Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma caused by slow-growing bacteria that resembles a fungus. It is usually spread from person to person by droplet nuclei through the air. The lung is the usual infection site but may also be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes. The primary infectious agent, Mycobacterium tuberculosis,is an acid-fast aerobic rod that grows slowly and is sensitive to heat and ultraviolet light.
Mycobacterium bovis and Mycobacterium avium have rarely been associated with the development of a TB infection (Brunner and Suddarth, 2003). In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person’s immune system acts to “wall off” the bacteria. Tuberculosis is treatable with a six-month course of antibiotics (World Health Organization, 2013). Tuberculosis is a worldwide public health problem, and the mortality and morbidity rates continue to rise. In 2011, the largest number of new TB cases occurred in Asia, accounting for 60% of new cases globally. There were about 8. million people fell ill with TB and 1. 4 million died from TB.
Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top three causes of death for women aged 15 to 44 (World Health Organization, 2013). Tuberculosis is also the leading cause of death among HIV-positive people. At least one-third of the 34 million people living with HIV worldwide are infected with TB bacteria, although not yet ill with active TB. People living with HIV and infected with TB are 21 to 34 times more likely to develop active TB disease than people without HIV (World Health Organization, 2013).
The Philippines is among the 22 high burden countries for tuberculosis, according to the World Health Organization. It is the 6th leading cause of illness and the 6th leading cause of deaths among Filipinos. An estimated 200,000 to 600,000 Filipinos have active tuberculosis with 73 of them die every day. Another alarming fact is that there are about 80% of Filipinos have latent tuberculosis. In this condition, we already have the TB infection in our bodies, but the TB is still in the inactive state (Ong, 2012).
Therefore, the need for further studies about the disease is very much crucial in the management of the disease as well as way of preventing it. This study anchors its curiosity in studying a case about tuberculosis, the pathophysiology, common clinical manifestation, complications, diagnostic procedures, medical-surgical management and nursing management of the disease. This will delve further into the different nursing management of the signs and symptoms as well as promote compliance in curing the disease. Patient’s Data A case of B. O. S. 41 years old, male, single, Roman Catholic, currently residing at Urgello Street, Sambag I, Cebu City, Cebu was admitted for the first time at Vicente Sotto Memorial Medical Center (VSMMC) on November 7, 2012 at approximately 5:35pm with complains of cough with blood-tinged sputum. He is unemployed. Patient has a family history of asthma in both parents. Patient is smoker. He drinks alcohol occasionally. Patient admits that he was using prohibited intravenous drugs for the past 12 years. Patient has no known food and drug allergies. Patient is 5 feet and 5 inches tall and weighed 45 kg during admission. Patient is smoker alcoholic drinker.
No known food and drug allergies. Patient usually sleeps at 9pm and wakes up at 6am without afternoon naps. Patient was a carpenter and lives with his wife. History of Present Illness 2 years before, patient was admitted at Vicente Sotto Memorial Medical Center (VSMMC) and was diagnosed with asthma. He was advised by the doctor to stop smoking and yet failed to follow. He was also using prohibited intravenous drugs and admits that they share needles with his co-drug users. 2 days prior to admission, patient had productive cough with fever, night sweats and dyspnea. He medicated his self with his anti-asthma drug but symptoms persists.
He was also able to cough out blood tinged sputum and this opt him to consult a physician. Physical Assessment Integumentary Skin is equal in color throughout the rest of the body without unusual or prominent discolorations. Skin is slightly rough, flaky and dry with calluses on both palms of hands and soles of feet. Skin is intact, and there are no reddened areas. Skin is warm, pinches easily and immediately returns to its original position. There are presence of bruises and small wounds on right arm. Hair is black with white strands, cut short and did not reach the collar. Scalp is dirty and dry.
Nails on both hands and feet are kept short and clean, no abnormal discolorations noted. EENT Pupils are round with a regular border and are centered in the irises. Eyelashes are evenly distributed and curved outward along the lid margins. Skin on both eyelids is without redness, swelling, or lesions. Eyeballs are symmetrically aligned in sockets without protruding or sinking. Bulbar and palpebral conjunctivas are clear, moist, smooth and pinkish in color. Sclerae are white. Irises are round, flat, and evenly colored. The corneas are both transparent with no opacities; the lenses are free of opacities.
