SHRI RAM MURTI SMARAK COLLEGE OF NURSING BAREILLY

CASE STUDY
ON
TUBERCULOSIS

Submitted to: - Submitted by:-

Mr.Aneesh chandran Mrs.Santoshi Malhotra
Associate Professor M.Sc. Nursing 1st Year
SRMS college of nursing, Bareilly SRMS college of nursing, Bareilly

INDEX
S.NO CONTENT PAGE.NO
 1. STUDENT PROFILE
2. PATIENT BIOGRAFIC DATA
3. HISTORY COLLECTION
4. PHYSICAL EXAMINATION
5. SYSTEMIC EXAMINATION
6. INVESTIGATIONS
7. TREATMENT
8. MEDICATION
9. ANATOMY & PHYSIOLOGY OF RESPIRATORY SYSTEM
10. DISEASE CONDITION →PULMONARY TUBERCULOSIS
11. NURSING DIAGNOSIS
12. NURSING CARE PLAN
13. DIETARY CHART
14. HEALTH EDUCATION
15. THEORY APPLICATION
16. SUMMARY
17. CONCLUSION
18. JOURNAL REFERENCE
19. BIBLIOGRAPHY

STUDENT PROFILE

NAME OF THE STUDENT : Ms.Santoshi Malhotra

NAME OF THE COURSE : MSc Nursing

YEAR OF THE STUDY : 2020-2021

NAME OF THE SUBJECT : Community Health Nursing

CASE PRESENTATION ON : Tuberculosis

NAME OF THE GUIDE :

DATE OF SUBMISSION : 20/09/2021s

BIOGRAPHIC DATA:

Name of the patient : Mr. Ramesh Singh

Age : 48yrs

Sex : Male

Ip.no :12365

Ward : TB& Chest Ward

Department : Medicine

Unit : Chest and TB

Nationality : Indian

Religion : Hindu

Education : Illiterate

Occupation : Farmer

Income : 36000/year

Marital status : Married

Communication pattern :

Diagnosis : Tuberculosis

Address : Haridwar,UK.

Date of admission : 16/04/2018

Date of discharge : 24/04/2018

CHIEF COMPLAINTS : Patient complaints of

 Cough with expectoration since 2 months

 Blood in sputum & vomiting from 1 week
 Shortness of breath, chest pain
 Fever with chills
 Anorexia

HISTORY COLLECTION:

FAMILY HISTORY:
No. of persons in the family : 6 members

Type of family : single family

Any hereditary disease : expect patient no hereditary disease in

Family like D.M

Any deaths reason : no death in the family

Any consangious marriage : no consangious marriage

s.no Name of the members age sex education occupation Relation with Health
patient status
1. Mr.Ramesh Singh 45y M illiterate Farmer Patient Un healthy
2. Mrs.Premwati 35y F illiterate House wife Wife healthy
3. Ms.Rashmi Devi 21y F 5th class - Daughter healthy
4. Ms.Saroj Devi 18y F 9th class - Daughter healthy
5. Mr.Sarvesh Kumar 16y M 7th class - Son healthy
6. Mr.Sushil Kumar 13y M 3rd class - Son healthy

FAMILY TREE:
KEYS POINTS:

FEMALE

MALE

PATIENT

SOCIO ECONOMIC HISTORY:

