UNIVERSITY OF SOUTHERN PHILIPPINES FOUNDATION

College of Health Sciences

Nursing Department
Salinas Drive, Lahug Cebu City

Case Study Of
A Pregnant Woman With Pulmonary
Tuberculosis
NGCM 109 RLE

Submitted By:
Liz G. Quindala
Jiessa M. Tano
BSN-2

Submitted To:
Dr. Ivy Villaceran Gregorio RN, MAN.

April 7, 2022
 INTRODUCTION

In an age when we believe that we have the tools to conquer most

diseases, the ancient scourge of tuberculosis (TB) still causes 2 million
deaths a year worldwide? more than any other single infectious organism?
reminding us that we still have a long way to go. Even equipped with drugs
to treat TB effectively, we haven't managed to eradicate this deadly
infection.

Tuberculosis, or TB, is still one of the major causes of preventable

death in the world. TB is an infectious disease caused by TB bacteria
(Mycobacterium tuberculosis): a smart but deadly survivor with the cunning
ability to evade our immune system. The bacterium first of all has a sort of
harness: an almost impenetrable, unique surface which protects the
bacterium from attacks by our immune system and antibiotics.

After more than 30 years of declines in reported tuberculosis cases

and deaths, the mid-1980s and early 1990s saw a reversal of that trend in
the United States. Between 1985 and 1992, reported cases of tuberculosis
increased by 20 percent, from 22,201 in 1985 to 26,673 in 1992. The case
rate per 100,000 population increased by more than 12 percent, from 9.3 in
1985 to 10.5 in 1992.

Among the 30 high TB burden countries, the Philippines is ranked

fourth; and among the high multidrug-resistant TB burden countries, the
Philippines is ranked seventh. In 2019, there were an estimated 599,000 TB
cases. Global Tuberculosis Report, 2020. With the introduction of mandatory
private sector case notification, the Philippines have recorded a 29 percent
increase in case notifications since 2017.

While this is significant progress, an estimated 190,000 TB cases were

still “missed,” which means they were either not diagnosed or diagnosed but
not notified. For rifampicin-resistant TB and MDR-TB, the gap in cases
notified is even greater. In 2019, of the 21,000 estimated TB cases, only
6,251 cases were enrolled in treatment. Over the past five years, the
treatment success rate (TSR) for drug-susceptible TB (DS-TB) remained
around 90 percent; However, the cases notified from the private sector do
not usually have reported outcomes. Additionally, gaps in TB preventive
therapy (TPT) coverage continue to present an issue in TB elimination
efforts.

We, the student Nurse from the University Of Southern Philippines

Foundation gathered this hypothetical case study of a pregnant woman with
tuberculosis to know better tools are needed to control TB among patients.
Understanding latent TB infection and persistence of infection after
treatment is of the utmost importance. The discovery of new markers for
high and low risk individuals, in terms of development of TB and adequacy of
treatment, would allow evidence-based determination of who to treat, how
to treat, and how long to treat both for prevention and cure.
 PATIENT’S PROFILE
Biographic Data

Name : Mrs. L.G.Q.

Gender : Female
Age : 28yrs old
Birthday : March 3, 1992
Place of Birth :Cebu City
Case # : 01120
Nationality : Filipino
Civil status : Married
Address : Cebu City
Religion : Roman Catholic
Educational Level : College Graduate
Name of the Spouse : E.F.Q.
Name of Mother : Mrs. L.R.M.
Name of Father : Mr. R.B.M.
Chief Complaint: Shortness of breath on exertion

History of present illness:

A 28-year-old white female presents after admission to the general
medical hospital ward with a chief complaint of shortness of breath on
exertion. She reports that she was seen for similar symptoms previously at
her primary care physician’s office six months ago. At that time, she was
diagnosed with acute bronchitis and treated with bronchodilators, empiric
antibiotics, and a short course oral steroid taper. This management did not
improve her symptoms, and she has gradually worsened over six months.
She reports a 20-pound (9 kg) intentional weight loss over the past year.
She denies camping, spelunking, or hunting activities. She denies any sick
contacts.
GENOGRAM
 DEVELOPMENTAL TASK

(Erik Erikson’s)

Intimacy versus isolation is the sixth stage of Erik Erikson's theory of

psychosocial development. This stage takes place during young adulthood
between the ages of approximately 18 to 40 yrs. During this stage, the
major conflict centers on forming intimate, loving relationships with other
people.

People in early adulthood (20s through early 40s) are concerned with
intimacy vs. isolation. After we have developed a sense of self in
adolescence, we are ready to share our life with others. However, if other
stages have not been successfully resolved, young adults may have trouble
developing and maintaining successful relationships with others. Erikson said
that we must have a strong sense of self before we can develop successful
intimate relationships. Adults who do not develop a positive self-concept in
adolescence may experience feelings of loneliness and emotional isolation.

Erikson believed that not fulfilling any stage of development would

present problems in the future. If you weren’t able to develop a strong sense
of self-identity (stage five), you might have a hard time developing healthy
relationships. Trouble at this stage of development might prevent you from
nurturing individuals or projects that will “leave your mark” on future
generations. What’s more, long-term isolation can be detrimental to more
than your mental health.

Research shows that loneliness and social isolation can cause

cardiovascular disease. Some people may be able to have a relationship,
despite not building strong, intimate bonds. But that might not be successful
in the long run. One study found that women who were unable to develop
strong intimacy skills were more likely to be divorced by midlife.

The patient has a positive relationship with both husband, family and
friends. The patient is well-supported by her family. She receives positive
reinforcement and provides her comfort and reassurance. They love to go to
church every Sunday and eat together with their favorite dish. However the
patient feels lonely and sad at the same time because of her current
situation. She can no longer get together with her friends and co-workers.
She feels isolated and problematic with her state of affairs.
 HEALTH ASSESSMENT

Gordon’s Functional Health Patterns

Functional Health Before During hospitalization

Pattern Hospitalization

1. Health
Patient viewed health “Nag sige ko ubo ug naka
Perception and
as a state in which she feel usahay ug chest pain
Health
can perform her work ug nagka bantay ko nga ni
maintenance
daily and with the gamay ko tungod wala
absence of illness and nako gana mo kaon.
disease, she considered Usahay magka night
herself as a healthy sweats ko ug luya permi
human being, if she ako lawas” as verbalized
experiences fever, by the patient.
cough and colds She
takes OTC drugs that
are safe for pregnancy.
She rarely visits a
doctor to have a
check-up and seek
medical assistance.
2. Nutritional -
The patient has no She ate the food served in
Metabolic
allergies to foods and the hospital. He drinks 3
drugs, she eats meals or more glasses a day.
3 times a day with
“usahay dili nako mahurot
snacks in between, and
ug kaon sa gina served
she drinks 7-8 glasses
food dri sa hospital. Pero
of water.
nag kaon ko ug mga fruits
nga dala sa ako Husband”
as verbalized by the
patient.

3. Elimination
The patient usually The patient usually voids
voids 3-4 times a day, 3-4 times a day, she
she defecates once a defecates once a day
day daily, she doesn’t daily. The patient doesn’t
experience any have a problem regarding
problem in voiding and voiding and defecating.
defecating. She never
used any chemical
laxatives and stool
softeners.
 4. Activity and
She states that she The patients stated that
Exercises
does some household she becomes weak in
chores, such as prolonged activities. She
cleaning their living can only perform limited
room and gardening. activities due to her
She also does physical condition. The doctors say
exercise such as Yoga. she should avoid getting
tired.

5. Sleep and Rest

The patient usually The patient sleeps at 9:00
sleeps 4-5 hours, her pm and wakes up at 5:00
earliest time in going to am. She can consume 7-8
sleep is at 8:00 pm and hours of sleep, she takes
she wakes up at 4:00 a nap at noon for about
am, sometimes she 1-2 hours. Sometimes she
takes a nap at noon for is distracted, and her
about 30 minutes. She sleep is interrupted due to
doesn’t have any visitors and other health
difficulties going to care teams.
sleep and doesn’t use
“ Pero usahay makatug
any medication to
nako 11pm or 12pm
promote sleep.
tungod sigeg kug huna2
sa akung condition labi na
akong baby” as verbalized
by the patient.
6. Cognition and
The patient is oriented The patient is oriented to
perception
to people, time and time, place and person.
place, responses to
The patient feels worried
stimuli verbally and
and anxious
physically. She can
speak and understand
Bisaya, Tagalog, and
english.

7.
The patient is able to The patient's state that
Self-perception
express her feelings she believed admission
and self-concept
about her condition, will be helpful to adjust
she feels annoyed her in her needs and for
about her condition, the safety of the baby.
but she also wants to
feel better, she is
content seeing her
family, their support,
love and care.

8. Sexuality and
The patient started her Patient is satisfied with
Reproduction
menarche at the age her sexual activity,
age 12 years old and they’rewithout any
engages in sexual contraceptives used. She
intercourse at the age doesn’t have any
of 22 years old with her abnormalities or
partner. She had a dysfunctions that may
 regular menstrual cycle affect her reproductive
that lasted 4-6 days. system.

