TUBERCULOSIS

GROUP #2 MEMBERS:

CAJILIG, TREXZY
CANTO, MELANIE
CASCO, JEBSEN
CEZAR, ALYSSA
DAANG, JERICHO
DE LA PENA, SHARLENE
DEL ROSARIO, JASMINE
DELFIN, AUDREY
 TABLE OF CONTENTS

PRETEST QUESTIONS MELANIE CANTO

CASE SCENARIO ALYSSA CEZAR

OBJECTIVES TREXZY CAJILIG

MINI-LECTURE OF DISEASE JEBSEN CASCO & JERICHO DAANG

PATHOPHYSIOLOGY SHARLENE DELA PENA

LEVELS OF CARE JERICHO DAANG

PATIENT CORE COMPETENCY MELANIE CANTO

ENABLING COMPETENCY SHARLENE DELA PENA

ENRICHING COMPETENCY TREXZY CAJILIG

EMPOWERING COMPETENCY AUDREY DELFIN

NURSING CARE PLAN ALYSSA CEZAR & JASMINE DEL

ROSARIO

IMPLICATIONS JERICHO DAANG

BIBLIOGRAPHY JEBSEN CASCO

POST-TEST AUDREY DELFIN

Objectives:

General Objective:

After 15 minutes of the case study presentation, the student nurses will be able to:

 Develop knowledge, attitude and skills in providing a holistic and

comprehensive plan of nursing care.

Specific Objectives:

Knowledge

1. Explain the etiology, pathology, treatment, and management of Tuberculosis.

2. Describe the diagnostic tests used for Tuberculosis, its results and how it is

performed.

3. Discuss the mechanisms of the prescribed drugs for Tuberculosis.

4. Describe the nursing responsibilities in caring for patients with Tuberculosis.

Attitudes

1. Identify professional standards of patient confidentiality.

2. Explain the abilities of a nurse to provide for a client with Tuberculosis in a

compassionate and supportive manner

Skills

1. Properly assess the signs and symptoms of a patient with Tuberculosis.

2. Enumerate the possible risk factors of Tuberculosis.

Pre-test

1. Which of the following diagnostics tests is intended for latent tuberculosis infection?

a) Sputum smear microscopy

b) Polymerase chain reaction (PCR)

c) Interferon-gamma release assay (lGRA)

d) ELISA for TB antibodies

2. A patient presents with a 10 day history of high fever, cough and purulent sputum. A

CXR shows a dense consolidation in the RUL. The next step is:

a) Obtain sputum specimens for AFB and start TB treatment

b) Start a course of moxifloxacin

c) Refer the patient to a TB hospital

d) Obtain sputum specimens for AFB and culture/sensitivity examination and start

Azithromycin

3. How do you get TB?

a) Through the air

b) Through sexual contact

c) Through contaminated food

d) Through blood

4. What makes TB hard to diagnose?

a) Symptoms aren't always obvious

b) Symptoms come and go

c) The disease may take years to become active

d) A and B
5. What are the symptoms of active TB?

a) Weight loss

b) Night sweats

c) Loss of appetite

d) All of the above

6. What type of medication is used to treat Tuberculosis?

a) Antiviral medicines

b) Chemotherapy

c) Surgery

d) Antibiotics

7. In what way can TB be diagnosed?

a) Chest X-ray

b) Sample of sputum

c) Manteaux Skin test

d) All of the above

8. Which of the following is TRUE about how undernutrition can affect TB?

a) Undernutrition is a risk factor for Tuberculosis.

b) Tuberculosis can lead to overnutrition.

c) Undernutrition helps with the severity of tuberculosis.

d) Undernutrition does not affect Tuberculosis.