Bread winner of the family : Patient
Family income
Economic status of family
Type of house
Water facility
Electric facility
Sanitary facility
Disposable of waste
Availability of PHC/School
PAST MEDICAL HISTORY:
doctor as diabetes mellitus and used drugs for only 15days.
PAST SURGICAL HISTORY:
PRESENT MEDICAL HISTORY:
shortness of breath.Doctor diagnosed the case as pulmonary tuberculosis and patient is getting antiT.B drugs treatment.
PRESENT SURGICAL HISTORY:
PERSONAL HISTORY:
Patient habits
: RS.36000/year
: middle class
: pucca house
: available
: available
: not available
: open drainage system
: PHC & school are available.
Patient admitted in hospital,8 months back with the complaints of polyurea and weakness,diagnosed by
There is no significant of past surgical history for the patient
Patient admitted in hospital (general hospital)on 10-12-2010 with complaints of cough,haemoptysis and
Patient is not prescribed for any surgery. so no significant present surgical history.
: Patient is having habit of smoking and alcoholism
Hobbies : watching t.v,spending with family and friend’s
Sleeping pattern
No of hrs/day : 2hrs/day
No of hrs/night : 6hrs/day
NUTRITIONAL HISTORY:
Vegetarian or non-vegetarian : both
No of meals/day : 3times/day
FUNCTIONAL HISTORY:
Bowel pattern : 1or2 times/day
Bladder pattern : 1or2 times/hour
PHYSICAL EXAMINATION:
GENERAL EXAMINATION:
Nourishment : moderately nourished
Body build : moderate
Health : UN healthy
Activity : dull
MENTAL STATUS:
Consciousness : conscious
Look : depressed and anxious
POSTURE AND MOVEMENT:
Body curves : no body curves
Movements : normal
HEIGHT & WEIGHT : 175cms; 67kgs.
SKIN CONDITION:
Color : medium
Texture : dry
Temperature : warm
Lesions : no lesions over the skin
HEAD & FACE:
Scalp : clean
Dandruff &pediculosis : absent
Condition of hair : dry
Face : no puffiness
EYES:
Eye brows : symmetrical
Eye lashes : not infected
Eye balls : no protruded or shrunken
Eye lids : no edema
Conjunctiva :not pale in color
Sclera : no cyanosis or jaundice
Vision : normal
NOSE:
External nares : normal
Nostrils : normal
Nasal septal deviation : no septal deviation
Any discharge/bleeding : no bleeding
EARS:
External ears : normal
Any discharge : no discharge, no bleeding
Hearing : normal
MOUTH AND THROAT:
Lips : dry
Gums : not bleeding
Teeth : yellowish discolorization
Tongue : coated and dry
Dental cares : absent
Thyroid gland : not enlarged
Lymph nodes : not enlarged
CHEST:
Symmetry of chest : symmetrical
Heart rate : normal
Respiratory rate : wheezing respiratory sounds
ABDOMEN:
Inspection : no scars or lesions on abdomen
Palpation : no organomegaly
Percussion : no presence of fluids in abdomen
Auscultation : bowel sounds heard
GENITALIA & RECTUM:
Inguinal lymph nodes : not enlarged
Bleeding or discharge : absent
Any presence of S.T.D : absent
Any hemorrhoids : absent
Presence of constipation : slight constipation is presence
EXTREMITIES:
Upper extremities : movements are normal
Lower extremities : movements are normal
VITAL SIGNS:
Temperature : 100 f
Pulse : 72 bts/min
Respiration : 22br/min
B.P : 110/90mmhg.
INVESTIGATIONS

S.NO INVESTIGATIONS PATIENT NORMAL REMARKS

VALUE VALUE
1. Biochemistry
→fasting blood sugar 234mg/dl 70-110mg/dl Increased
→postprandial blood sugar 355mg/dl 80-140mg/dl increased

2. PATHOLOGY
→albumin in urea Nil Nil
→sugar in urine ++ Nil Increased
→H.B% 13.5mg/dl 12-15mg/dl Normal
→total W.B.C 9,800cumm 4000-11000 Normal
3. DIFFERENTIAL COUNT
→polymorphs 45% 45-47% Normal
→lymphocytes 41% 25-45% Normal
→eosinophils 12% 02-06% Increased
→monocytes 02% 02-10% Normal
4. E.S.R 10mm-13hs 0.7mm1sthrs Increased

5. MICROSCOPIC
EXAMINATION
→puscells 1-2 Nil Increased
→epithelial cells 0-1 Nil Increased
→R.B.C Nil Nil Normal
6. H.I.V Non reactive Non reactive Increased
7. SPUTUM EXAMINATION
→12-10-2010 Positive 2+ Negative Increased
→14-12-2010 Positive 2+ Negative increased

TREATMENT
 S.NO DRUG NAME DOSE ROUTE FREQUENCY ACTION
1. ANTI-TB DRUGS
→(z)pyrazanamide 2 tab 750mg Oral 2time/week
→(e)ethambutal 2 tab 600mg Oral 3time/week Anti tuberculosis
→(h)isoniazid 2 tab 300mg Oral 3time/week
→(r)refampicin 1 tab 450mg Oral 3time/week
→injstreptocid 0.75mg I.V TID

2. Inj. botropore I.V OD Analgesic

3. Inj. Viazapam I.V BD Sedative
4. Inj. Lupusulin 140,100 SC BD Antibiotic
5. Sypmits 1tsp oral BD

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM

STRUCTURES:

The anatomical structure through which air moves in and out is the respiratory tract. The organs of respiratory
system involve.