9. Roles and
The patient plays the The patient is
Relationship
role of a mother to her well-supported by her
child and a wife to her family. She receives
husband. The patient positive reinforcement and
stated that her provides her comfort and
Husband only spent a reassurance.
short time with the
family due to his work,
but they maintain good
communication, there
are no conflicts among
them and shares her
ideas when it comes to
decision making.

10. Stress and

The patient copes up “stress kaayu ko maglisud
tolerance coping
with stress by cooking, ko matulog kay sige kug
eating and gardening. huna2 sa akung baby pero
When they have a thankful kaayu ko sa ako
problem in their family, partner kay iya ko I
they resolve it by comfort ug tagaan ko niya
means of talking to prutas para mo gaan ako
each other. pamati” as verbalized by
the patient.
11. Values and
The patient’s religious “ampo lang ko sa ginoo
Belief
affiliation is Roman nga maayu ra ako
catholic, every Sunday panglawas ron ug tagaan
she goes to church with ko niya kusug para
the family. She also malampus ni akong
believes in “Albularyo”. kagoul ug unta nga ma
okay akung condition ug
akung baby” as verbalized
by the patient.
 Obstetric Assessment Form

Name of Patient: Patient LGQ

I. Personal Patient Profile:

II. Age: 28 Ht: 5’ft Wt: 54kg Marital Status: Married

Religion: Roman Catholic

Occupation: Call center Education: College Graduate

III. Profile of Spouse

Name: MR. EFQ Address: Cebu City

Age: 28 Ht: 5’5 Wt: 75kg Desired Family Size: 1 2 3 4 5 more

IV. Characteristics Influencing the Course of Pregnancy

LMP: Jan. 15, 2021 EDD: Oct. 22, 2021 Parity: Primigravida

Blood Type: O Rh: +

Menstrual Cycle: “3-5 days” Menarche: 13 yrs. old

Date of Quickening: During 18-24 weeks

Contraceptive History: None ( / ) Pills ( ) IUD ( )

Rhythm ( ) Condom ( ) Depo ( )

Other: (Pls. Specify)

Obstetric History: G- 1 T- 1 P- 0 A- 0 L- 0
 Highlight the signs and symptoms of pregnancy experienced:

Amenorrhea Urinary Frequency Braxton Hicks

Contraction

Breast Changes Skin Pigmentation Ballottement

Nausea and Vomiting Hegar’s Sign Leukorrhea

Fetal Movement Chadwick’s Sign

Did she receive prenatal care? Yes

At what age of gestation? 6 weeks

Did she take any medication? Yes

Did she have any complications, such as spotting, swelling of

her hands or feet, falls or surgery?(Specify) Client didn’t
experience any complications such as spotting, swelling of her
hands or feet, falls or surgery etc.

Pertinent Medical Conditions/Hospitalizations: None

Current Medications History: “ isoniazid INH in combination with three

other drugs, rifampin, pyrazinamide and ethambutol, Moringa Supplement
,Omega Fish Oil’

Usual Bowel Patterns: Every 3 days Exercise Patterns: Light Exercise

(Stairs walking)

Type and Hours of Employment: Call center agent 9pm-6am

Exposure to Hazardous Material (Occupational Hazards): NA
Plans for continued employment: ”Yes, After Birth”
Usual Rest Pattern: “Most of the time, Sitting and laying down”
Length: 4-5 hours Quality:Easily falls asleep but easily wakes up at dawn
to urinate Easily falls asleep but easily wakes up Regularity: Regular
everyday

Usual Sleep Pattern:” 5 hours kay naa man koy work gina atupag.

Length: 4-5 hours Quality:Easily fall asleep but easily wakes up at down to
urinate Regularity: Regular everyday

Eating Patterns:”Sa breakfast kay 1 egg ug 1 ½ cup nga rice. Otan with
fish and water”

Weight Gain: (Specify): 8kg Pre Pregnancy: 46kg

Social or Cultural Dietary Habits: None

No. of food servings from the food pyramid (calories, protein,
vitamins, minerals consumed daily)

History of Eating Disorder: (Specify) I love to eat sweets.

Sexual Activity: Sexual Satisfaction? “Yes”

Frequency:”Once a week”

Positions during Intercourse:”Side lying position”

Alternative Practices used to achieve sexual satisfaction: NA

IV. Attitude Towards Pregnancy

Was this pregnancy planned: Yes

What is her reaction during the present pregnancy: Client was

overwhelmed with mixed emotions, but she was happy.
What are the patient’s goals and values regarding this pregnancy
and other relevant areas: Client verbalizes “Go with the flow ra ko” upon
being asked about whether she’s following any values or has any goals with
regards to her current pregnancy.

Does she view this pregnancy positively or as interference in her

life? Views her pregnancy positively

What is her knowledge about health in general and pregnancy or

childbearing? Client verbalized that one must be healthy in terms of being
pregnant because if you contract any illness, the baby will be affected as
well, then in terms of delivery, pt already expects it to be painful but at least
it’s a normal delivery rather than having to go through c-section especially
since we’re still in the middle of pandemic.

Does she have any previous experience and concerns about this
pregnancy, birth and care of infants? If yes, pls. specify
Hasn’t experienced pregnancy and childbirth before but has tried to take
care of the infant.

How does she perceive labor and delivery, worse or

better?”Aware rako ani sa akong pagbuntis”
What are the emotional changes she is experiencing? “Wala raman koy
gipang’bati same ra sauna.” Is the family intact? “Yes”

What is the reaction of the family towards the pregnancy? Client’s

family was happy.

Does she have sufficient family and friends willing to provide

support? “Yes” Her present coping with lifestyle changes caused by
the pregnancy? “Same as usual, but unlike before I always go out”

Resume of antenatal classes and instructions: None

 Physical Assessment

General Survey

This physical assessment was conducted last March 19, 2022 at

8:30am to a 28 year old pregnant woman with pulmonary tuberculosis. The
patient was lying on bed, awake conscious and coherent; in respiratory
distress and was wearing a clean hospital gown. The patient has a fair
complexion, her skin is dry, and slightly moist. Buccal mucosa are dry. Upon
palpation there is a slight tenderness noted with full symmetrical chest
expansion when the patient takes a deep breath. There are no signs of
nodules and the patient complains of little pain in the upper region of the
lungs. She has an endomorphic body built and is well groomed. She is
cooperative and purposeful in her interaction with others. Patient established
good eye contact when conversing.

Vital Signs
Temperature : 38 C
Pulse Rate : 84bpm
Respiratory Rate : 23bpm
Blood Pressure : 100/80mmhg
Oxygen Saturation : 96%

Skin
The patient has a fair complexion. Her skin is dry , slightly moist,
Generally uniform in color except for the areas exposed to sunlight. No
lesions , with skin abrasions, and scars noted. She has a poor skin turgor.

Nails
Nails farewell trimmed and no nail polish. Fingernails have convex
curve curvature and a diamond shape as seen when the fingernails of both
right and left thumbs were joined together. The patient’s nails on both hands
and feet are smooth with vascular and pinkish nail beds and intact
epidermis. The pt has a capillary refill time of 2 seconds.
Head
The pt’s head is normocephalic. Skull is symmetrical and nodules or
masses and depressions are not noted. She has long, black, evenly
distributed hair below armpit level with no infestations (like lice, dandruff)
and infection noted. Facial features are symmetrical. Muscle strength of the
jaw was also normal.

Eye structures and visual acuity

The pt’s eyebrows are both aligned, evenly distributed and move
uniformly. Eyelashes are well distributed and are curled outward. Eyelids are
intact with no discharges and discoloration noted. Lids close symmetrically.
Palpebral conjunctiva appears light to pink, shiny and clear. Lacrimal ducts
are evident. The sclera appears to be white. The eyes constrict; with a
constriction of two millimeters when stimulated with a penlight and when the
penlight was drawn near to the pt’s nose. Iris are dark brown in color.
Cornea appears shiny and smooth. Pupils are equally round and are reactive
to light and accommodation. Edema and tenderness are not palpated. When
looking straight ahead , the pt can see objects in the periphery.

Ears and Hearing

Auricles are symmetrical, aligned with the outer canthus of the eye,
and are in the same color as facial skin. Auricles are mobile, and not tender,
Pinna recoils after it is folded. External canal is clear with minimal dry
cerumen. Inflammation masses or foreign bodies are absent.

Nose and Sinuses

Nose is uniform with skin color without any lesions and is symmetrical
without any signs of discharges and lesions. There is nasal flaring noted.
Nasal septum is not intact at midline. When palpated, the patient did not
display any signs of pain. The nasal mucosa is pink in color. When the facial
sinuses were palpated, the patient felt crepitus on palpation over the
maxillary sinuses.

Mouth
Outer lips are light pink in color, soft, moist, with symmetrical contour.
Inner Lips and buccal mucosa are dry and no ulcerations are noted. The oral
cavity is pink in color. The gums are intact and teeth are milky white in color.
The patient has good alignment of teeth and no dental caries are noted; the
client has 32 adult teeth. The tongue is pink, located at the midline, able to
move freely and as commands such as sticking out of the tongue and
moving it from side to side. The uvula is positioned midline of the soft
palate. There were no signs of inflammation and redness. Gag reflex is
present upon assessment.

