Pulmonary Tuberculosis



A. Background of the Study Pulmonary tuberculosis, a chronic sub-acute or acute respiratory disease commonly affecting the lungs characterized by the formation of tubercles in the tissues which tend to undergo cessation, necrosis and calcification. It is also known as poor man’s disease or consumption disease. The causative agent in this disease is Mycobacterium Tuberculosis, a rod shaped bacteria. The disease is transmitted by deliberate inoculation of microorganisms by droplet. This disease is transmitted to other people through the inhalation of organisms directly into the lungs from contaminated air. According to the department of Health (DOH) PTB is the 6th cause of mortality and morbidity in the Philippines as of 2007. (Navales, Handbook of Common Communicable and Infectious disease revised edition, pages 280-281.) This disease is can be acquired easily by person being in contact with an infected one, when you are living in a crowded area like the squatter’s area and when you have poor nutrition. It is commonly present in third world or developing countries like the Philippines. In 2004, 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.

B. Rationale for Choosing the Case The researchers decided to choose this case because they wanted to acquire more knowledge about Pulmonary Tuberculosis. They wanted to use the knowledge that they have acquired in promoting awareness to the people especially to the poor that they should seek for medical care in order to prevent the development and progression of PTB. The researchers also wanted to focus on preventive measures. PTB can cause Tuberculosis meningitis, a very rare and fatal disease and the researchers would not want that to happen, so they will focus more on information campaign as part of primary prevention of health. Presently our country has so many cases of PTB. C. Significance of the Study This study will help the nursing profession by providing information about the proper management and care for PTB patient. It will also educate the people, especially those with PTB and vulnerable individuals to seek medical care in order to prevent TBM. It will increase awareness about the importance of having a healthy lifestyle and clean environment. This study will elaborate the inter relatedness of environment, life style habits and acquiring Pulmonary Tuberculosis. D. Scope and Limitation of the Study This study is focused on the nursing aspect of care to those patients who have Pulmonary Tuberculosis. This study will only be used in the nursing profession. The researchers only focused their attention on the medications, diagnostics, care plan, pathophysiology and discharge planning. This study is not limited to the PTB patients only, but it is for all

people who are interested in PTB. We are more focused on primary prevention through health education because primary prevention is the true prevention. II CLINICAL SUMMARY A. General Data • Name: Eufemia Bugoy y Cia • Age: 46 y/o • Birthplace: Pulangi, Albay • Sex: Female • Religion: Roman Catholic • Civil Status: Married • Address: Baras, Rizal • Date Admitted: September 19, 2008 • Time Admitted: 2:10 am • Attending Physician: Dr. San Jose

B. Chief Complaint:
The patient was admitted at Rizal Provincial Hospital last September 19, 2008 at 2:10 in the morning due to the complaint of difficulty of breathing (DOB). She was attended at the Emergency department and had taken a clinical history and physical assessment. She was transferred at the Medical Ward particularly in the isolation room of the hospital for further evaluation of the complaint. She was attended by Dr. San Jose, a resident physician of the said hospital.

C. History of Present Illness:
Patient’s condition started about 6 months prior to consultation, as onset of cough, non-productive and an intermittent fever usually in the afternoon, moderate grade temperature which are not documented. According to her it was relieved by an intake of paracetamol. One week prior to admission the patient experienced worsening of the condition, she had productive cough nonbloody with whitish secretions. There is also difficulty of breathing and vomiting. The patient can’t eat properly because she has no appetite for food. She also experience stabbing pain on her chest according to the assessment it is 6/10 and it

radiates to his back. The patient only took paracetamol for her fever. On the day of September 19, 2008 she was rushed to the hospital because of difficulty of breathing. Previously when she started experiencing these conditions, she does not seek for any medical care from the physician because according to her it is still tolerable. D. Past Medical History The patient had upper respiratory tract infection when she was a child, she cannot remember. Previously she was not hospitalized. She does not have complete immunizations because according to her it is not available in their place during those days, She has no history of hypertension and Diabetes mellitus. Whenever she had any flu or cough, she uses herbal plants. She does not have any regular medical and dental check-ups. She does not have allergies to what ever kind of foods and medications as far as she knows. Whenever she had fever she takes Paracetamol and Bioflu. She does experience any severe accidents.

E. Familial History

Telesporo Cia, 75 Deceased CVA

Eugenia Chavez 65 Deceased VA

Carlito, 75

Litsilda, 50

Flusofid a, 48

Junior, 44 Eufemia, 46 PTB Arsenio, 50

Josephine , 42

Gaudiocio, 40

Blencio, 38


Analyn, 23

Anabel, 22

Analiza, 19

Ana Marie, 15

Arnold, 10

Legends Male Female PTB Pulmonary Tuberculosis F. CVAPhysical Assessment Cerebro Vascular Attack Upon Admission VA • Vehicular Accident • GCS-15 oriented to 3 spheres-(E4M6V5)

Date: September 19, 2008 Height: 62 inches

Inspection Has Hollowness Abnormal. symmetric nasolabial No edema and hollowness Rounded(normocephali c).com/hollowed/under-eyehollows. uniform consistence.5 C LOC: Oriented TECHNIQUE NORMS FINDINGS Weight: 31. no masses nor nodules Normal Inspection Palpation Symmetrical and palpebral fissure equal in size. Presence of edema and hollowness in the eye. Volume deficiency of fat within the orbit (the space inside of the bony eye socket). Smooth skull contour Smooth. and depressions 3. This condition of the patient is related to his nutritional status. and occipital prominences).html) C. with frontal. SKULL V/S: BP. HAIR 1.• • AREA A.90/70 mmHg. Inspection Palpation Evenly distributed Evenly distributed with Normal . palpebral fissure equal in size. Presence of nodules. she is malnourished.drmeronk. (http://www. Her BMI is 12. Evenness of growth. absence of nodules or masses Symmetric or slightly asymmetric facial features. masses. RR: 36 cpm. T-37. smooth skull contour Normal 2. Size.5 kilograms BMI: 12. shape and symmetry of the skull Inspection Palpation Rounded (normocephalic and symmetrical.5 (Severe Malnutrition) ANALYSIS and INTERPRETATION 1. CR: 84 bpm.5. nasolabial folds are symmetrical Normal 4. Facial Features Palpation Inspection Has no tenderness. parietal.

EYES A. thick hair 2. EYEBROWS Hair distribution. Lice may be contracted from infcetd clothes and direct contact with an infected person. resilient hair no patches of hair loss. There is pediculosis. Normal IV. Equal palpebral fissure. such as oil. smooth and resilient hair Presence of lice Normal. Maybe thick or thin Silky. The idea is that an oily substance. Fundamentals of Nursing 7th ed. FACE Facial features. or thinness of hair Inspection Palpation Inspection Palption and covers the whole scalp. palpebral fissures equal in size. Movements Normal . black.thickness. brown or blond depending on race. smothers the lice and they may die. maybe black. (Kozier. symmetric nasolabial folds Symmetrical facial features while talking or elevating the eyebrow. alignment. evenly distributed. Texture and oiliness over the scalp 3. symmetry of facial movements Inspection Symmetric or slightly asymmetric facial features. a type of parasitic infection. evenly Symmetrical and aligned with each other. symmetrical nasolabial folds. skin quality and movement Inspection Symmetrical and in line with each other. No infection and infestation Abnormal. Presence of infection and infestation Silky. Page 733) D.

moist. pale conjunctiva may be related to the low RBC level of the patient. cornea. ability to blink. EYELIDS Surface characteristics and position (in relation to the cornea. page 642) .distributed B. (Fundamentals of Nursing 5th edition by Taylor. and frequency of blinking) Inspection Upper eyelids cover the small portion of the iris. no ulcers Pale color. smooth in texture Abnormal. texture. Normal D. (Fundamentals of Nursing 5th edition by Taylor. EYELASHES Evenness of distribution and direction of curl Inspection Palpation Evenly distributed. pale conjunctiva may be related to the low RBC level of the patient. and the presence of lesions in the bulbar conjunctiva Inspection Palapation Pinkish or red in color. symmetrical Able to close the eyes and has the ability to blink. texture. no ulcers Pinkish or red in color. and sclera when eyes are open. CONJUNCTIVA 1. no foreign bodies. with presence of small capillaries. and the presence of lesions in the palpebral conjunctiva Inspection Palpation Pale Abnormal. Turned outward eyelashes. eyelids meet completely when the eyes are closed. Color. moist. no foreign bodies. turned outward are symmetrical. page 642) 2. with presence of small capillaries. Color. hair equally distributed Normal C.

Normal 2. Color. some capillaries maybe visible White sclera with some visible capillaries. SCLERA Color and clarity Inspection White in color. color depends on the person’s race Dark brown in color. PUPILS 1. no noted visible materials. looks smooth. no yellowish discoloration. shape. clear. anicteric sclera. Normal F. IRIS Shape and color Inspection Anterior chamber is transparent. transparent anterior chamber Normal H. clear or transparent Clear and smooth in texture Normal G. Light reaction and accommodation Inspection Dilates when looking at far objects and constricts when looking Normal .E. CORNEA Clarity and texture Inspection No irregularities on the surface. equally round Constrict briskly/sluggishly when light is directed Pupil size is 3mm. and symmetry of size Inspection Color depends on the person’s race. and are equal in size. size ranges from 3-7 mm.