 Nose
 Pharynx
 Larynx
 Trachea
 Two bronchi (one branch to each lung)
 Bronchioles and smaller air passages)
 Two lungs and their coverings, the pleura
 Muscle of respiration; the intercostals muscle & the diaphragmatic muscle.
Structurally the respiratory system consists of two portions.
1. THE UPPER RESPIRATORY SYSTEM: refers to the nose,pharynx and associated structures.
2. THE LOWER RESPIRATORY SYSTEM: refers to the larynx, trachea, bronchi and lungs.
Functionally the respiratory system also consists of two portions.
1. THE CONDUCTING PORTION consists of a series of inter connecting cavities and tubes, nose, pharynx, larynx, trachea, bronchi, and
bronchioles thatconduct air into the lungs.
2. THE RESPIRATORY PORTION consists of those portion of the respiratory system where the exchange of gases occur, respiratory
bronchioles, alveolar duct, alveolar sac and alveoli.

NOSE AND NASAL CAVITY

POSITIONS AND STRUCTURES: the nasal cavity is the 1st of the respiratory organs and consists of a large irregular cavity divided into two equal
passages by a septum. The posterior bony part of the septum is formed by the perpendicular plate of the ethmoidbone and the vomer. Interiorly it
consists of hyaline cartilage.

LINING OF THE NOSE: nose is lined with very vascular ciliated columnar epithelium which contains mucus secreting goblet cells.

FUNCTIONS OF NOSE: The function of the nose is to begin the process by which the air warm, moistened and filtered and cleaning of air.
  Olfactory stimuli are received
 Large hallow resonating chambers modify speech sounds

PHARYNX

POSITION: the pharynx is somewhat funnel shaped tube about 12-14 cm long that extends from the base of the skull to the level of 6th cervical
vertebra. It lies behind the nose, mouth and larynx and wide at its upper end.

STRUCTURE: pharynx is divided into 3 parts

1. Naso pharynx
2. Orophraynx
3. Laryngo pharynx

The pharynx is composed of 3 layers

1. Mucous membrane lining

2. Fibrous tissue
3. Muscle tissue

FUNCTIONS: passage way for air and food.

 Warming and humidifying

 Taste, hearing, protection
 Provides respiratory chamber for speech sounds
LARYNX

POSITION: the pharynx or voice box extends from the root of the tongue and the hyoid bone to trachea. It lies in front of the laryngo pharynx at the
level of 3rd, 4th, 5th, & 6th cervical vertebra.

STRUCTURE: the structure is composed of several irregularly shape cartilage attached to each other by ligaments and membranes. The main
cartilage are
  Thyroid cartilage -1
 Arythmoid cartilage-2
 Ericoid cartilage-1
 Epiglottis-1

FUNCTION: →Production

→helps in speech, protection of lower respiration tract.

→passage way for air, humidifying, filtering and warming.

TRACHAE

POSITION: The trachea or wind pipe is a continuation of and extends downwards about the level of 5th thoracic vertebra where it divides at the
carina into the right and left bronchi, one bronchus going to each lung.

FUNCTION:

 Cough reflex
 Support and patency
 Mucociliaryexcalator
 Warming, humidifying and filtering the air.

BRONCHI AND SMALLER AIR PASSAGES

The two primary bronchi are formed when the trachea

Divides it about the level of 5th thoracicvertebra. The bronchi pass downwards and outwards the root of the lungs. The right bronchi shortness and
wide than the left. It gives off a branch at the level higher than that of the pulmonary artery called the upper lobe bronchus and the other bronchus
passed below the artery is the lower lobe bronchus. The middle lobe bronchus arises from the lower lobe bronchus.

FUNCTIONS:

 Control of air entry

  Warming, humidifying, support.

THE LUNGS

POSITION:

There are two lungs lying on each side of the midline in the thoracic cavity. They are cone shaped and are
described as having an apex, base, costal layers and medial surfaces .

LOBES OF LUNGS:

The lungs are divided into lobes by fissures. The right lungs have the lobes and left lung has two lobes. Each lobe
is composed of a no. of lobes, lung tissue is elastic, porous and spongy.

FUNCTIONS OF LUNGS:

The function of the lungs is the interchanges of gases oxygen and carbondioxde. In pulmonary respiration
oxygen is taken through the nose and mouth. In breathing it flows along the trachea and bronchial tubes to the alveoli, where it comes into intimate
contact with the blood in the pulmonary capillaries, oxygen passages across the capillaries membranes and is taken up by the hemoglobin of the red
blood cells and carried to the heart from where it is pumped in the arteries to all parts of the body.