Neck
The neck is symmetrical with head centered and without bulging
masses. Neck movements are smooth. As the patient swallows, the thyroid
gland and thyroid cartilage moves upward. Trachea is in the midline. The
lymph nodes are not enlarged and not tender upon palpation. The neck
muscles are proportionally sized. The patient is able to move her head
sideward, extend and flex with smoothness and without any signs of
discomfort.

Chest and Lungs

Chest is symmetrical and the spine is vertically aligned. The pt has
bilateral symmetry of vocal fremitus. When palpated, there is a slight
tenderness noted with full symmetrical chest expansion when the client
takes a deep breath, with respiratory excursion of 6cm, there are no signs of
nodules and the patient complains of little pain left in the upper region of the
lungs.

Heart and central vessels

With murmurs or adventitious sounds were audible upon auscultation.
Palpitations are present. When the peripheral pulses were palpated the
pulses were symmetric at both left and right area. The carotid artery has full
pulsations and the quality stays the same. Peripheral veins in the legs and
arms showed no signs of phlebitis when the legs were inspected for swelling
and when the calves were palpated, the pt did not complain of any pain.

Breast and Axillae

The breast of the patient had no signs of hyper pigmentation or any
discoloration and lacerations, breasts were asymmetrical in size, tenderness
were noted. The areolas are dark brown with nipples that are round, pointing
in an outward direction and not equal in size. Discharges, lesions, nodules
and masses were noted. Moisture was felt at the axillary area with few hair
growths. The axillae is dark brown in color.

Abdomen
The abdomen striae gravidarum are evident on her abdomen.
Symmetric movements were seen when the patient inhales and exhales,
with positive tenderness on hypogastric area, linea nigra noted that light in
color. With 10 bowel sounds per minute upon auscultation. No masses noted
upon and palpation umbilicus is located in the umbilical region. with fatal
movement of a leopold's maneuver and fetal heart tone noted via
stethoscope.

Musculoskeletal
The patient's muscles have good tonicity. There were no signs of
contracture or any fasciculation or tremors seen. Upon palpation, the
muscles are firm at an active state with smooth movements. muscle
strength is equal at the post left and right side. The patient's both legs have
the same length. When the patient was allowed to move her legs up she
moved it slowly because she felt pain in her abdominal area. The bones were
palpated especially at the joint areas; there were no deformities.

Arms, Legs
Arms have equal length. With fair complexion edema is not noted.
With some hair noted legs also have equal length, edema not noted with
some hair. The color of the knee is darker than the other part.

Genitourinary
There were no discharges such as blood was noted upon assessment.
The labia majora is not swollen. Her pubic hair was evenly distributed, and
shaved halfmoon. There was no inflammation. Irritations such as redness
were noted, Hemorrhoids were not noted and able to void freely at least 6
times a day, and defecate 2 times a day.
 LABORATORY AND DIAGNOSTIC STUDIES

Test Normal Range Result

CBC

WBC 4.00-10.50 11 10^9L

RBC 4.20-5.40 3.81 10^12L

Hemoglobin 125-160 110 g/L

Hematocrit 0.37-0.47 0.40

MCV 78-100 89 fL

MCHb 27-31 30 pg

MCHb Conc. 0.32-0.36 0.36

Platelet count 150-450 273 10^9/L

Diff Count (Relative)

-Neutrophils 50.0-70.0 56.0%

-Lymphocytes 18.0-42.0 40.5%

-Monocytes 2.0-11.0 8.7%

-Eosinophils 0.0-6.0 1.2%

-Basophils 0.0-2.0 0.7%

Fasting Blood Sugar 70-100 88 mg/dl

Uric Acid 2.7-7.3 7.1 mg/dl

Potassium 3.5-5.0 3.49 meq/L

Cholesterol <200 176 mg/dl

Triglycerides 10-150 91.75 mg/dl

URINALYSIS

Color Yellow, amber Pale Yellow

Clarity Clear Clear

Sterility No microorganisms microorganisms

present present

pH 4.5-8 6
Specific gravity 1.010-1.025 1.020

Glucose Negative Negative

Ketone bodies Negative Negative

Blood Negative Negative

Nitrates Negative Negative

Sputum TB culture

Acid-fast bacilli (AFB) are rod-shaped bacteria identified through sputum culture
and smear. M. tuberculosis is the most prevalent species of mycobacteria and the
most infectious.

Sputum TB culture

Acid-fast bacilli (AFB) are rod-shaped bacteria identified through sputum culture
and smear. M. tuberculosis is the most prevalent species of mycobacteria and the
most infectious.

Result:

Positive for M. tuberculosis in the active stage of the disease. Sputum cultures will
be repeated 3 months into therapy to evaluate for possible nonadherence to
treatment or to identify drug-resistant bacilli.
Chest x-ray

Evaluates organs and structures within the chest for evidence of disease

Result

Interpretation:

A right upper lobe cavitary lesion on a chest x-ray of a patient with tuberculosis.
Mantoux tuberculin skin test

RESULT – Positive 2 weeks after exposure.

 Summary Of Significant Findings

HEALTH PATTERN PATIENT INTERPRETATION/

MANIFESTATION NURSING PROBLEM

Health Perception The patient had this Ineffective airway

and Health recurrent cough for clearance
maintenance almost a month and it
seems that she has Risk for impaired gas
difficulty breathing at exchange
times.

Activity- Exercise The patient stated that

she becomes weak in
prolonged activities.
She can only perform
limited activities due to Activity Intolerance
her condition. The
doctors say she should
avoid getting tired.

Nutritional-Metabolic The patient reported Imbalanced nutrition

Pattern that her appetite for less than body
any kind of food had
decreased.

Sleep and Rest The pt’s schedule for

Pattern work is a graveyard Disturbed Sleeping
shift. Patient reported Pattern
 that she only slept four
to five hours or less
each day.

Self- Perception and Client expresses an Body Image Disturbed

Self- Concept altered perception of
body appearance due
to pregnancy.

Anatomy and Physiology

The respiratory system is the network of organs and tissues that help
you breathe. It includes your airways, lungs and blood vessels. The muscles
that power your lungs are also part of the respiratory system. These parts
work together to move oxygen throughout the body and clean out waste
gases like carbon dioxide.

The respiratory system has many functions. Besides helping you inhale
(breathe in) and exhale (breathe out), it:
● Allows you to talk and to smell.
● Warms air to match your body temperature and moisturizes it to the
humidity level your body needs.
● Delivers oxygen to the cells in your body.
● Removes waste gases, including carbon dioxide, from the body when
you exhale.
● Protects your airways from harmful substances and irritants.

The respiratory system has many different parts that work together to
help you breathe. Each group of parts has many separate components.
Your airways deliver air to your lungs. Your airways are a complicated
system that includes your:
● Mouth and nose: Openings that pull air from outside your body into
your respiratory system.
● Sinuses: Hollow areas between the bones in your head that help
regulate the temperature and humidity of the air you inhale.
● Pharynx (throat): Tube that delivers air from your mouth and nose
to the trachea (windpipe).
● Trachea: Passage connecting your throat and lungs.
● Bronchial tubes: Tubes at the bottom of your windpipe that connect
into each lung.
● Lungs: Two organs that remove oxygen from the air and pass it into
your blood.

From your lungs, your bloodstream delivers oxygen to all your organs and
other tissues. Muscles and bones help move the air you inhale into and out
of your lungs. Some of the bones and muscles in the respiratory system
include your:
● Diaphragm: Muscle that helps your lungs pull in air and push it out.
● Ribs: Bones that surround and protect your lungs and heart.

When you breathe out, your blood carries carbon dioxide and other waste
out of the body. Other components that work with the lungs and blood
vessels include:
● Alveoli: Tiny air sacs in the lungs where the exchange of oxygen and
carbon dioxide takes place.
● Bronchioles: Small branches of the bronchial tubes that lead to the
alveoli.
● Capillaries: Blood vessels in the alveoli walls that move oxygen and
carbon dioxide.
● Lung lobes: Sections of the lungs — three lobes in the right lung and
two in the left lung.
● Pleura: Thin sacs that surround each lung lobe and separate your
lungs from the chest wall.

Some of the other components of your respiratory system include:

● Cilia: Tiny hairs that move in a wave-like motion to filter dust and
other irritants out of your airways.
● Epiglottis: Tissue flap at the entrance to the trachea that closes when
you swallow to keep food and liquids out of your airway.
● Larynx (voice box): Hollow organ that allows you to talk and make
sounds when air moves in and out.
PATHOPHYSIOLOGY
 Nursing Care Plan #1
Dx: Ineffective airway clearance related to presence of bronchial infection and secretion as evidenced by
adventitious breath sound.