9. Which is not an anti-T.B. drug?

a) Cephalexin

b) Isoniazid

c) Rifampicin

d) Ethambutol

10. Which of the following is false regarding adverse reactions to TB drugs?

a) Drug induced neuropathy can be prevented by routine supplementation

with Pyridoxine

b) Jaundice is a common adverse effect and is always due to liver

adaptation which is self-limiting.

c) Joint pains are an adverse reaction to pyrazinamide and usually respond

well to non-steroidal anti-inflammatory drugs

d) Females and those with pre-existing liver disease are more susceptible

to drug induced hepatitis.

Case Scenario

Mr. Carerra, 67 years old retired baker and pastry chef and is a chain smoker for

15 years. He is admitted to the clinical area because of productive cough of more than

two weeks, hemoptysis, anorexia and weight loss. His temperature is slightly elevated

every afternoon. After performing a Manteaux skin test, he is considered a patient

suspected with pulmonary tuberculosis.

Mini-lecture

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium

tuberculosis. It generally affects the lungs, but can also affect other parts of the body.

Although TB is spread in a similar way to a cold or the flu, it isn't as contagious. You

would have to spend prolonged periods (several hours) in close contact with an infected

person to catch the infection yourself. Not everyone with TB is infectious. Children with

TB or people with a TB infection that occurs outside the lungs don't spread the infection.

TB is transmitted by air such as: coughing, sneezing and spitting. Thus, close

contacts, especially household members, could be infected with TB. M.Tuberculosis can

stay in the air for several hours and it is possible to inhale them even if the infected

person is not inside the room. If a person has TB, he or she will commonly have:

 Coughing that lasts three or more weeks

 Coughing up blood

 Fever

 Night sweats and Chills

 Loss of appetite

 Chest pains
  Unexplained weight loss.

Tuberculosis can also affect other parts of your body, including your kidneys,

spine or brain. When TB occurs outside your lungs, signs and symptoms vary

according to the organs involved. For example, tuberculosis of the spine may

give you back pain, and tuberculosis in your kidneys might cause blood in your

urine.

Anyone can get TB but people who are at great risk include: people who live in,

come from, or have spent time in a country or area with high levels of TB, people in

prolonged close contact with someone who's infected with TB, people living in crowded

conditions, people with a condition that weakens their immune system such as HIV,

people undergoing treatments that weaken the immune system such as chemotherapy

or biological agents, older adults or younger people, people in poor health or with a poor

diet because of lifestyle and other problems such as drug misuse, alcohol misuse, or

homelessness and also people who smoke are at risk.

To diagnose pulmonary TB specifically, a doctor will ask a person to perform a

strong cough and produce sputum up to three separate times. The doctor will send the

samples to a laboratory. At the lab, a technician will examine the sputum under a

microscope to identify TB bacteria. In addition to this test, a doctor can also “culture” a

sputum sample. Doctors can also order a polymerase chain reaction (PCR) assay to be

performed. This tests the sputum for the presence of certain genes from the germs that

cause TB. Other exams like CT scan, Bronchoscopy, Thoracentesis, and Lung Biopsy

can also look for pulmonary TB, which may be hard to diagnose in children, and in

people who have HIV or multidrug-resistant TB (MDR-TB).The most commonly used

diagnostic tool for tuberculosis is a simple skin test, though blood tests are becoming

more commonplace. A small amount of a substance called PPD tuberculin is injected

just below the skin of your inside forearm.

It’s important to get treatment for latent TB even if you have no symptoms.

You can still develop pulmonary TB disease in the future. You may only need one TB

drug if you have latent TB. Recent research suggests that a shorter term of treatment —

four months instead of nine with combined medication may be effective in keeping latent

TB from becoming active TB. If you have pulmonary TB, your doctor may prescribe

several medicines. You’ll need to take these drugs for six months or longer for the best

results.

The most common TB medicines are: Isoniazid, Pyrazinamide, Ethambutol,

Rifampin. The first part of TB prevention is to stop the transmission of TB from

one adult to another. Identify people with active TB and then curing them through the

provision of drug treatment. The second part is to prevent people with latent TB from

developing active and infectious TB. Third part of TB prevention is TB infection control.

