LAGUNA NORTHWESTERN COLLEGE

A. Mabini St. San Antonio, San Pedro, 4023 Laguna

A Case Study of Gastrointestinal

Tuberculosis

Submitted by:

GARCIA, Mary Claire Legaspi – 4th year

LOPEZ, Trisha – 4th year
PADILLA, Angelita Cabal – 4th year
MANCENON, Angelica Saludadez – 3rd year
MITRA, Diana Jene Navarro – 3rd year
OLAMAN, Kristine Joy Tacquiawan – 3rd year
LAYDEROS, Angelica Viray – 2nd year
MARASIGAN, Cy Eric Manalaysay – 2nd year
MOLINA, Faye Abegail Ulson – 2nd year
MORENO, Elieana Zheree Manansala – 1st year
PATACSIL, Catherine Enlab – 1st year
PEREZ, Ciara Mariko – 1st year
QUEZON, Mariah Dagohoy – 1st year
RIVADELO, Charmaine Tonelada – 1st year
ROSELLO, Jen Blessy Jasareno – 1st year

Submitted to:

Mr. Irvin Dicdican RN., LPT., MSN., MaEd.,

Instructor

Bachelor of Science in Nursing

 TABLE OF CONTENTS

INTRODUCTION
CHAPTER I - PATIENT’S PROFILE
A. General Data
B. Admission Profile
C. History of Present Illness
D. Past Medical History
E. Heredo-Familial illness
F. Personal/Social History

CHAPTER II – PHYSICAL ASSESSMENT

CHAPTER III- ANATOMY AND PHYSIOLOGY

CHAPTER IV- PATHOPHYSIOLOGY

CHAPTER V- MEDICAL MANAGEMENT

CHAPTER VI- LABORATORY TEST RESULTS

CHAPTER VII- DRUG STUDY

CHAPTER VIII- NURSING CARE PLAN

CHAPTER IX - BIBLIOGRAPHY
 INTRODUCTION

Gastrointestinal tuberculosis is an uncommon form of tuberculosis caused by Mycobacterium

tuberculosis, which typically affects the gastrointestinal (GI) tract. Tuberculosis is a bacterial
infection that usually impacts the lungs and is spread through respiratory fluids when an infected
person coughs, speaks, sings, or sneezes. This infection can affect any part of the GI tract and
cause a variety of symptoms, including abdominal pain and swelling. Known as "the great
mimicker," its symptoms can resemble those of many other GI diseases.

The infection can reach the GI tract by swallowing contaminated phlegm from a TB lung
infection or through the bloodstream and lymphatic system from the lungs. Less commonly, it
can be contracted by ingesting milk products contaminated with Mycobacterium bovis, a related
bacterium affecting cows. Gastrointestinal tuberculosis can affect several parts of the GI tract,
including the esophagus (rarely), stomach, small intestines, large intestines, rectum, and anus.

Symptoms of gastrointestinal tuberculosis can mimic those of other GI conditions such as

Crohn's disease or cancer. The terminal ileum, the end of the small intestines, is most
commonly affected. A 2023 autopsy study found that 96% of over 4,500 individuals with
gastrointestinal tuberculosis had involvement in this area, with 10% also showing involvement in
the cecum, the beginning of the large intestines.

Common symptoms include abdominal pain, weight loss, fever, changes in bowel habits (more
commonly diarrhea than constipation), nausea, vomiting, dark tarry stools, paleness, anemia,
abdominal distention, ascites, enlarged liver and spleen, swollen lymph nodes, and an
abdominal mass. Between 6% and 38% of people with gastrointestinal tuberculosis also exhibit
lung symptoms such as a persistent cough with blood or mucus, exhaustion, high fever, night
sweats, unintentional weight loss, loss of appetite, and general sickness.

Risk factors for tuberculosis include close contact with individuals with gastrointestinal TB,
immigration from regions with high tuberculosis rates, working or spending time in hospitals,
homeless shelters, prisons, nursing homes, and residential homes for people with HIV.
Additional risk factors include smoking, heavy alcohol consumption, illicit drug use, and
conditions that weaken the immune system such as HIV, severe kidney disease, Crohn's
disease, head and neck cancer, and receiving an organ transplant.
 CHAPTER I: PATIENT’S PROFILE

A. General Data

Name: A.P.