DEFINING SCIENTIFIC EXPECTED INTERVENTION RATIONALE

CHARACTERISTICS BASIS OUTCOMES

Subjective Cough is the Short term goal: 1.) Establish rapport 1.) To gain pt./SO’s trust
most common After 3 hours of and cooperation
data:
symptom of nursing
“Naa koy ubo nga pulmonary 2.) Maintain infection 2.) PTB is transmitted
mag sigeg balik2, intervention, client
tuberculosis. It will be able to control through the via droplet inhalation
for pila nani ka may produce use of mask and so proper precaution
months and readily expectorate
yellowish or secretions and will performance of hand should be performed
tungod ani mag Greenish colored washing before and to avoid transmission
lisod kog have absence or
sputum decrease in after contact with to other clients.
ginagawa.” As especially during Client.
verbalized by the episodes of
the day. dyspnea.
patient. Eventually, the 3.) Monitor temperature 3.) Febrile reactions are
sputum may be Long term goal: as indicated. indicators of continuing
Objective data: streaked with presence of infection.
After 10 hours of
● Abnormal blood.
nursing
breaths 4.) Place client in high 4.) Elevating the head
intervention, the
sounds : Furthermore, a fowler’s position and of the bed and
goal is partially
person with PTB encourage reposition turning client every
crackles met as evidenced
may experience every two hours. two hours help in
● Dyspnea; by client’s
fatigue and loss decreasing the
use of participation to
of energy. It may pressure placed on
breathing and
accessory affect his or her the diaphragm.
coughing exercises
muscle for ability to
and ability to
respiration. expectorate 5.) Maintain room or 5.) Allergen may
Expectorate
● Restlessness secretions, too. environment free trigger more
sputum upon
Aside from that, from any sorts of accumulation of
evaluation; The
 ● Difficulty difficulty of patient will readily Allergen. secretion due to
breathing expectorate respiratory response.
verbalizing
signifies that secretions and will
● Elevated there may be an have absence or 6.) Teach and encourage 6.) These exercises
shoulders accumulation of decrease in deep breathing and hasten the expulsion
● Easy secretion in the episodes of coughing exercises. of sputum and aids in
fatigability bronchial cavity dyspnea. maintaining airway
● Productive of the lungs. patency.
cough
● Chills at 7.) Emphasize to 7.) Fluids help loosen
night increase fluid intake secretion in the
● Loss of depending on individual Lungs.
appetite as tolerability or as
claimed. indicated.
● Chest X- ray
and sputum 8.) Instruct to take 8.) Warm fluids help in
examination warm liquids instead of loosening the
revealed cold tones. secretions while cold
positive for liquids triggers
tuberculosis. cough more often.

Vital signs:
9.) Provide postural 9.) Through the aid of
drainage and percussion. gravity and
● RR= 23
percussion secretions
breaths/
are readily expelled.
min
● PR= 95
10.) Monitor breathing 10.) It provides baseline
beats/min
patterns and breath data for future
● T= 37.5
Sounds. comparison in the
degree
evaluation of disease
celsius
Condition.
● BP=100/80
 11.) Educate client and 11.) PTB can be
mmhg.
family about disease transmitted through
condition and the droplet inhalation
need for compliance and 6 months
with the therapeutic compliance to
regimen. medication is needed
in order to be treated
with it.

12.) Administer 12.) For the

prescribed medications pharmacological
as ordered. management of the
patient’s condition.

Reference: Nurse’s Pocket Guide 15th Edition by Doenges, Moorhouse, and Alice C. Murr.
 Nursing Care Plan #2
Dx: Risk for impaired gas exchange related to altered oxygen supply as evidenced by wheezes upon auscultation.

DEFINING SCIENTIFIC EXPECTED INTERVENTION RATIONALE

CHARACTERISTICS BASIS OUTCOMES

Impaired gas Short term goal: 1.) Establish rapport . 1.) To gain pt./SO’s trust
Subjective
exchange is a and cooperation
data: After 2 hours
state in which of nursing 2.) Monitor and record
“ Lain jud kaayu there is excess vital signs. 2.) To obtain baseline
interventions, data
akong pamati labi or deficit the client will be
na mag lakaw ko oxygenation and able to
dali rako ma kapoy carbon dioxide demonstrate on
ug mura kog mag elimination. The how improve 3.) Monitor respiratory 3.) To assess for rapid or
compensatory ventilation & rate, depth and rhythm. shallow respiration that
apas sakong
mechanism of oxygen tissues occur because of
ginhawa.” As lungs is to lose & absence of hypoxemia and stress
verbalized by the effectiveness of symptoms of
patient. its defense respiratory
mechanisms and distress. 4.)Duskiness and
Objective data: allow organisms 4.) Monitor skin and central cyanosis
● The patient to penetrate the mucous membrane indicate advanced
manifested sterile lower Long term goal: color. hypoxemia
several respiratory tract After 5 days
episodes of where of nursing
pallor inflammation interventions, 5.) Assess pt’s general 5.) To note for etiology
● Tachypnea develops. the client will condition. precipitating factors that
● Restlessness Disruption of demonstrate on can lead to impaired gas
● Nasal flaring mechanical how improve exchange
● Use of defenses and ventilation &
ciliary motility
 accessory leads to oxygen tissues
muscles for colonization of & absence of 6.) Auscultate breath 6.)Presence of wheezes
breathing lungs and symptoms of sounds, note areas of may indicate
● Irritability subsequent respiratory decreased/adventitiou bronchospasm/retained
● Somnolence infection. distress. s breath sounds as secretions.
Inflamed and well as fremitus.
PT manifest the fluid-filled
following: alveolar sacs
cannot exchange
● Cyanosis oxygen and 7.) Elevate head of the 7.) Oxygen delivery
● Diaphoresis carbon dioxide pt. may be improved by
● Confusion effectively. The upright suctioning.
Pt’s Vital signs: release of
endotoxins by
● RR= 23 the microbes can
breaths/ min 8.) To enhance lung
lodge in the 8.) Note for presence of
● PR= 95 brain, affecting Cyanosis. expansion.
beats/min the respiratory
● T= 37.5 center in
degree medulla resulting 9.)To assess inadequate
celsius in altered 9.) Encourage frequent
systemic oxygenation or
● BP=100/80 oxygen supply. position changes and
hypoxemia.
mmhg deep-breathing
Exercises

10.) Administer 10.) For the

prescribed medications pharmacological
as ordered. management of the
patient’s condition
 Nursing Care Plan #3
Dx: Activity Intolerance related to insufficient oxygen for activities of daily living as evidenced by reports of fatigue
and exertional dyspnea.

DEFINING SCIENTIFIC EXPECTED INTERVENTION RATIONALE

CHARACTERISTICS BASIS OUTCOMES

-Presence of a Short term goal: 1.) Establish Rapport. 1.) To gain clients
Subjective
space-occupying participation and
data: After 3-4
liquid in the cooperation in the nurse
“Kapoy kaayu hours of nursing
pleural space, patient interaction.
interventions,
akong lawas bisan the lung recoils the patient will use 2.) Dramatic changes in
sa pagsaka sa inward, the chest identified
wall recoils 2.) Assess heart rate and rhythm,
hagdanan ug pag techniques to
outward, and the cardiopulmonary changes in usual blood
hugas plato dili improve activity pressure, and
diaphragm is intolerance. response to physical
nako progressively worsening
depressed activity, including vital
makalahuwatay inferiorly. This signs, before, during and fatigue result from an
Long term goal: imbalance of oxygen
usahay tungod ani may lead to after activity. Note
akong gipamati.” decrease lung accelerating fatigue. supply demand.
volume and may After 2-3 days of
As verbalized by
nursing 3.) To note for any
the patient. result to
interventions, the abnormalities and
significant 3.) Assess patient’s
patient will report deformities present
hypoxemia and general condition
Objective data: measurable within the body
can only be Adjust client’s daily
relieved by increase in activity activities and reduce
thoracentesis. intolerance. intensity of level.
● Generalized
weakness Due to 4.) To prevent strain and
● Limited inadequate overexertion.
range of ventilation there 4.) Discontinue activities
motion as would be that cause undesired
limitations in psychological changes.
 observed activity as
use of tolerance to
accessory activity may 5.) Instruct client in
occur. unfamiliar activities 5.) To conserve energy
muscles and promote safety.
during and in alternate ways
breathing. to conserve energy.

Pt’s Vital signs:

6.) Encourage patient to
● RR= 23 have adequate bed rest 6.) To provide relaxation.
breaths/ min and sleep.
● PR= 95
beats/min
● T= 37.5 7.) Assist the client in 7.) To prevent risk for fall
degree Ambulation. that could lead to injury.
celsius
● BP=100/80
mmhg
8.) Fatigue affects both
the client’s actual and
8.) Note presence of perceived ability to
factors that could participate in activities.
contribute to fatigue.

9.) To determine current

status and needs
9.) Ascertain client’s associated with
ability to stand and participation in needed
move about and degree or desired activities.
of assistance needed or
use of equipment.

10.) Give client

 information that
provides evidence of 10.) To sustain the
daily or weekly motivation of the patient.
progress.

11.) Encourage the client

to maintain a positive 11.) To enhance sense of
attitude. well being.

