MANILA DOCTORS COLLEGE

President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay City

HEALTH CARE: RELATED LEARNING EXPERIENCE

NURSING PROCESS

I. ASSESSMENT

A. General Data

Patient’s Initials: L.R.T.

Address: Tondo, Manila
Age: 20years old
Sex: Male
Date of birth: 10/2/1989
Civil Status: Single
Occupation: Pedicab driver at Divisoria (Before he got sick)
Informant: Client (L.R.T.)
Order of Admission: Out Patient Department /Home visit
Date of history taking: January 28, 2010

B. Chief Complaint

The client goes to the health center for the compliance to the drug therapy
prescribed by the physician. Client is under the Directly Observed Treatment Short
Course (DOTS) program for duration of ten days. He was diagnosed with Pulmonary
Tuberculosis Category I on January 12, 2010.

C. History of Present Illness

Last November 2009 the patient started to experience productive cough, difficulty
of breathing, intermittent fever, chest pain, and night sweats. On December 16, 2009, the
patient vomited sputum with blood (hemoptysis). That prompts him to seek medical
attention at GAT Emilio Aguinaldo Medical Center. He also had a second opinion last
December 22, 2009 at the San Lazaro Hospital where he had Chest X-Ray and the
finding was suggestive of PTB. He went back to GAT Emilio Aguinaldo Medical Center
for further testing for his disease. On January 11, 2010 and January 12, 2010, he took
Sputum test at GAT (Results will be further discuss later on Laboratory Findings). He
was referred to the Barrio Magsaysay Health center for his medication.

D. Past History

Childhood Illness: None

Adult Illness: Pulmonary Tuberculosis
Immunization: Unrecalled
Adult Immunization: None
Previous Hospitalization: None
Operations: None
Injuries: None

Medications taken prior

to going to the hospital: Biogesic
Allergies: No known allergies
E. System Review

1. Health Perception – Health Management

Before L.R.T was diagnosed of Pulmonary Tuberculosis (PTB), he sees health as

being able to do everyday things well and according to the manner he wants it and not
getting sick easily. In terms of supplements, he doesn’t take vitamins or any medication
to help treat his acute conditions like fever, coughs and colds. He just lets it subside.
However, if his condition worsens, he goes to the health center or to any nearby drugstore
to buy medicine (e.g Biogesic) . He used to smoke 1 pack of Marlboro cigarette in one
day and would drink alcohol with his friends at Divisoria where they share single glass
and pass it to the next person, only if there are people who invite him.

When L.R.T. started to experience (November 2009) coughing, intermittent fever,

difficulty of breathing, right upper chest pain (8 out of 10, 10 being the highest, 1 being
the lowest), excessive sweating while sleeping, fatigue, and loss of appetite he begins to
be conscious of his health and sought advice. He ranked his health 5 out of 10 (10 being
the highest, 1 being the lowest).

At the present, L.R.T is more conscious with his health since he was diagnosed
with PTB. Now, he sees health as a need; a need for him to work effectively and
continuously. He is compliant with his medications because he wants to work once again
to help his mother with the family finances. He has stopped smoking and drinking. Even
though he has taken medications for PTB, he still has productive cough as he verbalizes:
“Yung ubo ko ma-plema… yellow o kaya green yung kadalasang kulay. Minsan nga
lang, mahirap ilabas yung plema,” Since he started undergoing DOTS therapy, he
verbalized that there was decrease in coughing, difficulty of breathing, chest pain (4 out
of 10 with 10 being the highest, 1 being the lowest), absence of excessive sweating when
sleeping, fever, and increased appetite. He ranked his health as 7 out of 10 (10 being the
highest, 1 being the lowest).

2. Nutritional Metabolic Pattern

Before he was diagnosed with PTB, he had a good appetite. He only eats when he
feels hungry. His usual food intake includes rice and street foods (kwek-kwek, kalamares,
fish ball) since he works near Divisoria which is the food available and affordable for
him. He drinks 6 to 7 glasses of water every day. He drinks alcohol (Ginebra) every night
where they share a single glass then pass it to the next person. He did not experience any
difficulty in swallowing. He also does not have any allergies in food and in medications.

When he was diagnosed with PTB, his appetite decreased. He wasn’t able to eat
much because he felt weak. He also experienced a drastic decrease of weight; 72 kg to 60
kg (12 kg weight loss) for two months duration. He verbalizes: “Wala akong ganang
kumain, kaya nga nabawasan talaga timbang ko mula 72 kilograms naging 60 kilograms
nalang ako sa loob ng 2 buwan.”

Last January 28, 2010, according to the patient, there was an improvement in his
appetite in comparison to the time when he is experiencing cough, intermittent fever,
difficulty of breathing, chest pain, excessive sweating when sleeping, and fatigue. He
now eats three times a day, which includes rice (1 to 2 cups a meal) and viand usually
fried fish (tuyo, galunggong), pork, chicken, and vegetables (e.g ginisang kangkong). He
still drinks 6 to 7 glasses of water a day. He no longer drinks alcoholic beverages as
verbalized by the client. He is now taking anti-tuberculosis drugs (Rifampacin,
Ethambutol, Isoniazide, Pyrazinamide) as adherence to DOTS therapy.
3. Elimination Pattern

Before being diagnosed with PTB, L.R.T didn’t have any problems regarding his
elimination pattern and didn’t use any laxatives to aid him in eliminating feces. He
defecates once a day, usually early in the morning or before going to bed, his stool was
formed and can be easily eliminated. He would urinate three times a day depending on
his fluid consumption. He describes his urine as slightly yellowish and clear in color. He
does not have odor problems.

During the month of November 2009, the patient verbalized that he has sputum
secretions ranging from yellow to green in color. Last December 16, he coughed out
blood. He also told us that he experienced night sweating.

Last January 28, 2010, his elimination pattern remains the same. He verbalized
that he no longer experiences night sweating. Patient’s urine change from yellow to
orange as a side effect of the medication he is taking (Rifampacin).

4. Activity – Exercise Pattern

Before he was diagnosed with PTB, he is usually found working as a pedicab

driver at Divisoria where they drink alcohol and share a single glass then pass it to the
next person. He cleans the house everyday and plays basketball with friends. At this time
he doesn’t get tired easily.

After the diagnosis of PTB, he doesn’t go out much anymore. He stoppped

working as a pedicab driver and stayed at home to rest and get better. He has stopped
smoking and drinking as well. According to L.R.T “Isa talaga sa malaking pagbabago
sakin ay yung madali nakong mapagod at hingalin, di na ko makapag-side car at
makagawa ng ilang bagay.”

According to L.R.T last January 28, 2010, he can walk short distances only
because he gets tired easily and feels shortness of breath. His main form of exercise now
is walking. As verbalize by the patient: “Simula nung lagi na akong inuubo, madali na
akong hingalin at parang nauubusan ng hininga.”