In the lungs carbondixide a waste product of metabolism, passes across the alveolar capillaries membranes from
the blood capillaries to the alveoli and trachea is breathed out through the nose and mouth.

BLOOD SUPPLY:

The pulmonary artery carries the deoxygenated blood from the right ventricle of the heart to the lungs. With in
the lungs pulmonary artery divides into many branches which eventually and in a dense capillary network around the walls of alveoli. The exchanges
of gases between air in the alveoli and blood in the capillaries takes place. The pulmonary capillaries join up eventually becoming true pulmonary
veins. They leave the lung at the helium and convert oxygenated blood to the left atrium of the heart and distributes all over the body by means of
aorta.

The blood supplies to the respiratory passages and lymphatic drainage.

DISEASE CONDITION
INTRODUCTION: Pulmonary tuberculosis is a communicable disease suffered by all ages. It is most common opportunistic infection in persons
with H.I.V infection. It is a primary infectious disease which affects the lung parenchyma; and causes pulmonary tuberculosis. It may also
transmitted to the other parts of the body including the meninges, kidneys, bones, joints, intestine and lymph nodes. The disease also affects animals
like cattle. This is called bovine tuberculosis. The primary infection agent is ‘mycobacterium tubercle’, is an acid fact, aerobic and grows slowly and
is sensitive to heart and ultraviolet light. The common clinical manifestations are persistent cough for 3wks, low grade fever, weight loss, chest pain,
haemoptysis, shortness of breath, dyspnoea etc. dots is the effective treatment to level this tuberculosis effectively which is provided by RNTCP.

Hippocrates called this disease as ‘pihithesis’ which means to dry of disease accelerated greatly.

 In 1882 Robert kotch discovered tuberculosis bacillus.

 In 1882 rontgen, discovered x-ray, which provide extra valuable aid in diagnosis of tuberculosis.
 In 1907, von piaget discovered tuberculosis test
 In India it was introduced in 1949.

DEFINITIONS:

1. According to K.A.PARK tuberculosis is defined as a specific infectious disease caused by mycobacterium tuberculi.
2. According to Dr.N.C.DEY& Dr. T.K. DEY ‘tuberculosis is a specific infectious granuloma caused by mycobacterium tuberculosis and
characterized by chronic inflammatory changes with inflammation of tubercle. Resulting in creation or necrosis, ulceration and healing by
fibrosis or calcification.
3. According to SHARON MANTIK LEWIS tuberculosis is an infectious disease caused by mycobacterium tuberculi, it usually involves the
lungs, but also occurs in the larynx, kidneys, bones, and adrenal glands, lymph nodes and meninges; and can be disseminated throughout the
body.
4. According to VIDYA RATNAM tuberculosis is a specific pulmonary or non pulmonary communication disease in acute or chronic forms.
5. According to SUZANNE E.SMEITZER & BRENDA G.BARE tuberculosis is an infectious disease that primary affects the lung parenchyma.

INCIDENCE:

Tuberculosis remains a worldwide public health problem, which is estimated 1/3rd of the world’s population is
infected with mycobacterium tuberculi.

 15 million of tuberculosis infection cases are present

  Every year 5 million people develop active tuberculosis world wide and 2.5 million deaths annually.
 W.H.O has reported a global prevalence of 14% of drug resistant tuberculosis
 By 2005, WHO predicts there will be 10.2 million new cases and Africa will have more cases than any other region.

ESTIMATED NEW TUBERCULOSIS CASES:

Sales

IN INDIA: Indian accounts for nearly 1/3rd of global burden of tuberculosis. Every year approximately 2.2 million people develop tuberculosis of
which about 1 million are now smear positive, die of tuberculosis every day.

TYPES OF TUBERCULOSIS:There are mainly two types of tuberculosis

1. Pulmonary tuberculosis
2. Extra pulmonary tuberculosis

PULMONARY TUBERCULOSIS:
 Pulmonary tuberculosis is caused by the mycobacterium tuberculosis and is characterized by the formation of
lesions mainly in the lungs. The primary infection usually occurs in childhood and is asymptomatic. A few patients develop primary produces a
febrile illness which is generally mild and last for not more than 7-14 days. Slightly dry cough is occasionally present. The primarily it may be
accompanied by reythema, which is characterized by bluish, red tender, lesions on the skin and less common on the thigh. The leucocytes count is
normal but the erythrocyte sedimentation rate is raised, primary tuberculosis can usually detected in chest radiography.

SMEAR POSITIVE PATIENT: Tuberculosis in a patient with one septum specimen positive for mycobacterium tuberculosis.

