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COLLEGE OF NURSING
Malolos Bulacan
This is the case of a fifty-one year old female diagnosed of Pneumonia vs. Pulmonary
Tuberculosis
Submitted by:
Labrador, Bernadette M
BSN 4A/3B
Submitted to:
This is the case of a fifty-one year old female client residing at RMB Balagtas Bulacan, who was admitted at Gregorio Del Pilar District Hospital last August
Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease caused by various strains of mycobacterium,
usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when
people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections
eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims.
The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight. Infection of other organs causes a wide range of
symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological
culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic
resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus
Calmette-Guérin vaccine.
A third of the world's populations are thought to be infected with M. tuberculosis, and new infections occur at a rate of about one per second. The proportion
of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still
increasing. In 2007 there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries. In
addition, more people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance
abuse, or AIDS. The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in
Pneumonia is an inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli)
and abnormal alveolar filling with fluid (consolidation and exudation). The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange.
Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its cause
may also be officially described as unknown when infectious causes have been excluded. Typical symptoms associated with pneumonia include cough, chest
pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial
pneumonia is treated with antibiotics. Pneumonia is common occurring in all age groups, and is a leading cause of death among the young, the old, and
the chronically ill. Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any complications,
According to the Department of Health (DOH) PTB is the 6th cause of mortality and morbidity in the Philippines as of 2008. This disease is can be acquired
easily by a person being in contact with an infected one, when you are living in a crowded area like the squatters area and when you have a poor nutrition. it is
commonly present in third world or developing countries like the Philippines. In 2007, mortality and morbidity statistics included 14.6 million chronic active cases,
8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting
tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse or AIDS. The distribution of tuberculosis is not uniform
across the globe with about 80% of the population in many Asian and African countries testing positive in tuberculin tests, while only 5-10% of the US population
testing positive.
OBJECTIVES
General
• To be able to established Nursing Care Plan for a client with Pulmonary Tuberculosis
Specific
• To be able to differentiate Pulmonary Tuberculosis from other disease with the presenting signs and symptoms.
BIOGRAPHIC DATA
Birthplace: Masbate
Nationality: Filipino
Sex: Female
Occupation: Housewife
Health Care Financing and usual source of medical care: With the help of her children and help by their neighbors.
Educational Attainment: Elementary Undergraduate
B. CHIEF COMPLAINT
“Madalas akong inuubo kung kaya’t hinihingal ako at sumasakit ang aking sikmura pagkatapos kong maubo.” as verbalized by the client.
The client was admitted at Gregorio Del Pilar District Hospital at exactly 8:30 pm of August 3, 2010. She brought to the hospital by her children
because of cough. Her symptoms occur after the rain falls; she also experienced colds, headache and also difficulty of breathing.
Client stated that during her childhood she had experienced chickenpox and was not able to recall if she had experience to have mumps before. She
stated that there is an immunization given to her but cannot recall what it is. She said that she experienced cough since last year until now. And she takes
Solmux, Cefalexin, and Ambroxol to relieve it as she explained. But her symptoms didn’t exist until now, she also states that she has asthma; the medication
she takes is Ventolin. She included that she has no allergies to drug and foods. Mrs. SRC’s first hospitalization was due to her present condition which
having a cough.
E. FAMILY HEALTH ILLNESS HISTORY
Mrs. SRC stated that she cannot recall what the cause of death of her grandparents on both paternal and maternal side. She stated that her father and
mother died because of Lung problem. She has four (4) siblings and all of them doesn’t experiencing cough. Her husband was also admitted at the said
hospital because of Lung Problem according to the client. See the Family’s Genogram on the next page:
FAMILY’S GENOGRAM
LEGENDS:
+ -Deceased
-Female -Male
F. FUNCTIONAL HEALTH PATTERNS
I. Health Perception Client stated that absence of any disease will be Client described that being healthy is being free from any
considered as healthy individual. She doesn’t smoke and illness and can do whatever she wants to do without any
drink liquor. She also stated that sometimes she disobey difficulties in doing things. Now, that she has been
rules pertaining of having a good health because of her hospitalized, she realized that being aware on one’s health
simple life. Client described that being healthy is being is really important in person’s life. And she will follow her
physically fit, eating a balance diet, taking care of health doctor’s advice.
II. Nutritional and Metabolic Pattern Client stated that she eats whatever foods he wants and Due to her condition Mrs. SRC maintains her diet. During
when it is available. And have no difficulty in eating, these days she loses her appetite but trying to eat nutritious
chewing and swallowing. foods and drinks at least 8 glasses of water each day.
Lugaw ½ cup
Water 500ml
Lunch
Rice 1 cup
Water 500ml
Dinner
Rice 1 cup
Sabaw ng sinigang na
baboy 1 cup
300ml of water
August 6, 2010 Breakfast
Lugaw ½ cup
Milk 1 cup
Lunch
1 cup of rice
small
200 ml of water
III. Elimination Pattern Client defecates twice a day with the characteristics of Client defecates once a day with soft, brown in color and
soft and semi-formed, cylindrical and brown in color. with normal odor.
