectoratio range of 12-20 - Promoting - The nurse Client’s
n of blood cpm; display airway instructs the respiratory rate
(hemoptysis) decreasing clearance.. patient about is within normal
Objective: accompanied amount of correct range of 12-19
Temperature: by low grade secretion; and positioning to cpm
38° C fever, night improve facilitate
sweats and appetite drainage and Secretions
Pulse Rate: 90 to increase
loss of decreased
bpm fluid intake to
appetite Long Term: promote
After one week systemic Client’s
Respiratory
Rationale: of nursing hydration. restlessness is
Rate: 25 cpm
Vulnerable to intervention alleviated
Blood Pressure: invasion and the patient will - Adherence - medications
multiplication be able to to the is the most Client’s appetite
N/A
of pathogenic experience treatment effective is improved as
organisms normal regimen. evidenced by
Oxygen means of
which may respiration as increase in
Saturation: preventing
evidenced by
90% at room air compromise absence of transmission weight
health .
dyspnea,
absence of - Promoting
bronchial activity and - progressive
secretions adequate activity
nutrition. schedule
that focuses
on
increasing
activity
tolerance
and muscle
strength and
a nutritional
plan that
allows for
small,
frequent
meals.
- Preventing - hygienic
spreading of measures
tuberculosis including
infection. mouth care,
covering the
mouth and
nose when
coughing and
sneezing,
proper
disposal of
tissues, and
handwashing.
VII. DRUG STUDY

Name of Drug Classification Indication and Side effects or Special Nursing
and Mechanism Contraindication Adverse Precautions Responsibilities
of Action Reactions
Generic Name Classification: Indications Adverse  Use cautiously  Drug's

in the elderly, pharmacokineti
Reaction:
Isoniazid Antituberculotics  Actively those with cs vary among
chronic non- patients
growing CNS: peripheral
isoniazid- because drug
neuropathy,
tubercle bacilli seizures, toxic related liver is metabolized
disease or in the liber by
Brand Name  Preventive encephalopathy,
memory chronic genetically
therapy for TB impairment, toxic alcoholism, controlled
Isotamine, PDP- Mechanism of psychosis those with acetylation.
Isoniazid Action: seizure
Contraindications: EENT: optic disorders  Peripheral
neuritis and
Dosage May inhibit cell-  Contraindicated atrophy
(especially if neuropathy is
taking more common
wall biosynthesis in patients with phenytoin), and in patients who
300mg GI: epigastric
by interfering acute hepatic distress, nausea,
those with are slow
severe renal acylators,
with lipid and disease or vomiting
impairment malnourished,
DNA synthesis; isoniazid-related Hematologic: alcoholic, or
Route  Dialyzable diabetic.
bactericidal liver damage. agranulocytosis,
aplastic anemia, drug: yes
P.O  If signs and thrombocytopenia,
eosinophilia,  Give pyridoxine
symptoms to prevent
suggest hepatic
hemolytic anemia,
sideroblastic
 Overdose S&S:
peripheral
Nausea,
Frequency anemia neuropathy
damage, vomiting ,
discontinue Hepatic: hepatitis, dizziness,
Q.D. bilirubinemia, slurring of  Monitor and
isoniazid jaundice speech, intervit patients
because more blurring of monthly.
Metabolic: vision, visual
severe form of hyperglycemia, hallucinations,
liver damage hypocalcemia, respiratory  For those
hypophosphatemi distress, CNS patients older
can occur a, metabolic depression than age 35,
acidosis progressing also measure
from stupor to hepatic enzyme
Skin: irritation at
coma, levels before
injection site
seizures, and periodically
severe throughout
metabolic treatment.
acidosis,
acetonuria,
hypercalcemia

of Action Reactions
Generic Name Classification: Indications Adverse Use cautiously  Perform

