NURSING CARE STUDY OF A PATIENT WITH PULMONARY TUBERCULOSIS

BY

NAME: LEVI JENNIFER ADANNA

MATRIC NUMBER: ……………………………

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES
ABIA STATE UNIVERSITY, UTURU

NOVEMBER, 2024

1
NURSING CARE STUDY OF PATIENT WITH PULMONARY TUBERCULOSIS

BY

NAME: LEVI JENNIFER ADANNA

MATRIC NUMBER: ………………………………

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES
ABIA STATE UNIVERSITY, UTURU

IN PARTAIL FULFILMENT OF THE REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF ‘‘REGISTERED
NURSE” CERTIFICATE

NOVEMBER, 2024

i
 APPROVAL/ CERTIFICATION PAGE

This is to certify that the client care by LEVI JENNIFER ADANNA with index number

…………………………………………………………………..has been examined and approved

for the award of Registered Nurse Certificate.

…………………...... ………………………..

Date

…………………...... ………………………..

Dr. Mrs. Emonye Date

…………………...... ………………………..

External Examiner Date

ii
 ACKNOWLEDGEMENT

I must sincerely acknowledge God Almighty for his infinite grace and mercy to complete this

case study.

I am particularly grateful to my supervisor ………………… for her guidance and corrections

throughout the course of this work.

A big thank you to all my colleagues which in one way or another contributed to the success of

this work.

God bless you all.

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 Table of Content

Cover Page i

Title Page ii

Approval/Certification iii

Acknowledgment iv

Introduction

Patient’s Bio Data 1

Family Composition 2

Socio-Economic Status 2

Disease History 2

Anatomy and Physiology of the Lungs 3

Comprehensive Literature Review 7

Incidence 7

Causes 7

Pathophysiology 8

Clinical Manifestations 9

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Diagnostic Investigations 10

Complications 10

Application of the Nursing Process 11

Nursing History 11

Nursing Management 12

Nursing Diagnoses 12

Nursing Care Plan 13

Pharmacological Review 17

Progress and Discharge Summary 25

Conclusion 27

Nursing Implication 27

Recommendation 28

References 29

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 INTRODUCTION

Tuberculosis (abbreviated as TB for tubercle bacillus) is a common and deadly infectious disease

caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis most commonly

attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic

system, the circulatory system, the genitourinary system, bones, joints and even the skin. Other

mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti,

and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect

healthy adults.

This is a case of Ms. R. S, a 21 years old resident of Ogbor hill, Aba who was admitted at Abia

State University Teaching Hospital, Aba on July 14, 2022 due to serious manifestations of cough

and dizziness and was diagnosed with Pulmonary Tuberculosis.

I choose Ms. R. S among all the other patients in the ward because as we have seen in her

condition, her case is very interesting in the sense that by just assessing her, we could already

identify many health problems. I also intended to contribute to her care according to my skill set.

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Objectives of the Study

The study aims to

1. To fully comprehend the disease condition Tuberculosis, its pathophysiology, medical

management and the nursing interventions that a student nurse can apply.

2. It also aims to gather pertinent information about the client’s health history and how the

disease developed.

2
Patient’s Bio-data

Name of Patient: Ms. R. S

Age: 21 yrs

Sex: Female

Diagnoses Pulmonary Tuberculosis

Ward Female Medical Ward

Religion: Christianity

Occupation: Student

Nationality Nigeria

State of Origin Abia State

Address: Umualangwa Isialangwa

Next of Kin: Mrs. R. E

Address of Next of Kin: Umualangwa Isialangwa

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Family History

Ms, R. S is from a family of seven including the parents and her four siblings. The family is

made up of three girls and one male. She is the third born child of his parents. Ms. R.S and her

relative stated that no one has ever had the condition, Tuberculosis in their family and she is the

first to have Tuberculosis in their family. Her mother also stated that she never had any

complications during any of her child birth.

Socio-economic History

Ms. R. S, is a 21 year old lady who lives in a shared flat with her friends and roommate and

studies Chemistry at the Federal University of Technology, Owerri (FUTO). The room is shared

with three of her friends. She is a 200 level student of Industrial chemistry. She is a Christian

and attends the Salvation Ministries.