5. Sleep and Rest Pattern

Before he was diagnosed, he sleeps at 9:00 am and wakes up at 9:00 pm since he

works as a pedicab driver at night. He would sleep 12 hours every day because he is
always tired from work. He feels well rested when he wakes up and doesn’t need any
sleeping pills to get him to sleep.

According to the patient, during the month of November 2009, he had difficulty
in sleeping because of persistent cough. He would read comics or stay outside the house
until he feels sleepy. He sleeps for seven hours with interruption and would feel pain in
his chest area when he sleeps on his left side. He usually wakes up sweaty as verbalized.

When L.R.T was interviewed last January 28, 2010, he told us that at present he is
able to sleep better. His cough has lessened and his numbers of hours of sleep have
somehow increased (12 hours). He now wakes up at 9:00 am and sleeps at 10:00 pm with
naps (30 minutes) in the afternoon. The reason of this change in sleep pattern is because
the client already stopped working. Until now he still feels chest pain while sleeping in
left side lying position. He feels rested and energetic whenever he wakes up.
6. Cognitive Perceptual Pattern

Before the diagnosis of PTB, L.R.T. does not need to use any aids for vision and
hearing. At first, he was not aware of his condition and its complications that prompt him
to seek medical attention.

At present, upon understanding the severity, the patient immediately adhered to

the medications needed to cure his condition. The patient can relate to ideas and topics.
He grasps ideas and questions easily, and he does not have difficulties in learning with
regards to health teaching. He thinks futuristically as evidenced by setting a goal- to be
healthy again. He still does not need to use aids for vision and hearing.

7. Self Perception or Self Concept Pattern

Before he was diagnosed with PTB, he was confident about himself because he
can do everything that he wanted. He can work, socialize, and play basketball with his
friends.

Last January 2010 when he found out that he has PTB, his perception about
himself changed. He immediately stopped his job and limited himself from his previous
activities. He felt conscious about talking with other people that’s why he wears a mask
when he speaks. He separated his utensils from his family’s things and normally stays at
the second floor to avoid contact with his siblings.

According to the patient last January 28, 2010 he feels secure because he is able
to control his illness by compliance to medication and he knows that his condition can get
better. Since then he is now able to walk around, do some house hold chores and talk
other people.

8. Role-Relationship Pattern

Before the diagnosis, he acted as a father figure to his younger siblings since their
parents are separated. He helps with their finances by working as a pedicab driver at
Divisoria. He serves as a role model to his younger siblings as he tell them how to act in
different situations of life. Whenever they have problem they would just let it pass and
talk about it as soon as they have relaxed. There are no problems in relationship among
family members for they have close ties. He has close friends that he can rely on. The
patient knows his right as a person and he follows rules and regulation desired for the
group and the society he belongs to.

At present time he no longer serves as the bread winner of his family because of
his illness. Even in his illness, his family is supportive to him. He separates his things,
especially utensils in able to prevent transmission of disease. His friends remained
supportive despite his condition.

9. Sexual Reproductive Pattern

Mr. L.R.T. is still dependent to his mother when it comes in facing big decisions;
but mostly he decides and does things independently. He is happy with his friends and
significant other. L.R.T has undergone circumcision when he was 12 years old. And
before he was diagnosed he has had sexual intercourse seldom without the use of
contraceptives. For him being a man is able to stand up for his family and being able to
give the needs of his mother and younger siblings financially.
 Nothing has changed in the present except that he is not sexually active because it
may cause transmission of the disease.

10. Coping/Stress Pattern

Before he had PTB, he goes out of their house and talks to his friends to relieve
his stress. At times he would sleep or read comics to help him forget about his problem.

Upon diagnosis, he sleeps to help him relax and stays at home to avoid other
distraction. For him not being able to do things he usually do, like hanging out with
friends and working as a pedicab driver causes him stress.

At present time he doesn’t feel any stress. He feels better because he can now
walk around their community and socialize.

11. Values and Beliefs

L.R.T is a Roman Catholic but seldom goes to church except when somebody
invited him to go with them. He prays at home and doesn’t lose his faith. According to
him, he also has sets of beliefs that were influenced by the people around him.

At present time, his faith in God has become stronger. Even though he does not
go to church every Sunday he exercises his faith by praying that he would surpass this
challenge in life. He was able to attend the recent Feast of the black Nazarene, hoping
that it would help him recover from his illness.

F. Family Assessment

Initials Relationship Age Sex Occupation Educational

Attainment

Y.R.T. Mother 42 Female Banana-cue High School

and Camote- Graduate
cue Vendor

L.R.T. Sister 19 Female None High School

Graduate

L.R.T. Sister 18 Female None High School

Graduate

L.R.T. Brother 9 Male None Elementary

(Grade 3)

G. Heredo-Family Assessment

Maternal –Cancer (Colon), Tuberculosis

Paternal- none
H. Developmental History

Theorist Age Task Patient’s

Description

Erik Erikson 20 Identity vs. Role Mr. L.R.T. is

-Theory of Confusion confident and sure
psychosocial about his identity. He
development. knows his role as a
child, a friend and
member of the
society.
Sigmund Freud 20 Genital Mr. L.R.T. is still
-Theory of dependent to his
psychosexual mother when it comes
development in facing big
decisions; but mostly
he decides and do
things independently.
He is happy with his
friends and
significant others.
Jean Piaget 20 Formal Operation Although Mr.
-Cognitive Phase L.R.T.’s educational
development theory attainment is Grade 3,
he thinks and decides
rationally. The patient
can relate to ideas and
topics. He grasps
ideas and questions
easily, and he does
not have difficulties
in learning. He thinks
futuristic as
evidenced by setting a
goal- to be healthy
again.
Lawrence Kohlberg 20 Law and Order The patient knows his
-Moral development Orientation right as a person. He
theory follows rules and
regulation desired for
the group and the
society he belongs to.
Fowler 20 Individuating- Mr. L.R.T. is a
-Spiritual Reflective catholic and even
development theory though he does not go
to church every
Sunday he exercises
his faith especially
this time. According
to him, he also has
sets of beliefs that
were influenced by
the people around
him.
I. Physical Examination:

Day 1: January 28, 2010

Vital Signs:
Temp: 37.6 C
PR: 94 bpm
RR: 26 cpm
BP: 130/80 mmHg
Height: 5’9’’ or 175.4 cm
Weight: 60 Kgs (BMI: 19.5)
Ideal Body Weight: 72.72kg

Day 2: January 29, 2010

Vital Signs:
Temp: 37 C
PR: 79 bpm
RR: 24 cpm
BP: 110/70 mmHg
Height: 5’9’’ or 175.4 cm
Weight: 60 Kgs (BMI: 19.5)
Ideal Body Weight: 72.72kg

Day 3: January 30, 2010

Vital Signs:
Temp: 37.1 C
PR: 85 bpm
RR: 24 cpm
BP: 120/90
Height: 5’9’’ or 175.4 cm
Weight: 60 Kgs (BMI: 19.5)
Ideal Body Weight: 72.72kg

BMI: 19.5

 Underweight = <18.5
 Normal weight = 18.5-24.9
 Overweight = 25-29.9
 Obesity = BMI of 30 or greater

Regional Examination:

General Survey

The patient appears alert and coherent. He is able to stand still with posture in a slouched
stance. The patient has slight difficulty of breathing because according to him, he walked a long way.