1. Spread from the primary focus to Hilary and meditationallymph gland to form the primary complex heals spontaneously.
2. Direct extension to the primary focus progressive pulmonary tuberculosis.
3. Spread to pleura: tuberculosis pleurisy and pleural effusion.
4. Blood- borne spread: pulmonary, skeletal, renal, genitor urinary infection often months or years later.
5. Massive spread: millarytuberculosis and meningitis.

SMEAR NEGATIVE PATIENT: diagnosis is based on culture positive for mycobacterium tuberculosis, but sputum smear examination negative for
acid-fast bacilli.

EXTRA PULMONARY TUBERCULOSIS:Tuberculosis can effected any organ and tissues of the body such as the pleura (pleurisy) lymph nodes,
abdomen, genito urinary tract, skin, bones and joints, meninges of the brain etc.

1. LYMPHADENITIS: The most common extra pulmonary of disease in the lymph nodes enlargement in any site can occurs but cervical
and medisternal glands involvement are most common follow by axillaries and inguinal. The enlargement of lymph nodes are usually painless
and initially mobile but becomes melted together with time when creation and liquefaction occur, the swelling and many discharges through
the skin with the formation of abscess and sinus formation is common.
2. GASTRO INTESTINAL TUBERCULOSIS: ulceration of tongue can occur but rare fever, night sweats, anorexia and weight loss are
usually prominent and right iliac Forsa may be palpable. Diarrhea, malabsorption, intestine and peritoneum tuberculosis peritonitis is
characterized by abdominal pain, abdominal distension and constitutional symptoms.
3. PERICARDIAL DISEASE: disease occurs in two main forms, pericardial effusion and constrictive pericarditis fever and night sweats are
rarely prominent and the presentation is usually coincides with breathlessness and globular enlarged heart and chest radiography, constriction
is associated with a trial fibrillation and pericardial calcification.
 4. CNS TUBERCULOSIS: tuberculosis meningitis is an externally serious form of infection which can be associated with milliary
tuberculosis but can also be present in the absence of generalized disease. This is threatened disease with headache, neck stiffness, vomiting,
disorder consciousness are the features of the disease.
5. BONE AND JOINT TUBERCULOSIS: skeletal infection is relatively common. Tuberculosis of the spine usually presents with chronic
back pain and involves the chronic and lumbar spine. The infection starts as a disarthritis and then spreads along the spinal ligaments’ to
involve the adjacent anterior vertebral bodies causing angulations of the vertebral with subsequent kyposis. Tuberculosis can affects any joint,
but most frequently involves the hipor knee presentation is usually insidious with pain and swelling.
6. GENITO URINARY TUBERCULOSIS: renal tuberculosis is fairly common term of non pulmonary tuberculosis but rarely gives raise to
symptoms until the renal lesions are eccentric. Haematuria, increased frequency of maturation, dysuria and can be caused by renal
tuberculosis.
Infection of the fallopian tubes was a common cause of infertility. It can give raise to salphingitis and tubal
abscess. In men genitourinary tuberculosis may present as epidymitis or protatitis.

EPIDEMIOLOGICAL FACTORS

1. AGENT FACTORS:
a. Agent : mycobacterium tuberculi
b. Source of infection : human source , bovine source
Human source: human with sputum positive for tuberculi bacilli and either received no treatment or nor has been treated fully.
Bovine sources: infected milk
c. Communicability : patients are infected as long as they remain untreated. Effective anti microbial treatment reduces infectivity by
90% within 48 hrs.
2. HOST FACTORS:
A. age : it affect all ages. In India 1% from under age of 5yrs the infection index climbs to about 30% at age 15yrs, the majority of
cases are 20-40yrs. In developed countries prevalence is higher in elder’s age group.
B. sex : more prevalent in males than in females.
C. hereditary : it is not a hereditary disease.
D. nutrition : malnutrition is believed to predispose to tuberculosis.
 E. immunity : man has no inherited immunity, can be acquired as a result of natural infection or B.C.G vaccination. Cellular
immunity provides limit further multiplication and spread of bacilli.

3. SOCIAL FACTORS: Includes many non medical factors such as

o Poor quality of life

o Poor housing
o Over crowding
o Under nutrition
o Lack of education
o Large family
o Early marriage
o Lack of awareness of causes of illness.