She urinates for about 3-4 times a day. The client’s urine She urinates for about 3-4 times a day. The client’s urine is
IV. Activity- Exercise Pattern Client has a full self- care. Client has low activity level because of her health
0 Dressing I Feeding
0 Grooming II Bathing
I Dressing
Level 0: Full self- care
II Grooming
Level I: required use of equipment or device
II Bed mobility
Level II: required assistance or supervision from
another person
V. Sleep- Rest Pattern Client stated before the illness she sleeps at around 7pm- During her illness, Mrs. SRC stated that she have difficulty
8pm and wake up at 6:00am. She reported no problems of falling asleep at the first two days of admission it’s just
falling asleep because of her illness but also due to the hospital
VI. Cognitive- Perceptual Alteration For her she believes that she is healthy even though she Client stated she feels that she is not in good physically
cannot eat those foods that are delicious. She loves her healthy and not emotionally healthy due to her condition.
family and her neighbors and reports that they are very She loves her family and her neighbors and reports that
supportive when their problem arises. they are very supportive when their problem arises.
Client doesn’t wear eyeglasses; Mrs. SRC has no Client doesn’t wear eyeglasses; Mrs. SRC has no difficulty
difficulty in learning and easy to learn things. And when in learning and easy to learn things. And when she feels
she feels any discomfort she usually sleeps and tells this any discomfort she usually sleeps and tells this to her
her self as simple wife who wants to experience irritable because of her condition. She reported that she
everything in his life. She usually finds happiness into the have no problem about her self-perception and self-
simple things surrounds her, especially when it is about concept. Since the illness started the client became worried
his family and her neighbors. because of what might happen to her and to her family
hospital.
VIII. Role and Relationship Pattern Client stated that her family is a nuclear type. She likes to She misses her neighbors and her children also. Her
keep her family happy and healthy by showing love and daughter is the one who’s taking care of her and she is very
care. Decisions in the family were made between her and thankful that she had such a daughter. Her neighbors
her husband. She always kept an open communication helping them by giving them money for the hospital bill or
with her husband and children. Her relationships with her for the medicine that she takes.
IX. Sexuality- Reproductive Pattern The client refused to talk about her sexual matters. The client refused to talk about sexual matters.
X. Coping- Stress Pattern She was telling to her daughter if she has discomfort. She Mrs.SRC keeps telling to her daughter whenever there is a
handles problems with her family. They can face any discomfort or pain because she feared what might happen
problems in their life, as the client stated. to her if she will hide what she feels.
XI. Values and Beliefs Pattern She doesn’t get all the things that he wants especially The only changes in her values belief is that she is much
when it regards to material things, because of insufficient attached now to God. And just letting her to decide of what
financial capacity for such materials and also because of will happen to her. And she also said that she thinks that it
the condition of her family. But she stated that even is a punishment of God.
though they are not that rich, still they are happy together
healing sometimes.
ANATOMY AND PHYSIOLOGY
We often complete the daily tasks of living without thinking about the respiratory system. We breathe in and
out and take for granted one of our most vital organ systems. The respiratory system provides the oxygen necessary to
sustain life. It consists of both upper and lower respiratory tracts. It is divided into two functions: conducting and
respiration.
The function of the respiratory system is to give us a surface area for exchanging gases between the air and our
circulating blood. It moves that air to and from the surfaces of the lungs while it protects the lungs from dehydration,
temperature changes and unwelcome pathogens. It also plays a part in making sounds such as talking, singing, other
nonverbal sounds and works with the central nervous system for the ability to smell.
The upper respiratory system consists of the nostrils (external nares), nasal cavity, nasal vestibule, nasal septum, both hard and soft palate, nasopharynx,
pharynx, larynx and trachea. Within the nostrils, course hairs protect us from dust, insects and sand. The hard palate serves to separate the oral and nasal cavities.
There is a protective mucous membrane that lines the naval cavities and other parts of the respiratory tract. It is secreted over the exposed surfaces and then the cilia
sweep that mucus and any microorganisms or debris to the pharynx, so it is swallowed and then destroyed in stomach acids.
Lower Respiratory Anatomy
The trachea branches off into what is known as the bronchi (more commonly called bronchial tubes). These two main bronchi have branches forming the
bronchial tree. Where it enters the lung, there is then secondary bronchus. In each lung, the secondary bronchi divide into tertiary bronchi and in turn these divide
repeatedly into smaller bronchioles. The bronchioles control the ratio of resistance to airflow and distribution of air in our lungs. The bronchioles open into the
alveolar ducts. Alveolar sacs are at the end of the ducts. These sacs are chambers that are connected to several individual alveoli, which make up the exchange
The Lungs
The human respiratory system has two lungs, which contain lobes separated by deep fissures. Surprisingly, the right lung has three lobes while the left one
has only two lobes. The lungs are made up of elastic fibers that give it the ability to handle large changes in air volume. The pleural cavity is where the lungs are
located. The diaphragm is the muscle that makes up the floor of the thoracic cavity and plays a major role in the pressure and volume of air moving in and out of the
lungs.