Patient’s Past Medical History

Mrs. R. E, the patient’s mother stated that she (Ms. R. S) had completed her immunizations

while he was still young. The patient's family has no history of pulmonary tuberculosis in the

family. As I interviewed her mother, she states that she is the first one in their family to have this

condition. However, patient stated that in the previous year, she was admitted to the hospital

because of extreme fever. Then on January 1 2022, she was admitted to the Abia State University

Teaching Hospital for 4 days due to cough, dizziness and diarrhea.

History of Present Illness

Ms. R.S stated that a week prior to her admission, she experienced dizziness and pain while

coughing. She also stated that she was always gasping for air. She tried to treat it with over-the-

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counter medications but the symptom worsened, so her family decided to seek medical attention.

Upon arrival, Ms R. S was met with myself and other nurses. I took the vital signs and recorded.

Mrs R.S had a pyrexia of 38.5°C, she was cachectic and had pleuritic chest pain. Her respiratory

rate is slightly raised at 18 per minute and she had a tachycardia of 114 beats per minute. Blood

pressure was normal. She was met with the attending doctor and laboratory tests were ordered.

She was also sent for a chest x-ray. The lab results showed that inflammatory markers

erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were raised at 72 mm/h and

65.4 mg/L. The chest X-ray was reported as abnormal: 'Patchy shadowing seen in left upper

lobe. She was diagnosed of Pulmonary TB.

Past surgical history:

Ms. R. S stated that he had never undergone surgery before.

Clients Belief

Ms. R. S and her family had less knowledge about the illness. They expressed confidence of

getting well soon because according to them, they believed that with God’s healing through good

nursing and medical treatment she would have a complete recovery and return to her schooling.

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 ANATOMY AND PHYSIOLOGY OF THE LUNGS

Description: The lungs are two pyramid-shaped organs that are connected to the trachea by the
right and left bronchi; on the inferior surface, the lungs are bordered by the diaphragm. The lungs
are enclosed by the pleurae, which are attached to the mediastinum. The right lung is shorter and
wider than the left lung, and the left lung occupies a smaller volume than the right.

Parts of the Lung

The lungs are made up of the apex, base, and the costal and medial surface.

Apex: This is rounded and rises into the root of the neck. about 25 mm above the level of the
middle third of the clavicle. It lies close to the first rib and the blood vessels and nerves in the
root of the neck.

- Base: This is concave and semilunar in shape, and lies on the upper (thoracic) surface of
the diaphragm.
- Coastal surface: This is the broad outer surface of the lung that lies directly against the
costal cartilages, the ribs and the intercostal muscles.
- Medial surface: The medial surface of each lung faces the other directly across the space
between the lungs, the mediastinum. Each is concave and has a roughly triangular-shaped
area, called the hilum at the level of the 5th. 6th and 7th thoracic vertebrae. The primary
bronchus, the pulmonary artery supplying the lung and the two pulmonary veins draining
it, the bronchial artery and veins, and the lymphatic and nerve supply enter and leave the
lung at the hilum. The mediastinum contains the heart, great vessels, trachea, right and
left bronchi, esophagus, lymph nodes, lymph vessels and nerves.

Divisions of the Lung

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The right lung is divided into three distinct lobes: superior, middle and inferior. The left lung is
smaller because the heart occupies spare left of the midline. It is divided into only two lobes:
superior and inferior. The divisions between the lobes are called fissures.

The two primary bronchi are formed when the trachea divides, at about the level of the 5th
thoracic vertebra.

- The right bronchus is wider, shorter and more vertical than the left bronchus. It is
approximately 2.5 cm long. After entering the right lung at the hilum it divides into three
branches, one to each lobe. Each branch then subdivides into numerous smaller branches.
- The left bronchus is about 5 cm long and is narrower than the right. After entering the
lung at the hilum it divides into two branches, one to each lobe. Each branch then
subdivides into progressively smaller airways within the lung substance.

Blood Supply: Bronchial artery

Nerve Supply: The parasympathetic system causes bronchoconstriction, whereas the

sympathetic nervous system stimulates bronchodilation.