In preventing TB transmission inside the household, the following actions should be

taken: Houses should be adequately ventilated, Anyone who coughs should be

educated on cough etiquette and respiratory hygiene, and should follow such practice at

all times, If possible, sleep alone in a separate, adequately ventilated room and avoid

crowded or public places.

Tuberculosis is completely curable through short-course chemotherapy. DOTS or

Directly Observed Treatment Short course is the internationally recommended strategy

for TB control that has been recognized as a highly efficient and cost-effective strategy.

The core intervention involves a health worker who observes the patient when

swallowing each dose of anti-TB medication. DOTS also involves the regular collection

of sputum specimens until two consecutive samples test negative for AFB. DOTS

involves treatment with a four-drug regimen [INH, RIF, pyrazinamide and ethambutol
(EMB)] for 6–9 months. DOTS must be used throughout the entire course of therapy for

best cure rate.

DOTS have five main components:

 Government commitment.

 Case detection by sputum smear microscopy.

 Standardized treatment regimen of six to nine months observed by a

healthcare worker or community health worker for at least the first two months.

 A drug supply.

 A standardized recording and reporting system that allows assessment of

treatment results.
Pathophysiology

Predisposing Factors Precipitating Factors

Gender – Males 62% more likely Chain smoker – Smoking

to acquire TB. doubles the risk of developing
Age – Older adults are TB
vulnerable to develop TB. 57% Occupation – Baker: smoke from
TB deaths are among older the brick oven used.
adults.

Bacteria enters the airway to

the alveoli where they multiply

Bacilli are transported via lymph

system and bloodstream

Macrophages ingest and

surround the tubercle bacilli and
form a barrier called granuloma
that keeps the bacilli contained.

Immune system can’t contain

the bacilli

Tuberculosis
Levels of Care

PROMOTIVE

 Promote rest and sleep cycle.

 Smoke-Free environment.

 Hand washing.

 Avoid going to places with high risk of people infected with TB.

 Nutritious and well balanced diet.

 Good Ventilation

PREVENTIVE

 Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis.

 Annual Check-up or seek medical attention with the physician.

 Wash your hands after sneezing, coughing or holding your hands near your

mouth or nose.

 Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used

tissues in a plastic bag, then seal and throw it away.

 Blood tests, Imaging tests, and sputum test.

DIAGNOSTIC TESTS

 TB Skin test - involves injecting a small amount of fluid (called tuberculin) into

the skin in the lower part of the arm. Then the person must return after 48 to 72

hours to have a trained health care worker look at their arm. The health care

worker will look for a raised hard area or swelling, and if there is one then they

will measure its size. They will not include any general area of redness.
 IGRAs - are blood tests that measure a person’s immune response to the

bacteria that cause TB. The immune system produces some special molecules

called cytokines. These TB tests work by detecting a cytokine called the

interferon gamma cytokine. In practice you carry out one of these TB tests by

taking a blood sample and mixing it with special substances to identify if the

cytokine is present.

 Sputum Smear - Smear microscopy of sputum is often the first TB test to be

used in countries with a high rate of TB infection. Sputum is a thick fluid that is

produced in the lungs and the airways leading to the lungs. A sample of sputum

is usually collected by the person coughing. To test for TB several samples of

sputum will normally be collected. In 2012 it was suggested that two specimens

can be collected on the same day without any loss of accuracy.

 Fluorescent microscopy - is a way of making sputum TB tests more accurate.

With a fluorescent microscope the smear is illuminated with a quartz halogen or

high pressure mercury vapor lamp, allowing a much larger area of the smear to

be seen and resulting in more rapid examination of the specimen.

 X-ray - If a person has had TB bacteria which have caused inflammation in the

lungs, an abnormal shadow may be visible on a chest x-ray. Also, acute

pulmonary TB can be easily seen on an X-ray. However, what it shows is not

specific. A normal chest X-ray cannot exclude extra pulmonary TB.

 CURATIVE

 Enroll in the TB-DOTS program.