Normal . Transient mayopia occurs due to influenza. VISUAL ACUITY 1. It is caused by an eyeball that is longer than normal. page 1963). Medical Surgical Nursing7th edition. move in unison. LACRIMAL GLAND Palpability and tenderness of the lacrimal gland K. with parallel alignment Moves in Unison Normal Palpation No edema or tenderness over lacrimal gland No tenderness and edema noted. both directly and consensual I. which may be a familial trait. Near vision Inspection Able to read newsprint at near objects. it is a refractive defect of the eye in which collimated light produces image focus in front of the retina when accommodation is relaxed. VISUAL FIELDS Peripheral visual fields Inspection When looking straight ahead. EXTRAOCULAR MUSCLES Eye alignment and coordination Inspection Both eyes coordinated. Constricts when there is light. J. client can see objects in the Can see objects in the periphery. Nearsightedness (Myopia) Abnormal.to the eye. Normal L. steroids. sever dehydration and large intake of antacids. (Black.

Nasal flaring suggests airway obstruction. flexible and elastic pinna. tip of auricle aligned at the outer canthus of the eye. symmetrical. Nasal septum (between the nasal Inspection Symmetric and straight. no discharge or flaring.Any deviations in shape. HEARING ACUITY TESTS 1. AURICLES 1. Normal 2. Uniform color Nasal septum intact Symmetric and straight. Client’s response to normal voice tones Inspection Normal voice tones audible Can hear normal volume tones or words. and not tender. pinna recoils after it is folded Same color as the facial skin. firm. symmetry of size. size. Abnormal. Normal VI. about 10 degrees from vertical Mobile. and position Inspection Color same as facial skin. EARS A. Texture. elasticity and areas of tenderness Palpation Smooth in texture. auricle aligned with outer canthus of eye. Color.periphery V. no tenderness Normal C. NOSE 1. Uniform color with nasal flaring. Nasal discharge shows the presence of mucus secretions in the air tract. Normal Inspection Nasal septum intact . or color and flaring or discharge from the nares 2.

Inspection Not tender Not painful when palpated Normal Inspection Palpation Uniform pink color. (Black.chambers) 3. and displacements of bone and cartilage VII. (Black. MOUTH A. Normal 4. soft. symmetry of contour. moist. texture. Abnormal. BUCCAL MUCOSA Color. B. moist. May suggests dehydration. . and the presence of lesions Inspection Uniform pink color. page 208). color and texture Palpation Not tender. no lesions Nor tenderness nor lesions. and elastic texture Pink color and dry. Tenderness. Right nares is with secretion. Abnormal. May suggest cellular dehydration. ability to purse lips Pink in color. smooth texture. page 208). smooth. not patent right nares show the presence of mucus secretions and would suggest there is an infection in the respiratory system. moisture. masses. soft. Medical Surgical Nursing7th edition. dry and cracked lips Abnormal. SINUSES Identification of the sinuses and for tenderness VIII. LIPS Symmetry of contour. Patency of both nasal cavities Palpation Inspection and in midline Air moves freely as the client breathes through the nares and in midline Only left nares is patent. Medical Surgical Nursing7th edition. glistening.

Color and texture of the mouth floor and frenulum. movement and base of the tongue Inspection Located and positioned in the center. Normal 3. smooth. Abnormal. thin whitish coating. TEETH Color. smooth tongue base with prominent veins Smooth with no palpable nodules. GUMS Color and condition Inspection Pink gums. lumps. Have tooth decay in the lower right second molars. TONGUE/FLOOR OF THE MOUTH 1. or excoriated areas Palpation Inspection No tenderness nor Normal . (http://en. no retraction Pink gums. Normal 2. color and texture. number and condition and presence of dentures Inspection 32 adult teeth.wikipedia. no tenderness Central position. Pink and moist. intact dentures Has 31 adult teeth. Tongue moves freely and no pain felt. Inspection pink color. pink color. smooth.org/wiki/Halitosis).C. shiny tooth enamel. It is also related to dental carries and frequency of tooth brushing. The most common location for mouth-related halitosis is the tongue. Position. moves freely. D. white. has no visible retractions Normal E. Have bad breath. most unpleasant odors are known to arise from proteins trapped in the mouth which are processed by oral bacteria. slightly rough. Any nodules. moist. The patient has yellowish teeth.

pinkish in color. May suggests dehydration. pinkish 3. Normal 2. no discharge. has quite rough texture Positioned at the center of the oropharynx Normal 2. smooth. (Black. Medical Surgical Nursing7th edition. shape. and effortless respirations Difficulty of breathing Abnormal. Gag reflex X. page 208). texture and the presence of bony prominences Inspection Palpation Light pink. Color. labored breathing is a common manifestation affecting clients with cardiac and pulmonary disorders. PALATES and UVULA 1. of normal size Present Has no discharge. color. soft palate. and discharge of the tonsils Inspection Pink and smooth. ANTERIOR THORAX 1.lumps. more irregular texture Positioned in midline of soft palate masses The hard palate has a lighter color than the soft palate. Color and texture Inspection Normal Inspection Pink and smooth posterior wall Dry. lighter pink hard palate . Breathing patterns Inspection Present Normal Inspection Quiet. OROPHARYNX and TONSILS 1. Abnormal. THORAX A. Position of the uvula and mobility (while examining the palates) G. Size. or excoriated areas F. It is related to . rhythmic.

Spinal alignment Inspection Spine vertically aligned Skin intact. has equal warmth on both sides. uniform temperature. uniform temperature. Temperature. page 1756). 2. chest wall intact. and masses Palpation Normal . symmetry. page 1566). Shape. chest wall intact. Anterior thorax auscultation Auscultation Has crackles sounds on the upper thorax & lower thorax Abnormal. and comparison of anteroposterior thorax to transverse diameter Inspection Palpation Anteroposterior to transverse diameter in ratio 1:2. It is usually heard during inspiration. no Normal 3. no tenderness. tenderness.obstructed airway. (Black. POSTERIOR THORAX 1. Medical Surgical Nursing7th edition. crackles or rales are audible when there is a sudden opening of small airways that contain fluid. Medical Surgical Nursing7th edition. has equal Normal 2. It also related to the decreased size of the lungs due to PTB. no masses Bronchovesicular and vesicular breath sounds Has an intact skin. Temperature. No masses. tenderness. Normal 3. (Black. Chest symmetric Has a anteroposterior to transverse diameter ratio of 1:2. masses Palpation Skin intact. elliptical in shape and symmetrical chest Has a vertical alignment No masses nor tenderness. B.

Sounds on the aortic and pulmonic areas. (http://www. TRICUSPID AREA Auscultation No pulsations No pulsations felt Normal Auscultation No pulsations. AORTIC and PULMONIC AREAS B. Diminished lung sound on the posterior right lung. Posterior thorax auscultation Auscultation Vesicular and bronchovesicular breath sounds warmth on each side Has crackles heard on the anterior and middle part of right and left lungs. CARDIOVASCULAR AREAS AUSCULTATION Auscultation Auscultation Has pulsation Has full and rapid pulsation. 84 bpm/minute. CARDIOVASCULAR A. has a lub sound on the apex and dub sounds Normal Normal Normal . Abnormal. APICAL AREA Auscultation Has full pulsation Normal D. no lift or heave Pulsations visible in 50% of adults and palpable in most PMI in fifth LICS at or medial to MCL Aortic pulsations S1: Usually heard at all sites Usually louder at the apical area S2: Usually heard at all sites No pulsations of lifts Normal C. EPIGASTRIC AREA E.tenderness.nurse411.asp) XI. no masses 7.com/Heart_Lung_Sounds. the condition is related to the decreased size of the right lung and poor inspiratory effort due to pain.

Medical Surgical Nursing7th edition. turns head. Abnormal. (Black. and changes from sitting to supine position. on the tricuspid area. slightly shorter duration than diastole at normal heart rate (60 to 90 beats/min) Diastole: silent interval. decreased amount of blood volume passing the artery. Carotid artery palpation Palpation Symmetric pulse volumes.Usually louder at the base of heart Systole: silent interval. Normal Has weak pulsation. Blood pressure is 90/70 mm Hg. . quality remains same when the client breathes. CAROTID ARTERIES 1. Symmetrical pulse. thrusting quality. page 1574). slightly longer duration than systole at normal heart rates S3: in children and young adults S4: in many older adults XII. full pulsations.

Normal 2. Abdominal movements associated with respirations. Skin integrity Inspection Unblemished skin. Fundamentals of Nursing 7th ed. Presence of a foul smelling odor. subclavicular.Symmetry of contour Inspection Has a symmetrical abdominal contour Abdominal movements noted when inhaling. (Kozier et. or scaphoid(concave) No evidence of enlargement of liver or spleen Symmetric contour Uniform color and has no blemishes Has a concave abdomen. and supraclavicular lymph nodes Inspection No tenderness. but when decomposed or acted upon by bacteria in the skin. uniform color Flat. Enlargement of liver or spleen Inspection No enlargement of the spleen and liver seen Normal 4. Abnormal. ABDOMEN 1. visible peristalsis in very lean people. Axillary. peristalsis or aortic pulsations Inspection Symmetric movements caused by respiration. The secretion of these glands is odorless. AXILLAE 1.al. or nodules Have no masses and nodules. Abdominal contour Inspection Normal 3. unpleasant odor. Normal 5. it takes on a musky.elastic arterial wall XIV. aortic pulsations in thin Normal . masses. rounded(convex). Page 699) XV. The appocrine glands located in the axillae produces sweat.

possibly related to the amount of food that patient is eating. Muscle tonicity Inspection Proportionate to the body. JOINTS 1. Possible exhaustion experienced by the patient when she coughs. no pain. Joint swelling Inspection No swelling.persons at epigastric area 6. Muscle strength Palpation Has equal muscular strength on both sides Weak muscle strength Abnormal.org/wiki/Muscle_weakness) Palpation 4. no crepitus Normal . no crepitus No swelling. even in both sides Has no fasciculation and tremors Weak muscle tone Normal Inspection Normal Abnormal. possibly related to the amount of food that patient is eating. MUSCULOSKELETAL SYSTEM A. Muscle size and comparison on the other side 2.wikipedia. even in both sides No fasciculation and tremors Even and firm muscle tone Proportionate to the body. (http://en. no pain.org/wiki/Muscle_weakness) C. Vascular pattern Inspection No visible vascular pattern Has no blood vessels visible Normal XVI. Fasciculation and tremors in the muscles 3. no warmth. (http://en.wikipedia. no redness. MUSCLES 1. no redness. no warmth. Possible exhaustion experienced by the patient when she coughs.