Address: San Pedro, Laguna

Gender: Male

Age: 41 years old

Date of Birth: October/27/1982

Nationality: Filipino

Religion: Roman Catholic

Occupation: Company driver

Status: Married

B. Admission Profile

Date of Admission: 05/23/2024

Time of Admission: 7:58 am

Date of History Taking: 05/23/2024

Chief Complaint: Abdominal Pain

Admission Diagnosis: Generalized Peritonitis secondary and ruptured

appendicitis

Final Diagnosis: Gastrointestinal Tuberculosis

Other/Additional Diagnosis: Exploratory Laparotomy omental biopsy

Admitting Physician: Nona Nicole Tupong, MD

C. History of Present Illness

1-day PTC, vomiting 2x, abdominal pain, effectful food w/ associated fluke meals.

FH PTC, abdominal pain from epigastric area to RLQ then eventually quantized
10/10 radiate to back, resisted current consult @ER.
 D. Past Medical History

Based on the interview, the patient has no past medical history, no allergies and
no current medication.

E. Heredo-Familial illness

During the interview, the presenters asked the patient if the patient family had a
history of illnesses or allergies. He said that his brother has gallstones disease,
his mother has hypertension and his father also has hypertension and stroke.

F. Personal/Social History

Patient A.P. was born on October 27, 1982, in San Pedro, Laguna. He has a wife
and three children living together under one roof. He is a company driver. He
said that he drinks and smokes occasionally. The patient stated that he has no
history of respiratory disorders or other related illnesses.
 CHAPTER II - PHYSICAL ASSESSMENT

FOCUS FINDINGS

General Appearance Awake, alert, NICRD

Mental Status Oriented to 3 spheres

Skin + Pinkish
- Jaundice

HEENT +AS PPC

-NAD

Chest/Lungs SCE CBS

Heart AP NRRR

Abdomen Soft tender & rebound

Rectum/Genitalia Intact

Extremities +FEP
-Cyanosis

VITAL SIGNS:

DATE & TIME TEMP PULSE RR C/R B/P

7am 36.9 109 22 98 130/90

8am 36.9 104 23 97 130/80

10am 37.2 85 22 96 140/90

11am 37.3 86 20 100 130/80

12pm 37.5 100 22 99 130/80

1pm 37.5 89 20 99 130/80

2pm 37.4 94 20 99 130/80

3pm 37.4 111 21 99 130/80

4pm 37.0 101 21 99 120/80

5pm 36.8 101 22 98 130/80

8pm 38.1 101 22 98 100/80

9pm 38.6 - - - -

10pm 38.5 - - - -

11pm 36.6 80 20 98 110/70

12am 36.5 89 21 97 110/80

1am 36.4 85 20 98 110/70

2am 36.7 88 20 98 110/70

3am 36.9 90 21 97 100/70

4am 36.1 77 18 98 100/80

CHAPTER III - ANATOMY AND PHYSIOLOGY

Digestive System
 The digestive system, also known as the gastrointestinal (GI) tract, is a complex system responsible for
the breakdown, absorption, and assimilation of nutrients from food, as well as the elimination of waste
products. It comprises a series of organs that work together to facilitate these processes. It is responsible
for the breakdown and absorption of nutrients, water, and electrolytes while also serving as a vital barrier
against pathogens. Gastrointestinal tuberculosis (GI TB) occurs when Mycobacterium tuberculosis infects
the digestive tract, and its impact on digestive system physiology can be profound.

Mouth: Digestion begins in the mouth, where food is ingested, chewed, and mixed with saliva. Saliva
contains enzymes, such as amylase, which start the breakdown of carbohydrates.

Esophagus: After swallowing, food travels down the esophagus, a muscular tube that connects the
mouth to the stomach, through a process called peristalsis.

Stomach: The stomach secretes gastric juices containing enzymes and hydrochloric acid, which break
down proteins and kill bacteria. This creates an acidic environment. Muscular contractions mix food with
gastric juices, forming chyme, a semi-liquid mixture.
Small Intestine: Digestion continues in the small intestine with the help of enzymes from the pancreas
and bile from the liver. Nutrient absorption primarily occurs here, facilitated by villi and microvilli, tiny
finger-like projections that increase surface area.

Large Intestine: The large intestine absorbs water and electrolytes from the remaining chyme, forming
feces. It also houses beneficial bacteria that help ferment undigested carbohydrates, producing gases
and some vitamins.

Lymphatic System: The lymphatic system is integral to immune function. Lymph nodes, lymphatic
vessels, and lymphatic organs help filter and circulate lymph fluid, which carries white blood cells and
other immune cells to fight infections and remove toxins.