 Medications. The most common medications used to treat tuberculosis include:

Isoniazid, Rifampin (Rifadin, Rimactane), Ethambutol (Myambutol) and

Pyrazinamide. If you have drug-resistant TB, a combination of antibiotics called

fluoroquinolones and injectable medications, such as amikacin, kanamycin or

capreomycin, are generally used for 20 to 30 months.

REHABILITATIVE

 Occupational therapy is prescribed for tonic and kinetic purposes to improve or

maintain muscle tone and to relieve emotional stress.

 Houses should be adequately ventilated;

 Anyone who coughs should be educated on cough etiquette and respiratory

hygiene, and should follow such practice at all times;

 Spend as much time as possible outdoors; If possible, sleep alone in a separate,

adequately ventilated room;

 Spend as little time as possible on public transport;

 Spend as little time as possible in places where large numbers of people gather

together.

 Cough etiquette and respiratory hygiene means covering your nose and mouth

when coughing or sneezing. This can be done with a tissue, or if the person doesn’t

have a tissue they can cough or sneeze into their upper sleeve or elbow,

but they should not cough or sneeze into their hands. The tissue should then be

safely disposed.
Educating people about TB is also an important part of TB prevention, as well as

ensuring that people who need TB treatment receive it as soon as possible.

2. COMMUNICATION:

To be able to communicate therapeutically is one of the essential skills a nurse must

possess. The nurse must speak at a rate that the client understands. The following

techniques may be observed to produce a useful conversation:

 Ask open-ended questions - This lets the client feel in control of the direction of

the conversation, encourages to share relevant material about her life, her way of

thinking and for the nurse to gather a detailed data about the patient.

Nurse: “How do you feel sir?”

Patient: “I feel stupid for smoking too much. I regret doing that to myself.”

Nurse: “What is on your mind?”

 Making Observations– The nurse is considered to be purposeful gathering of

information from the client receiving care to inform clinical decision making and

that the client can recognize and compare her own observations.

Nurse: “Are you okay sir? You look uneasy”

Patient: “I sometimes have difficulty in breathing and it seems like my couch isn’t

getting better I feel like I’m not getting well.”

Nurse: “It’s ok sir. We are here to help you in every way that we can.”

Patient: “Thank you.”

 Acknowledging Patient’s feelings –The nurse will help the patient that his

feelings will be understood and accepted for him to continue expressing them.

Patient: “I want to get better so I can go home. I miss my family.”

Nurse: “It must be so hard for you to be away from your family and home.”
 Silence - This gives the client time to collect their thoughts.

Nurse: “…….”

Health Education

Objectives Content Outline Teaching

Strategies
Following a 1 hour
discussion, the patient will
be able to:
Tuberculosis- is a disease
caused by bacteria called
1. Describe what Mycobacterium tuberculosis. The Discussion
tuberculosis is. bacteria usually attack the lungs,
but they can also damage other
parts of the body. It spreads
through the air when a person
with TB of the lungs or throat
coughs, sneezes, or talks. You
are more likely to get TB if you
have a weak immune system.

Signs & Symptoms of disease:

2. Identify signs and  A bad cough that lasts 3 Lecture
symptoms of tuberculosis. weeks or longer
 Weight loss
 Loss of appetite
 Coughing up blood or mucus
 Weakness or fatigue
 Fever
 Night sweats