The patient is cooperative in our nursing assessment and he was able to answer most of our
questions. He is very attentive and listens carefully to the questions and discussion the group is
performing. Patient is easy to talk with. He understands fully what was happening during the
interview and assessment.
A. Skin
I:
 Is brown to dark brown in color
 Absence of lesions.
P:
 Is warm to touch
 Absence of tenderness and masses
 Has normal skin turgor.

B. Nails
I:
 Are convex.
 Have long and transparent nails.
 Nail bed is pinkish in color.
P:
 Nail has a smooth texture.
 Has good capillary refill of 2-3 sec.

C. Head & Face

I:
 Is elongated.
 Is aligned at the center of the body.
 Facial features are symmetrical

P:
 Skull is smooth.
 Absence of tenderness and masses.
 Hair is short, smooth and shiny.
 Facial movements are symmetrical.

D. Eyes
I:
 Eyebrows are symmetrically aligned and hair is evenly distributed.
 Pinkish conjunctiva
 The eyelids do not cover the sclera and blink reflex is present.
 Corneas are transparent and colorless
 Pupils are equal in size, rounded and reactive to light and accommodation

E. Ears
I:
 Has the same color with facial skin.
 Are symmetrical.
 Are aligned with the outer cantus of the eyes.
 Showed good hearing results to various volume level of the interviewer.
P:
 Absence of tenderness and masses

F. Nose
I:
 Nares are symmetrical
 Absence of discharge
 Nasal flaring is present during speaking
 P:
 Absence of tenderness, especially in the sinuses.
 Absence of masses or nodules

G. Mouth & Pharynx

I:
 Internal structures of his mouth are pinkish in color.
 Lips are dark pink in color, dry and it is symmetrical
 Tonsils are pinkish to reddish in color with no swelling.
 Teeth are yellowish in color
 Two front teeth are present of tooth decay.
 Tongue can move freely
 tonsils show no signs of inflammation
 Absence of swelling.
P:
 Absence of tenderness.
 Gag reflex not tested.

H. Neck
I:
 Is at the center of the body
 Neck muscles can move if full ROM, without any discomfort
 Absence of neck vein distention
 Enlarged Superficial Anterior cervical lymph nodes were observed.

P:
 Tenderness was noted at the location of the right superficial Anterior cervical
lymph node

I. Thorax & Lungs

I:
 With spontaneous breathing pattern
 Depressed clavicular area
 Retractions at 2nd-10th intercostals spaces are visible during respiration.
 Spine is straight without any deviations.
 Ribs slope across and down.
 Active movement occurs within the intercostals spaces.
 Client is in a slouch position, observable during standing and sitting position
Pa:
 Vibration was felt during tactile fremitus test stronger at the top (Supra Clavicular
Region), diminishing as it goes down (Infra Scapular Region).
 Diaphragmatic excursion is asymmetrical; right side slightly expands more than
the left.
Per:
 Percussion notes resonate across the posterior thorax except at the scapular region
 The lowest point of resonate is just above the diaphragm region.
A:
 Diminished vesicular and vesicular breath sounds are present at the posterior
thorax
 Bronchovesicular breath sounds are heard louder at the upper right part of the
thorax
  Anterior thorax so as bronchial, especially in placing the stethoscope midsternal
line and tubular breath sound at the anterior thorax.
 Crackles heard at both posterior lungs

J. Cardiovascular/Heart
I:
 The aortic, pulmonic and the tricuspid areas are absent from pulsations
 Absence of lifts and heaves was observed in the tricuspid area.
 The apical area has visible pulsation apical area has no visible lifts or heaves.
 The epigastric area has visible pulsation.
 Carotid has symmetric pulse as the radial pulse and the apical pulse.
Pa:
 A heart rate of 94 beats per minute (based on January 29, 2010); beat is strong
and fast, with regular rhythm
A:
 No extra heart sounds was heard.

K. Breast and Axillae

I:
 A tattoo of “Juliet” was seen on the middle of the chest; 2x5inches in size
 No lesion was present.
 Presence of hair was noted on the axillae.
P:
 Axillary is dry.
 Palpable axillary lymph nodes were noted.

L. Abdomen
I:
 Stomach is flat, no scars is noted.
 Umbilicus is at midline.
A:
 The bowel sounds are intermittent (every 5-35 times per minute)
Pa:
 Percussed dullness over the liver 6-12cm and tympanic all over quadrants

M. Extremities
I:
 Tattoo of a dragon is present at the right deltoid (approximately 2x4 inches)
 Able to stand still and walk in slow manner
 Posture is in a slouch stance but with alignment of the hips and shoulders.
 There are no gross deformities that are found in the body.
 Hair evenly distributed
 Skin color is dark brown.
P:
 Absence of tenderness

M. Genitals
 Client refused to perform
 Client does not perform self testicular examination

N. Rectum & Anus

 Client refused to perform
  Client verbalized the absence of palpable lesions or masses, tenderness, pain in
defecation.

O. Neurologic Exam

A. Mental and Emotional Status

 Conscious, coherent and oriented to time, place and date
 Responds quickly to the question asked
 Client keeps nail long, keeps hair short
 Is able to understand written and spoken words very well.

B. Intellectual Function
 The client’s immediate recall, recent and remote memory is normal.
 The client is able to answer simple questions properly.
 He is able to explain phrases in a complete detail and associates related concepts
normally.
 Able to weigh the importance of seeking help.

II. PERSONAL HISTORY

Habits: L.R.T walks around the community, playing basketball
with his friends, helping his mother in their household
chores.

Vices: Started Smoking 15 years old and he consumes one pack

per day. Drinking Alcohol (Before diagnosis of
Tuberculosis)

Lifestyle: He has changed his lifestyle from sedentary to a healthy

one. He now eats a balanced meal, which includes, rice,
vegetables, and meat. And also, he drinks 6-7 glasses of
water and has already stopped drinking alcohol and
refrained from smoking.

Social Affiliation: None

Client’s usual day like:
He wakes up at 9 in the morning, eats breakfast, cleans the
house and bathes. On Mondays, Wednesdays and Fridays,
at around 10am, he goes to the health center to get his
medicine. He socializes with their neighbors. Then he goes
home and sleeps at around 10pm.