ETIOLOGY AND RISK FACTORS

1. Close contact with someone who has active tuberculosis, inhalation of airborne nuclei from an infected person is proportional to the amount
of time spend in the same air space.
2. Overcrowding and substandard housing.
3. Mal nutrition.
4. Person without health care (impoverished, minorities, children under 15yrs, young adult between 15-44yrs.
5. Primary infection 1yr previously
6. Substance abuse (I.V or injection drug users and alcoholic)
7. Immigration from countries with a high prevalence of tuberculosis.
8. Immune compromised status (ex: pt with HIV, cancer, transplantation organs and prolonged high dose corticosteroid therapy)
9. Malignancy (especially, lymphoma, leukemia)
MODE OF TRANSMISSION: Tuberculosis is transmitted mainly by droplet infection and droplet nuclei generated by sputum positive patient with
pulmonary tuberculosis. Coughing generates the largest no. of droplet of all sizes. Tuberculosis is not transmitted by the patients. In bovine
tuberculosis transmission occurs through UN boiled milk.

INCUBATION PERIOD: The time from receipt of infection to the development of positive tuberculosis test ranges from 3 to 8 wk and thereafter
the development of disease depends upon closeness of the contact extends of the disease and sputum positively to the source and parasite
relationship. Thus the incubation period may be weeks, months or years.

RESISTANCE: The mycobacterium is killed by heat at 60 degree in 15-20min. bacilli in sputum can remain alive for 20-30hrs even it exposed to
sunlight.

PATHOPHYSIOLOGY:

When a susceptible individual inhales the air that containing mycobacterium bacilli, they become infected and sources infection

The bacilli also transmitted via lymph system, blood stream to other parts of the body and other areas of the lungs.

The bacteria are transmitted through the airways to the alveoli

The bacteria deposited and begin to multiply

The body in immune system responds by initiating an inflammatory reaction

Phagocytes engulf the bacteria and tuberculosis specific lymph nodes destroy the bacilli and normal tissue.
 ↓

Tissue reaction cause accumulation of exudates in the alveoli bronchopneumonia

Granuloma

Granulomar are then transmitted to a fibrous tissue mass

The material (bacteria macrophages) becomes necrosis forming a cherry mass

The cherry mass becomes calcified and formed a collage nous smear

The material liquefies and may drain into the trachea bronchial tree

This is cough up with sputum.

CLINICAL MANIFESTATION:The most common symptom of the pulmonary tuberculosis is persistent cough for 3wks or more usually with
expectoration. Persistent cough for 3wks or more may be accompanied by one or more of the following symptoms.

BOOK PICTURE PATIENT PICTURE

 Weight loss Present
 Tenderness Present
 Fever Present
  night sweats Present
 chest pain Present
 shortness of breath (dysponea) Present
 loss of appetite Present
 haemoptysis Present
 chest tightness Present
 anorexia Present
 lethargy Present

DIAGNOSTIC EVALUATION:

BOOK PICTURE PATIENT PICTURE

1.HISTORY COLLECTION
 cough with sputum
 low grade fever
 drug abuse Not done
 smoking and alcoholism Done
 disturbed nutritional pattern Not done
 functional pattern Done
 hereditary disease Not done
 congenital disease Not done
2.PHYSICAL EXAMINATION
 fever,(↑ed temperature) Done
 purulent cough Done
 weight loss Done
 dyspnoea& SOB Done
 haemoptysis Done
 anorexia Done
 crackled lung sounds Done
3.INVESTIGATION
 complete blood count Done
 E.S.R Done
  Examination of blood fluid(pleural peritoneal Not done
& spinal fluid)
 Tuberculosis skin test Not done
 Chest x-ray Done
 Bacteriological studies
 Sputum smear Done
 Sputum culture

CHEST INVESTIGATION:

EXAMINATION RESULTS GRADING NO.OF FIELDS TUBE

EXAMINED
 More than 10AFB Positive 3+ 20
 1-10 AFB
 10-19 AFB Positive 2+ 50
 1-9 AFB Positive 1+ 100
 NO AFB Scantly Record exact no 200
negative 0 100

COMPLICATION:

1. Pleural effusion : pleural exudates of protein rich fluid. It appears as localized plueratic pain in deep inspiration.
2. Pneumonia : result when large amount of tubercule bacilli are discharged from liquefied necrotic lesions into lungs and
lymph nodes.
3. Millary tuberculosis : necrotic complex through a blood vessel, large no. of organs involved the blood stream and spread to all body
organs.
4. Emphyma or pyopneumothroqx : organism spilling into the plural spaces, from rupture of cavity.
5. Meningitis : in advanced pulmonary destruction & fibrous.
MANAGEMENT:

Management for tuberculosis patient including the following

1. Medical management → chemotherapy

→DOTS treatment
2. Dietary management
3. Surgical management
4. Nursing management.