12.) Assist the client in a

semi-fowler's position 12.) To promote easy
Elevate the head of the breathing.
Bed.

13.) Assist the client in

13.) To maintain an open
learning and
airway.
demonstrating
appropriate safety
measures.

14.) Instruct the SO not 14.) To prevent injuries.

to leave the client
Unattended.

Reference: Nurse’s Pocket Guide 15th Edition by Doenges, Moorhouse, and Alice C. Murr.
 Nursing Care Plan #4
Dx: Imbalanced nutrition less than body requirements related to fatigue as evidenced by poor muscle tone.

DEFINING SCIENTIFIC EXPECTED INTERVENTION RATIONALE

CHARACTERISTICS BASIS OUTCOMES

Subjective data: Short term:

1.) Document patient’s 1.) Useful in defining the
wala koy gana ko kaon Imbalanced nutritional status on degree or extent of
tungod sa ka kapuy sa Nutrition: Less After 8hrs of admission, noting skin problem and appropriate
ako lawas” as Than Body nursing turgor, current weight choice of interventions.
Requirements is and degree of weight
vebalized by the interventions, the
loss, integrity of oral
patient. state where the patient will initiate mucosa, ability or
individual behaviors/lifestyle inability to swallow,
experiences changes to regain presence of bowel tones,
nutritional and/or to maintain history of nausea and
deficits due to appropriate vomiting or diarrhea.
Objective data: either a shortage weight.
● BMI: 18.5 of nutrient
● Loss of supply or higher Long term goal:
2.) A certain patient’s
appetite metabolic 2.) helpful in identifying
usual dietary pattern.
● Weak and demand. specific needs and
After 1 week of strengths.
restlessness
nursing
● Fatigue
interventions, the
● Skin is pale
Weight loss patient will
and dry
among people demonstrate
● Oral
with TB can be progressive weight
mucosa is
caused by gain toward goal
pale and dry
several factors, with normalization 3.) Useful in measuring
● Skin turgor 3.) Monitor I&O and effectiveness of
including of laboratory
 is decreased reduced food values and be free weight periodically. nutritional and fluid
intake due to of signs of support.
Pt’s Vital signs: loss of appetite, malnutrition.
nausea and
● RR= 23
abdominal pain. 4.) May affect dietary
breaths/ min
Equally under 4.) Encourage and choices and identify
● PR= 95
nutrition provide for frequent rest areas for problem solving
beats/min
weakens the periods. to enhance intake and
● T= 37.5
body's ability to utilization of nutrients.
degree
fight disease.
celsius
● BP=100/80
5.)Provide oral care
mmhg 5.) Helps conserve
before and after energy, especially when
respiratory treatments. metabolic requirements
are increased by fever.

6.) Reduces bad taste

6.) Encourage small, left from sputum or
frequent meals with medications used for
foods high in protein and respiratory treatments
carbohydrates. that can stimulate the
vomiting center.

7.) Creates a more

7.) Refer to a dietitian normal social
for adjustments in environment during
mealtime, and helps
dietary composition. meet personal, cultural
preferences.

8.) Provides assistance in

8.) Consult with planning a diet with
respiratory therapy to nutrients adequate to
schedule treatments 1–2 meet patient’s metabolic
requirements, dietary
hr before or after meals.
preferences, and
financial resources post
discharge.

9.) Encourage patient to 9.) To gain weight

eat high calorie, high in
protein and high fats
foods.
 Nursing Care Plan #5
Dx: : Disturbed sleeping pattern related to chest pain and recurrent coughing.

DEFINING SCIENTIFIC EXPECTED INTERVENTION RATIONALE

CHARACTERISTICS BASIS OUTCOMES

Disturbed Short term 1.) Determine patterns 1.) to improve the

Subjective
sleep Pattern is of sleep in the past in patient’s sleep.
data: goal:
involving a a normal environment:
disturbance in a amount, bedtime
After 8hrs of routines, depth,
“mag lisud ko person's regular nursing length, positions, aids,
katug tungod ma circadian or interventions, and other interfering
sigeg hotoy sleep pattern. the patient factors.
akung ubo then Disturbed sleep obtains optimal
mo sakit sad ako can have many amounts of
adverse health 2.) Encourage daytime 2..) stress may be
dughan” as sleep as
consequences, physical activities but reduced by therapeutic
verbalized by the evidenced by
including instruct the patient to activities and may
patient. rested
fatigue, avoid strenuous promote sleep.
appearance,
decreased activities before
verbalization of
Objective data: cognitive focus, bedtime.
feeling rested,
and altered and
● Weak and
mood, and can improvement in
restlessnes 3.) promotes sleep.
be a potential sleep pattern. 3.) Encourage patient
s
warning sign for to take milk.
● Fatigue
medical issues,
4.) Consistent
 ● Irritable researchers Long term goal: 4.) Instruct the patient schedules facilitate
believe that a to follow a consistent regulation of the
● Sleepiness
lack of sleep daily schedule for rest circadian rhythm and
during the
may trigger After 2 days of and sleep. decrease the energy
day needed for adaptation
inflammatory nursing
● Skin is pale to changes.
pathways that interventions, the
and dry
exacerbate the patient will be
Pt’s Vital signs: pain. able to identify
individually 5.) Napping can
● RR= 23 5.) Inhibit the patient
appropriate disrupt normal sleep
breaths/ from daytime naps
interventions to pattern
min unless needed.
promote sleep,
● PR= 95 reports improved
beats/min sleep, and
● T= 37.5 reports increase 6.) Introduce relaxing
degree sense of activities such as warm 6.) provide relaxation
celsius well-being and bath, calm music, and distraction to
● BP=100/80 feeling rested. reading a book, and prepare the mind and
mmhg relaxation exercises body for sleep.
before bedtime.

7.) Provide measures 7.) to decrease or

to relieve pain before it relieve pain.
becomes severe.
 DRUG STUDY #1
Source: Nursing 2008 drug handbook /wolters kluwer/Lippincott /Williams & Wilkins.
Drug Classification Mechanism Indication Contraindicati Adverse Nursing
of action on reaction Responsibility

Generic General - Interferes - Concomitant - CNS: Before:

Name: classification: with bacterial -Tuberculosis therapy with -Consider the
Headache,
RNA amprenavir, 15 rights of
Rifampin Semisynthetic fatigue,
synthesis by -Prevention of saquinavir, drug
agent binding to Meningococca ritonavir, drowsiness,
administration;
DNA-depend l Infections hypersensitivit behavioral Right
ent RNA y to other changes, medication,
Trade polymerase, -Staphylococc rifamycins. dizziness, right dose,
Name: preventing al Infections mental right route,
attachment - Use
Rifadin Functional confusion, right patient,
to DNA, -H. cautiously in
Classification: generalized right to
thereby Influenzae patients with
Patient’s numbness, educate, right
blocking RNA Prophylaxis liver disease.
dose: Antibiotic, ataxia. to refuse, right
transcription.
Antitubercular assessment,
150 mg, Patient -CV: Shock
right
300mg Indication: -EENT: Visual
Therapeutic evaluation,
disturbances, right to
Effect: Tuberculosis
PO exudative, approach, right
Bactericidal conjunctivitis. technique,
in -GI: right time,
susceptible Pancreatitis. right
microorganis Pseudomembra frequency,
ms. nous colitis, right site, right
reason, right
epigastric
documentation.
distress,
anorexia, -Give drug with
nausea, at least other
vomiting, berculotic.
-Look alike
abdominal
sound alike:
pain, diarrhea,
Don’t confuse
flatulence, sore
rifampin with
mouth and rifabutin or
tongue. rifapentine.
-GU: Acute -For best
renal failure absorption,
hemoglobinuria give capsules 1
, hematuria, hour before 2
menstrual hours after
meals.
disturbances,
-Hematologic:
During:
Thrombocytope
-Monitor
nia, transient,
hepatic
leukopenia,
function,
eosinophilia,
hematopoietic
hemolytic
studies, and
anemia.
uric acid
-Hepatic:
levels. Drug’s
Hepatotoxicity
systemic
-Metabolic:
effects may
Hyperuricemia
asymptomatic
-Musculoskel
ally raise liver
etal:
function test
osteomalacia
results and
-Respiratory:
dyspnea, uric acid
wheezing. level.
-Skin: Pruritus,
urticaria, rash After:
-Other: flu like
-Instruct a
syndrome,
patient who
discoloration of
can't tolerate
body fluids,
capsules on an
porphyria
empty stomach
exacerbation.
to take drug
with meals and
a full glass of
water.

-Warn the
patient that
she may feel
drowsy and
that drug can
turn body
fluids red
orange and
permanently
stain contact
lenses.

-Advise woman
using
hormonal
contraceptives
to consider
another form
of birth control
pill.

-Advise patient
to contact
prescriber if
she
experiences
fever, loss of
appetite,
malaise,
nausea,
vomiting, dark
urine, or
yellow low
discoloration of
the eyes or
skin.