Rank in the Family: Second Child

Travel: None

III. ENVIRONMENTAL HISTORY

 L.R.T lives in a two-story house with one door and five windows. Their house has
a height of 4.20 meters, a width of 3.74 meters and a length of 5.94 meters. There are two
windows on the first floor and three on the second floor. The house has 2 bedrooms, one
in the 1st floor and the other one in the 2nd floor. The client sleeps in the 1 st floor,
separated from his mother and siblings. The client stated that they have no problems with
ventilation at night because the air is cold during the evenings. They have their own
private bathroom. They gather all their garbage in the morning at around 5:30am and put
it in the street where it is being collected every six in the morning by the municipal
garbage collector. They do not experience any flooding in the area. They do not have
problems with mosquitoes because they spray Baygon around once every three days.
They have no problems with seeking health care because they are located near a health
center, although L.R.T. verbalized that they still prefer going to a hospital because of the
higher quality of health care. They usually drink mineral water, and they get their tap
water from Nawasa. They get their electricity from Meralco. The client verbalized that
since they are near a market place, they do not have problems with buying food. They do
not own the house they live in. As the client stated, “Caretaker lang kami nitong bahay.
Hindi na kami nagbabayad ng renta pero kami bahala sa pagmamaintain ng bahay.”

The client worked in Divisoria before. He verbalized that the surroundings were
dusty, crowded, dirty, and “lahat ng puede mong langhapin malalanghap mo na.”
Currently, L.R.T. does not work due to his current health condition.

IV. OB/GYNE HISTORY (Not Applicable)

V. PEDIATRIC HISTORY

MATERNAL AND BIRTH HISTORY

Birth date: 10/2/1989
Birth weight: Unrecalled
Type of Delivery: Normal Spontaneous Delivery
Condition after Birth: Normal
Hospital: Unrecalled

VII. LABORATORY RESULTS

Chest X-Ray Procedure

Before the Procedure

 The physician will explain the procedure to you and offer you the opportunity to ask any
questions that you might have about the procedure.
 Generally, no prior preparation, such as fasting or sedation, is required.
 Dress in clothes that permit access to the area to be tested or that are easily removed.
 Notify the radiology technologist if you have any body piercing on your chest.
 Based upon your medical condition, your physician may request other specific
preparation.

During the Procedure

Generally, a chest x-ray follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may interfere
with the procedure.
2. You will be given a gown to wear.
3. The particular view that the physician orders will determine how you are positioned for
the x-ray such as lying, sitting, or standing. You will be positioned carefully so that the
desired view of the chest is obtained. The physician will also specify the number of films
to be made.
4. For a standing or sitting film, you will stand or sit in front of the x-ray plate. You will be
asked to roll your shoulders forward, take in a deep breath, and hold it until the x-ray
exposure is made. For patients who are unable to hold their breath, the radiology
technologist will take the picture at the appropriate time by watching the breathing
pattern.
5. It will be important for you to remain still during the exposure, as any movement will
blur the film.
6. For a side-angle view of the chest, you will be asked to turn to your side and raise your
arms above your head. You will be instructed to take in a deep breath and hold it as the x-
ray exposure is made.
7. The radiology technologist will step behind a protective window while the images are
being made.

While the x-ray procedure itself causes no pain, the manipulation of the body part being
examined may cause some discomfort or pain, particularly in the case of a recent injury or
invasive procedure such as surgery. The radiology technologist will use all possible comfort
measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

Chest X-Ray
Institution: San Lazaro Hospital
Date of examination: 12-22-09

X-Ray No. 10181 Date: 12-22-09

FAMILY NAME: FIRST NAME: M.I. AGE: SEX: CS: PAVILION:
T L R. 20 M S OPD
ADDRESS:
ATTENDING PHYSICIAN:
EXAMINATION:
Chest X-ray
ROENTOGENOLOGICAL AND ULTRASOUND FINDING:

There is undue haziness of the right upper lobe with cystic and cavitary images.
Heart and great vessels are normal in size and configuration.
The rest of the visualized chest structures are unremarkable.

IMPRESSION:
= EXTENSIVE CAVITARY PTB RIGHT

Hospital Interpretation:
Findings suggestive of PTB. Both upper lungs with cavitations in the right upper lung
Significance:

This examination was performed to specify which lobe and which part of the lung
parenchyma is affected or has cavitations already. This is also done to know the extent of
damage that was caused by the bacteria.

Interpretation:
The results of this examination have shown that the patient has positive cavitations at the
right upper lung.

Direct Sputum Smear Microscopy

Institution: GAT Emilio Aguinaldo Memorial Medical Center
Date of examination: 1/11/2010 and 1/12/2010

Specimen Date Diagnosis

1 1/11/2010 S 0 negative

2 1/12/2010 P 1+ positive

3 1/12/2010 P 1+ positive

LEGEND:
S – Saliva
P – Purulent (sputum)

Hospital Interpretation

In the client’s case, LRT was tested three times, with the first result as negative while the
next two results came out positive. The first result came out negative because the specimen
collected was saliva from the client. Saliva may not contain Mycobacterium tuberculosis
organisms. The second and third came out positive because the sample collected was purulent.
Mycobacterium tuberculosis may live in the sputum of the client.

For the first test, the result was 0. This means that there was no Mycobacterium
tuberculosis organisms found. For the second and third tests, the results were 1+. This indicates
the presence of Mycobacterium tuberculosis on the sputum of the client. The highest result is 3+,
which means that the client is still in the early stages of the disease.

Significance:

DSSM is the primary diagnostic test used by the Philippine Government, specifically the
DOH as a confirmatory examination for Tuberculosis. This examination detects the specific
bacteria which caused the disease.

Interpretation

A definitive diagnosis of tuberculosis can only be made by culturing Mycobacterium

tuberculosis organisms from a specimen taken from the patient (most often sputum, but may also
include pus, CSF, biopsied tissue, etc.). A diagnosis made other than by culture may only be
classified as "probable" or "presumed". For a diagnosis negating the possibility of tuberculosis
infection, most protocols require that two separate cultures both test negative.

In the client’s case, LRT was tested three times, with the first result as negative while the
next two results came out positive. The first result came out negative because the specimen
collected was saliva from the client. Saliva may not contain Mycobacterium tuberculosis
organisms. The second and third came out positive because the sample collected was purulent.
Mycobacterium tuberculosis may live in the sputum of the client.
 For the first test, the result was 0. This means that there was no Mycobacterium
tuberculosis organisms found. For the second and third tests, the results were 1+. This indicates
the presence of Mycobacterium tuberculosis on the sputum of the client. The highest result is 3+,
which means that the client is still in the early stages of the disease.
VIII. DRUG STUDY