Ears are symmetrical. Its skin is smooth, with no lesions, lumps or nodules. Color is consistent with facial color. Small amounts of cerumen noted on each ear. No abnormal discharges noted. Pinna recoils after being folded. Nose is at the center of the face. Left and right nares are symmetrical. Nasal flaring noted. Nasal structure is smooth and symmetric; nasal color is the same as the rest of the face; patient reported no tenderness. The nasal mucosa is dark pink, moist, and free of exudates. The nasal septum is intact and free of ulcers or perforations. Lips are dry without lesions or swelling.
Teeth are yellowish and showed signs of tooth decay; no dentures are seen and some teeth are missing or with dental caries. Buccal mucosa is pinkish; tissue is smooth and moist without lesions. Tongue is pink, moist, a moderate size with papillae present. The tongue’s ventral surface is smooth, shiny, and pink, with visible veins and no lesions. The frenulum is in midline; hard palate is pale with firm, transverse rugae. Foul odor noted while mouth was wide open. Uvula hangs freely in midline, tonsils are pink and symmetric, and throat is normally pink. Respiratory Nasal flaring observed. Nailbeds are pink and nails do not show signs of lubbing. Has productive cough associated with dyspnea. Has family history of asthma. No known allergies. Patient has a respiratory rate of 32 cycles per minute with shallow, rapid breathing. Have abnormal breath sounds, especially over the upper lobes upon auscultation. Cardiovascular Chest pain, dyspnea, and dizziness noted. No previous history of cardiovascular disease. The jugular venous pulse is not visible when patient sat upright and the jugular vein is not distended. Carotid pulse is equal bilaterally, apical pulse palpated in the 5th intercostal space at the left midclavicular line.
Apical heart rate auscultated, ranging from 73 to 80 beats per minute, regular rhythm, distinct S1 and S2 heart sounds are heard. No S3 or S4 auscultated. No splitting of heart sounds, snaps, clicks, or murmurs noted. Patient’s blood pressure ranges from 90/70 to 100/70 mmHg. Capillary refill time less than 2 seconds, radial and brachial pulses strong bilaterally. Femoral, popliteal, dorsalis pedis, and posterior tibial pulses strongly palpated bilaterally. No apparent varicosities or superficial thrombophlebitis. Nervous System Alert, oriented to person, place, day, and time. Good eye contact.
Able to follow directions, compare unlike objects and explain simple processes. Short-term and long-term memory intact. Anxious about daily activities and the future. Identified light touch, dull and sharp sensations to trunk and extremities. Able to perform repetitive alternating movements, finger-to-nose at smooth, good pace. No history of head injury, spinal cord injury, seizures, meningitis. Has difficulty swallowing or communicating due to dyspnea. Genitourinary Patient verbalized no pain, lesions, and discharge from penis. No swelling, lumps, or heavy feeling in scrotum.
Stated that he has no difficulty in urinating; no change in color, amount, or odor of urine; no pain when urinating; no urinary incontinence. Bladder is non-palpable, no distention was noted. Patient urinates at an average of 5-6 times a day in a 24 hour period. Reported that he has no change in sexual activity before hospitalization, no current difficulties in maintaining or attaining an erection, and no difficulty ejaculating. Musculoskeletal The patient is 5 feet 5 inches tall and weighed 45 kilograms during the admission. He is able to stand without sways. Gait is stable. Normal curves of cervical, thoracic, and lumbar spine.
Full, smooth ROM of cervical and lumbar spine. Shoulders are symmetrically round, no redness, swelling, or deformity or heat. Muscles are fully developed. Clavicles and scapulae are even and symmetric. Elbows are symmetric without deformities, redness or swelling. Patient has full ROM of upper extremities against resistance. Wrists are symmetric without redness, or swelling. They are nontender and free of nodules. Joints on both the upper and lower extremities are intact and functional. Patient is able to move his arms and leg freely. Gastrointestinal Skin of abdomen is free of striae, scars, lesions, or rashes.
Abdomen is flat and symmetric. Umbilicus is in midline and recessed with no bulging; surrounding area is free of masses, swelling, and bulges. Soft clicks and gurgles heard at a rate of eighteen sounds per minute. No masses, no tenderness or guarding in any quadrant with light palpation. Liver, spleen, kidneys, and urinary bladder are not palpable. Patient reported no recent change in bowel patterns before hospitalization, any constipation, diarrhea or blood in stool. He has no history of anal or rectal surgery or trauma and no congenital deformities. Patient’s oral fluid intake is limited to 1. 5 liters per day.