-Advise patient
to avoid
alcohol during
therapy.
 DRUG STUDY #2
Source: Nursing 2008 drug handbook /wolters kluwer/Lippincott /Williams & Wilkins.
Drug Classificatio Mechanism Indication Contraindicatio Adverse Nursing
n of action n reaction Responsibility

Generic General - Inhibits -Active - Acute hepatic -CNS: Before:

Name: classificatio mycolic acid Tuberculosis disease, history Peripheral - Consider the
n: synthesis. (in of neuropathy, 15 rights of
Isoniazid Causes Combination hypersensitivity seizures, toxic drug
Isonicotinic disruption of with One or reactions, encephalopath administration
acid bacterial cell More hepatic injury or y, memory ; Right
derivative wall, loss of Antitubercul severe adverse impairment, medication,
acid-fast ars reactions with toxic right dose,
Trade Name: properties in previous psychosis. right route,
Functional susceptible isoniazid -EENT: Optic right patient,
Isotamine mycobacteria
Classificatio - therapy. neuritis and right to
n: . Active only Tuberculosis atrophy. educate, right
during Prophylaxis -GI: Nausea, to refuse,
Antitubercular bacterial cell vomiting, right
division. epigastric assessment,
Patient’s
distress. right
dose: Therapeutic
-Hematologi evaluation,
50mg Effect
c: right to
PO. Agranulocytos approach,
is,aplastic right
anemia, technique,
thrombocytop right time,
enia, right
hemolytic frequency,
anemia,eosino right site,
philia,siderobl right reason,
astic anemia. right
-Hepatic: documentatio
hepatitis, n.
jaundice, -Always give
bilirubinemia drugs with
-Metabolic: other
hyperglycemia antituberculoti
,metabolic cs to prevent
acidosis, development
hypocalcemia, of resistant
hypophosphat organisms.
emia.
-Skin: During:
irritation at -Monitor
injection site. hepatic
-Other: function
Rheumatic closely for
and lupus like changes.
syndromes, Elevated liver
hypersensitivit function study
y reactions results occur
pyridoxine in about 15%
deficiency, of patients;
gynecomastia. most
abnormalities
are mild and
transient, but
some may
persist
throughout
treatment.

-Give
pyridoxine to
prevent
peripheral
neuropathy.

After:

-Instruct
patient to take
drug exactly as
prescribed;
warn against
stopping drug
without
prescriber’s
consent.

-Advise patient
to take drug 1
hour fore or 2
hours after
meals.
-Tell the patient
to notify the
prescriber
immediately if
signs and
symptoms of
liver
impairment
occur, such as
appetite loss,
fatigue,
malaise, yellow
skin or eye
discoloration,
and dark urine.

-Advise patient
to avoid
alcoholic
beverages
while taking
drug. Also tell
her to avoid
certain foods;
fish, such as
skipjack, and
tuna, and
products
containing
tyramine, such
as aged
cheese, beer,
and chocolate
because, drug
has some MAO
inhibitor
activity.

-Encourage
patient to
comply fully
with treatment,
which may take
months or
years.
 DRUG STUDY #3
Source: Nursing 2008 drug handbook /wolters kluwer/Lippincott /Williams & Wilkins.
Drug Classification Mechanism Indication Contraindicatio Adverse Nursing
of action n reaction Responsibility

Generic General Acute gout, Before:

-General:
Name: classification: May disrupt Tuberculosis severe hepatic -Consider the
Fever.
mycobacteri (in dysfunction porphyria and 15 rights of
Pyrazinamid Synthetic
um combination dysuria have drug
e pyrazine
tuberculosis with other Diabetes rarely been administration;
analogue
membrane Antitubercular mellitus, reported. Right
transport. s porphyria, renal -Gastrointes medication,
impairment, tinal: The right dose,
Functional Renal/Hepatic history of gout, right route,
principal
Trade Classification: Impairment children (safety right patient,
adverse effect
Name: not established), right to
Antitubercular is a hepatic
history of reaction educate, right
Tebrazid
alcoholism, Hepatotoxicit to refuse, right
concurrent y appears to assessment,
medication be dose right
associated with related, and evaluation,
hepatotoxicity may appear right to
Patient’s approach, right
at any time
dose: technique,
during
50 mg/kg right time,
therapy.
PO twice right
-Gl:
weekly. frequency,
disturbances
PO. right site, right
including
nausea, reason, right
vomiting and documentation
anorexia have .
also been -Before using
reported. this
:Hematologi medication, tell
c and your doctor or
Lymphatic: pharmacist
Thrombocyto your medical
penia and history,
sideroblastic especially of:
anemia with liver disease,
erythroid kidney disease,
hyperplasia, diabetes, gout,
vacuolation of high uric acid
erythrocytes level in the
and increased blood, alcohol
serum iron use.
concentration
have occurred During:
rarely with
this drug. -Alcohol may
Adverse increase the risk
effects on of liver disease.
blood clotting Avoid alcoholic
mechanisms beverages while
have also using this
been rarely medication.
reported. Pyrazinamide
-Other: Mild may cause live
arthralgia and bacterial
myalgia have vaccines (such
been reported as typhoid
frequently. vaccine) to not
Hypersensitivi work well. Tell
ty reactions your health care
including professional that
rashes, you are using
urticaria, and pyrazinamide
pruritis have before having
been any
reported. immunizations/v
Fever, acne, accinations.
photosensitivi
ty, porphyria, After:
dysuria and
-Pyrazinamide
interstitial
should be
nephritis have
discontinued
been reported
and not be
rarely.
resumed if signs
of
hepatocel-lular
damage or
hyperuricemia
accompanied by
acute gouty
arthritis appear.
-Patients started
on pyrazinamide
should have
baseline serum
uric acid and
liver function
determinations.
Those patients
with preexisting
Liver disease or
those at
increased risk
for drug related
hepatitis (e.g.,
alcohol abusers)
should be
followed closely.
 DRUG STUDY #4
Source: Nursing 2008 drug handbook /wolters kluwer/Lippincott /Williams & Wilkins.
Drug Classificatio Mechanism Indication Contraindicatio Adverse Nursing
n of action n reaction Responsibilit
y

Generic General Interferes -Tuberculosi -Optic neuritis. -CNS: Before:

Name: classificatio with RNA s, Other Use in young -Consider
Headache,
n: synthesis. Mycobacteri children, the 15 rights
Ethambutol dizziness,
al Disease unconscious pts, of drug
Isonicotinic or anyone fever, mental
confusion, administratio
acid Therapeutic -Renal unable to report
derivative Effect: Impairment visual changes. hallucinations, n; Right
malaise,perip medication,
Suppresses -Use cautiously heral neuritis. right dose,
Trade Name:
multiplication in patients with -EENT: Optic right route,
Functional of impaired renal
Myambutol neuritis right patient,
Classificatio mycobacteria function,
-GI: Anorexia, right to
n: cataracts,
nausea, educate,
recurrent eye
Antitubercular inflammation, vomiting, right to
gout, or diabetic abdominal refuse, right
Patient’s retinopathy. pain, GI assessment,
dose: upset. right
-Hematologi evaluation,
100mg, right to
c:
400mg approach,
Thrombocytop
enia right
PO.
-Metabolic: technique,
Hyperuricemia right time,
-Musculoskel right
etal: Joint frequency,
pain right site,
-Respiratory right reason,
: Bloody right
sputum documentati
-Skin: Toxic on.
epidermal -Perform
reactions, visual acuity
precipitation and color
of acute gout. discriminatio
n tests
before and
during
therapy.

During:
-Ensure that
any changes
in vision
don’t result
from the
underlying
condition.
-Always give
drug with
other
antitubeculot
ics to
prevent
development
of resistant
organisms.
-Monitor uric
acid level;
observe
patient for
signs and
symptoms of
gout.

After:
-Reassure
patients that
visual
disturbances
usually
disappear
several weeks
to months
after the drug
is stopped.
Inflammation
of the optic
b=nerve is
related to
dosage and
duration of
treatment
-Inform
patient that
drug is given
with other
antituberculoti
cs.

-Stress
importance of
compliance
with drug
therapy

-Advise
patient to
report
adverse
reactions to
prescriber.
 DRUG STUDY #5
Source: Nursing 2008 drug handbook /wolters kluwer/Lippincott /Williams & Wilkins.
Drug Classificatio Mechanism Indication Contraindicatio Adverse Nursing
n of action n reaction Responsibility

Before
Generic Therapeutic Absorption: Treatment -Gastrointesti -Consider the
Contraindicated
Name: Fish class: well and nal 15 rights of
in: drug
Oil Nutritional observed intolerance.
prevention Hypersensitivity
supplements from the GI Which administration;
of to Right
Brand tract after involves a
supplement preservatives, medication,
Name: Pharmacolo oral reaction from
docosahexaen gic class: deficiencies colorant, or right dose, right
administratio additives, your immune
oic acid (DHA) Essential fatty . Special route, right
n. including system, patient, right to
acid formulation
tartrazine , intolerances educate, right
Dosage: supplements. s are
saccharin, and involve the to refuse, right
1tab/day available
aspartame (oral gastrointestin assessment,
for patients al tract. In the right evaluation,
forms) some
with 30 minutes to right to
products contain
particular 48 hours after approach, right
alcohol and
needs, eating a food technique, right
should be
including: that you're time, right
avoided in frequency, right
Prenatal patients with truly
intolerant to, site, right
known reason, right
intolerance. you
documentation.
experience
-Assess patient
Use cautiously uncomfortable
for signs of
in: Patients with symptoms, nutritional
including deficiency
anemia of
nausea, before and
undetermined
diarrhea or throughout
causes.
constipation, therapy.
gas, and
bloating. -Asses previous
sensitivity
reaction

-Assess for
contraindication
s or cautions
which are
contraindication
s use of these
agents.