DRUG INDICATION ACTION SIDE NURSING PATIENTS TEACHINGS

EFFECT/ADVERSE CONSIDERARTION
REACTION
DATE ORDERED: Treatment of Inhibits CNS: Optic neuritis Assessment: -Take drug in a single daily dose; it
January 18, 2010 pulmonary tuberculosis (loss of visual acuity, History: Allergy to ethambutol, may be taken with meals if GI upset
GENERIC NAME: tuberculosis in bacterial growth changes in color optic neuritis, impaired renal occurs.
Ethambutol conjunction with by altering perception red – green function. -Take this drug regularly; avoid
CLASSIFICATION at least one other cellular vision changes), fever, Physical: Skin color, lesion; missing doses. Do not discontinue
: antituberculous ribonucleic acid malaise, headache, orientation, reflexes, this drug without first consulting
Antituberculous drug drug to prevent the (RNA) synthesis dizziness, mental ophthalmologic examination; your health care provider.
DOSAGE: development of and phosphate confusion, liver evaluation, bowel sounds; -Following side effects may occur:
Tablet: 500mg once a resistant metabolism. disorientation, CBC, liver and renal function nausea, vomiting, epigastric distress;
day for 6 months organisms. hallucinations, test. skin rashes or lesion; disorientation,
peripheral neuritis. Intervention: confusion, drowsiness, dizziness (use
GI: Anorexia, nausea, -Encourage the patient not to caution if driving or operating
vomiting, GI upset, discontinue therapy without first dangerous machinery; use precaution
abdominal pain, consulting the health care to avoid injury)
transient liver provider. -Arrange to have periodic medical
impairment. -Administer daily dose with food check – up. This will include an eye
Hypersensitivity: to minimize nausea and vomiting. examination and blood test.
Allergic reactions- -Single daily dose must be used -Report changes in vision and rash.
dermatitis, pruritus, in combination with other
anaphylactoid antituberculous agents.
reaction. -Perform baseline assessment of
Other: Toxic patient’s degree of alertness and
epidermal necrolysis, orientation to name, place and
thrombocytopenia, time before initiating therapy.
joint pain, acute gout. -Make regularly scheduled
subsequent mental status
evaluations and compare
findings. Report development of
alterations.
 -Provide patients safety during
episodes of altered behavior or
period of dizziness.
-Before initiating therapy, check
for any visual alterations using
color vision chart.
-Report the development of visual
disturbances for the health care
provider’s evaluation.
GENERIC NAME: It interferes with CNS: Peripheral Assessment: -Take drug in a single daily dose.
Isoniazid lipid and nucleic neuropathy, History: Allergy to isoniazid, Take on empty stomach, 1 hr before
CLASSIFICATION acid biosynthesis convulsions, toxic isoniazid associated adverse or 2 hr after meals. If GI upset occurs
: in actively encephalopathy, optic reactions; acute hepatic disease; take with foods.
Antituberculous drug growing tubercle neuritis and atrophy, renal dysfunction; lactation. -Take this drug regularly; avoid
DOSAGE: bacilli. It also memory impairment, Physical: Skin color, lesion; missing doses. Do not discontinue
Tablet: 500mg once a disrupts the M. toxic psychosis. orientation, reflexes, peripheral this drug without first consulting
day for 6 months tuberculosis cell GI: Nausea, vomiting, sensitivity, bilateral grip strength; your health care provider.
wall and inhibits epigastric distress, ophthalmologic examination; -Do not drink alcohol, or drink as
replication. bilirubinemia, adventitious sound; liver little as possible. There is an
bilirubinuria, elevated evaluation; CBC, liver and renal increased risk of hepatitis if these
AST, ALT levels, function test, blood glucose. two drugs are combined.
jaundice, and Intervention: - Avoid tyramine-containing and
hepatitis. -Encourage the patient not to histamine-containing food in diet.
Hematologic: discontinue therapy without first -Following side effects may occur:
Agranulocytosis, consulting the health care nausea, vomiting, epigastric distress;
hemolytic or aplastic provider. skin rashes or lesion; numbness,
anemia, -Give on an empty stomach, 1hr tingling, loss of sensation.
thrombocytopenia, before or 2 hrs after meals; may -Arrange to have periodic medical
eosinophilia, be given with foods if GI upset check – up. This will include an eye
pyridoxine deficiency, occurs. examination and blood test.
pellagra, -Single daily dose must be used -Report weakness, fatigue, loss of
hyperglycemia, in combination with other appetite, nausea, vomiting, yellowing
metabolic acidosis, antituberculous agents. of skin or eyes, darkening of the
hypocalcemia, -Decrease tyramine-containing urine, numbness or tingling in hands
hypophosphatemia and histamine-containing food in or feet.
due to altered vitamin diet.
D metabolism. -Consult with physician and
Hypersensitivity: arrange for daily pyridoxine in
Fever, skin eruptions, diabetic, alcoholic or
lymphadenopathy, malnourished patients; also for
vasculitis. patients who develop peripheral
neuritis.
-Discontinue drug and consult
with physician if signs of
hypersensitivity occurs.
-When paresthesias are present,
the patient must be cautioned to
inspect the extremities for any
skin breakdown because of
diminished sensation.
-Caution the patient not to
immerse feet or hands in water
without first testing the
temperature.
-Monitor patients with
paresthesias for adequate
nutrition.
-Provide patient safety and
assistance in ambulation.
-Incidence of hepatotoxicity
increases with age and with
consumption of alcohol. This
reaction usually occurs within the
first 3 months of therapy and is
thought to be an allergic reaction.
Symptoms are anorexia, nausea,
 vomiting, jaundice,
hepatomegaly, slpenomegaly and
abnormal liver function test.
GENERIC NAME: Prevents RNA CNS: headache, Assessment: -Take drug in a single daily dose; it
Rifampicin synthesis in drowsiness, fatigue, History: Allergy to rifampicin, may be taken with meals if GI upset
CLASSIFICATION mycobacterium dizziness, inability to acute hepatic disease, pregnancy, occurs.
: by inhibiting concentrate, mental lactation. Physical: Skin color, -Take this drug regularly; avoid
Antituberculous drug DNA-dependent confusion, generalized lesion; gait, muscle strength; missing doses. Do not discontinue
DOSAGE: RNA polymerase. numbness, ataxia, orientation, reflexes, this drug without first consulting
Tablet: 500mg once a This blocks the muscle weakness, ophthalmologic examination; your health care provider.
day for 6 months key metabolic visual disturbances, liver evaluation; CBC, liver and -Following side effects may occur:
pathways needed exudative renal function test and urinalysis. reddish-orange coloring of body
for conjuctivitis. Intervention: fluids, nausea, vomiting, epigastric
mycobacterium Dermatologic: Rash, -Encourage the patient not to distress, skin rashes, numbness,
cells to grow and pruritus, urticaria, discontinue therapy without first tingling, and drowsiness, fatigue (use
replicate. pemphigoid reaction, consulting the health care caution if driving or operating
flushing, reddish- provider. dangerous machinery; use precaution
orange discoloration -Administer daily dose with food to avoid injury.)
of body fuids-tear, to minimize nausea and vomiting. -Arrange to have periodic medical
sweat, urine, saliva, -Single daily dose must be used check – up. This will include an eye
sputum. in combination with other examination and blood test.
GI: Heartburn, antituberculous agents. -Report fever, chills, muscle and
Anorexia, nausea, -Prepare patient for the reddish- bone pain, excessive tiredness or
vomiting, gas, cramps, orange coloring of body fluids. weakness, loss of appetite, nausea,
diarrhea, Soft contact lenses may be vomiting, yellowing of skin or eyes,
pseudomembranous permanently stained; advice the unusual bleeding or bruising, skin
colitis, pancreatitis, patient not to wear them during rash nor itching.
elevations of liver therapy.
enzymes, hepatitis. -Arrange for follow-up of liver
GU: Hemoglobinuria, and renal function tests, CBC,
hematuria, renal ophthalmologic examinations.
insufficiency, acute
renal failure,
 menstrual
disturbances.
Hematologic:
Eosinophilia,
thrombocytopenia,
transient leucopenia,
hemolytic anemia,
decreased hgb,
hemolysis.
Other: Pain in
extremities,
osteomalacia,
myopathy, fever,
flulike syndrome.