EXTREMETIES Inspection. no pain when moved. Normal Normal Normal Normal Normal Findings Actual Findings Analysis and interpretation . no warmth. No edema. Coherent Able to state what happened to her in the past. time and place. Normal Neurologic Assessment: Category Mental Status Level of Consciousness Orientation Language test Recall Alert Oriented Coherent Able to remember Alert Oriented to person. Palpation No swelling. no pain. no redness.

myopia or nearsightedness. CN III. able to read. (Black. VI Occulomotor Trochlear Abducens (+) Extraoccular Movement (EOM). Able to move the eyes in any direction in unison. There is constriction and consensual accommodation. can maintain balance Can hear clearly and can walk. uvula Present gag reflex. it is a refractive defect of the eye in which collimated light produces image focus in front of the retina when accommodation is relaxed. X Glossopharyngeal Vagus .Cranial Nerves CN 1 Olfactory CN 11 Optic Able to smell and recognize stimuli 20x20 vision. With active corneal reflex. Lateral Upward and downward. able to read. able to CN IX. Facial asymmetry Normal Able to feel my finger on her face while covering her eyes. with bilateral facial sensation. sever dehydration and large intake of antacids. Normal CN V Trigeminal CN VII Facial CN VIII Vestibulocochlear Able to feel and clearly identify stimulus. Pupils react to light. Normal (+) gag reflex. Medical Surgical Nursing7th edition. Normal Abnormal. steroids. Transient mayopia occurs due to influenza. which may be a familial trait. 3-5 mm [pupil size] Able to identify the scent of the alcohol Pupil size is 3 mm. (+) Corneal reflex . IV. pupils reactive to light. page 1963). It is caused by an eyeball that is longer than normal. Normal (+) Facial symmetry Normal Able to hear clearly.

Normal Can shrug shoulders against resistance and can turn the head fro right to right. soft palate rises Able to shrug shoulders against resistance and able to turn the head side and against resistance. Possible exhaustion experienced by the patient when she coughs. .org/wiki/Muscle_weakness) Right Arm Left Leg Right Leg Abnormal Abnormal Abnormal G. Normal Able to protrude the tongue and move it side to side.wikipedia. Abnormal. Patterns of Functioning The researchers utilized the Gordon’s typology in assessing the pattern of functioning of our patient in her life. possibly related to the amount of food that patient is eating. +4 active motion against some resistance. +4 active motion against some resistance. CN XII Hypoglossal Muscle Strength Left Arm MNT Grading System: (+5) Active motion against full resistance (+5) Active motion against full resistance (+5) Active motion against full resistance (+5) Active motion against full resistance +4 active motion against some resistance. Able to move tongue from side to side swallow and able to idebtify the taste of the food. (http://en. +4 active motion against some resistance. How does she manages and takes care of herself based on Eleven Patterns.CN XI Accessory (Spinal) at the center.

instead she cleans the house and washes the clothes of her family. • She often forgot to cover her mouth and nose when someone sneezes and coughs in front of her. providing only the care that patients cannot or should not provide for themselves. What is important is that personal care be carried out conveniently and frequently enough to promote personal hygiene. • She takes a bath once a day and brushes her teeth once a day. • She washes her hands regularly but not always using soap. oyster and others. Nurses assist the patient with basic hygiene must respect individual patient preferences. • Whenever she is sick. when necessary. regarding hygiene. • Does not experience any accidents. oregano. • For her. hands should always be washed after using the toilet.wikipedia. she used herbal medicines like guava leaves. Illness. called personal hygiene. Medical problems arising from malnutrition are commonly referred to as deficiency diseases. or trace minerals. She can eat fish. she get’s money from her children Norms and Standards Measure for personal cleanliness and grooming. • Health for her is important for proper functioning. The time of the day one bathes and how often one shampoo or changes the bed linens. reduced activity and energy. • She was never been hospitalized.Health Management • The patient doesn’t have complete immunization because according to her it is not available during those days and having immunization during those years are expensive and they cannot afford it. or . • No known allergies to any foods and drugs. • She does not have any regular medical and dental check-ups. page 1005). reduced intelligence and various cognitive abilities. Various studies have confirmed that improved personal hygiene practices reduce illness rates. and poorer health overall are directly implicated to nutrient deficiencies. Deficiency in iron. 2002. the nurse helps the patient to continue some hygiene practices. etc. • When she feels discomfort in her body she also goes to the manghihilot because it is available on their area and it is more approachable.Functional Health Pattern Prior to Hospitalization Health perception. malnourished people either do not have enough calories in their diet. Personal hygiene practices vary widely among people. To maintain good hygiene. Most commonly. Deficiency in micronutrients such as Vitamin A reduces the capacity of the body to resist diseases. 2001). Malnutrition is the lack of sufficient nutrients to maintain healthy bodily functions and is typically associated with extreme poverty in economically developing countries. • She does use lotion.org/wiki/Malnourishment) The main purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. and sleeping garments are relatively unimportant. and can teach the patient and family members. changing a diaper. promote physical and psychological well-being. iodine and vitamin A is widely prevalent and represent a major public health challenge. she can do what she wants and does not experience any diseases. reduced muscle growth and strength. being healthy is important. particularly diarrhea and pneumonia. An array of afflictions ranging from stunted growth. reduced leadership and assertiveness. • When she is experiencing something wrong in her body. lagundi. (http://en. she does not tell it promptly because according to her it is tolerable. • When she had a disease. or are eating a diet that lacks protein. In these situations. tending to someone who is sick. A person is healthy when she is strong. • She does not have a regular exercise. • A person has a disease when she eats little amount of food. hospitalization and institutionalization generally require modifications in hygiene practices. • The patient is malnourished. vitamins. Larson and Aiello. shampoo and soap. when she is weak. (Larson. (Fundamentals of Nursing 5th edition by Taylor. reduced sociability.

handling raw meat. Be sure to consult with your doctor or an herbalist before self-treating. rheumatoid arthritis. Alcohol rub sanitizers kill bacteria. weight management. The patient is non-smoker and she does not drink any alcoholic beverages. or any other situation leading to potential contamination.al. (Kozier et. Fundamentals of Nursing 7th ed. eczema. and . following the recommended portions of the 5 food groups. Please see our monographs on individual herbs for detailed descriptions of uses as well as risks. Fundamentals of Nursing 7th ed. and irritable bowel syndrome. or poultry. and potential interactions. she usually eats 4 spoons of rice with viand only. • She eats food given by the hospital. • When her cough started.• • • especially to the eldest. Nutrition is a basic human need that changes throughout the life cycle and along the wellness-illness continuum. which is working abroad. menopausal symptoms. Page 1171. chronic fatigue. • She is taking vitamin B6 and other medications. and she feels clean and neat. cardiovascular diseases. she usually eats banana because it is affordable and readily available in their place. side effects. she is not eating the appropriate amount of food. Some common herbs and their uses are discussed below. vaccinia. herpes.htm) Nutritional Metabolic Pattern • She loves to eat pork. • She is not choosy when it comes to any cook and kind of food. • She drinks 5 glasses of water a day. Conventionally. It is due to her cough.wikipedia.edu/altmed/articles/herbal-medicine000351. with special attention to protein. Habits about eating are affected by many factors like financial and health conditions.1181) An adult individual needs to balance energy intake with his or her level of physical activity to avoid storing excess body fat. • For her. fish.al. • She eats 3x a day • She does not eat any junk foods. She denies the use any illicit drugs. fitness. RSV.org/wiki/Hand_washing) Herbalists treat many conditions such as asthma. She wears slippers while inside their house. calcium and limiting consumption to cholesterol. (http://en. Pre menopausal women need to ingest sufficient calcium and vitamin d to prevent osteoporosis. (http://www. the amount of food she consumes is adequate. including under fingernails is seen as necessary. and the prevention of chronic diseases such as osteoporosis. page 1135) An adequate food intake consists of balance essentials nutrients: water. • According to her husband. and hepatitis) and fungus. tuberculosis. fats. among others. proteins.umm. Herbal preparations are best taken under the guidance of a trained professional. rhinovirus. Dietary practices and food choices are related to wellness and affect health. (Fundamentals of Nursing 5th edition by Taylor. fish and vegetables. (Kozier et. Page 1180. cancer. • During snack time. She feels that her hygienic practices are adequate. the use of soap and warm running water and the washing of all surfaces thoroughly. Two to three liters of fluid should be included in the diet. and viruses (including HIV. Hands should also be washed before eating. migraine. influenza. • During her hospitalization.1175) The middle aged adult should continue to eat a healthy diet. handling or cooking food. multi-drug resistant bacteria (MRSA and VRE). • She takes food supplement but it is not frequent. premenstrual syndrome. she is on diet as tolerated with aspiration precaution. vitamins and minerals. carbohydrates.