CHEMOTHERAPY: pulmonary tuberculosis is treated primarily with chemotherapeutic agent for 6-12months. Currently used anti tuberculosis drugs
are classified into two groups.

a. Bacterial drugs include: - rifampici 450mg

- Isoniazid 600mg
- Streptomycin 0.75mg
- Pyrazinamide 150mg

These drugs will kill the bacteria within first time of medication.

b. Bacteriortatic drugs includes: -ethambutol 800mg

-thioantagone 150mg

These drugs inhibit the multiplication of bacilli and leads to their destruction by the immune mechanism of the host.

DOTS: (DIRECT OBSERVED TREATMENT SHORT TREM)

Dots are a strategy to ensure cure by providing the most effective medicine and conforming that it is taken. In
DOTS, treatment is given into two phases. 1. Intensive phase, 2. Continuation phase. During intensive phase health worker or other person watches
the patient swallow the drugs. In continuation phase the patient is issued medicine for 1wk. treatment is given according to categories. There are three
categorie
 CATEGEORY OF TYPE OF THE PATIENT REGIMEN
TREATMENT
Category-I -New sputum +ve
-seriously ill sputum smear negative 2(HRZE)3
-seriously ill, extra pulmonary 4(HR)3
-sputum smear +ve
-sputum smear +ve failure
Category –II -sputum smear +ve treatment 2(HRZES)3
-sputum smear –ve 1(HRZE)3
-not seriously ill 5(HRE)3
Category-III -extra pulmonary, not seriously ill
2(HRZ)3

4(HR)3

DIETARY MANAGEMENT: Dietary therapy is very much important for the moderate increase in basal metabolic rate and in the
breakdown of tissue protein. Principles of dietary therapy include.

1. It should be moderate high in promote healing and high enough in calories. Regain lost weight. The protein intake should enough average
from 75-100gm/day, for adults and caloric intake is 2500-3000 calories.
2. The diet should include all foods rich in minerals and vitamins

VITIMINS: calcium is important for the calcification of the tuberculosis nodes.

 Iron is necessary to prevent haemoptysis

 Fluidup to 300ml 1 day unless the patient is edematous
 Milk is important because of high content of proteins, calcium, vitamins. So at least liter of milk a day should be accompanied in any form,
eggs, meat, fish, cheese etc.
 Fats and carbohydrates help to meet caloric needs.
 Food should be planed easily digested and should serves alternatively.
SURGICAL MANAGEMENT: when the medical treatment has failed to check and heal the disease process, surgical
management for the tuberculosis is necessary. Surgical procedure includes…..

1. PNEUMONECTOMY : removal of entire lung

2. LOBECTOMY : removal of lobe of lung
3. SEGMENTAL RESECTION/SEGMENTECTOMY: one or more segments of lungs are removed.
4. WEDGE RESECTION : The disease position on surface of the lung is removed.

NURSING MANAGEMENT:

1. PREVENTION OF TRANSIMISSION OF DISEASE:

During hospitalization appropriate infection control and hospital employ with health practice are essential.
2. TEACHING PATIENT SELF CARE:
Nurses play a vital role in caring for the patient with tuberculosis and the family which include assessing the
patient ability to continue therapy at home.
 Nurses should interact with patient and family about infection control procedures such as proper disposal
of tissue, covering the mouth during coughing, sneezing and hand hygiene should maintain.
 Assessment of patients ad hence to the medication regimen.
3. IMPORTANCE OF DIET:
Nurses should explain the family members about the importance of diet.
 Advice the patient to take high protein and caloric diet to prevent healing and regimen for weight gain.
 Encourage the patient to take large amount of fluid diet.
 Encourage the patient to take egg, milk, fish, cheese, to nutritional needs.
4. CONTINUING CARE:
Asses the patient for adverse effect of medication and therapeutic regimen (taking medication as prescribed,
protecting, self hygiene, adequate diet, participating in an appropriate level of activity).
 Instruct the patient and the family members to seek medical care for recurrent infection.
 Instruct them to keep the medicine in safety place without reach of children.
NURSING DIAGNOSIS