CHAPTER IV - PATHOPHYSIOLOGY
 CHAPTER V - MEDICAL MANAGEMENT

DATE/TIME DOCTOR’S DOCTOR’S ORDER RATIONALE

NOTE

MAY A: >Please admit under the  PLR x 1L @ 120cc/hr.:

23,2024 GENERALIZED service of Dr.TIPON Gastrointestinal
PERITONITIS >NPO tuberculosis can lead to
secondary to >PLR x 1L @ 120cc/hr complications such as
ruptured >Diagnostics: CBC with dehydration due to
appendicitis PC (complete blood symptoms like diarrhea
count with platelet count) and vomiting. This fluid
ABO PT/PTT NA,K,Crea order aims to address
Chest Xray (AP/L) any dehydration present
before surgery and to
optimize the patient's
fluid status.

Diagnostics:
>TX: (meds) 1.
Piptozabactum  CBC with PC:
4.5 g now after Tuberculosis can affect
anst then q8 the blood, causing
anemia or other
abnormalities. Platelet
count is essential as
 tuberculosis can affect
platelet production or
Paracetamol function.
600mg TN q8  ABO Typing, PT/PTT:
These tests are
necessary for surgical
preparedness to ensure
 blood compatibility and
assess the risk of
Omeprazole 40
bleeding during surgery.
mg TN OD
 NA, K, Crea:
>For Laparoscopic
Tuberculosis can affect
appendectomy
renal function, so it's
>Please secure consent
essential to assess
prior admission and
electrolyte levels and
 procedure kidney function.
>VS Q2  Chest X-ray (AP/L):
>Monitor I&O q1 without Gastrointestinal
fail >Refer tuberculosis can spread
>Please insert foley to the lungs, causing
catheter now pulmonary tuberculosis.
>Refer A chest X-ray helps
assess the extent of lung
involvement.

TX (Treatment):

 Piptozabactum: Given
before surgery to prevent
postoperative infections,
which can be more
severe in patients with
tuberculosis.
 Paracetamol:
Tuberculosis can cause
fever and pain.
Paracetamol helps
manage these
symptoms.
 Omeprazole: Patients
with gastrointestinal
tuberculosis may have
gastric involvement or
may be on medications
that can cause gastric
irritation. Omeprazole
helps reduce gastric acid
secretion and prevent
irritation.
  For Laparoscopic
appendectomy: If the
patient has
gastrointestinal
tuberculosis and
presents with symptoms
suggestive of
appendicitis, an
appendectomy may be
indicated. However, it's
crucial to differentiate
between appendicitis and
other abdominal
pathologies that mimic its
symptoms, including
tuberculosis.
 VS Q2: Tuberculosis can
cause fluctuations in vital
signs, and closely
monitoring them every 2
hours allows for early
detection of any
deterioration or
complications.
 Dehydration is a concern
in patients with
gastrointestinal
tuberculosis, and close
monitoring of fluid intake
and output is essential to
prevent further
complications.
 Please insert foley
 catheter now: This
might be indicated if the
patient is unable to
urinate due to abdominal
distension or other
factors related to
gastrointestinal
tuberculosis, ensuring
adequate urinary
drainage during surgery.

MAY 24, S/P (status post) Anesthesia

2024 ExLap, postoperative order:
conditional >Transfer to Recovery  After surgery for
biopsy order room. Moderate high gastrointestinal
GETA back rest. tuberculosis, transferring
BP 138/90 >Hook to O2 via the patient to the
HR: 98 facemask @ 4-6 lpm recovery room with a
RR: 20 >Hook to standard moderate high backrest
SPO2: 100% monitor helps optimize
>Monitor VS q15 x 1 hr. respiratory function and
then q30 until stable aids in the prevention of
>Monitor I&O accurately aspiration and respiratory
and record complications.
>NPO  Hook to O2 via
>IVF: D5LR 1L x 8 hours facemask @ 4-6 lpm:
2 cycles then D5NM 1L x Oxygen therapy is
8 hours initiated to ensure
>Meds: ketorolac 30mg adequate oxygenation,
IV q8 x 6 doses ANST especially in patients
Tramadol 50mg IV who may have
q6x8doses compromised lung
>Keep patient function due to
 thermoregulated
>WOF (watch out for):
Hypotension,
desaturation, severe
pain, profuse bleeding
>Refer  Standard monitoring
 Monitor VS q15 x 1 hr
 Monitor I&O accurately
tuberculosis involvement.
The flow rate of 4-6 liters
per minute helps
maintain optimal oxygen
saturation levels.
equipment, including
ECG, pulse oximetry,
and blood pressure cuff,
is attached to
continuously monitor the
patient's vital signs and
detect any abnormalities
promptly.
then q30 until stable:
Frequent monitoring of
vital signs every 15
minutes for the first hour
postoperatively and then
every 30 minutes until
stable helps ensure early
detection of any signs of
hemodynamic instability
or respiratory
compromise, which can
be more pronounced in
patients with
tuberculosis.
and record: Accurate
measurement and
recording of intake and
 output are essential for
assessing fluid balance
and renal function,
especially in patients with
gastrointestinal
tuberculosis who may be
prone to fluid imbalances
due to vomiting or
diarrhea.
 The patient is kept NPO
(nothing per orem,
nothing by mouth) to
prevent aspiration in
case of delayed recovery
from anesthesia or
postoperative nausea
and vomiting.
 IVF: D5LR 1L x 8 hours
2 cycles then D5NM 1L
x 8 hours: Intravenous
fluid therapy is initiated to
maintain hydration and
electrolyte balance.
Initially, D5LR (5%
dextrose in lactated
Ringer's solution) is
administered to provide
glucose and address
fluid deficits.
Subsequently, D5NM
(5% dextrose in normal
saline) is administered to
maintain hydration.
 Pain management is
crucial in postoperative
care. Ketorolac and
tramadol are prescribed
for pain relief, with
ketorolac administered
intravenously every 8
hours for a total of 6
doses and tramadol
intravenously every 6
hours for a total of 8
doses.
 Maintaining
normothermia helps
prevent complications
such as surgical site
infections and shivering,
which can increase
oxygen consumption and
stress on the body.
 Close monitoring for
signs of complications
such as hypotension,
desaturation, severe
pain, and profuse
bleeding is essential for
timely intervention and
management.