lifestyle. the amount and quality of fluid or food intake. (http://www. it is also affected. but when her condition exacerbated. A person’s urinary habits depend on social culture. Fundamentals of Nursing 7th ed. generalized muscle weakness. Most people have individual pattern of elimination including frequency. • She urinates 7x a day and does not feel any pain and difficulty.al. eggs and lean meats move more slowly through the intestinal tract. and procedures such as diagnostic test and surgery. page 1341) The frequency of defecation is highly individualized. daily patterns. Sufficient bulk in the diet is necessary to provide fecal volume. medication. emotional states. Activity stimulates peristalsis. and balance their energy intake accordingly. • According to her the characteristic of her stool is hard. (Fundamentals of Nursing 5th edition by Taylor. Fundamentals of Nursing 7th ed. personal habits and physical abilities. page 1229). (Fundamentals of Nursing 5th edition by Taylor. The excretory function of the kidney diminishes with age but usually not significant below normal levels unless disease intervenes. In order to remain healthy. Page 1228). dry and colored dark brown.al.faqs. For most people defecation is a private affair experienced easily only in the comfort of one’s own bathroom. varying from several times per day to two to three times per week. Lowresidue foods such as rice.diabetes. Bland diets and lowfiber diets are lacking in the bulk and therefore create insufficient residue of waste products to stimulate the reflex for defecation. . timing considerations.html) Inadequate nutrition is associated with marked weight loss. increased susceptibility to infection. Page 1256). position and place. • She feels pain at her abdomen on the hypogastric and umbilical area. Page 1190). based on their level of physical activity.al. adults must be aware of changes in their energy needs. thus facilitating the movement of chime along the colon. Urine collects in the bladder contains between 250 to 450 ml of urine. Defecation may be difficult in shared hospital room with only a curtain for privacy.org/nutrition/A-Ap/AdultNutrition. For adults (ages eighteen to forty-five or fifty). (Kozier et. the level of activity. pathologic processes. (Kozier et. • Previously her defecation pattern is daily. Elimination • She defecates twice a week and sometimes she feels pain and difficulty. Elimination can be affected by a person’s developmental stage. Fundamentals of Nursing 7th ed. impaired pulmonary function and prolonged length of hospitalization. weight management is a key factor in achieving health and wellness. (Kozier et. altered functional ability.

the toxins are released into the bloodstream. (Kozier et. or immobility related to illness. Fundamentals of Nursing 7th ed. Activity and Exercise • She does not have any work. Fundamentals of Nursing 7th ed. Page 1118). complications resulting from immobility differ occurrence and severity based on the patients age and overall health status. • She does not involve her self in any vigorous activities. • When she cleans. The human body was designed for motion. it is usually for 1 hour because she gets easily tired. When you burn fat. • Her usual activity is cleaning the house. (Fundamentals of Nursing 5th edition by Taylor. But too much insulin in the bloodstream keeps your body from burning stored fat. • Her youngest child helps her in the household chores. she is a plain house wife. cooking and washing the clothes of her children. inactivity. hard exercise—that makes you sweat— is very good for you. and are quickly carried out of the body through sweat. • She loves to listen to radio programs usually in the afternoon. who is in-charge of her children. Insulin is commonly referred to as “the fat-making hormone. page 1116) Vigorous physical activity is not always needed to achieve positive result. the number of functioning nephrons decreases to some degree. a person receives from exercise. The wonderful tool of exercise can help teens become fit and healthy. and regular exercise is necessary for its healthy functioning. she is aware that her activity is not enough. Exercise also helps to regulate the amount of insulin released into the bloodstream. and she recognizes the importance of having regular exercise. By having a high metabolism. • However. • When after all the chores are done she will rest and watch television. The amount of flood intake affects the urinary frequency of an individual. This inoculates you against the probability of developing cancerous and diseased cells. Years of an overworked pancreas—the organ that produces . (Kozier et. Performing some form of physical activity daily will significantly boost your “basal metabolic rate”—the number of calories your body burns in order to keep you alive. you burn calories 24 hours a day—even while you sleep! You can literally turn your body into a fat-burning machine! This has many benefits: With a strong metabolism comes a strong immune system. Therefore.al. • She likes to converse with her friends and neighborhood.al. page 1117) Lack of exercise. impairing the kidneys filtering abilities. Individuals who choose inactive lifestyles or who are forced into inactivity by illness or injury placed themselves at high risk for serious health problems. Foods high in sodium or fluids high in sodium ca cause fluid retention because water are retained to maintain the normal concentration of the electrolyte.” Its job is to metabolize blood sugar into energy. or injury place a person at high risk for serious health problems. Like the benefits. (Fundamentals of Nursing 5th edition by Taylor.With age. Immobility can affect the major body systems. Page 12581259).

Cognition is greatly affected by education. It is important however that a person follows a pattern of rest that maintains well-being. do not begin a running routine until you have performed two to three months of aerobic walking. (Kozier et. 8 hours of sleep a night has been the accepted standard for adults despite obvious variations seen in the general population. Illnesses and various life situations that . • According to her she is sensitive to the feelings of the people around her.” However. Running is the quickest way to lose weight. Medical Surgical Nursing7th edition. high cholesterol and others. The most common aerobic exercise is walking. Fundamentals of Nursing 7th ed. • She can express her feelings appropriately. stress. (http://www. The main goal of aerobic exercise is to keep the heart elevated for an extended period of time for the purpose of strengthening the heart and lungs. • She stops studying because of financial problem • She can read and write properly. • She is not always reading any books like pocket books. disease-free. decreased energy. such as: Sleep apnea. • She is aware to different people or happening around her. you significantly reduce the chances of developing this disease.al. page 1880). Exercise can also help control other problems. and overall healthier person. • She is experiencing intermittent sleep disturbance because according to her she feels difficulty of breathing and cough. For no known reason. cardiovascular disease. Presence of any sensory abnormalities affects or halters perception that would affect proper communication.org/youth/articles/0201-tioe. perceptual ability and ability to process information. if you use— burn—more calories than you consume. Cognition involves a person’s intelligence. Perception is affected by the sensory diseases. • There are no any blockages of communication noted. from simple to complex problem solving and from concrete to abstract ideas. Page 359). because it burns many calories. Sleep and Rest • The patient regularly sleeps at 8:00pm and wakes up at 1:00 pm. Those who study and develop their skills have better cognitive performances because they have been provided with different information and chances to develop their self. There are too many benefits to list here. • During the interview her voice is weak. Many factors affect a person’s ability to rest.insulin—can lead to “onset (type 2) diabetes. (Black. • She does not have any difficulty when it comes to communication. However. to avoid extreme muscle aches or injuries.thercg. It represents a progression of mental abilities from illogical to logical thinking. But be assured that this tool can help you become a fit. • She can talk properly. It also tones your calves and thighs.html) Cognitive-perceptual • The patient is an elementary graduate. moodiness. stronger.

Salamat.amphetamines and antidepressants) and some are seen to cause sleep problems (steroids. and overall health. Page 1169-117). She feels that her sleep and rest is inadequate. A positive self concept is essential to a person’s mental and physical health. memory and problem solving. Turner et al. Sleep quality is also influenced by certain drugs Some decreases REM sleep (barbiturates . Individuals with a positive self concept are better able to develop and maintain interpersonal relationship and resist psychological and physical illness. Working memory is important because it keeps information active for further processing and supports higher-level cognitive functions such as decision making. Fundamentals of Nursing 7th ed. as well as reducing the risk of accidents. Scientists have shown numerous ways in which sleep is related to memory. In a study by Zager et al in 2007. • As a mother. She takes a nap in the morning from 8 am to 11 am.wikipedia. the sleep-deprived rats' blood tests indicated a 20% decrease in white blood cell count. allowed 18 women and 22 men to sleep only 26 minutes per night over a 4-day period.[8] A widely publicized 2003 study[9] performed at the University of Pennsylvania School of Medicine demonstrated that cognitive performance declines with fewer than eight hours of sleep. Subjects were given initial cognitive tests while well rested and then tested again twice a day during the 4 days of sleep deprivation. and episodic memory.• • • • • • She usually sits because according to her she can breath more easily. she sometimes feels sad because she cannot do the previous things like going with her husband in the farm. appearance. On the final test the average working memory span of the sleep deprived group had dropped by 38% in comparison to the control group. (http://en. Self concept involves all of these self perceptions. • According to her husband she is a good mother and a good wife. a significant change in the immune system.[21] rats were deprived of sleep for 24 hours. Sleeping is important to her.org/wiki/Sleep) Self concept is one’s mental image of oneself. She sleeps together with her husband. that is. When compared with a control group. caffeine and asthma medications) (Kozier et. The National Sleep Foundation in the United States maintains that eight to nine hours of sleep for adult humans is optimal and that sufficient sleep benefits alertness. They have a separate room from their children. Drummond. causes physiological stress tends to disturb sleep. It has also been shown that sleep deprivation affects the immune system and metabolism. Body image is ho the Self-perception • According to her there is something wrong in her health and body. reasoning.al. In a study conducted by Turner. and Brown[28] working memory was shown to be affected by sleep deprivation. values and beliefs that influences behaviors and that are referred to when using the words I or me. .