Reaction: in patients with visual acuity
Ethambutol Antituberculotics Adjunctive
CNS: dizziness,
impaired renal and color
treatment for
fever, function, discriminatio
pulmonary TB hallucinations,
headache, cataracts, n test before
Brand Name
malaise, mental recurrent eye and during
confusion,
Etibi, Myambutol Mechanism of peripheral neuritis inflammation, therapy
Contraindications:
Action: gout, or  Ensure that
EENT: optic
Contraindicated in neuritis, diabetic any changes
May inhibit
Dosage children younger irreversible retinopathy in vision
synthesis of one blindness
than 13 years old, don't result
25 mg/kg. or more GI: abdominal
Dialyzable drug:
patients with from an
metabolites of pain, anorexia, GI unknown
hypersensitive to upset, nausea, underlying
susceptible vomiting
drug and patients condition
Route bacteria,
with optic neuritis Hematologic:  Obtain AST
changing cell thrombocytopenia,
P.O and ALT
metabolism leukopenia,
neutropenia levels before
during cell
Metabolic: therapy, and
division;
Frequency hyperuricemia monitor
bacteriostatic
Musculoskeletal: these levels
Q.D.
joint pain every 3 to 4
Skin: toxic weeks
epidermal  In patients
necrolysis,
dermatitis, pruritus with
impaired
rental
function,
base dosage
on drug level
 Monitor uric
acid level;
observe
patient for
signs and
symptoms of
gout

of Action Reactions
Generic Name Classification: Indications Adverse • Take medication • Monitor CBC

Reaction: exactly as directed. with
Pyranizamide Antitubercular/ First-line therapy Therapy may be
CNS: psychosis, continued for 6 differential, liver
of active mo–2 yr.
Bacteriostatic, seizures, optic function tests,
tuberculosis, in neuritis.
bacteriocidal and uric acid
Brand Name combination with • Report
EENT: visual numbness of levels.
other agents. disturbances. extremities or
Biogesic decrease in • Teach the
Multi-drug GI: drug-induced vision.
hepatitis, nausea, Take pyridoxine client carefully
regimen prevents vomiting.
Mechanism of (B6) to about the
Dosage resistance. neuropathy.
Action: Derm: rashes. regimen, public
• Avoid the use
2.0 g. Preventive Endo: of alcohol. health concerns,
Inhibit
treatment gynecomastia. and possible
mycobacterial • Avoid tyramine-
(exposed to active Hemat: bone side effects.
cell wall containing foods.
Route TB) may be marrow changes.
synthesis and • Maintain • Monitor vision
accomplished with Neuro: appointments for
P.O interfere with and for nerve
monotherapy. peripheral regular follow-up.
metabolism; one neuropathy. • Be aware that pain/paresthesi
first-line drug Contraindications: Misc: fever, drug
urine may change as.
color (“r” drug =
Frequency interferes with •Anemia, cardiac &
that begins with “r”
red).
causes urine to be • Therapy will
RNA pulmonary disease.
discolored red (r =
Q.D. Hepatic or severe renal continue until 2
transcription. red!).
disease. sputum samples
Bactericidal/bact
for acid-fast
eriostatic action. •Liver toxicity
(hepatocyte necrosis) bacillus (AFB)
may occur with doses
not far beyond labeled are negative.

dosing.

of Action Reactions
Generic Name Classification: Indications Adverse  use Monitor hepatic

Reaction: cautiously in function,
Rifampicin Antituberculotics  Pulmonary TB,
CNS: headache, patients hematopoietic
with other
fatigue, with liver studies and uric
antituberculotic drowsiness,
behavioral disease or acid level.
Brand Name s changes, diabetes
 Meningococcal dizziness, mental Watch for and
Rifadin, Mechanism of confusion  Dialyzable
carriers report to
rimactane, rotact Action: drug: poorly
 Cholestatic CV: shock prescriber signs
 Overdose
Dosage inhibits DNA- pruritus EENT: visual
and symptoms
S&S:
dependent RNA Contraindications: disturbances, of hepatic
2.0 g. exudative Nausea,
polymerase, conjunctivitis,
impairment For
contraindicated vomiting, TB, a three-drug
which impairs tooth discoloration
with patients abdominal
RNA synthesis; GI: pancreatitis, regimen of
Route hypersensitive to pain,
bactericidal pseudomembrano rifampin,
rifampin or related us colitis, pruritus,
P.O epigastric distress, isoniazid and
drugs headache,
anorexia, nausea, pyrazinamide is
vomiting, increasing
abdominal pain recommended
lethargy,
Frequency in the initial
GU: acute renal transient
failure, phase of short-
Q.D. hemoglobinuria, increase in
course therapy,
hematuria, liver
menstrual which is usually
disturbances enzymes or
continued for 2
bilirubin
Hematologic: months.
thrombocytopenia, levels,
transient brownish Don't confuse
leukopenia,
eosinophilia, red or rifampin with