 Maintain JP drain,
measure output q4 and
record: Jackson-Pratt
drain maintenance and
 monitoring of output
every 4 hours help
prevent fluid
accumulation and detect
any signs of infection or
bleeding.
 Maintain IFC, measure
output q1 and record:
Intermittent Foley
catheter maintenance
and hourly monitoring of
urine output help assess
renal function and fluid
balance.
 Regular wound care is
essential for preventing
infection and promoting
wound healing in patients
undergoing surgery for
gastrointestinal
tuberculosis.
 VS q2 and record: Vital
signs are monitored
every 2 hours to assess
the patient's stability and
response to treatment.
 I&O qshift: Intake and
output are measured and
recorded every shift to
monitor fluid balance and
renal function.
 Close observation for
signs of abdominal pain,
 hypotension (systolic
blood pressure less than
90 mmHg), tachycardia
(heart rate greater than
90 bpm), and decreased
urine output (less than 30
cc/hr) helps detect
complications such as
bleeding, sepsis, or renal
impairment.

MAY S/P exploratory >NPO for now  Intravenous fluids are

25,2024 laparotomy, >IVF: c/o anes prescribed as per the
order biopsy DX: for peritoneal fluid anesthesiologist's
gene expert discretion. Given the
TX: patient's condition and
the potential fluid shifts
associated with surgery
and tuberculosis,
 intravenous fluids are
likely necessary to
Piptozabacton maintain hydration and
4.5 g TIV q8 electrolyte balance.
 DX: for peritoneal fluid
gene expert: This
indicates the need for
 testing peritoneal fluid
using gene expert
Omeprazole
technology to confirm the
40mg TIV OD
presence of
Mycobacterium
tuberculosis in the
abdominal cavity.
 Peritoneal fluid analysis
is crucial for diagnosing
gastrointestinal
 tuberculosis.
 TX: Treatment involves
Pain medications antibiotic therapy and
c/o anes acid suppression:
>Maintain JP drain,  Piptozabacton 4.5 g TIV
measure output q4 and q8: Piptazobactam, a
record broad-spectrum
>Maintain IFC, measure antibiotic, is administered
output q1 and record intravenously every 8
>Daily wound care hours to target the
>VS q2 and record tuberculosis infection and
>I&O qshift prevent complications
>WOF: abdominal pain, such as secondary
hypotension (SBP less bacterial infections.
than 90) Tachycardia  Omeprazole 40mg TIV
greater than 90 and OD: Omeprazole, a
urine output less than 30 proton pump inhibitor, is
cc/hr >Refer administered
intravenously once daily
to reduce gastric acid
secretion and prevent
gastric irritation, which
can be exacerbated by
tuberculosis medications
and stress from surgery.
 Pain medications c/o
anes: Pain management
is essential
postoperatively, and the
specific medications
 prescribed may vary
based on individual
patient factors and
anesthesia preferences.
 Maintain JP drain,
measure output q4 and
record: Jackson-Pratt
drain maintenance and
monitoring of output
every 4 hours help
prevent fluid
accumulation in the
surgical site, reducing
the risk of infection and
promoting wound
healing.
 Maintain IFC, measure
output q1 and record:
Intermittent Foley
catheter maintenance
and hourly monitoring of
urine output are essential
for assessing renal
function and ensuring
adequate urinary
drainage, especially
considering potential
renal involvement in
tuberculosis and
perioperative fluid shifts.
 Regular wound care is
crucial for preventing
infection and promoting
 healing of the surgical
incision site, particularly
important in patients with
tuberculosis who may
have impaired immune
function.
 Vital signs are monitored
every 2 hours to assess
the patient's
physiological stability,
detect any signs of
postoperative
complications, and
ensure early intervention
if needed.
 Intake and output are
measured and recorded
every shift to monitor
fluid balance, renal
function, and response to
treatment, facilitating
adjustments to fluid and
medication management
as necessary.
 Close observation for
signs of complications
such as abdominal pain,
hypotension (systolic
blood pressure less than
90 mmHg), tachycardia
(heart rate greater than
90 bpm), and decreased
urine output (less than 30
 cc/hr) allows for early
detection and
management of
postoperative
complications, including
infection, bleeding, and
hemodynamic instability.