Illness and trauma can also affect the self-concept. or a parent-child relationship. Psychologists have suggested that all humans have a basic. such as a romantic or intimate relationship. the individual is more likely to think positively about the physical and non-physical concept of self. • She can form a healthy relationship with others. marriage. and are the basis of social groups and society as a whole. • She is being cared by her children who are very supportive to her. neighborhoods. and engage in activities together. People in a relationship tend to influence each other. showing care and putting trust. feeling of joy an others.al. Role-relationship • She was the fourth child in her family. People responds to different stressors such as illness and alterations in function related to aging in a variety of ways: acceptance. acquaintances. • She does not have any enemies. Relationship to another person is a developed manner in which there is the sharing of self. (Kozier et. An interpersonal relationship is a relatively long-term association between two or more people. Because of this interdependence. or some other type of social commitment. Sexuality-reproductive person perceives the size. work. • She has a harmonious relationship with her brothers and sisters. • Her children have a good relationship to her.wikipedia. If a person’s body image closely resembles one’s ideal body. Pages 957-962). such as family. relationships can be viewed in terms of attachment styles that develop during early childhood. • She is performing the trypical responsibilities of a plain house wife. motivational drive to form and maintain caring interpersonal relationships. appearance and functioning of the body. (http://en. • She is the person who chooses her friends. clubs. They may be regulated by law. or mutual agreement. She is simple. These patterns are believed to influence interactions throughout adulthood by shaping the roles people adopt in relationships. withdrawal and depression are common. share their thoughts and feelings. People undergoing role-strains are frustrated because they feel or made to feel inadequate or unsuited to a role. According to attachment theory. regular business interactions. • Her husband is a good husband he is a provider who does everything for the family to have food. A relationship is normally viewed as a connection between two individuals.org/wiki/Intimate_relationship) Sexuality is defined not only by a person’s genetalia but also by . • She is married to Arsenio and they have 6 children. Self concept is also affected by role-strains.• • Her strength is her family. it will facilitate the channeling of the ideas. they are helping each other. A healthy relationship affects an individual’s emotional development. Whenever there are any problems. and churches. All relationships involve some level of interdependence. custom. friends. • She is a very quite person. Fundamentals of Nursing 7th ed. when there are any circumstances that involving any family member she is concerned and make some moves. denial. anything that changes or impacts one member of the relationship will have some level of impact on the other member. This association may be based on emotions like love and liking. Interpersonal relationships take place in a great variety of contexts.

body image and sexual identity. page 931) Sexuality is a crucial part of a person’s identity. to our emotional well-being and to the quality of our lives. attitudes and feelings. • Her husband or children taps her back when she coughs. sleep disturbances. (Kozier et. hair changes. Sexual desires fluctuates within each person and varies from person to person. The incidence of osteoporosis and cardiovascular lipid changes also increases. Women through the menopausal period experiences hot flushes. During the middle adulthood both men and women experience decreased hormone production causing the climacteric. O’ Briens conceptual model of spiritual well- . Coping-stress • Whenever she has problem. Value-belief • She is a Roman Catholic • She attends mass occasionally. It can also be defined as learned behaviors in how a person reacts to his or her own sexuality and by how one behaves in relationships with others. emotional.• • • • • • She is engage in sexual activity to her husband only. Presently she is still active in her sex life. psychologic. changes are more gradual.980). and forgiveness are met. vaginal dryness. Pages 973).al. page 855) Spiritual well-being is the condition that exists when the universal spiritual needs for meaning and purpose. communication and love. • When she experiences coughing and difficulty of breathing she just relaxes and breathes deeply. She is also able to express her feminine attitudes. Many coping behaviors are learned. they may not experience any physiological respose. She is aware that she will have cessation of her menstruation.al. genital tract atrophy. The climacteric in the males is no as dramatic in the females. based on one’s family past experiences. based on her gender. Fundamentals of Nursing 7th ed. usually called menopausal in women. (Fundamentals of Nursing 5th edition by Taylor. • When she gets mad. vasomotor instability. The world health organization defined sexual health as the integration of the somatic. mood changes and skin. (Fundamentals of Nursing 5th edition by Taylor. Fundamentals of Nursing 7th ed. She still have regular menstruation. physical and spiritual make up. she just keep quiet. Pages 975. Coping mechanisms which are behaviors used to decrease stress and anxiety. love and belonging. If people suppresses or block out conscous sexual desires. These events often affect the individuals selfconcept. which plays a significant role in the satisfaction. Sex is central to who we are. and socio-cultural influences and expectations. Sexual response love and play involve people’s emotional. She dresses appropriately. she asks guidance from our Lord • She watches television as her stress management. (Kozier et. intellectual and social aspect of sexual beings in ways that are positively enriching and that enhances personality. • She always listen to radio programs when she feels lonely.

and frothy. Pages 975. Fundamentals of Nursing 7th ed. Previously her defecation pattern is daily. The expression of a person’s spiritual energy to others is manifested in loving relationship with and service to others. Defecation may be difficult in shared . Relating to one’s inner self or soul may be achieved through conducting an inner dialogue with a higher power or with one’s self through prayer or medications. as to avoid aspiration. thickened food on a small frequent feeding. Patient voids 7 times a day. Spiritual beliefs are of special importance to nurses because of the many ways they can influence a patient’s level of health and self-care behaviors. religious practice and spiritual contentment. empathy. She eats 4 spoons of rice with viand because according to her it is due to her cough. People nurture or enhance their spirituality in many ways. She eats anything that is being served to her. INTERPRETATION and ANALYSIS The patient can eat any food she wants as long as it is dry. (Kozier et. and defecate twice a week. She believes in ghosts. thickened. being in illness identified three empirical referents of spiritual wellbeing: personal faith. joy and laughter and participation in religious services and associated fellow gatherings and activities and by expression of compassion. H.979). Spiritual well-being is manifested by a generally feeling of being alive. Activities of Daily Living ASPECT 1. she participates in the activities like fasting. 2. and elementals. Elimination The patient does not defecate or urinated during the conduct of the interview.• • • • • • • She always ask the guidance of our Lord Whenever there are Christian events. For her education is very important to her children. but when her condition exacerbated. Pages 996). It should be in a small frequent feeding. purposeful and fulfilled. fish and vegetables.al. She respects and obeys her husband. forgiveness and hope. Does not always pray the rosary. like Holy week. She doesn’t experience any pain and difficulty in terms of urination. She is not taking food supplements like vitamins frequently. it is also affected.al. She eats dry. She does not eat junk foods. She seldom reads the bible. others focus on the expression of their spiritual energy with others or outer world. For most people defecation is a private affair experienced easily only in the comfort of one’s own bathroom. so she and her husband is doing all the efforts to send their children to school. She eats thrice a day. Nutrition PRIOR TO HOSPITALIZATION Patient loves to eat meat. Fundamentals of Nursing 7th ed. (Kozier et. DURING HOSPITALIZATION The patient is on diet as tolerated with aspiration precaution. Some focus on development of the inner self or world. She is advised to chew food properly. The patient does not defecate for more than a week due to decreased gastric motility related to decrease physical activity.

(Fundamentals of Nursing 5th edition by Taylor. The patient regularly sleeps at Deep breathing and coughing exercises are advised and performed. Sleep and Rest . brushes her teeth once a day. She wears slippers while inside their house. cigarettes and illicit drugs. she is aware that her activity is not enough. Substance Use The patient doesn’t use any prohibited substances like alcohol. She feels that her hygienic practices are adequate. She does not have routine exercise. even cigarette smoking and alcohol drinking. Exercise Cleaning their house is the only activity she considered as her exercise. The patient has decreasing function as the disease progresses. Patient is a non-smoker and denies use of illicit drugs. Patient takes a bath every day. However. She is experiencing intermittent sleep disturbance because according to her she feels difficulty of breathing and cough. There is body odor noted. She takes a nap in the morning from 8 am to 11 am. Not applicable The patient does not use any addictive substances. When after all the chores are done she will rest and watch television. page 975 & 979) 3. Hygiene Not applicable 5. She loves to listen to radio programs usually in the afternoon. 6. and she recognizes the importance of having regular exercise. She sleeps together with her husband. 4. The patient performs deep breathing exercise as instructed by the nurse. Illicit drugs are strictly prohibited in the hospital premises.hospital room with only a curtain for privacy. She does not drink alcohol. and she feels clean and neat. Sleeping is important to her.

4x 1012 per liter 5-10x109/L 81. Sexual Activity She dresses appropriately.40 g/L 4’2-5. -Is a disease. it is the place where an individual is being treated from severe cases. mental and social well-being and not merely the absence of disease or infirmity.8:00pm and wakes up at 1:00 pm. Illness and Hospitalization ILLNESS For the patient. For the patient. . an individual is weak and eats little amount of food. or treatment for some diseases. does not experience any sickness and energetic.2% 0. Presently she is still active in her sex life Not applicable I. (Blackwell’s Nursing Dictionary) HEALTH The patient believes that being healthy is being strong. diagnostic test. 19. Patients Concept about Health. 2008 .Placement of an individual in a hospital for observation. either physically or mentally. . Laboratory and Diagnostic Examination PROCEDURE Hemoglobin Hematocrit RBC count WBC Neutrophils Lymphocytes Basophils NORMS 120-160g/L 0.3% 10.1% RESULT INTERPRETATION and ANALYSIS DATE Sept. She still has regular menstruation.Health is defined as a state of complete physical. She is engage in sexual activity to her husband only. WHO definition J. She feels that her sleep and rest is inadequate because of her conditions.38-0. 7. based on her gender. (Blackwell’s Nursing Dictionary) HOSPITALIZATION The patient looks at hospitalization as the last recourse when one has an illness. sickness or the condition of being in a poor health.