GENERIC NAME: Dermatologic: Assessment: -Take this once a day with any other
Pyrazinamide Rashes, History: Allergy to antituberculous agents.
CLASSIFICATION photosensitivity. pyrazinamide, acute hepatic -Take this regularly; avoid missing
: GI: hepatotoxicity, disease, gout diabetes mellitus, doses. Do not discontinue this drug
Antituberculous drug nausea, vomiting, acute intermittent porphyria, without first consulting health care
DOSAGE: diarrhea. pregnancy, lactation. provider.
Tablet: 500mg once a Hematologic: Physical: Skin color, lesion; joint -Following side effects: loss of
day for 6 months Sideroblastic anemia, status; liver evaluation; liver appetite, nausea, vomiting, rash,
adverse effects on function test, serum and urine sensitivity to sunlight.
clotting mechanism or uric acid level, blood and urine -Have periodic medical check-up
vascular integrity. glucose, CBC. Intervention: including blood test to evaluate drug
Other: Active gout. -Administer only in conjunction effects.
with other antituberculous agent. -Report fever, malaise, loss of
-Administer once a day. appetite, nausea, vomiting, darkened
-Arrange follow-up of liver urine, yellowing of skin or eyes,
function test (AST,ALT) prior to severe pain in great toe, instep, ankle,
and every -4wks during therapy. heel, knee and wrist.
-Discontinue drug if liver damage -Increase fluid intake to help remove
or hyperuricemia in conjunction uric acid.
with acute gouty arthritis occurs.
IX. List of priority problem

1. Ineffective airway clearance related to copious tracheobronchial secretions secondary to

bacterial infection as evidenced by difficulty of breathing.
2. Ineffective breathing pattern related to decreased lung volume capacity and frequent
productive cough as evidenced by difficulty of breathing.
3. Imbalanced Nutrition: Less than Body Requirements related to loss of appetite as evidenced
by weight loss.
4. Activity intolerance related to inadequate oxygen supply, as evidenced by easy fatigability.
5. Ineffective coping related to lower activity level and the inability to work as evidenced by
verbalization of problem.
 X. Nursing Care Plan

CUES/DATA NURSING RATIONALE GOALS and INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS OBJECTIVES
Subjective: Ineffective airway - Airway must be Within 1 hour of Independent Within one hours, the
“ Yung ubo ko ma- clearance related to given the first intervention: 1. Teach and These techniques goals and objectives
plema… yellow o copious attention as based on encourage the use of help to improve have been fully met
kaya green yung tracheobronchial the rule of ABC diaphragmatic ventilation and as indicated by:
kadalasang kulay. secretions secondary which is Airway, breathing and mobilize secretions
Minsan nga lang, to bacterial infection Breathing and coughing techniques. without causing 1. Patent airway
mahirap ilabas yung as evidenced by Circulation. In 1. The patient will (Please see attach) breathlessness and through mobilization
plema”, as verbalized Dyspnea addition, difficulty be able to maintain fatigue of secretions as
by the patient of breathing can patent airway evidenced by
cause anxiety to the through mobilization productive cough.
Objective: client that is why of secretions as 2. Perform postural Uses gravity to help
- Presence of immediate attention evidenced by drainage with raise secretions so
crackles upon must be done. productive cough. percussion and they can be more
auscultation. Retained secretions vibration. easily expectorated. 2. Ability to
-Continuous dry can cause blockage 2. The patient will -Position patient in a effectively cough up
coughing. of airway which will be able to effectively side lying with both secretions after
- Vital Signs taken as further cause cough up secretions knees flexed with treatments and deep
follows: difficulty of after treatments and pillow at waist level breaths.
Temperature=37.6 breathing. deep breaths.
Pulse Rate=94 beats (Fundamentals of 3. Encourage oral Increased fluid
per minute Nursing 7th edition intake of fluids within intake reduces the
Respiratory Rate= 26 by Kozier et al. p. the limits of cardiac viscosity of mucus
breathes per minute 1299) reserve (3L of fluids) produced by the
BP= 130/80 goblet cells in the
-Maintaining a airways. It is easier
patent airway is vital for the patient to
to life. Coughing is mobilize thinner
the main mechanism secretions with
for clearing the coughing.
airway. However,
the cough may be
ineffective in both 4. Explain effects of Smoking contributes
normal and disease smoking, including to bronchospasm
states secondary to second-hand smoke. and increased mucus
factors such as pain, production in the
trauma, respiratory airways.
muscle fatigue, or
neuromuscular
weakness. Other
mechanisms that
exist in the lower
bronchioles and
alveoli to maintain
the airway include
the mucociliary
system,
macrophages, and
the lymphatics.
Likewise, conditions
that cause increased
production of
secretions can
overtax these
mechanisms.
 CUES/DATA NURSING RATIONALE GOALS and INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES
Subjective: Ineffective -Inspiration and/or After 30 minutes of Independent After 30 minutes of
“Simula nung lagi breathing pattern expiration that does intervention: 1. Encourage intervention, the
na akong inuubo, related to decreased not provide adequate sustained deep breaths goals and objectives
madali na akong lung volume ventilation by: have been fully met,
hingalin at parang capacity and proven that:
nauubusan ng frequent productive -Respiratory pattern o Using demonstration These techniques
hininga.”, as cough as evidenced monitoring (emphasizing slow help to improve
verbalized by the by dyspnea addresses the 1. The patient’s inhalation, holding ventilation and 1. Vital Signs as
patient patient’s ventilatory breathing pattern is end inspiration for a mobilize secretions follows:
pattern, rate, and maintained as few seconds, and without causing
Objective: depth. Most evidenced by passive exhalation) breathlessness and Temperature=37.3
- Use of accessory pulmonary eupnea, and regular fatigue Pulse Rate=90 beats
muscles while deterioration is respiratory per minute
breathing preceded by a rate/pattern. o Asking patient to This simple Respiratory Rate= 20
- Retractions in ribs change in breathing yawn. technique promotes breathes per minute
present while pattern. Respiratory deep inspiration. BP= 130/80
breathing failure can be seen
-Continuous with a change in
coughing respiratory rate,
- Vital Signs taken as change in normal
follows: abdominal and
Temperature=37.6 thoracic patterns for
Pulse Rate=94 beats inspiration and
per minute expiration, change in
Respiratory Rate= 26 depth of ventilation,
breathes per minute and respiratory
BP= 130/80 alternans.
 CUES/DATA NURSING RATIONALE GOALS and INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES
Subjective: Imbalanced - This condition Immediately after 1. Discuss eating To appeal to client’s The goals and
“Wala akong ganang Nutrition: Less than needs to be intervention, the habits, including food likes or dislikes. objectives have been
kumain, kaya nga Body Requirements addressed patient will verbalize preferences. fully met as the
nabawasan talaga related to loss of immediately for the and demonstrate patient verbalizes and
timbang ko mula 72 appetite as client to be able to selection of foods or demonstrates
kilograms naging 60 evidenced by weight gain enough strength meals that will 2. Discourage These may decrease selection of foods or
kilograms nalang loss in performing her achieve a cessation beverages that are appetite and lead to meals that will
ako sa loob ng 2 usual activities. of weight loss. caffeinated or early satiety. achieve a cessation of
buwan” as carbonated before weight loss.
verbalized by the -The body obtains meals.
client. energy in the form of
calories from 3. Review and Patients may not
Objective: carbohydrates, reinforce the understand what is
-Thin protein and fat. The following to patient or involved in a
-Signs of weakness body uses energy for caregivers: balanced diet.
voluntary activities o The basic four food
such as walking and groups, as well as the
involuntary activities need for specific
such as breathing. minerals or vitamins.
(Fundamentals of -Vitamin C (Helps the
Nursing 7th edition immune system to
by Kozier et al.) produce antibodies)
-calcium (help relief
for tuberculin lesions
-vitamin B6(combats
toxic effect of INH)