The symptoms should get better

after the person is on medication
for a couple of weeks. If they
don’t or if they come back after
getting better, the nurse or
physician needs to be notified.
 Diagnostic Tests:
3. Cite the possible
diagnostic tests for
Tuberculosis.
Complications:
4. Recognize the
complications that will
follow if Tuberculosis is
not given appropriate
attention.
 AFB (Acid-Fast Bacillus) Discussion
Smear and Culture- to identify
infections caused
by Mycobacterium tuberculosis,
the cause of tuberculosis, and
other Mycobacterium species,
which are known as acid-fast
bacilli (AFB); to monitor the
effectiveness of treatment
 Chest X-rays - This test can
help diagnose and monitor
conditions. This can show
damage in your lungs, but you
might need further tests to
prove you have TB, such as
sputum and culture tests or
scans.
 TB screening- Tests help to
determine whether a person
has become infected
with Mycobacterium
tuberculosis bacteria.
 Tuberculin Skin Testing- Is a
tool for screening for
tuberculosis and for
tuberculosis diagnosis.
 Spinal pain - Back pain and Lecture
stiffness are common
complications of tuberculosis.
 Joint damage - Tuberculous
arthritis usually affects the hips
and knees.
 Swelling of the membranes
that cover your brain
(meningitis) - This can cause a
lasting or intermittent headache
that occurs for weeks. Mental
changes also are possible.
 Liver or kidney problems -
Your liver and kidneys help
filter waste and impurities from
your bloodstream. These
functions become impaired if
the liver or kidneys are affected
by tuberculosis.
  Heart disorders - Rarely,
tuberculosis can infect the
tissues that surround your
heart, causing inflammation
and fluid collections that may
interfere with your heart's ability
to pump effectively. This
condition, called cardiac
tamponade, can be fatal.

 Medications.
5. Understand the -Isoniazid Lecture
treatment that relieve
-Rifampin (Rifadin,
and those that
Rimactane)
aggravate the
condition. -Ethambutol (Myambutol)
-Pyrazinamide
 Isolation

 Screening Methods-
Intradermal PPD, Tine test.

 Surgery- resection of infected

lung.

Collaboration and Teamwork

 Doctor – is a physician who provides both the first contact for a person with an

undiagnosed health concern as well as continuing care of varied medical

conditions, not limited by cause, organ system, or diagnosis.

 Nurse – are healthcare professionals educated and trained to provide health

promotion and maintenance through the diagnosis and treatment of acute illness

and chronic conditions.

 Radiologist - a medical specialty that uses electromagnetic radiation and

ultrasonic to diagnose and treat disease injury. Radiologists see inside the
 patient’s body with imaging studies like CT scan, MRI, X-ray and Ultrasound.

 Medical Technologist - is an allied health professional that analyzes and tests

body fluids and tissues. This includes blood, urine, CSF, synovial fluid, all types

of tissue samples, and almost any type of sample removed from a patient for

testing. They are responsible for operating and maintaining complex analyzers

that are used in a laboratory and ensuring the laboratory results of each patient

are accurate and timely.

 Dietitians - teaches the client the proper diet, eating guidelines and help develop

meal plans.

 Pharmacists - is a health professional who, in addition to dispensing prescription

medication to patients, also provides excellent information about your medication

your physician has. He or she explains physicians' instructions to patients so

these individuals can use these medications safely. Pharmacists also educate

patients on the use of prescriptions and over-the-counter.

 Family/Folks – they are always with the patient, they also collaborate and

observe if the patient is adhering to the therapy. Also we should collaborate with

them to provide encouragement and emotional support all throughout the TB

program.

Management of Resources

 Medicine - medications are the cornerstone of tuberculosis treatment. But

treating TB takes much longer than treating other types of bacterial infections.

With tuberculosis, you must take antibiotics for at least six to nine months.
 The exact drugs and length of treatment depend on your age, overall health,

possible drug resistance, the form of TB (latent or active) and the infection's

location in the body.

 Mask – Surgical masks are used to protect the mouth and nose from

splashes or sprays of blood/body fluids, or respiratory secretions, and to

place on coughing patients to reduce dissemination of respiratory

secretions. They may have either ear loops or ties, and can be either

pleated or made of molded material. Surgical masks are cleared by

the FDA as having fluid-resistant properties.

 Gloves - Clean, disposable gloves are worn during direct contact with

blood/body fluids, mucous membranes, non-intact skin, or any other

potentially infectious material. They are also worn as a part of contact

precautions (for persons infected with pathogens transmitted by the

contact route, such as MRSA, VRE, and RSV) while directly touching the

patient or when in the immediate patient environment. Disposable gloves

are available in latex, vinyl, and nitrile materials.