Vital signs BP.08 umol/L 135-145mmol/L 3. The film shows presence of infiltrates or clouds. DATE September 19.5% 0. RR: 36 cpm. 2008 MEDICAL PROCEDURES/ORDERS History taking Physical assessment Neurological Assessment Chest-x-ray NURSING ASSESSMENT and FUNCTION Upon admission: -GCS E4 V5 M6 . particularly the lower lobe of the right lung. T-31. CR: 84 bpm. difficulty of breathing. coughing. she was placed in a wheel chair.Monocytes Eosinophils Platelets Fasting Blood Sugar Urinalysis Creatinine Na K Sputum Test/AFB • • Electro Cardiogram Chest X-ray 7.5 C .5mmol/L Negative The patient had undergone chest x-ray upon admission.90/70 mmHg. Course in the Ward The patient was accompanied by her husband and her children. L.6-5.2-106. weight loss and chest pain. This diagnosis is supported by the pathognomonic signs that manifested by the patient. the patient’s attending physician.9% 150-450x109/L 70-110 mg/dl 44. San Jose. The right is smaller than the left lung. This diagnosis is supported by the following diagnostic exam such as Culture and Sensitivity of the sputum and chest x-ray. Impression/Diagnosis Dr. who diagnosed the disease as Pulmonary tuberculosis. K. These include intermittent fever in the afternoon. While waiting for the doctor.

Not always covering her nose and doing proper hand washing are the practices that have predisposes the patient to develop the disease.IVF of PNSS 1 liter 20 gtts/min to run for 12 hours.On DAT with AP M. Ecologic Model Hypothesis The patient developed PTB thru the inhalation of mycobacterium tuberculosis due to being exposed to an environment. . Roman Catholic  Highest educational attainment: Elementary graduate. -Due meds given .IV insertion done at the right arm. . • Host • •  46 yrs old Female Filipino. • B complex 2 ampules TIV stat • Cefuroxime 500 mg/Cap • Theophylline 1 cap TID • Salbutamol and Guiafene Sin + tab TID PO .  Living together with her family in Baras.Kept rested -Advised relatives to use mask and hand washing regularly. . The disease is directly transmitted through inhalation of organisms directly into the lungs. .Physical assessment done . specifically in their community.Neurologic assessment done -crackles noted upon auscultation. then every 6 hours. A rod-shaped organism.X-ray result obtained. . Agent • Tuberculosis is a common and deadly infectious disease caused by mycobacterium mainly Mycobacterium tuberculosis. Rizal  Have incomplete vaccination.. .Medications • Nausil 1 ampule TIV stat.Patient was oriented.History taking . where in some people around her have Pulmonary Tuberculosis.   . 2:40 AM -Received from ER to Medical surgical ward.Placed in isolation room .Diet as Tolerated with aspiration precaution. infusing well. She had come in close contact with people who had PTB. Mycobacterium tuberculosis.

Environment The patient resides in a crowded community where in cases with Tuberculosis is present. Does not have a regular medical check up. Exposed to a person who is carrier of M. Does not always cover her nose and mouth when exposed to a person who coughs or sneezes. Does not regularly take vitamins and minerals Does not have a regular medical check up. The researchers used the epidemiologic web causation model. Takes a bath once a day and brushes teeth once.     Practices hand washing but improper without soap. Tuberculosis. Does not always cover her nose and mouth in situations needed to. in which this model focuses to the complex multi factorial causes of a disease. Financial insufficiency. People who are most commonly infected are those who have repeated close contact with an infected person. TB is an airborne infection. The present environment where she resides is not polluted. .

Airborne transmission Does not practice proper hand washing. Inadequate of knowledge about health management . Exposure to a carrier of M. Not covering the nose and mouth when someone sneezes or coughs causes the bacteria in their sputum to travel through the air. This bacterium enters the host thru the nose and mouth. Degen eration of health y cells. Weakened immune system Lack of immunizations Taking a bath once a day and brushing teeth only once.. 643) Mayco Bacterium Tuberculosis . Analysis PTB is caused by mycobacterium tuberculosis. The so called airborne transmission will now take place affecting the individual.Educationa l attainment . (Brunner and Suddarth’s Textbook of Medical. It is the true prevention. Hand washing has been the most effective means of preventing transfer. It first affects the alveoli of the lungs then this bacterium spreads thru the bloodstream. Living in an unhealthy place predisposes the individual to develop certain diseases especially those within the respiratory system. This bacterium migrates to other parts of the body. tuberculosis.Surgical Nursing 11th ed by Smeltzer et al p.. HOST Infected of Tuberculosis Meningitis.

it is expelled through automatic coughing. . practicing proper hand washing. they are focused on promoting wellness through health education especially to that of the poor. The larynx is covered by the epiglottis. Personal discipline is a crucial factor. the nasal cavity. Breathing. The upper part consists of the nose. working in conjunction with the circulatory system. but closes during swallowing. and bronchial tree. The human respiratory system consists of the respiratory tract and the lungs. Blood vessels in the nose and nasal cavity release heat and warm the entering air. The cilia move pieces of the mucus with its trapped particles to the throat. As nurses. The epiglottis stays open during breathing. supplies oxygen to the body's cells. The lower part consists of the trachea (windpipe). The nose has openings to the outside that allow air to enter. The tract can be divided into an upper and a lower part. If something other than air enters the trachea. personal hygiene and use of personal protective equipments are the things that are very important. The exchange of these gases occurs across cell membranes both in the lungs (external respiration) and in the body tissues (internal respiration). white connective tissue). Stomach acids destroy bacteria in swallowed mucus. Respiratory tract The respiratory tract cleans. which is supported by a framework of cartilage (tough. This cavity is lined with mucous membrane and fine hairs called cilia. Hairs inside the nose trap dirt and keep it out of the respiratory tract. The human respiratory system. removing carbon dioxide in the process.Conclusion and recommendation The researchers therefore conclude that PTB can be prevented if we always clean the environment. nasal cavity. a flap of elastic cartilage that moves up and down like a trap door. where it is spit out or swallowed. or pulmonary ventilation. This valve mechanism keeps solid particles (food) and liquids out of the trachea. Air leaves the nasal cavity and enters the pharynx. Mucus moistens the incoming air and traps dust. and moistens air during its trip to the lungs. and larynx (voice box). warms. describes the process of inhaling and exhaling air. The external nose leads to a large cavity within the skull. II CLINICAL DISCUSSION OF THE DISEASE A. Anatomy and Physiology Respiration is the process by which living organisms take in oxygen and release carbon dioxide. bronchi. pharynx (throat). From there it passes into the larynx.

internal respiration takes place.02 inch (0. A fluid between the two membrane layers reduces friction and allows smooth movement of the lungs during breathing. the bronchi subdivide repeatedly into smaller airways. The oxygen diffuses or passes into the tissue fluid. The heart separates them. Diaphragm: Dome-shaped sheet of muscle located below the lungs separating the thoracic and abdominal cavities that contracts and expands to force air in and out of the lungs. The terminal bronchioles enter cup-shaped air sacs called alveoli (pronounced al-VEE-o-leye). . This branching network within the lungs is called the bronchial tree. Terminal bronchioles have a diameter of about 0. The right lung is somewhat larger than the left. surrounds and protects the lungs. The lungs The lungs are two cone-shaped organs located in the chest or thoracic cavity. The lungs are divided into lobes. These provide an enormous surface area for gas exchange. each one of which receives its own bronchial branch. air-conducting subdivisions of the bronchi in the lungs.Alveoli: Tiny air-filled sacs in the lungs where the exchange of oxygen and carbon dioxide occurs between the lungs and the bloodstream. A sac. One layer of the pleura attaches to the wall of the thoracic cavity and the other layer encloses the lungs. Inside the lungs. Air enters the trachea in the neck. As blood passes through these vessels and air fills the alveoli. The average person has a total of about 700 million gas-filled alveoli in the lungs. When this blood reaches the cells of the body.5 millimeter). and then into the cells. Bronchial tree: Branching. while the cartilage rings prevent them from collapsing. Pleura: Membranous sac that envelops each lung and lines the thoracic cavity. At the same time. called bronchi (pronounced BRONG-key). Bronchi: Two main branches of the trachea leading into the lungs. This process—external respiration—causes the blood to leave the lungs laden with oxygen and cleared of carbon dioxide. Elastic fibers in the trachea walls allow the airways to expand and contract during breathing. Eventually they form tiny branches called terminal bronchioles. each entering a lung. A network of capillaries (tiny blood vessels) surrounds each alveoli. the exchange of gases takes place: oxygen passes from the alveoli into the capillaries while carbon dioxide passes from the capillaries into the alveoli. carbon dioxide in the cells diffuses into the tissue fluid and then into the capillaries. Epiglottis: Flap of elastic cartilage covering the larynx that allows air to pass through the trachea while keeping solid particles and liquids out. The trachea divides behind the sternum (breastbone) to form a left and right branch. Mucous membrane lines the trachea and C-shaped cartilage rings reinforce its walls. The carbon dioxide-filled blood then returns to the lungs for another cycle. called the pleura.

A healthy adult breathes in and out about 12 times per minute. As a consequence. The diaphragm relaxes and its dome curves up into the chest cavity. The rest of the air remains in the respiratory tract. Nerves from the brain send impulses to the diaphragm and intercostal muscles. By contracting. Under normal circumstances. humans inhale and exhale about one pint (475 milliliters) of air in each cycle. air rushes into the lungs during inhalation. Lung expansion is brought about by two important muscles. The diminished size of the chest cavity increases the pressure in the lungs. it moves down. When the diaphragm contracts. which also increases the size of the chest cavity. the ribs move up and outward. the diaphragm and intercostal muscles reduce the pressure inside the lungs relative to the pressure of the outside air. The intercostal muscles are located between the ribs. Total lung capacity is about 12. Regardless of the volume of air . stimulating them to contract or relax. the diaphragm (pronounced DIE-a-fram) and the intercostal muscles. Only about three-quarters of this air reaches the alveoli. When the intercostal muscles contract. the reverse occurs. and the size of the chest cavity is increased. thereby forcing air out. but this rate changes with exercise and other factors. The diaphragm is a dome-shaped sheet of muscle located below the lungs that separates the thoracic and abdominal cavities. The dome is flattened.Breathing Breathing exchanges gases between the outside air and the alveoli of the lungs.5 pints (6 liters). while the intercostal muscles relax and bring the ribs down and inward. During exhalation.