o Importance of
maintaining adequate
caloric intake; an
average adult needs
1800 to 2200 kcal/
day.
o Foods high in
calories and protein
that will promote
weight gain and
nitrogen balance (e.g.,
small frequent meals
of foods high in
calories and protein)
*Perform health
teaching according to
client’s level of
understanding.
 CUES/DATA NURSING RATIONALE GOALS and INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES
Subjective: Activity intolerance - This nursing After 8 hours of Independent The goals and
“Isa talaga sa related to inadequate diagnosis is not life intervention, 1. Determine patient's Assessment guides objectives have been
malaking pagbabago oxygen supply, as threatening and perception of causes treatment. partially met as
sakin ay yung evidenced by easy doesn’t need of fatigue or activity evidenced by:
madali nakong fatigability immediate attention, intolerance. These
mapagod at hingalin, however, it can may be temporary or
di na ko makapag- affect the body’s 1. The patient will permanent, physical or 1. The patient still
side car at normal functioning. maintain activity psychological. experienced
makagawa ng ilang (Fundamentals of level within shortness of breath
bagay.” as Nursing 7th edition capabilities, as 2. Establish guidelines Motivation is during activities.
verbalized by the by Kozier et al. p. evidenced by normal and goals of activity enhanced if the
client. 1068) heart rate and blood with the patient and patient participates
pressure during caregiver. (Avoid any in goal setting.
Objective: -Most activity activity, as well as kind of heavy work)
- Increased heart rate intolerance is related absence of shortness
and respiratory rate to generalized of breath, weakness, 3. Encourage adequate Rest between
response to minimal weakness and and fatigue. rest periods, especially activities provides
activity. debilitation before meals, exercise time for energy
- Exertional secondary to acute or sessions, and conservation and 2. Patient verbalized
discomfort or chronic illness and 2. Patient will ambulation. recovery. Heart rate and used energy-
dyspnea disease. Activity verbalize and use recovery following conservation
intolerance may also energy-conservation activity is greatest at techniques.
be related to techniques. the beginning of a
emotional states rest period.
such as depression or
lack of confidence to
exert one's self. 4. Refrain from Patients with limited
performing activity tolerance
nonessential activities. need to prioritize
tasks.
5. Support patient in Muscles that are
establishing a regular deconditioned
regimen of exercise consume more
according to the oxygen and place an
patient’s level of additional burden on
functioning. Example the lungs. Through
is exercise through regular, graded
walking. exercise, these
muscle groups
become more
conditioned, and the
patient can do more
without getting as
short of breath.
 CUES/DATA NURSING RATIONALE GOALS and INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES
Subjective: Ineffective coping -For most persons, After 8 hours of Independent The goals and
“Isa talaga sa related to lower everyday life interventions: objectives have been
malaking pagbabago activity level and the includes its share of 1. Evaluate resources Appropriate problem fully met as
sakin eh yung inability to work stressors and and support systems solving requires indicated by:
madali nakong demands, ranging available to patient. accurate information
mapagod at hingalin, from family, work, 1. The patient will Resources may and understanding 1. The patient
di na ko makapag- and responsibilities identify own include significant of options. Often identified his own
side car at to major life events maladaptive coping others, health care patients who are maladaptive coping
makagawa ng ilang such as illness How behaviors. providers such as ineffectively coping behaviors.
bagay.” As one responds to such home health nurses, are unable to hear or
verbalized by the stressors depends on 2. Patient will community resources, assimilate needed 2. Patient identified
patient. the person’s coping identify available and spiritual information. available resources
“Kinakaya ko resources. Such resources and counseling. and support systems.
namang iwasan yung resources can include support systems.
mga dati kong optimistic beliefs, 2. Assess level of The patient could not 3. Patient described
bisyo” social support 3. Patient will understanding and start changing his and initiated
networks, personal describe and initiate readiness to learn lifestyle if he cannot alternative coping
Objective: health and energy, alternative coping needed lifestyle understand the strategies.
-Verbalization of problem-solving strategies. changes. teachings and if he is
inability to cope skills, and material not motivated and
-Physical symptoms resources. convinced to do so.
such as lack of Vulnerable
appetite is a possible populations such as
evidence those in adverse 3. Establish a working An ongoing
socioeconomic relationship with relationship
situations and those patient through establishes trust,
with complex continuity of care. reduces the feeling
medical problems of isolation, and may
may not have the facilitate coping.
resources or skills to
cope with their acute
or chronic stressors.

4. Provide Verbalization of
opportunities to actual or perceived
express concerns, threats can help
fears, feelings, and reduce anxiety.
expectations.

5. Encourage patient During crises,

to identify own patients may not be
strengths and abilities. able to recognize
their strengths.
Fostering awareness
can expedite use of
these strengths.

6. Encourage patient This helps patient

to set realistic goals. gain control over the
situation. Guiding
the patient to view
the situation in
smaller parts may
make the problem
more manageable.

7. Instruct in need for These facilitate

adequate rest and coping strengths.
balanced diet. Inadequate diet and
fatigue can
themselves be
 stressors.