hemolytic anemia
orange rifabutin,
Hepatic: discoloratio rifaximin,
hepatotoxicity
n of skin, rifapentine or
Metabolic:
urine, Rifamate
hyperuricemia
sweat,
Musculoskeletal:
muscular
saliva, tears
weakness, pain in and feces
extremeties
Respiratory:
SOB, wheezing
Skin: pruritus,
rash, urticaria
VIII. DISCHARGE PLAN/ HEALTH TEACHING

Prevent the spread of TB
Consider isolation needs:
 Discharge potentially infectious TB patients only to settings where no new persons will be exposed.
 For infectious patients, consider logistics of primary care appointments for new and pre-existing
conditions and ensure appropriate follow-up.
 Reinforce the need to stay home (except for health-care visits, where masks should be worn) until the
health department and clinician determine that isolation is no longer needed.
 Do not discharge infectious patients to congregate settings (e.g., nursing home, shelter, correctional
facility) unless they will be in an airborne infection isolation room.
Ensure that patient is tolerating daily dosing of TB medications.
 The first-line TB medications should be given at the same time of day in a single daily dose.
 Address any adverse effects prior to discharge.
Educate the patient.
 Educate patient about the length of therapy, the importance of careful adherence to treatment and
follow-up appointments, and the consequences of untreated TB.
 Emphasize the benefits of directly observed therapy (DOT) as an effective way to complete TB therapy as
quickly as possible and prevent drug resistance. DOT is strongly recommended for all patients with
presumed or confirmed active TB.
 Review potential medication side effects and when to report them.
 Reinforce infection control measures to patients with infectious TB (i.e., wear a mask; stay home from
school, work, or other public settings; avoid contact with previously unexposed persons; cover mouth
when coughing or sneezing).
Home care
 Take your medicine exactly as directed. Continue taking it even if you start to feel better. You will take
medicine for at least 6 months and maybe longer. Not taking your medicine for the full course may lead
you to get 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 work.
 If you are taking birth control pills, use an additional backup method of birth control. Some TB medicines
may interfere with the pill’s effectiveness.
 Check with your healthcare provider before taking any over-the-counter medicines.
 Sleep in a room alone and with good air flow (ventilation).
 Limit your activity to avoid feeling tired. Plan frequent rest periods.
 Keep your healthcare appointments. You will need to be checked regularly for several months to a year to
make sure you are free from TB bacteria.
IX. ARTICLE/ JOURNAL