Gordon’s Functional Health Pattern Health Perception / Health Management Pattern The patient described his health before to be fair and strong. He verbalized that good health is very vital because without it, he would not be able to perform his activities of daily living. He admits that it was a mistake of taking vices as early as teenage years and he was willing to take any consequences he has done to his body. He was also using prohibited drugs. Patient does not perform any exercise due to laziness and lack of motivation. Cognitive/ Perceptual Pattern The patient has no problems with hearing, smelling, taste and tactile touch.
The patient is able to read labels of the newspaper 14 feet away without difficulty. Patient is able to recall events and informations an hour ago, a day before and events a year ago. Rest/ Sleep Pattern Before the hospitalization, the patient usually sleeps late at night at around 9 o’clock pm and wakes up early in the morning at 4 o’clock am with a total hour of sleep of 7 hours straight without night awakenings. Now, he usually sleeps late at night (10-11 o’clock pm) and wakes up at around 4 o’clock am with a total hour of sleep of 5 hours with night awakenings due to noise and disturbances in the hospital.
The patient usually stays in bed and takes naps in the afternoon for approximately two hours. Self- Perception Pattern The patient’s most concern about right now is being able to do his activities of daily living without difficulty in breathing. Patient is very anxious with the disease he has. He is able to maintain good eye contact. He has difficulty answering the questions due to shortness of breath upon exertion. Coping- Stress Tolerance Pattern The patient usually makes his decision together with his girlfriend. As observed, he coped up with stress by talking to his girlfriend. Statement of the Problem
The study aims to present a case about tuberculosis and the signs and symptoms manifested by the client. Specifically, the study seeks to answer the following queries: a. What is the cause of Tuberculosis and how do the predisposing and precipitating factors contribute to the formation of the disease. b. What is the pathophysiology of Tuberculosis and the possible effects to the different systems brought about by the disease condition. c. What are the available diagnostic procedures that may be used to diagnose Tuberculosis? d. What is the recommended medical management for Tuberculosis? e. What are the possible nursing problems elating to the disease that should be prioritized throughout the care?
f. What are the specific nursing interventions that may be given to patients with Tuberculosis? Significance of the study The findings of this study will give information about Tuberculosis. This study aims to focus on Tuberculosis in a broad manner and increase the body of knowledge about the disease in the field of nursing. Patient. Patients diagnosed with Tuberculosis would benefit from this study through gaining knowledge about the disease process and how they may be treated and prevent complications which may improve quality of life.
Community. Through this study, the people in the community will be aware of information and ideas related to tuberculosis. They will gain a better knowledge and perception about tuberculosis and will exercise the appropriate action to prevent acquiring the disease. Nursing Practice. This endeavor will also help nursing clinicians generate understanding on the needs of the patients diagnosed with Tuberculosis. The findings of this research will give them additional information about the different management given to the specific patient. Health-Allied Professional.
This study will give them informations about the proper precaution to be done in handling patients with tuberculosis. It will also enhance their knowledge in understanding the course of the illness. Future Researcher. The study will serve as a future reference for future researchers to explore and discover other ideas or studies that will help these patients improve quality of life. Methodology Research Design The study uses Descriptive type of research design which aims to comprehensively describe and discover the disease process in a narrative format, shaping relevant information that congruently relates to the selected case study.
Research Locale This study was conducted at Vicente Sotto Memorial Medical Center which is a tertiary-level hospital located at B. Rodriguez, Cebu City. It has an eight hundred (800) bed capacity as of 1998. It began operation in 1911 as Hospital Del Sur and was soon legally established as Southern Islands Hospital (Wikipedia, 2011). After 84 years of operation, it was renamed to Vicente Sotto Memorial Medical Center to honor Senator Vicente Sotto on May 21, 1992 through Republic Act 7528.
The group was assigned at Communicable Ward and covered all patients with 1:3 loads per member. The ward can accommodate a maximum of 115 patients. Research Instrument Standard institutional forms were used all throughout the nursing care. These includes Nursing Care Plans, Drug Study Form, Physical Assessment Form were used to gather patient’s data relevant to the study. Aside from the institutional forms, other instruments that were used are references like books, internet websites and the patient’s chart. Data Gathering Procedure
Interview through verbal questioning, observed patient’s subjective and objective ways were taken into account in terms of collecting relevant information that will be utilized in the study. The patient’s chart was also utilized to countercheck data and to obtain results that are significant which may help the researcher produce a more comprehensive study. The following data which was acquired from the chart includes general data of the client, laboratory results, list of medications and doctor’s order. A few questions were asked to the significant others to verify some information written in the chart.