Assess for any hypersensitivity.A short-acting β2adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. Bronchodialtor -Relief and prevention of bronchospasm in patients with reversible obstructive airway disease -Inhalation: Treatment of -Contraindicated with hypersensitivity to albuterol. SAlbutamol . .Be cautious when driving. SIDE EFFECTS -Stomach stomach -pain -Diarrhea -Headache . . -Eat food is a small frequent way. This residual air keeps the alveoli and bronchioles partially filled at all times.Restlessness . and A3 receptors almost equally. the lungs always retain about 2.Teach the patient to avoid smoking.breathed in and out.Hypersensitivity . . . headache. C. .vomiting.Monitor patients’ heart rate. -Use cautiously with diabetes mellitus (large IV doses can aggravate diabetes and ketoacidosis). antagonizing A1. . -COPD CONTRAINDICATION .Assess for CNS effects. which explains many of its cardiac effects and some of its anti-asthmatic effects. drowsiness.Assess for any hypersensitivity to albuterol.Insomnia . fatigue.For chronic obstructive diseases of the airway.Mild stimulant -Bronchodilator INDICATION . Drug Study GENERIC / BRAND NAME Theophylline ACTION -The main mechanism of action of theophylline is that of adenosine receptor antagonism.Irritability NURSING INTERVENTION . . change in taste . A2. .Educate the importance of taking the right amount in the right time of medications.Pregnant.Maintain betaadrenergic blocker on stand by. CLASSIFICATI ON . -Dizziness. .Theophylline is a non-specific adenosine antagonist.5 pints (1200 milliliters) of air.

Nausea .Encourage them to go to the doctor before drinking any vitamins. .Enhance immune and nervous system function.acute attacks of bronchospasm -Prevention of exercise-induced bronchospasm. .Support and increase the rate of metabolism.Dizziness . . hepatic. thus inhibiting cell wall biosynthesis.Vomiting . -Bacteria . Cefuroxime .Headache .Increased BUN and Creatinine . .Antibacterial .GI bleeding .Encourage patient to take the vitamin regularly. .Maintain healthy skin and muscle tone . . .Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls.Promote cell growth and division including that of the red blood cells that help prevent anemia.Hypersensitivity to cefuroxime and other cephalosphorine. . with prolonged therapy.Treatment of susceptible infections of the lower respiratory tract .Educate the importance of taking the right amount in the right time of medications.Water soluble Vitamin .Assess for any hypersensitivity. Vitamin B . . monitor renal. and hematologic function.Treatment of infections caused by staphylococci and other microorganisms like klebsiella.Observe for signs and symptoms of anaphylaxis during first dose.

(hydrolyzing glycosaminoglycan s: tending to break down/lower the viscosity of mucin- . nausea. and drink immediately. dizziness. flu.Most decongestants cause response from adrenoreceptor a1. -Contraindicated with asthmatic patients and patients with history of peptic ulceration. . . -Should be taken with food -The sachet should be dissolve into a glass of cold or warm water.Guiafen eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. FLUIMUCIL (nausil) Mucolytic -Acute & chronic respiratory tract affections w/ abundant mucus secretions. chiefly responsible for vasoconstriction (a2 modulates adrenaline/noradre naline levels.Expectorant -Used to relieve congestion and to treat cough due to colds.Nervousness. vomiting and headache. . nausea. or if you have problems where the supply of blood and oxygen to the heart is reduced also known as ischemic heart disease. vomiting. b2 dilates the bronchial walls. and b3 induces lipolysis). since both Fluimucil and the other drug effect .Assess for any allergies. stomatitis. -Aerosol treatment: Rhinitis.Decongestant . -Used in the treatment of wet cough. b1 is the most stimulating and increases cardiac output. severe coronary artery disease. -Do not dissolve other medicines together with Fluimucil. bronchospasm. -Urticaria. . -Instruct the patient to consult a doctor when the side effects continues. or hay fever.MEDICINE IS NOT RECOMMENDED if you have a history of severe high blood pressure. trouble sleeping. -Is any agent which dissolves thick mucus usually used to help relieve respiratory difficulties. .Be careful when driving or operating machines. .Instruct the patient that they should swallow the medication whole.

could be influenced or cancelled.Assess for any allergies.. *Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration. . *Use of a vented intravenous administration set with the vent in the open position could result in air embolism.containing body secretions/compon ents). Long Term Objective After two month of intensive treatment the patient will not experience the signs and symptoms of PTB. IV Fluid Treatment / Infusion Classification Indication Contraindication Nursing Responsibilities *Do not connect flexible plastic containers of intravenous solutions in series. do not piggyback connections.e. The complications brought about by PTB will be prevented through proper participation to the different medical and nursing interventions. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic contain. i. Such use could result in air embolism due to residual air being drawn from one container before administration of the fluid from a secondary container is completed. *Hypovolemia *Heat-related emergencies Plain NSS Isotonic *Freshwater drowning *Diabetic ketoacidosis(DKA) *CHF III NURSING PROCESS A. .

difficulty of breathing can cause anxiety to the client that is why. CR: 84 bpm. Wala namang plema. warm to touch -Increase body temperature higher than normal range -Increased respiration -The patient is sweating -T: 37. Breathing and Circulation. “Matagal na akong inuubo.Oriented .B.GCS E4V5M6 . . Nahihirapan akong huminga”. Addressing the problem to proper health care provider will give patent airway to the client.Has hallow eyes.5˚C Subjective: .The patient is only eating 4 spoons of rice with viand. immediate attention must be done. RANK 1 JUSTIFICATION Airway must be given the first attention as based on the rule of ABC which is Airway.90/70 mmHg.Patient verbalized.BP. RR: 36 cpm. This condition needs to be addressed immediately for the client to be able to gain enough strength in performing her usual activities. “Naku hindi na nawala ang lagnat ng asawa ko. Problem List CUES Subjective Cues: . Oxygenation is a vital need for every cell.  The body obtains energy in the form of calories  .Bluish nail beds. p. pabalik-balik na lang” Objective: -Flushed skin. as they can result in delirium and convulsions. Subjective: -The husband of the client verbalized. -The patient is coughing without phlegm.Presence of adventitious breath sound (Crackles) upon auscultation. if there are any problems related to it can easily affect the functioning of the individual. . . Objective Cues: .Difficulty vocalizing . Lack of action in this health care problem may cause dehydration which may later cause a bigger threat to the health of the client.5 C .  Retained secretions can cause blockage of airway which will further cause difficulty of breathing (Fundamentals of Nursing 7th ed by Kozier et al.The relative verbalized “Hindi siya Imbalanced Nutrition: Less than Body Requirements related to inability to ingest food 3 NURSING PROBLEM Ineffective airway clearance related to retained secretions in the respiratory tract secondary to bacterial infection as evidenced by crackles upon auscultation. 1299)  Hyperthermia related to infection as evidenced by increased WBC 2  This demands immediate treatment/care and  subsequent medical attention. T-37. In addition. This is an actual problem that needs to addressed.

6th ed by Potter and Perry p. . . protein and fat.The patient regularly sleeps at 8:00pm and wakes up at 1:00 pm. (Fundamentals of Nursing 7th ed by Kozier et al. 1206)  Subjective: . cooking and washing the clothes.) Activity intolerance related to inadequate oxygen supply as evidenced by easy fatigability. (Fundamentals of Nursing 7th ed by Kozier et al. . because of prolonged cough as evidenced by decreased BMI.Minimal subcutaneous fat. Objective: .The patient weight is 31.nakakakain ng maayus dahil sa kanyang ubo”. (Fundamentals of Nursing.Poor muscle tone. Nursing Care Plan Sleep Deprivation related to prolonged physical discomfort (dyspnea) as evidenced by inability to concentrate 5 .  A lack of rest for long periods can cause illness or worsening of existing illness.Her usual activities is cleaning the house. .   This condition doesn’t need immediate attention but needs to be addressed for sleep is a basic human need.5 kilograms. it can affect the body’s normal functioning  Individuals who have inactive lifestyles or who are faced with inactivity because of illness or injury are at risk for many problems that can affect major body systems. 1068). 4 This nursing diagnosis is not life threatening and doesn’t need immediate attention.She is experiencing intermittent sleep disturbance because according to her she feels difficulty of breathing and cough. The body uses energy for voluntary activities such as walking and in involuntary activities such as breathing.Appears weak. Her maximum work is one hour only. . and then she would go to rest.She takes a nap in the morning from 8 am to 11 am. however. Subjective: . . Clients experience a significant decrease in the muscular strength and agility whenever they do not maintain a moderate amount of physical activity.The husband verbalizes that her wife is easily getting tired. C. Their children help her wife. . p. from carbohydrates.She usually sits because according to her she can breath more easily.