Knowledge on tuberculosis and utilization of DOTS service by tuberculosis
patients in Lalitpur District, Nepal
Abstract
Background: Tuberculosis is one of the major infectious diseases and is both complex
and serious. It is spread from person to person through the air, causing a public health
burden, especially in low- and middle-income countries. This study aims to assess the
knowledge on tuberculosis and the utilization of Directly-Observed Therapy, Short
Course (DOTS) service from the public DOTS centers in Lalitpur district of Nepal.
Method: A structured questionnaire was used to collect data from 23 DOTS centers in
Lalitpur district. Univariate and multivariate logistic regression was applied to assess the
knowledge on tuberculosis and utilization of DOTS among people living with
tuberculosis.
Results: Among 390 respondents, 80% of patients had knowledge of tuberculosis and
76.92% utilized the DOTS service from the DOTS center. People of higher age (50-60
years) [aOR; 13.96, 95% CI 4.79,40.68], [aOR; 10.84,95% CI 4.09,28.76] had significantly
more knowledge on TB and utilization of the DOTS service compared to the younger
group. Additionally, those who completed twelfth class [aOR; 2.25, 95% CI 0.46,11.07]
and [aOR;2.47, 95% CI 0.51,11.28] had greater knowledge of Tuberculosis and utilization
of DOTS compared to those who had not completed twelfth class. Likewise, compared
to urban residents, respondents in rural areas (aOR; 0.51, 95% CI 0.27,0.97) had less
knowledge of tuberculosis, (aOR; 0.57, 95% CI 0.32,1) and less chance of utilization of
the DOTS service from the DOTS center.
Conclusion: Approximately one quarter of patients did not have adequate knowledge
of tuberculosis and were not utilizing the DOTS service, particularly in younger age
groups, people living in a combined family, with no education, poor economic position,
and from rural areas. Findings of this study revealed that some specific programs are
needed for enhancing the knowledge and utilization of DOTS, particularly for those
patients whose economic situations extended from low to mid range.

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ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

NCM 112 (RLE)

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

SEPTEMBER 15, 2021

III . ....................................................... PHYSICAL EXAMINATION

IV. .................................... ANATOMY AND PATHOPHYSIOLOGY

V .. ...................... DIAGNOSIS AND LABORATORY PROCEDURE

VI. ................................................................. NURSING PROCESS

VII. ....................................................................... DRUG STUDY

VIII. ............................ DISCHARGE PLAN/HEALTH TEACHING

IX. ............................................................. ARTICLE/JOURNAL

Tuberculosis Risk Factors

 A friend, co-worker, or family member has active TB.

• Establish therapeutic relationship with client and family

II. NURSING HEALTH HISTORY

Age: 35 years old

Civil Status: Married

c. Present Illness History

e. Family Health History

III. PHYSICAL EXAMINATION

Pulse Rate: 90 bpm

Respiratory Rate: 25 cpm

Blood Pressure: N/A

Oxygen Saturation: 90% at room air

IV. ANATOMY AND PATHOPHYSIOLOGY

V. LABORATORY AND DIAGNOSTICS

Diagnostic tests for active TB

Test type Principal WHO policy Advantages Limitations

Smear Non- Recommended Inexpensive, simple, rapid, Cannot

LED Recommended Inexpensive, simple, rapid Cannot

Automated GeneXpert Recommended Rapid (2 h to result). Detects Higher cost

Loop- LAMP assay Not Rapid, simple Subjective

Rapid Recommended For rapid differentiation of Expensive

Diagnostic tests for active TB

Test type Principal WHO policy Advantages Limitations

Serodiagnosti Over 20 Not recommended Poor

Interferon- QuantiFERON Not recommended for diagnosis of active TB Complex to

Drug susceptibility tests

Test type Principal WHO policy Drugs tested Advantages Limitations

Phenotypic Non- Recommended All drugsb Gold-standard Extremely

Line probe MTBDR-Plus; Recommended RIF, INH Result in 2 Expensive

Diagnostic tests for active TB

Test type Principal WHO policy Advantages Limitations

Line probe MTBDRsl Not yet Fluoroquinolone Result in 2 Low

Automated GeneXpert Recommended RIF Result in 2 h Cartridge

Microscopic Non- Recommended RIF, INH Low-tech. Subjective

Colometric Non- Not yet RIF, INH Low-tech. Subjective

Nitrate Non- Not yet RIF, INH Low-tech 10– Subjective

Diagnostic tests for active TB

Test type Principal WHO policy Advantages Limitations

Phage assays FASTplaque, Not RIF, INH N/a Poor

Sequencing Non- No policy Depends on gene Can provide Requires

VI. NURSING CARE PLAN

VII. DRUG STUDY

Generic Name Classification: Indications Adverse  Use cautiously  Drug's