1. Ineffective airway Clarence related to increased mucous production and bronchial secretions.
2. Ineffective breathing pattern, dysponea related to shortness of breath.
3. Altered body temperature (hyper pyrexia), related to infection.
4. Fluid volume deficit related to fever, night sweats.
5. Altered skin integrity related to de hydration.
6. Altered nutritional status (less than body requirements) related to anorexia, loss of appetite.
7. Activity intolerance related to weakness and fatigue.
8. Knowledge deficit regarding treatment regimen related to lack of awareness, illiteracy.
9. Sleep pattern disturbance related to night sweats and fever.
10. Anxiety and stress related to disease condition.
NURSING CARE PLAN

ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

DATA DIAGNOSIS
Subjective data: Ineffective air Airway -asses the patient breathing -Assessed the patient -to know the patient -
Patient complaints way clearance clearance pattern, frequency of breathing pattern and breathing pattern so
of related to will be cough and amount of observed that pt in cough that to plan
 Difficulty increased maintaine sputum and color. blood stained sputum. appropriate measures
in mucus d -educate the patient to take -educated the patient to for patient.
breathing. production. more water and fluids. take more water and -to dilute the
 Excess -provide comfortable fluids. thickness of sputum Air way of
sputum position to the patient. -provide fowler’s & reduce dry cough. patient was
production -educate the patient to position to the patient. -to make patient maintained
avoid bronchial irritatants. -educated the patient to comfortable while clearly.
Objective data: -administrates drugs as avoid cigarette smoking. breathing.
Patient is having prescribed by the -administered anti -to prevent coughing
 Dysponea physician. tuberculosis drugs. due to bronchial
 Shortness irritants.
of breath To fasten the process
 heamoptisis of disease healing.

ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION RATIONALE EVALUTION

DIAGNOSIS
Subjective data: Altered body Body -assess the condition of - assessed the patient -to monitor the
Patient complains temperature temperatur the patient. condition. patient condition.
of (hyper e will be -check vital signs -checked the vital signs -to know the
 fever pyrexia) maintained especially temperature. temp-100 degree F. severity of
 shivering related to normal. -apply cold compress -applied the cold compress infection. -body temperature of
 weakness infection. or cold sponge. to the patient. -to reduce fever,& the patient was
 headache -encourage the patient -encourage the patient to to maintain maintained normal.
to take more fluids and take more fluids and cold balanced body
Objective data: cold drinks. drinks. temperature.
Patient is having
  increased -administers anti -advice the patient to take -to make the body
temperatur pyratic drug to patient . complete rest. cool with help of
e -administered anti pyretic cool drinks.
 chills tab-paractemol 500mg, -to make the
 night oral to the patient. patient comfortable
sweats and to prevent
general weakness.
-to reduce fever by
controlling the
infection.

ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
Subjective data: Altered Nutritiona -assess the nutritional -assessed the nutritional -to monitor the
Patient complaints nutritional l status of pattern of the patient. status of the patient. nutritional status of
of status (less the patient -check the body weight -checked the body weight the patient.
 not feeling than body will be of the patient daily. of the patient. -to assess the
to eat any requirements maintaine -maintain intake and -maintained intake and progress of disease.
thing related to d normal. output chart. output chart. -to maintain normal Nutritional status
 dry mouth anorexia and -encourage the patient -encouraged the patient to nutritional status. of the patient was
 sputum loss of to have small and have small and frequent -to make the diet improved.
production appetite. frequent diet. diet. digested easily and
 cough -educate the patient to -educated the patient to to make patient eat
have fluids and liquids have fluids and liquid more & easily.
Objective data: diets. diets. -to make the patient
Patient is having -educates the patient to -educated the patient to have adequate diet in
 anorexia take caloric and protein take caloric and protein any form.
 weight loss rich diet. rich diet.
 Imbalanced
nutritional
status.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS
Subjective data: Activity Self activity -assess the patient -assessed the patient self -to monitor patient
Patient complaints of intolerance of the activity of the activity. self care activity.
 Weakness related to patient will patient. -assessed the patient in -assessed the
 No energy to weakness and be -assess the patient in doing self care activity patient to find out Self care activity
do work fatigue. improved. doing the self care while taking food. the level of self of the patient was
 Cough and activity such as -encourage the patient to care while taking improved.
chest pain changing dress, do coughing and breathing food, changing
while doing bathing and oral exercises. dress.
work. hygiene. -provided semi fowlers -to improve
Objective data: Encourage the position when sleeping. breathing pattern
Patient is having patient to do active - advised patient to take and to drain out
 Self care and passive adequate diet. the sputum from
deficit exercise. lungs.
 Activity -provide semi -to maintain the
intolerance fowlers position general health of
 Weakness when sleeping. the patient.
 Poor personal -advice the patient
hygiene. to take adequate
diet.