 Respiratory equipment - breathing equipment and respiratory equipment your

department needs. Save now on the breathing and respiratory equipment you

need including pocket masks, CPAP supplies, oxygen supplies, resuscitation

masks, oxygen regulators, nebulizers.

Environment

Since TB has been linked anecdotally with environmental risk factors that go

hand-in-hand with poverty: indoor air pollution, tobacco smoke, malnutrition,

overcrowded living conditions, and excessive alcohol use. We should provide a clean

environment free from smoke and pollution, if anyone in the family members smoke

advise the member to stop smoking especially around the client, we should also

collaborate with the dietician together with our client for proper food management and

eating guidelines for our patient to follow to regain optimum health, also we should

advise our client and their folks to avoid over crowded places to prevent the disease

from spreading and also to protect the client from other sickness and lastly we should

explain to client the effects of excessive alcohol use to their sickness in order to prevent

further complications.

Records Management

 Assess the patient’s past and present health history.

 All objective and subjective data should be gathered from both the client and

folks.

 Laboratory should be review and analysis to monitor for the severity of

Tuberculosis.

 All intervention and procedure done to the client must be documented for legal

and other purposes.

 Patient’s record and files must be kept confidential.

 Make sure that the recording of documents, records monitoring and data must be

written appropriately with clear and legible hand writing.

  Client’s vital signs and other monitoring are recorded properly.

Research

DATE/ TIME FOCUS DATA PROGRESSIVE NOTES

06/06/18 Difficulty in Data: Action:

breathing
8:00 AM  Use of  Assess respiratory rate to
accessory provide basis for evaluating
muscles to adequacy of ventilation
assist  Note chest movement during
breathing. respiration.
 Abnormal  Auscultate breaths sounds
breath and note areas with presence of
sounds and adventitious sounds.
wet crackles  Administer PAI to loosen
 Restless secretions
 RR : 26  Suction and document
bpm respiratory secretions.
 Maintain patient on moderate
high back rest.

8:30 AM
Response:
 Client displayed patency of
airway as manifested by
respiratory rate is back to
normal range secretion
decreased and restlessness is
alleviated.

1. Abstract

Tuberculosis is an infectious disease which is caused by bacteria. The

disease is mostly transmitted from person to person, usually by inhaling bacteria-

carrying air droplets. Tuberculosis most commonly affects the lungs, but it can also

affect any other organ. The infection doesn`t always result in disease. The human

immune defense cells can check and control pathogens, so that progression to disease
only occurs in about 10% of adults. However the infection may remain latent and can

reactive at any time, also after decades if e.g. the immune system is weakened. If left

untreated, tuberculosis is a life-threatening illness.

The World Health Organization estimates that every day 20,000 people develop

tuberculosis and 5,000 people die from it. The main burden of tuberculosis is carried by

developing countries. The cases of tuberculosis have been declining in Germany for

years. But the global increase of tuberculosis affects every region of the world, also

developed countries.

2. Abstract

The Philippines is one of the highest tuberculosis (TB) burden countries in

the world with nationwide coverage of directly observed treatment, short-course

(DOTS) achieved in 2003. This study reports on the National TB Control Program
(NTP) surveillance data for the period 2003 to 2011. During this period, the
number of TB symptomatic examined increased by 82% with 94% completing the
required three diagnostic sputum microscopy examinations. Of the 1 379 39
cases diagnosed and given TB treatment, 98.9% were pulmonary TB cases. Of
these, 54.9% were new smear-positive cases, 39.3% new smear-negative cases
and 4.7% were cases previously treated. From 2008 to 2011, 50 030 TB cases
were reported by non-NTP providers. Annual treatment success rates were over
85% with an average of 90%; the annual cure rates had an eight-year average of
82.1%. These surveillance data represent NTP priorities – the large proportion of
smear-positive cases reflected the country’s priority to treat highly infectious
cases to cut the chain of transmission. The performance trend suggests that the
Philippines are likely to achieve Millennium Development Goals and Stop TB
targets before 2015.
Quality Improvement

 Hospital staff (Nurses) should be knowledgeable about the infectious and the

disease process to protect the patient and themselves from the infection to
spread.