8. Teach use of Relaxation reduces

relaxation, exercise, stress, anxiety, and
and diversional dyspnea and helps
activities as methods patient cope with
to cope with stress. disability.
XI. ON GOING APPRAISAL

The patient started to take the medication ordered by his doctor last January 18, 2010. He
takes 4 types of pulmonary tuberculosis medications every two days in the Bario Magsaysay
Health Center at around 10:00am. The medicines that he takes are isoniazid, Rifampicin,
pyrazinamide, Ethambutol. During Fridays, he gets his medicine for Sunday because the Health
Center is closed during weekends. The patient is currently adhering to the medications given to
him and applying techniques such as using his own utensils to prevent/break the chain of
infection. Below is a list of activities that was done by the group during the OPD Duty:

January 28, 2010: The group performed initial interview and assessment to the patient.
Physical examination was done. Discussed to the patient interventions that
will alleviate some of his problems regarding his condition. Interventions
are as follows:
1. Determine the patient’s perception of causes of fatigue or
activity intolerance.
2. Establish guidelines and goals of activity with patient and
caregiver.
3. Encourage patients adequate rest periods.
4. Refrain from performing nonessential procedures.
5. Support patient in establishing a regular regimen of
exercises.
6. Evaluate resources and support systems available to patient.
7. Assess level of understanding and readiness to learn needed
lifestyle changes.
8. Establish a working relationship with patient.
9. Provide opportunities to express concerns.
10. Encourage patient to identify own strengths and abilities.
11. Encourage patient to set realistic goals.
12. Instructed patient need to rest and have balanced diet.
13. Teach use of relaxation, exercises, and diversional
activities.

January 29, 2010: The group performed nursing interventions to address the problems
experience by the patient. The following are the intervention rendered on
this day:
1. Teach and encourage the patient the use of diaphragmatic
breathing and coughing techniques.
2. Perform postural drainage with percussion and vibration.
3. Encourage oral intake of fluids within the limits of cardiac
reserve.
4. Explain effects of smoking, including second hand smoke.
5. Encourage sustained deep breaths.

January 30, 2010: The group performed additional interviews and assessment to the patient
and rendered interventions that were not discuss previously. The
interventions are:
1. Discuss eating habits.
2. Discourage beverages that are caffeinated or carbonated.
3. Review patient about the food types he needs to eat more or
less.
XII. DISCHARGE PLAN

Medication – Remind client’s to maintain compliance of any medication (Rifampicin, Isoniazid,

Pyrazinamide, Ethambutol and vitamin B6) that the doctor prescribes. To take the drugs at the
exact time as indicated by the doctor’s order. Teach patient on the side effect they might
encounter in taking the drug. Teach patient on the consequences of not taking the drugs on time.
Explanation: The drugs for Pulmonary Tuberculosis like Rifampicin should be taken on schedule
because if the drug was discontinued for 2 weeks the medication should be repeated again from
the start. And the resistance of the bacteria to the drug will strengthen.

Exercise – Teach patient on the importance of regular physical exercise such as 30 minutes brisk
walking. Teach patient Deep Breathing Exercise and coughing exercise. Resume previous
activities. Avoid extraneous activities.
Explanation: this techniques helps to improve ventilation and mobilize secretions.

Treatment - Continue the medication as prescribed by the physician. Drink a lot of water. If
regular sputum test is ordered, have the test taken.
Explanation: The drugs for Pulmonary Tuberculosis like Rifampicin should be taken on schedule
because if the drug was discontinued for 2 weeks the medication should be repeated again from
the start. And the resistance of the bacteria to the drug will strengthen. Water is an effective to
decrease the viscosity or dissolve the phlegm.

Health Education - Advice patient to do regular hand washing. Reiterate importance of

avoiding smoking, second hand smoke, polluted areas and drinking. Advice patient to cover his
mouth while sneezing and coughing. Advice patient to do not spit anywhere. Tell the patient
about the importance of using his own utensil
Explanation: To break the chain of infection. Smoking, second hand smoke, polluted areas, and
drinking can increase severity of the disease.

OPD – Follow up – Follow the Directly Observed Treatment program of the government. Visit
the health center for check-ups, at least one check up per week. Advice the patient to tell the
physician if the symptoms are severe, such as if has difficulty in breathing, fatigue, chest pain,
and productive cough for 5 days.
Explanation – Follow ups are important to monitor the effectiveness of the prescribe
medications. DOTS is a program by the government to check whether TB patients are complying
to the treatment regimen.

Diet – Advice patient to not to skip meals, diet should be high caloric content, drink a lot of
water (at least 8 glasses of water a day). Eat fruits and vegetables. Eat calcium rich foods (Milk).
Eat vitamin c rich foods (mangoes, broccoli, cauliflower, tomato). Avoid high fat diets
(Candies).
Explanation: calcium rich food provides relief for Tuberculin lesions. Vitamin C will strengthen
the immune system of the patient

Signs and Symptoms – Dyspnea, Non-productive or productive cough, Hemoptysis (Blood

tinge sputum), Chest pain that maybe pleuritic or dull, Chest Tightness, Fatigue, Anorexia, and
Weight Loss.
Explanation: Signs and symptoms are integral part in diagnosis of a Pulmonary Tuberculosis
patient.
ATTACHMENTS:

Breathing exercise
General Instructions
-Breath slowly and rhythmically to exhale completely and empty the lungs completely.
-Inhale through the nose to filter, humidify, and warm the air before it enters the lungs.
-If you feel out of breath, breath more slowly6 by prolonging the exhalation time.
-Keep the air moist with a humidifier.

Diaphragmatic Breathing
-Place one hand on tyh3 abdomen and the other hand on the middle of the chest to increase the
awareness of the position of the diaphragm and its function in breathing.
-Breath in slowly and deeply through the nose, letting the abdomen protrude as far as possible.
-Breath out through pursed lip while tightening the abdominal muscles.
-Press firmly inward and upward on the abdomen while breathing out.
-Repeat for one minute follow with a rest period of two minutes.
-Gradually increase duration up to five minutes, several times a day.

Pursed Lip Breathing

-Inhale through the nose while slowly counting to three the amount of time need to “smell a
rouse”
-Exhale slowly and evenly against pursed lips while tightening the abdominal muscle.
-Count to seven slowly while prolonging expiration through pursed lips the length of time to say
blow out the candle.
-While sitting in a chair fold arms over the abdomen
-Inhale through the nose while counting to three slowly
-Bend forward and exhale slowly through pursed lips while counting to seven slowly.
-While walking;
Inhale while walking two steps
Exhale through pursed lip while walking four or five steps

Effective coughing technique

-The patient assumes a sitting position and bends slightly forward. This upright position permits
a stronger cough
-The patient’s knees and hips are flexed to promote relaxation and reduce strain in abdominal
muscle while coughing.
-The [patient inhales slowly through the nose and exhale through the pursed lip several times
-The patient should cough twice during each exhalation while contracting the abdomen sharply
with each cough
-the patient splits incision area, if any, with firm hand pressure or supports it with a pillow or
rolled blanket while coughing.