Our lungs filter and deliver oxygen that is necessary for healthy red blood cells. It is important that we keep the respiratory tract healthy through proper rest,
(DOB, cough)
Accumulation of exudates in
the alveoli that can cause
recurrence of
bronchopneumonia
DRUG STUDY
DRUG NAME DATE ORDERED/ ROUTE/ GENERAL ACTION/ INDICATION/ NURSING IMPLICATION
DATE TAKEN/ DOSAGE/ CLASSIFICATION/ PURPOSE
GIVEN FREQUENCY MECHANISM OF
ACTION
Cefuroxime August 4, 2010 750 mg TIV q 8° Action: Treatment of the Assess for infection (v/s,
Bind to bacterial cell wall following infections appearance of sputum, urine
membrane, causing cell caused by susceptible at beginning and during
death. Bactericidal action organisms. Respiratory therapy.
against bacteria. tract infection. Before initiating therapy,
obtain a history to
Classification: determine previous use of
Anti- infective and reactions to penicillin
or cephalosporin. Person
with a negative history of
penicillin sensitivity may
still have an allergic
response.
Obtain specimens for
culture and sensitivity
before initiating therapy.
First dose may be given
before receiving results.
Observe patient for signs
and symptoms of
anaphylaxis (rash, pruritus,
wheezing) discontinue the
drug and notify physician or
the other health care
professional immediately if
these symptoms occur.
Salbutamol neb. August 6, 2010 2.5-10mg q 4° Acton: Used as a Assess lung sounds,. Pulse
Binds to beta2- bronchodilator to and BP before
adrenergic receptors in control and prevent administration and during
airway smooth muscle, reversible airway peak of medication. Note
leading to activation a obstruction caused by amount, color and character
adenyl cyclase. asthma. Used as a of sputum produced.
quick-relief agent for Monitor pulmonary
Classification: acute bronchospasm function test before
bronchodilators and for prevention of initiating therapy and
exercise-induced periodically during therapy
bronchospasm. to determine effectiveness
of medication.
Compressed air/oxygen
flow should be 6-
10L/minute; a single
treatment of 3ml lasts about
10 minute.
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: “nahihirapan akong Ineffective airway Short term: Monitor Indicative of Short term:
huminga” as verbalized clearance related respiration and respiratory
by the client. to asthma After 1 hour of nursing After 1 hour of nursing
breathe sounds, distress or
intervention, client will intervention, client was able
noting rate and accumulation
O: be able to maintain to maintain airway patency.
sounds. of secretions.
airway patency.
the patient is Long term:
Evaluate client To determine
coughing Long term:
cough/gag ability to After 2 days of nursing
difficulty After 2 days of nursing reflex. protect own intervention, client was able
vocalizing intervention, client will airway. to clear secretions readily.
be able to clear secretions
To open or
readily. Position head
maintain open
appropriate for
airway in at
condition.
rest.
To take
Elevate head of advantage of
bed and change gravity of
position q 2°. lower pressure
on the
diaphragm.
To maximize
effort.
Encourage deep
breathing
exercise.
periods with
activities.
S: “sumasakit ang Acute Pain Short term: Demonstrate individualized To help lessen the pain. Short term:
sikmura ko pagkatapos relaxation technique.
kong maubo”as After 3-4 hours of After 3-4 hours of nursing
verbalzied by the client nursing intervention, the Observe for non verbal intervention, the patient's pain
patient's pain scale will To assess the client scale was decreased from 7/10
cues of discomfort. properly To protect client
O: decrease from 7/10 to to 4/10.
4/10. from injury.
Guarding Long term:
Long term: Instruct patient to inform To prevent underlying
behavior
nurse if pain relief is not condition. After 1-2 hours of nursing
Observed After 1-2 hours of achieved. intervention the patient was
evidenced of nursing intervention the verbalized absence of pain.
pain patient will verbalize Inform patient of procedure To prevent further
that may increase pain and
With pain scale absence of pain offer suggestions of complication.
of 7/10 coping.
Encourage to perform
breathing exercises. To reduce pain
DISCHARGE PLANNING
Continue taking anti –TB drugs. The intensive phase is for 2 months and the maintenance phase is for 4 months. Medicines are readily available at the health
center.
E- Instructed the patient to practice deep breathing exercise and coughing exercises. Resume previous activities. Prevent extraneous work. Have a regular
physical exercise like brisk walking for 30 minutes daily. For financial insufficiency, there are government drug stores available. The patient may continue her
work.
T- Follow faithfully the regimen for tuberculosis, especially the medications. Have a regular sputum test ordered by the doctor.
H-
o Always cover the mouth and the nose when exposed to person who coughs or sneezes.
o Should not spit anywhere, instead spit in a single container to prevent transfer of M. Tuberculosis.
O- Instruct to have a regular check up at the nearest health center, at least once a week to monitor the progress of the treatment.
D-
S- Always pray for the guidance of the Lord. Spiritual health affects the wellness of an individual greatly. Strengthen relationship with Lord by showing love