-Perform a
complete
physical
assessment to
establish
baseline status.

During:
-Monitor effects
of altered
glucose levels.
 HEALTH TEACHING PLAN #1
Topic: Pulmonary Tuberculosis

General Objective: Within 35 minutes of active interaction with the patient and patient’s SO, they will
understand what pulmonary tuberculosis is and its risk factors, signs and symptoms.
LEARNING LEARNING LEARNING TIME ALLOTTED TEACHING STYLE EVALUATION
OBJECTIVES CONTENT ACTIVITY

Within 35 mins. After 35

of active minutes of
interaction with active
the patient and interaction with
patient’s SO will the patient and
be able to: patient’s SO,
understood
1.) Define What is Questioning 5 minutes Questioning what
what is pulmonary and Lecturing pulmonary
pulmonary tuberculosis? using a visual tuberculosis is
Tuberculosis. –Tuberculosis is aid and its risk
a bacterial factors, signs
infection that and symptoms.
can pass
through the air
between
people. When it
affects the
lungs, the
medical name
for this is
pulmonary
tuberculosis. It
 can cause chest
pain, severe
coughing.

Persons who
2.) Enumerate have been 10 minutes Conversational/
the risk, signs Recently One on one Discussion
and symptoms Infected with discussion
of pulmonary TB Bacteria
tuberculosis. This includes:

- Close contacts
of a person
with infectious
TB disease

- Persons who
have
immigrated
from areas of
the world with
high rates of TB

- Children less
than 5 years of
age who have a
positive TB test

- Groups with
high rates of TB
transmission,
such as
homeless
persons,
injection drug
users, and
persons with
HIV infection

- Persons who
work or reside
with people
who are at high
risk for TB in
facilities or
institutions
such as
hospitals,
homeless
shelters,
correctional

facilities,
nursing homes,
and residential
homes for
those with HIV

Persons with
Medical
Conditions
that Weaken
the Immune
System
people with any
of these
conditions:

-HIV infection
(the virus that
causes AIDS)

-Substance
abuse

-Silicosis

-Diabetes
mellitus

- Severe kidney
disease

- Low body
weight

- Organ
transplants

- Head and
neck cancer

- Medical
treatments
such as
corticosteroids
or organ
transplant

-Specialized
treatment for
rheumatoid
arthritis or
Crohn’s disease

Other factors

- Using
substances. IV
drugs or
excessive
alcohol use
weakens your
immune system
and makes you
more
vulnerable to
tuberculosis.
- Using
tobacco.
Tobacco use
greatly
increases the
risk of getting
TB and dying of
it.
- Working in
health care.
Regular contact
with people
who are ill
increases your
chances of
exposure to TB
bacteria.
Wearing a mask
and frequent
hand-washing
greatly reduce
your risk.
-Living or
working in a
residential
care facility.
People who live
or work in
prisons,
homeless
shelters,
psychiatric
hospitals or
nursing homes
are all at a
higher risk of
 tuberculosis
due to
overcrowding
and poor
ventilation.
- Living with
someone
infected with
TB. Close
contact with
someone who
has TB
increases your
risk.
Signs and
A. Signs and symptoms of Lecture proper 10 minutes Questioning
symptoms. active TB and Lecturing
include: using a visual
aid.
- Coughing for
three or more
weeks
- Coughing up
blood or mucus
- Chest pain, or
pain with
breathing or
coughing
- Unintentional
weight loss
- Fatigue
- Fever
- Night sweats
- Chills
- Loss of
appetite
Tuberculosis
can also affect
other parts of
your body,
including the
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 might
 cause back
pain, and
tuberculosis in
your kidneys
might cause
blood in your
urine.

You can’t get One on One 10 minutes Conversational/

3.) How does discussion Discussion
pulmonary TB
pulmonary TB by:
spread?
● shaking
hands
● sharing
food or
drink
● sleeping
in the
same bed
● kissing

TB is airborne,
which means
you can
become
infected with M.
tuberculosis
after breathing
air exhaled by
someone with
tuberculosis.
This can be air
from:

● coughing
● sneezing
● laughing
● singing

The germs can

stay in the air
for several
hours. It’s
possible to
inhale them
even when the
infected person
isn’t in the
room. But
usually you
have to be
close to
someone with
TB for a long
period of time
to catch it.
 HEALTH TEACHING #2

Topic: Compliance to Medications

General objective: Within 30 minutes of nurse-patient interaction, the patient will be able to acquire
knowledge, skills, and attitude on taking the prescribed medications regularly.
LEARNING LEARNING LEARNING TIME TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY ALLOTTED STYLE

After 30
Within 30 Definition of I.Introduction minutes of
minutes of Terms nurse-patient
nurse patient Establish interaction, the
interaction, the rapport to the patient was be
patient will be Compliance is patient and able to:
able to: the extent to catch his
which a patient attention by Explained what
1.) Explain correctly asking what do One-on-one medication
what follows medical you think about 5minutes formal compliance is.
medication advice (eg, compliance to discussion with
compliance is. treatment medication? visual aid Explained the
regimen, purpose and
lifestyle tips, II.Lecture major goal of
advice Proper treatment for
concerning TB patients.
disease ● Definition
management). of terms Identify
● Purpose different
 and main techniques on
The major goals goal of how to improve
of treatment for treatment medication
TB disease are for TB compliance.
2.) Explain the to patients. 5minutes One-on-one
Purpose and ● Identify formal Enumerate and
major goal of - Cure the different discussion with explain the
treatment for individual technique visual aid dosage
TB patient. patient. s how to common side
improved effects of
-Minimize risk complianc Antitubercular
of death and e to drugs.
disability; and medicatio
ns
-Reduce ● Enumerat
transmission of e and
M. tuberculosis explain
to other the
persons. dosage
and
-To ensure that common
these goals are side
met, TB disease effects of
must be treated antituberc
for at least 6 ular
months and in drugs.
some cases
even longer. III.
Questioning
To help
improve ● Asked the
 compliance: patient
3.) Identify “What is
different ● At each the 10minutes One-on One
techniques on appointm importanc formal
how to improve ent, ask if e of discussion with
compliance to the complianc visual aid
medications. patient is e to
taking medicatio
their ns?
medicatio
n on
schedule
and as
prescribe
d.
● Review
possible
side
effects
when
changing
a
regimen.
● Discuss
what are
the DO,s
and
DONT’S
when
they
experienc
 e adverse
effects.
● Stress the
importanc
e of
following
a regimen
● Recomme
nd
patients
use tools
(e.g; pill
calendar,
pill case,
digital
dispenser,
and
mobile
app) to
help with
medicatio
n
tracking.
● Tailor
solutions
to specific
patient
needs
and
challenge
s during
 the
treatment

The following
medications are
commonly used
to treat TB:

Rifampin

-The capsules One-on One

4.) Enumerate come in two formal
and explain the strengths, 10minutes discussion with
dosage and 150mg or visual aid.
common side 300mg.
effects of
Antitubercular -The colors vary
drugs with the
different brands
and strengths.

-They must be
taken on an
empty
stomach; you
should take
them an hour
before food or
two hours after
food.
Isoniazid

- Each small
white tablet
contains 100mg
of Isoniazid and
the adult dose
is 300mg daily

- Adverse
effects are
uncommon but
they can
sometimes
cause minor
symptoms such
as feeling
irritable,
tiredness, lack
of
concentration,
and a
worsening of
acne.

Ethambutol
- Tablets come
in two
strengths, 400
mg and 100mg.
Your doctor will
give you your
dose according
to your weight.

-It is important
to report any
change in your
eye sight
particularly if
you notice a
change in your
color vision or
you develop
blurred vision.
Contact your TB
Case Manager
or doctor as
soon as you
notice or even
suspect any
problems with
your vision.
 HEALTH TEACHING #3
Topic: Coughing Exercise

General Objective: Within30 minutes of health teaching, the patient will be able to develop lifestyle changes and
reduce early morbidity and increase quality of life.