MAY 26, (+) Skin lesion at >Calamine lotion to  Patients with

2024 buttocks noted apply 2x a day at gastrointestinal
buttocks area tuberculosis may
experience
gastrointestinal
symptoms such as
diarrhea, which can lead
to frequent bowel
movements and
increased irritation of the
skin in the buttocks area
due to prolonged
exposure to fecal matter.
 Calamine lotion has
soothing properties and
forms a protective barrier
over the skin. Applying it
to the buttocks area can
help soothe any existing
irritation and provide a
protective layer that
reduces friction and
irritation from clothing
and bodily fluids.
 Skin irritation in the
 buttocks area can cause
itching and discomfort,
especially in the
presence of diarrhea and
increased moisture.
Calamine lotion can help
alleviate itching and
provide relief from
discomfort, promoting
comfort and improving
the patient's quality of
life.
 Irritated and broken skin
in the buttocks area is
susceptible to secondary
bacterial infections,
which can further
complicate the patient's
condition. Calamine
lotion's antiseptic
properties can help
prevent such infections
by creating a protective
barrier and maintaining
skin integrity.

CHAPTER VI – LABORATORY TEST RESULTS

A. Hematology

PARAMETER RESULT REFERENCE VALUES

 Hemoglobin 146 140-175 g\L

Hematocrit 0.44 0.41-0.50

RBC Count 4.86 4.5-5.9 ×10 12/L

WBC Count 18.90 4.4-11 ×10 9/L

Platelet Count 310 150-450 ×10 9/L

DIFFERENTIAL COUNT

Neutrophils 0.91 0.50-0.70

Lymphocytes 0.05 0.20-0.40

Monocytes 0.04 0.0-0.07

Eosinophils 0.0-0.05

Basophils 0.0-0.01

Stabs 0.0-0.05

Date: 05-23-2024

PARAMETER RESULT REFERENCE VALUES

Hemoglobin 103 140-175 g\L

Hematocrit 0.31 0.41-0.50

RBC Count 3.59 4.5-5.9 ×10 12/L

WBC Count 11.19 4.4-11 ×10 9/L

Platelet Count 275 150-450 ×10 9/L

DIFFERENTIAL COUNT

Neutrophils 0.84 0.50-0.70

Lymphocytes 0.07 0.20-0.40

Monocytes 0.07 0.0-0.07

Eosinophils 0.02 0.0-0.05

Basophils 0.0-0.01
 Stabs 0.0-0.05

Others Manually Checked

Date: 05-26-2024

B. URINALYSIS

TEST RESULT REFERENCE VALUES

PHYSICAL & CHEMICAL EXAM

Color Dark Yellow Straw to Dark Yellow

Transparency Hazy Clear

Ph 5.0 5.0-7.5

Specific Gravity 1.030 1.005-1.030

Sugar +2 Negative

Protein TRACE Negative

MICROSCOPIC EXAM

Red Blood Cells 0-2 0-3/HPF

Pus Cells 3-5 0-5/HPF

Bacteria None seen None-Few

Epithelial Cells None seen None-Few

Mucus Threads Few None-Few

Cast HYALINE CAST 2-3 None

COARSE GRANULAR 1-2 None

Crystals None seen

Amorphous Materials Urinates Moderate

Date: 05-23-2024

C. ELECTROLYTES
 RESULT REFERENCE VALUES

Sodium 134.2 135-145 mmol/1

Potassium 3.65 3.5-5.3 mmol/1

Date: 05-23-2024

D. CLINICAL CHEMISTRY I

TEST SI VALUE REFERENCE CONVENTIONAL REFERENCE

RESULT VALUES RESULT VALUES

Creatinine 61.90 79.56-132.6 0.68 0.9-1.5 mg/dl

umol/L

E. LABORATORY REPORT

COVID19 ANTIGEN DIAGNOSTIC TEST

METHOD USED: Lateral Flow

KIT USED: PANBIO COVID-19 Rapid Test Device
LOT NO.: 41ADH608A
EXPIRY: 08/24/2024
SPECIMEN: Nasopharyngeal Swab (NPS)