ASSESSMENT NURSING DIAGNOSIS Ineffective airway clearance related to retained secretions in the respiratory tract secondary to bacterial infection as evidenced by crackles upon auscultation.al.90/70 mmHg. Perform the Blanch Test. After 3 hours the client will be able to mobilize her secretions through the interventions done by the NURSING INTERVENTION RATIONALE EVALUATION Subjective Cues: . Perform Chest . combined with GOAL and OBJECTIVES Goal: Within 4 hours of nursing intervention.5 C . Objective 2: IndependentFacilitative: 1.Health status is regulated through homeostatic mechanisms. . . -The patient is coughing without phlegm. the patient will be able to maintain patent airway through the mobilization of secretions as evidenced by productive cough. “Matagal na akong inuubo. FON 5th ed. Page 1386) -Tapping the chest can loosen the secretions. 3. A change in V/S might indicate health change.Has hallow eyes. RR: 36 cpm. Objective Cues: . FON 5th ed. The lungs become quickly filled with fluid and become very stiff. -Crackles are intermittent sounds that occur when air moves through airway that contain fluids. .Blanch test reflects the adequacy of o2 circulation in the periphery. Objectives: 1. Observe for respiratory rate and rhythm. presence of nasal flaring.Bacterial infection of the respiratory system.Was the family willfully accepted the interventions 2. the relative will assess the physical condition of the client by accepting at least 4 nursing interventions to be done in the patient. For 10 minutes.Was the patient able to maintain patent airway? -Was the patient able to mobilize her secretions? -Was the patient able to have patent airway? Adequacy -Was all the planned nursing interventions are enough in achieving and maintaining patent airway? -Was all the resources of the nurse like time and effort are enough? Appropriateness -Was the interventions mentioned are applicable and beneficial to the patient? Acceptability . Obtain vital signs of the patient. Page 1251) 4. FON 5th ed.Patient verbalized. (Taylor et. and use of accessory muscles when breathing like the diaphragm and coastal muscles.Difficulty vocalizing .Oriented . Effectiveness . Health Implication: This condition can cause Acute Respiratory Distress Syndrome (ARDS) which results from the combination of infection and inflammatory response. 2.Presence of adventitious breath sound (Crackles) upon auscultation.Inflammatory response Root Cause: .Retained secretions in the respiratory tract. Intermediate Cause: . (Taylor et. Nahihirapan akong huminga”. Auscultate the lungs to note any lung sounds. CR: 84 bpm.Bluish nail beds.al. T-31.al. Objective 1: IndependentFacilitative: 1. (Taylor et. Wala namang plema. BACKGROUND KNOWLDEGE Intermediate Cause: . Page 523) -Nasal flaring and use of accessory muscles indicates increased effort is required for breathing. .BP.GCS E4V5M6 . This stiffness.

Increase the amount of oral fluid intake as ordered by the doctor. Page 1896) nurse at least 4. 3. the nurse will maintain patent airway of the patient through the performance of at least 3 interventions. MSN 7th ed. (Black. The lack of volume causes the blood to be thick and sluggish and may decrease the mobilization of nutrition and toxins out of the circulation. Page 2201) . physiotherapy. After 50 minutes. Suction secretion as needed. 2.Current data indicates that fluid restriction may actually reduce blood volume and decrease cerebral circulation. DependentSupplemental: 1. Medical Surgical Nursing 7th ed. Elevate the head of the bed. Page 1652) . Objective 3: IndependentFacilitative: 1. -Position changes done to the patient.For maximal lung expansion that will improve oxygen delivery. (Black. . -Suction removes secretions through the use of a strong pressure. (Black. Septic shock is one potential complication. . Administer bronchodilators as ordered. Patient should be maintained in a euvolemic state rather than a fluid-restricted state. MSN 7th ed.They act on the respiratory tract. Dependent-Facilitative: 1.difficulties extracting oxygen due to the alveolar fluid creates a need for ventilation. it opens narrowed airways.

was the family of the client able to assess for the causative/ contributing factor/s? Yes____ No_____ Why_____ Intermediate Cause: Infection of M. Position the head in the midline of the body. the client will be able to lessen temperature of at least 1˚C range from that of 39˚C41˚C to 38˚C-39˚C and be free of chills INDEPENDENT • Identify underlying cause (eg. After 1 minute of nursing intervention. hypothalamic dysfunction. After 30 minutes of nursing interventions.al.5˚C Hyperthermia related to inflammatory response as evidenced by warm to touch skin. warm to touch -Increase body temperature higher than normal range -Increased respiration -The patient is sweating -T: 37. the family of the client will be able to assess for the causative/ contributing factor/s and be able to participate 2. Etiology Immediate Cause: Inflammatory response of the body against microorganis ms.. was the family of the client able to evaluate effects of hyperthermia and . • To know for the right treatment to be given. 1. After 12 minutes of nsg. Tuberculosis Root Cause: Weakened immune 1. “Naku hindi na nawala ang lagnat ng asawa ko. Page 1396) Asessment Nursing Diagnosis Background Knowledge Goal And Objectives Nursing Interventions Rationale Evaluation EFFECTIVENESS Subjective: -The husband of the client verbalized.2. Int. (Taylor et. FON 5th ed. such as drug overdose and infection). pabalik-balik na lang” Objective: -Flushed skin. allow free movement of the diaphragm and expansion of the chest wall. After 1 minute of nursing intervention.

page 667. • Monitor/ record all sources of fluid loss such as urine. 2. Give particular attention to the temperature.106˚F (38. conduction and diffusion. 3. After 15 minutes of nursing intervention. 4. BSN. in one intervention. was the family of the client able to assist with measures to reduce body temperature and participate in at least 6 out of 7 interventions? Yes____ No_____ Why_____ • Oliguria and/or renal failure may be occurring due to hypotension. CS] • To note for further care to be given. [NANDA] • Evaporation is decreased by environmental factors of high humidity and high ambient temperature as well as body factors producing loss of • Note presence/ absence of sweating as body attempts to increase heat loss by evaporation. Copyright 2002 by Marilyn E.9˚C41. Doenges. septic endocarditis or Tuberculosis (TB). RN. • Assess for presence of posturing or seizures. After 12 minutes of nursing interventions. the family of the client will be able to evaluate effects of hyperthermia and be able to participate in at least 3 out of 4 interventions.system. Was the family of the client able to attain wellness after the 2 interventions? Yes____ . MA. INDEPENDENT • Monitor patient’s vital signs. Chills often precede temperature spikes. • Temperature of 102˚F. Fever pattern may aid in diagnosis. [Nursing Care Plans Edition 6. particularly in children. able to participate in at least 5 out of 7 interventions? Yes____ No_____ Why_____ Health Implication: Fevers of 104 F (40 C) or higher demand immediate home treatment and subsequent medical attention. eg 24 hour period suggest septic episode. as they can result in delirium and convulsions.1˚C) suggests acute infectious disease process. dehydration.

CS] No_____ Why_____ Efficiency: Were interventions done within the time frame? ___Yes ___ No. page 667. avoid use of alcohol. Doenges.DEPENDENT • Administer antipyretics. 3. fever should be controlled in patients who are neutropenic or asplenis. [NANDA] • Used to reduce fever by its central action on the hypothalamus. alcohol is very drying to skin. BSN. Copyright 2002 by Marilyn E. Why? _______________ INDEPENDENT • Provide tepid sponge baths. In addition. Acceptability: Were the interventions accepted by the client and his family? ___Yes ___ No. fever may be beneficial in limiting growth of organisms and enhancing autodestruction of infected cells. Copyright 2002 by Marilyn E. However. the family of the client will be able to assist with measures to reduce body temperature and participate in at least 3 out of 4 interventions. Why? . [Nursing Care Plans Edition 6. actually elevating temperature. • May help reduce fever. Note: use of ice water/ alcohol may cause chills. page 667. Doenges. After 15 minutes of nursing interventions. ability to sweat or sweat gland dysfunction. [Nursing Care Plans Edition 6. RN. Why? _______________ Appropriateness: Were the interventions realistic to the norms? ___Yes ___ No. MA.

increased respiratory/heart rate). [NANDA] • Indicates need for prompt intervention. CS] _______________ Adequacy: Were all the plans adequate? ___Yes ___ No. Why? • Provide high-calorie diet. MA. [NANDA] INDEPENDENT 4. • Discuss importance of adequate fluid intake. . RN. [NANDA] • To meet increased metabolic demands. • To prevent dehydration. Flushed skin. increased body temperature. BSN. • To support circulating volume and tissue perfusion. the family of the client will be able to promote wellness and give 2 out of 2 interventions. • Review signs and symptoms of hyperthermia (eg.DEPENDENT • Administer replacement fluids and electrolytes. tube feedings or parenteral nutrition. After 2 minutes of nursing intervention.

Discharge Planning Medications Exercise/Economic Factor Treatment Health Teaching Out patient Follow-up Continue Taking the Anti-TB drugs. Prevent extraneous work. Spiritual health affects the wellness of an individual greatly. You should practice hand washing regularly. Resume previous activities. there are government drug stores available. Also eat fruits and vegetables. Eat vitamin c rich food to strengthen immune systems. The diet should be high caloric. Have a regular sputum test. Have a regular physical exercise like brisk walking for 30 minutes daily. there is productive cough more than 5 days and there is chest pain and experiencing fatigue. You should not spit anywhere. The patient may continue her work in the factory.D. Always pray for the guidance of the Lord. Medicines are readily available at the health center. Strengthen relationship with Lord by showing love and respect to the people around you. Tuberculosis. at least once a week to monitor the progress of the treatment. If there are any food supplements available. Follow faithfully the regimen for tuberculosis. Practice deep breathing exercise and coughing exercises. Always have a regular check up at your nearest health center. especially the medications. instead spit in a single container to prevent transfer of M. For financial insufficiency. as ordered by the doctor. Always drink a lot of water. Always cover the mouth and the nose when exposed to person who coughs or sneezes. The client should report immediately to the physician if there is difficulty of breathing. Don’t skip meals. consult it with the doctor. The intensive phase is for 2 months and the maintenance phase is for 4 months. Diet Spiritual/Sexual Activities .

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