LEARNING LEARNING LEARNING TIME TEACHING EVALUATION

OBJECTIVE CONTENT ACTIVITY ALLOTTED STYLE

Within 30 After 30
minutes of minutes of
nurse patient nurse patient
interaction, the interaction, the
patient will be patient was
able to: able to:

● Explained
the
1. Explain what Definition and I. definition
coughing terms: Introduction 10 minutes One on one of
exercise is. formal coughing
Coughing is a Establish discussion with exercise.
technique that rapport to the visual aid ● Explained
helps move patient and the
mucus from the catch her purpose
lungs. It should attention by and
be done in asking what importanc
combination you think about e of
with another coughing coughing
act; it involves exercise. exercise.
 taking a breath ● Demonstr
in, holding it, ated the
and actively steps of
exhaling. coughing
Breathing in exercise.
and holding it
enables air to
get behind the
mucus and
separates it
2. Explain the from the lung II. Lecture 10 minutes One on one
purpose and wall so it can Proper formal
importance of be coughed ● Definition discussion with
coughing out. of term visual aid
exercise ● Purpose
and
It's important importanc
to practice e of
coughing coughing
exercises so exercise.
that you’ll be ● Steps of
able to do the coughing
exercise below exercise.
easily. These
exercises will
help your
breathing clear
your lungs, and
3. Demonstrate help you loosen III.
the steps of and cough up Questioning 10 minutes
coughing mucus more ● Were you
exercise effectively. able to One on one
understan formal
d what discussion with
coughing visual aid
To help you exercise
cough is?
● Take a ● What is
slow, the
deep purpose
breath. and
Breath in importanc
through e of
your nose coughing
and exercise?
concentra ● Can you
te on fully demonstr
expandin ate the
g your steps on
chest. how to do
● Breath coughing
out exercise?
through
your
mouth
and
concentra
te on
feeling
your
chest sink
downwar
 d and
inward.
● Take a
second
breath in
the same
manner.
● Take a
third
breath,
this time
hold your
breath for
a
moment
then,
then
cough
vigorousl
y. As you
cough,
concentra
te on
forcing all
the air
out of
your
chest.
● Repeat
the
exercise
two more
times.
 HEALTH TEACHING #4

Topic: PREVENTION OF TUBERCULOSIS

General Objective: Within 40 minutes of the nurse and patient interactions, the patient and the
significant others will be able to understand the ways how to prevent tuberculosis.

LEARNING LEARNING LEARNING TIME TEACHING EVALUATION

OBJECTIVES CONTENT ACTIVITY ALLOTTED PLAN

Within 30 After 40
minutes of minutes of the
nurse-client nurse and client
interaction the interactions,
patient and the patient and the
significant other significant
will be able to: others were
able to know
the specific diet
to prevent TB
as evidenced by
● Know the One on one answering the
diet which discussion and 20 minutes Lecture style nurse’s
can group questions about
prevent discussion it and were able
tuberculo to know the
sis. lifestyle
modification
that can
1. Know diet prevent TB.
which can DIET THAT CAN
prevent PREVENT
TUBERCULOSIS
tuberculo
:
sis
● Leafy,
dark-color
ed greens
like kale
and
spinach,
for their
high iron
and
B-vitamin
content
● Plenty of
whole
grains,
like whole
wheat
pastas,
breads,
and
cereals

● Antioxida
nt-rich,bri
ghtly-colo
 red
vegetable
s, such as
carrots,
peppers,
and
squash,
and
fruits, like
tomatoes,
blueberrie
s, and
cherries
— think
of buying
produce
in a full
rainbow
of colors
● Unsaturat
ed fats
like
vegetable
or olive
oil,
instead of
butter
2. ) Understand Avoiding
the ways of alcohol, Group
living that can cigarretes and discussion and 20 minutes Lecture style
prevent dust particles counseling
tuberculosis.
● Indulge in
daily
exercise
● Take all of
your
medicines
as they’re
prescribe
d, until
your
doctor
takes you
off them.
● Keep all
your
doctor
appointm
ents.
● Always
cover
your
mouth
with a
 tissue
when you
cough or
sneeze.
Seal the
tissue in
a plastic
bag, then
throw it
away.
● Wash
your
hands
after
coughing
or
sneezing
 HEALTH TEACHING #5

Topic: Healthy Eating Habits & its importance

General objective: Within 20 minutes of nurse-client interaction, the patient will be able to understand
the importance of proper healthy eating habits for herself and be motivated to eat healthy foods.
LEARNING LEARNING LEARNING TIME TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY ALLOTTED STYLE

Within 20 Healthy Defines Healthy After 20

minutes of eating habits Eating Habits minutes of
verbally and 3 minutes
nurse-client means eating nurse-client
will ask the
interaction a variety of patient about interaction,
the patient main foods what she think the patient
healthy eating
will be able that give you was able to
habit is
to: the nutrients understand
 you need to the
maintain your importance of
1. Define proper healthy
health, feel
Brainstorming eating habits
Healthy good, and and discussion for herself and
have energy. motivation to
eat healthy
foods.

A well balance
2. Identify and
diet provides all
know the 5 minutes One on one
of the energy
importance of doscussion
you need to
healthy habits
keep active
throughout the
day. Nutrients
you need for
growth and
repair, helping
you to stay
strong and
healthy and
help to prevent
diet- related
illness, such as
such some
some cancers
 Healthy and
3. Identify what Healthy foods unhealthy foods
healthy foods are considered 2 minutes identification
should be eaten to be the food
more and items that are
whats not. rich in nutrition
and have a
beneficial effect
on our overall
health. Healthy
food includes
many organic
food options
like natural
food, whole
foods, etc.
Healthing
eating is
usually referred
to as eating
clean meals
that provide
nutrients and
are important
to give you
energy,
maintain
health, anf
make you feel
good like
vegetables and
fruits.
 Discharge Planning

● Educated patient and SO

about the importance of taking
up her medicines as
prescribed by the physician.
● Briefly explained the right
dose, time, route, purpose,
Medication side effects, and
contraindications of the
medications.
● Emphasize the importance of
therapeutic compliance and
advised not to take
medications without
consulting a physician.
● Advised patient not to miss
taking the medications
prescribed by the physician

Environment ● Encourage patient and family

to provide a conductive home
with a calm, clean and
well-ventilated environment
to promote relaxation.
● Instruct the patient not to
allow anyone to smoke in the
house or anywhere near the
patient.

Treatment
● Educated patient to get
involved in the Directly
Observed Therapy in order for
the healthcare providers to
make sure that you take the
medicines correctly.
● Instructed patient to contact
 the healthcare provider if they
have questions or concerns
about the condition or care.
● Follow-up treatment care was
schedule
● Tell the patient not to
discontinue his medications
without medical advice.

Health Education
Educated patient the ways and tips
on how to prevent the spread of TB:

● Wash your hands often.

Wash your hands several
times each day. Wash after
you use the bathroom and
before you prepare or eat
food. Use hand sanitizer that
contains alcohol if soap and
water are not available. Do not
touch your eyes, nose, or
mouth without washing your
hands first.
● Cover a sneeze or cough.
Use a tissue that covers your
mouth and nose. Throw the
tissue away in a trash can
right away. Then wash your
hands well with soap and
water or use a hand sanitizer.
Do not stand close to anyone
who is sneezing or coughing.

● Take your medicine as

directed. If you forget to take
your pills one time, skip that
dose and take the next
 scheduled dose. Write down
that you missed a dose and
tell your healthcare provider at
your next visit.

● Tell family, friends, and

coworkers that you have TB.
They may have latent TB and
need to take medicine to
prevent it from becoming
active.
● Encouraged expectoration of
sputum.
● Encouraged patient to increase
fluid intake to 3000 mL/day to
help decrease the viscosity of
secretions, facilitating
expectoration.
● Engage in physical activity or
exercise regularly.
● Get enough rest.
● Eat a balanced diet.
● Keep the living area well
ventilated.

Observable signs and symptoms Signs of a condition are things

someone else can see or know
about you, like you have a rash or
you’re coughing. Symptoms are
things you feel yourself that others
can’t see, like having a sore throat
or feeling dizzy. Learn the signs and
symptoms of active TB in the lungs
include:
● Bad cough that lasts 3
weeks or longer
● Coughing up blood or
 sputum (mucus from deep
inside the lungs)
● Chest pain
● Fever
● Fatigue
● Loss of appetite
● Unintended weight loss
● Chills
● Night sweat

Diet
Instructed and educated
patient that TB should aim to have a
healthy balanced diet. A healthy
balanced diet can be achieved by
having foods from four basic food
groups. These are:

● cereals
● vegetables and fruits
● milk and milk products,
meat, eggs & fish
● oils, fats and nuts and
oils seeds

Avoid alcoholic and caffeinated

drinks.

Spiritual ● Allow client to express

positive feelings of spirituality
● Always have faith in God and
ask for help and guidance
● Encourage the patient and
Family outlook prior and
during recovery
REFERENCES:

Health Assessment in Nursing / Janet R. Weber / Jane H. Kelley

Marieb, Elaine Nicpon,Hoehn, Katja. (2012) Human anatomy & physiology /Boston :
Pearson

Pillitteri, Adele. Maternal & Child Health Nursing: Care of the Childbearing &
Childrearing Family.Marieb, Elaine Nicpon,Hoehn, Katja. (2012) Human anatomy &
physiology /Boston : Pearson

https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/obstetrics-an
d-gynecology/tuberculosis-in-pregnancy/#:~:text=Mother%2Dto%2Dchild%20transmissi
on%20of,amniotic%20fluid%20or%20genital%20secretions.