SARSCOV-2 ANTIGEN RAPID TEST RESULT: Negative

Date: 05-23-2024

`CHAPTER VII - DRUG STUDY

 NAME OF CLASSIFICATI INDICATIONS/ ADVERSE EFFECTS/ NURSING
DRUG, ON/ CONTRAINDICATI SIDE EFFECTS RESPONSIBILITY
GENERIC MECHANISM ONS
NAME, BRAND OF ACTION
NAME,
DOSAGE,
FREQUENCY,
ROUTE OF
ADMINISTRATI
ON

Doctor's Order: Piperacillin: Piperacillin: For the  Nausea  Watch for

Piperacillin + Binds to specific treatment of  Diarrhea seizures; notify
tazobactum penicillin- polymicrobial  Fever the physician
binding proteins infections.  Constipation immediately if
Generic Name: located inside the patient
 Vomiting
Piperacillin, the bacterial cell Tazobactum: Used develops or
 Headache
Tazobactum wall, inhibiting in combination with increases
 Mouth Sores
the third and piperacillin to seizure activity.
 Heartburn
last stages of broaden the  Monitor signs of
Brand Name:  Stomach pain
cell wall spectrum of pseudomembra
Zosyn  Difficulty falling
synthesis. piperacillin nous colitis,
or staying
antibacterial action, including
Dosage: asleep
Tazobactum: treating susceptible diarrhea,
4.5g
Broadens the infections, including abdominal pain,
Important: fever, pusbor
spectrum of those caused by
Frequency: q6 mucus in stools,
piperacillin by aerobic and
making it facultative gram- amd other
Route of effective against positive and gram-  Rash severe or
Administration organisms that negative anaerobes.  Itching prolonged GI
: IVF express beta- Contraindications: problems
 Hives
lactamase and Hypersensitivity to (Nausea,
 Difficulty
Classification: would normally piperacillin, vomiting,
breathing or
Penicillin, beta- degrade them tazobactum, β- heartburn)
swallowing
lactamase through the lactamase inhibitors Notify the
 Wheezing
inhibitors irreversible and history of physician or
 inhibition of severe allergic  Severe nursing staff
beta-lactamase reactions to β- diarrhoea immediately of
enzymes. lactams (e.g. these signs.
cephalosporins,  Monitor signs of
carbapenems, allergic
monobactams). reactions and
anaphylaxis

Doctor's Tramadol is a Tramadol is a

Order: centrally acting strong painkiller
Tramadol analgesic that from a group of  Nausea  Watch for
has opioid medicines called  Vomiting seizures or
Generic agonist opiates, or  Constipation increased
Name: properties. It narcotics. It is  Lightheadedne seizure
Tramadol binds to μ- used to treat ss activity,
opiate moderate to  Dizziness especially at
Brand Name: receptors in severe pain,  Headache the onset of
Tramet the CNS especially after an drug
resulting in operation or Important: treatment.
Dosage: inhibition of serious injury. Document the
50mg neuronal number,
Frequency: uptake of Contraindication duration, and
 Sleep apnea
q8 norepinephrine s: Acute severity of
 Agitation
and intoxication with seizures, and
 Hallucinations
enhancement centrally acting report these
Route Of  Severe
of serotonin analgesics, findings
Administratio stomach/abdo
release may hypnotics, immediately to
n: IV minal pain
also contribute psychotropic the physician
to its analgesic drugs, alcohol, or or nursing
Classification
effect. other opioids; staff.
:
Therapeutic: uncontrolled  Notify the
analgesics epilepsy, physician
(centrally significant immediately if
acting) respiratory patient is
depression, acute unconscious
or severe or extremely
bronchial asthma difficult to
(In unmonitored arouse.
setting or lack of
resuscitative
equipment),
known or
suspected
gastrointestinal
obstruction
(including paralytic
ileus). Children
<12 years and in
children <18 years
who have
undergone
tonsillectomy
and/or
adenoidectomy.