 Patients must be instructed with the correct and sufficient information about the

medical and administrative aspect of healthcare that they are receiving.

 Shared learning or learning collaborative to provide a quality care in which

practices can share challenges, lessons learned, and best practices and draw

motivation and inspiration.

 There should be communication between staff and health care team as well as

with the patient to have a right and effective treatment regarding patient

conditions.

 Data feedback among care providers to improve practices with information on

their performance and help target areas for improvement.

 The healthcare team must be well trained on their profession to know how to

administer care to patients and care needs.

 The organization should have modern technologies and medicines to be used

within the service of care in patients.

 Correct equipment and instruments must be used to improved care.

A. Institution

 Secondary care:

Consultation for specialist in a large hospital.

 Infection and control centers:

 Helps control a dynamic range of solutions to prevent the spread of infections.

 Emergency Department:

In this setting assessment, diagnosis and treatment of infection, respiration and

circulation

 Laboratory Department:

Medical laboratory tests are carried out on clinical specimens in order to obtain

information about the health of a patient in order to provide diagnosis, treatment,

and prevention of disease.

Process

 Hospitals should focus on improving patient experience throughout the

continuum of care, including by engaging patients and families before admission

and post-discharge

 Positive patient experience to improved outcomes of care

 Examine airway for difficulty of breathing and check sputum for laboratory

 Administer medications as prescribed by the physician

 Prevent spread of infection via droplet

Outcome

Successful outcome: If TB patients were cured (negative smear microscopy at the end of

treatment and on at least one previous follow-up test) or completed treatment with

resolution of symptoms. Patient comfortable and quality services by the health care

team.
Empowering Competencies

1. Ethico-Moral Responsibilities

 Beneficence – We should share information with the patient regarding their

treatment and condition. We should also make sure that we are providing the

correct treatment in order to protect our patient from risk and further

complications. The nurse is performing acts that can do good to the patient.

 Right for Justice – As a nurse we should be fair when it comes to dealing with our

patients and he/she must not discriminate the patient regardless of what is

his/her condition and respect their culture, belief and practices.

 Confidentiality – Make sure that all the information regarding our patient’s

treatments and condition will be only disclosed to the patient and those with the

consent of the client. All information must be kept private at all times.

 Non-Maleficence - It states; “to do no harm.” As nurses we should avoid

causing any harm to our clients while delivering a quality nursing care.

2. Moral Responsibilities

Article III Section 8 of Codes of Ethics under RA 9173

An act providing for a more responsive nursing profession, repealing for the purpose RA

7164 known as the “Philippines Nursing Act of 1991” and for other purposes.

Article I Section I states that this act shall be known as the “Philippines Nursing Act of
2002”

What a Registered Nurse should do:

1. Respect the “Patients’ Bill of Rights” in the delivery of quality nursing care.

2. Provide the patients and their families all the relevant information regarding the

client’s condition unless it is hold to be harmful to their well-being.

3. When conflict arises we should uphold and protect the rights of our patients regarding

their care and treatment.

Personal and Professional Development

In order for a registered nurse to enhance his/her knowledge, attitude and skills

about Pulmonary Tuberculosis, the nurse must: Give patient supportive care and help
them adjust to the changes that they may have to make during his illness. Include the

patient in any decision-making and let the family take part in the patient’s care

whenever possible. Educate the patient about the recommended diet. Record the

patient’s weight weekly. Teach the patient adverse effect of his medication and tell them

to report immediately. Emphasize the importance of regular follow up examination and

instruct the patient and family members concerning the signs and symptoms of recurring

TB. Stress the importance of faithfully following long term treatment.

