Professional Documents
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A case Presented by
LEVEL III, BLOCK 3
The term tuberculosis was first used in 1839; it was derived from the Latin word
tubercula, meaning small lump, referring to the small scars seen in tissues of infected
individuals. TB reappeared in Europe and the United States in epidemic form during the 19th
century. In 1882 German physician Robert Koch discovered the bacteria that caused TB. Using
simple but precise observations and experiments, Koch demonstrated the presence of the bacteria
and how it was transmitted.
Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It
also may be transmitted to other parts of the body, including meninges , kidneys, bones and
lymph nodes. The primary infectious agent, M. 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.
The signs and symptoms of pulmonary tuberculosis are insidious. Most patients have
low-grade fever, cough, night sweats, fatigue, and weight loss. The cough may be non-
productive, or mucopurulent sputum may be expectorated. Hemoptysis also may occur. Both
systematic and the pulmonary symptoms are chronic and may have been present for weeks to
months. Elderly patients usually present less pronounced symptoms than younger patients.
PATIENT’S PROFILE
Name: Patient A
Gender: Male
Nationality: Filipino
PATIENT’S HISTORY
Patient A, is a 80 year old male, a Filipino citizen who resides in Prado, Umingan. His
religious affiliation in Roman Catholic and he was married once and their union produced four
children. He used to work abroad as construction worker. He used to work long extended hours,
about 10-12 hours, in order to have money to send back to the country. He usually sleeps for just
7 hours a day. He usually sleeps at 9 in the evening and rises up at 4 am to get his act together.
He usually have pandesal and coffee as his meal for breakfast. After eating his meals, he lits up
a cigarette every single time. Smoking was his vice ever since he was a teenager. He is
hospitalized for the nth time; and for the same reasons, for PTB. All of his children are married
and have completed their studies. His eldest child is the one who stands watch on him most of
the time. He has health insurance card, and is willing to undertake everything necessary for him
to get well.
13 AREAS OF ASSESSMENT
Patient A is an 80 year old male with four children and used to work as a construction worker
abroad. His family belongs to the middle class group.
Patient A’s cardiac rate is 84 beats per minute and has a blood pressure of 120/70 mm Hg.
X. RESPIRATORY STATUS
Patient A has productive cough, dyspnea and crackles upon auscultation and changes in
respiratory rate and depth. His respiratory rate is 28breaths/min.
Patient A is experiencing clubbing of fingers and toes and enlarged or tender lymph nodes in
the neck.
The lungs are paired elastic structures enclosed in the thoracic cage, which is an airtight
chamber with distensible walls. Ventilation requires movement of the walls of the thoracic cage
and of its floor, the diaphragm. The effect of these movements is alternately to increase and
decrease the capacity of the chest. When the capacity of the chest is increase, air enters through
the trachea (inspiration) because of the lowered pressure within and inflates the lungs. When the
chest wall and diaphragm return to
their previous positions (expiration),
the lungs recoil and force the air out
through the bronchi and trachea.
PATHOPHYSIOLOGY
M. tuberculosis
Inhalation
Irritation of airway
Alveoli
Phagocytes
(neutrophils and
macrophages) Cough Crackle
Engulf many of the s
bacteria
Hyperventilatio Airway
n constriction
GRANULOMAS TB-specific
Surrounded by lymphocytes destroy Increase work
macrophages the bacilli and normal in breathing DOB
tissue
Transformed to a
fibrous tissue Accumulation of
mass exudates in the alveoli Impaired O2 and
ulceration
CO2 exchange
Spread
GHON TUBERCLE of the
bronchi
Bronchopneumonia Ventilatory demands
Necrosis
Scar formation
INTERPRETATION
In active pulmonary TB, infiltrates or consolidations and/or cavities are often seen in the
upper lungs. However, lesions may appear anywhere in the lungs. A reaction of 5 mm or greater is
defined as positive in those persons with nodular or fibrotic changes on CXR consistent with old healed
TB. An acid-fast smear and sputum culture that contains M. tuberculosis is an indication for pulmonary
tuberculosis.