Doctor's It inhibits the Short-term  Headache  Check that the

Order: production of treatment of  Fatigue patient is not
Paracetamol prostaglandins moderate pain,  Insomnia taking any
, which are especially after  Hypertension other
Generic substances in following surgery  Hypotension medications
Name: the body that and for short-term  Nausea containing
Paracetamol contribute to treatment of fever,  Vomiting paracetamol.
pain and when  Constipation  Monitor the
inflammation. administration by patient’s
Brand Name: It also affects IV route is response to
Ifimol the activity of clinically justified the medication
certain by an urgent need to ensure that
Dosage: neurotransmitt to treat pain or the medication
600mg ers in the brain hyperthermia is effectively
that are and/or when other managing the

Frequency: involved in the routes of patient’s pain

q8 perception of administration are and to make

pain. not possible. necessary

Route of adjustments to

Administratio Contraindication the dosage.

n: IV s: Hypersensitivity
to paracetamol

Classification and propacetamol

: HCI (prodrug of

Analgesics paracetamol).

(Non-Opioid) & Severe

Antipyretics hepatocellular
insufficiency.

Doctor's Celecoxib is a For relief of the  Headache  Assess patient

Order: selective signs and  Hypertension for allergy to
 Celecoxib noncompetitiv symptoms of  Upper sulfonamides,
e inhibitor of juvenile abdominal pain aspirin, or
Generic cyclooxygenas rheumatoid  Nausea NSAIDs.
Name: e-2 (COX-2) arthritis in patients  Diarrhea Patients with
Celecoxib enzyme. COX- 2 years and older.  Vomiting these allergies
Brand Name: 2 is expressed Contraindication should not
Celebrex, heavily in s: Contraindicated take
Celcoxx, inflamed in patients with Celecoxib.
Celenova, tissues where known  Monitor for
Emicox it is induced by hypersensitivity to signs and
inflammatory celecoxib, in symptoms of

Dosage: mediators. patients who have DRESS

200mg demonstrated (fever, rash,

allergic-type lymphadenop

Frequency: reactions to athy, facial

BID sulfonamides, in swelling)

patients who have periodically
experienced during
Route Of
asthma, urticaria, Therapy.
Administratio
or allergic-type
n: Oral
reactions after
taking aspirin or
Classification
other NSAIDs.
:
Class of
NSAIDs, COX-
2 Inhibitors
 Doctor's Omeprazole is Omeprazole  Stuffy nose  Nurses should
Order: a specific reduces the  Sneezing monitor
Omeprazole inhibitor of H+, amount of acid  Sore throat patients for
K (+)-ATPase your stomach  Fever signs and
Generic or ‘proton makes. It's widely  Stomach pain, symptoms of
Name: pump’ in used to treat gas gastroesopha
Omeprazole parietal cells. indigestion and  Nausea geal reflux
This enzyme is heartburn, and  Vomiting disease and

Brand Name: responsible for acid reflux. It's  Diarrhoea peptic ulcer

Omepron the final step also taken to  Headache disease.

in the process prevent and treat  When patients

Dosage: of acid stomach ulcers. are on long-

40mg secretion. Contraindication term

Omeprazole s: omeprazole,
blocks acid Omeprazole is physicians
Frequency:
secretion in contraindicated in should
OD
response to all patients with a monitor the
stimuli. history of patient for C.
Route of
hypersensitivity to difficile-
Administratio
the drug or any associated
n: IV
excipients from diarrhoea and
the dosage form. hypo
Classification
Hypersensitivity magnesia.
:
reactions like
Proton-pump
anaphylaxis,
inhibitors
urticaria, and
bronchospasm
 may occur.

Doctor's Ketorolac Ketorolac is used  Abdominal or  Assess the

Order: inhibits key to relieve Stomach pain patient first
Ketorolac pathways in moderately severe  Bruising before
prostaglandin pain, usually pain  Swelling of administering
Generic synthesis that occurs after face, fingers, Ketorolac.
Name: which is an operation or lower legs, Know the
Ketorolac crucial to its other painful ankles, and/or patient’s
mechanism of procedures feet history

Brand Name: action. Contraindication  High blood especially for

Kortezor Although s: Ketorolac is pressure allergies.