Teach the patient about the signs and symptoms that require medical assessment

such as: increased cough, hemoptysis, unexplained weight loss, fevers and night

sweats. Warn the patient taking Rifampicin that the drug temporarily makes body

secretion such as urine appear orange; re assure that this fact in harmless. Caution the

female patient taking oral contraceptives that the drug may be less effective while she is

taking Rifampicin.
Implications/Insights/Lesson learned of the disease entity in terms of:

 Nursing Education - Nurses need to be knowledgeable about Tuberculosis and

it’s complications in order to manage the symptoms of the disease and provide

comfort and quality care to the patient.

 Nursing Practice – Nurses play a vital role in caring for people with Tuberculosis

because as nurses we need to establish rapport in order to gain the full trust of

the patient. Tuberculosis has a lengthy treatment which is about 6-9 months so

trust from the patient is vital in order for the nurse to provide personal care.

 Nursing Research - Nurses should always be updated with the current

researches done on Tuberculosis so that they are aware of any new changes

made or any new treatments being done so that the nurse can apply this in their

plan of care for the patient.

Bibliography

 Hinkle, Janice L., and Kerry Cheever H. Brunner & Suddarth's Textbook of

Medical-Surgical Nursing. 13th ed. Vol. 2. N.p.: Lippincott Williams & Wilkins,

2010. Print.

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762970/

 https://www.dhs.wisconsin.gov/ic/ppe.htm

 https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosis-
treatment/drc-20351256

 https://www.tbfacts.org/tb-tests/
  TB Testing & Diagnosis”,
CDC www.cdc.gov/tb/topic/testing/http://www.cigna.com/individualandfamilies/he
alth-and-well-being/hw/medical-tests/tuberculin-skin-test-hw203560.html

 Cigna http://www.cigna.com/individualandfamilies/health-and-well-
being/hw/medical-tests/

 Guidelines for intensified case finding and isoniazid preventative therapy

for people living with HIV in resource constrained settings”, Geneva,

WHO, 2011 9 http:/www.who.int/tb/publications/2011/

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592293/

 https://en.wikipedia.org/wiki/Primary_care_physician

 https://en.wikipedia.org/wiki/Nurse_practitioner

 https://www.buyemp.com/category/breathing-respiratory-equipment

Post test Questions

1. It is transported via lymph system and bloodstream.

a. E. coli
b. Macrophages
c. Gram-negative
d. Bacilli

2. It takes how many months to cure the TB?

a. 6-9 months
b. 2-5 months
c. 2-8 months
d. 6-10 months

3. What is the most commonly used diagnostic test to test for Tuberculosis?

a. TB skin test
b. IGRAs
c. Fluorescent Microscopy
d. Sputum Smear
4. It is prescribed for tonic and kinetic purposes to improve muscle tone.

a. Interpersonal Therapy
b. Intermittent Therapy
c. Occupational Therapy
d. None of the above

5. It is an ethico-moral responsibilities that states to do no harm.

a. Beneficence
b. Non-maleficence
c. Maleficence
d. Right for Justice

6. It is a test that can detect the TB more accurately.

a. Sputum Smear
b. X-ray
c. Fluorescent Microscopy
d. IGRAs

7. Nurse A shares all the information the patient needs to know about her condition and
all the treatments she needs to undergo. Nurse is practicing what ethico-moral
responsibility.

a. Confidentiality
b. Non-maleficence
c. Beneficence
d. Right for Justice

8. To prevent TB transmission inside the household, the following should be practice

EXCEPT:

a. Sleep alone in a separate room

b. Spend little time as possible in public transport
c. Household should be adequately ventilated
d. Spend a lot of time in crowded places
9. It is a type of diagnostic test that identifies infection that is caused by mycobacterium
tuberculosis.
a. AFB
b. Chest X-ray
c. Skin Testing
d. TB screening

10. The following are recommended communication techniques that a nurse should use
with the client EXCEPT:
a. Acknowledging the client’s feelings
b. Silence
c. Asking close-ended questions
d. Making observations