Ketorolac is contraindicated in  Skin rash
non-selective patients with  Chest pain
Dosage:
30mg and inhibits moderate or
both COX-1 severe renal
and COX-2 impairment
Frequency:
enzymes, its (serum creatinine
q8
clinical efficacy >160 µ mol/l) or in
is derived from patients at risk for
Route of
its COX-2 renal failure due to
Administratio
 n: IV inhibition. volume depletion
or dehydration.
Classification Ketorolac is
: contraindicated in
Non-steroidal pregnancy, labour,
anti- delivery or
inflammatory lactation.
drugs
 CHAPTER VIII - NURSING CARE PLAN

Assessment Diagnosis Planning Implementation Evaluation

Subjective Data:  Acute pain  Patient will rate  Perform  After the
related to pain scale lower comprehensive provided
 Patient verbalize inflammation that the initial assessment of interventio
that he evidence by rate at a level that pain ns patient
experiences patient is acceptable  Administer will be able
vomiting and reporting  Patient will prescribed pain to properly
abdominal pain localized manifest vital sign medications describe
 Patient verbalize abdominal within normal  Encourage and where,
that the pain pain with the limit teach the when and
begins in the presence of  Patient uses patient to use how the
epigastric area vomiting pharmacological nonpharmacol pain his
and moved to the and ogical relief feeling
right lower nonpharmacologic methods  Patient’s
quadrant, it will al pain-relief  Monitor Vital vital sign
radiate to his back strategies sign and pain will be
and will eventually level within
spread normal
throughout the  Patient will
abdomen be able to
demonstra
Objective Data: te the
 Pain scale 10/10 correct and
as effective
 (+) soft, tender, non
round and pharmacol
rebounded ogical
abdomen techniques
 Pale looking will lessen
the pain
VS:  Patient will
verbalize
PR: 104 pain level
RR: 23 below 3
 Post-Operative NCP

Assessment Diagnosis Planning Implementation Evaluation

Objective Data: Risk for Infection:  To  Monitor  After following the
 S/P Exlap related to surgery prevent Vital signs provided intervention
and infection and there is no signs of
immunocompromised and to observe infection which helps
state evidence by promote signs of in the complete and
surgical incision healing infection timely healing of the
of the  Maintain patient’s surgical
surgical strict wound
site aseptic
technique
 Promote
proper
hand
hygiene
 Administer
prescribed
medications
 Provide
health
teaching
and
adequate
information

Nursing Management

Preoperative Nursing Management

 Obtain a detailed medical history, including allergies, current medications, previous

surgeries, and any chronic conditions.
 Conduct a thorough physical examination to assess the patient's overall health status.
 Ensure all preoperative tests are completed and reviewed.
 Explain the surgical procedure, including risks and benefits, to the patient and family.
 Provide instructions on fasting, medication adjustments, and bowel preparation if
needed.
  Review and manage medications, including stopping or adjusting anticoagulants and
other drugs as needed.
 Ensure appropriate skin preparation, including bathing and hair removal if necessary.
 Verify that informed consent is obtained and documented.

Intraoperative Nursing Management

1. Patient Safety:

 Verify patient identity and surgical site with the surgical team.
 Position the patient safely and comfortably to prevent pressure injuries.
 Maintain a sterile environment to prevent infections.

2. Monitoring:

 Continuously monitor vital signs, including heart rate, blood pressure, oxygen saturation,
and temperature.
 Monitor fluid balance, including input and output of fluids, to maintain hemodynamic
stability.
 Assist the anesthesiologist in monitoring the patient's response to anesthesia.

3. Documentation:

 Accurately document all intraoperative events, medications administered, and any

complications.
 Properly label and handle any specimens collected during the surgery.

Postoperative Nursing Management

1. Immediate Postoperative Care:

 Transfer the patient to the Post-Anesthesia Care Unit (PACU) for close monitoring.
 Frequently monitor vital signs and compare them to baseline values.
 Assess pain levels and administer prescribed pain medications.
 Ensure the patient's airway is clear and monitor for signs of respiratory distress.

2. Ongoing Postoperative Care:

  Conduct regular assessments, including monitoring for signs of infection, bleeding, and
thrombosis.
 Inspect the surgical site for proper healing and provide wound care as needed.
 Encourage early mobilization to prevent complications such as deep vein thrombosis
and pulmonary embolism.

3. Patient Education and Discharge Planning:

 Provide detailed instructions on wound care, medication management, and activity

restrictions.
 Schedule follow-up appointments and ensure the patient understands the importance of
attending them.
 Educate the patient and family on signs of potential complications and when to seek
medical help.

4. Documentation:

 Document all assessments, interventions, patient responses, and any changes in

condition.
 Prepare a comprehensive discharge summary, including details of the surgery,
postoperative course, and discharge instructions.

CHAPTER IX - BIBLIOGRAPHY

Yetman, D. (2024, January 19). Overview of Gastrointestinal Tuberculosis. healthline.

https://www.healthline.com/health/gastrointestinal-tuberculosis#complications

https://www.healthline.com/health/abdominal-tuberculosis
https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
https://www.ncbi.nlm.nih.gov/books/NBK556115/