COMPREHENSIVE LITERATURE ON PULMONARY TUBERCULOSIS

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Pulmonary tuberculosis (PTB) is a highly infectious contagious disease that primarily affects the

lungs. It is caused by bacteria called Mycobacterium tuberculosis, commonly known as the TB

bacteria. These bacteria spread through the air when an infected person coughs, sneezes, or talks.

PTB typically infects the lungs, but it can also spread to other parts of the body, leading to

extrapulmonary tuberculosis.

Incidence:

According to the World Health Organization (WHO), 9.9 million people contracted TB in 2020,

making it the ninth leading cause of death globally. 30 countries, including India, China, and

Nigeria, account for 84% of the global TB burden. The African region bears the highest burden,

followed by the Southeast Asian region (WHO, 2022).

Nigeria ranks sixth globally and first in Africa in terms of TB burden. In 2020, an estimated

467,000 Nigerians developed TB, accounting for 4.6% of the global burden. Over 15 Nigerians

die from TB every hour, translating to about 10,417 deaths per month (WHO, 2022).

Nigeria faces significant challenges in controlling TB, including underdiagnosis, limited access

to quality healthcare, and the high prevalence of HIV/AIDS, which further weakens the immune

system and increases TB susceptibility (KNCV).

Causes:

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Mycobacterium tuberculosis: The culprit is a specific bacterium called Mycobacterium

tuberculosis (Mtb). Unlike many other bacteria, Mtb has a tough cell wall that makes it resistant

to many antibiotics and allows it to persist inside human cells Causes:

Mycobacterium tuberculosis: The culprit is a specific bacterium called Mycobacterium

tuberculosis (Mtb). Unlike many other bacteria, Mtb has a tough cell wall that makes it resistant

to many antibiotics and allows it to persist inside human cells.

Transmission:

Airborne route: This is the main mode of transmission for pulmonary tuberculosis. When an

infected person coughs, sneezes, speaks, sings, or even laughs, they release tiny droplets

containing Mtb bacteria into the air. These droplets can remain airborne for several hours, and

anyone inhaling them can become infected.

Close contact: Spending prolonged time around someone with active TB, especially indoors,

increases the risk of inhalation.

Reactivation: Not everyone who breathes in Mtb bacteria develops active TB. In many cases, the

immune system can contain the bacteria, leading to a latent TB infection. However, factors like

compromised immunity (HIV/AIDS, malnutrition), certain illnesses, or aging can cause these

dormant bacteria to reactivate and lead to active TB. Causes:

9
Mycobacterium tuberculosis: The culprit is a specific bacterium called Mycobacterium

tuberculosis (Mtb). Unlike many other bacteria, Mtb has a tough cell wall that makes it resistant

to many antibiotics and allows it to persist inside human cells (Cole et al, 2022).

Mode of Transmission:

According to the Cole et al, (202)1, & Barry (2019), the major modes of transmission of

tuberculosis includes;

Airborne route: This is the main mode of transmission for pulmonary tuberculosis. When an

infected person coughs, sneezes, speaks, sings, or even laughs, they release tiny droplets

containing Mtb bacteria into the air. These droplets can remain airborne for several hours, and

anyone inhaling them can become infected.

Close contact: Spending prolonged time around someone with active TB, especially indoors,

increases the risk of inhalation.

Reactivation: Not everyone who breathes in Mtb bacteria develops active TB. In many cases,

the immune system can contain the bacteria, leading to a latent TB infection. However, factors

like compromised immunity (HIV/AIDS, malnutrition), certain illnesses, or aging can cause

these dormant bacteria to reactivate and lead to active TB.

Pathophysiology of Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) is a chronic infectious disease caused by the bacterium

Mycobacterium tuberculosis. TB mainly affects the lungs, but can also spread to other organs

through the bloodstream or lymphatic system. The pathophysiology of pulmonary TB involves

three stages: primary infection, latent infection, and active disease.

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Primary infection occurs when a person inhales droplets containing M. tuberculosis from an

infectious source. The bacteria reach the alveoli and are engulfed by macrophages, which try to

kill them. However, some bacteria survive and multiply within the macrophages, forming

granulomas or tubercles. These are clusters of immune cells that wall off the bacteria and prevent

them from spreading. Most primary infections are asymptomatic and resolve spontaneously, but

some may progress to active disease.

Latent infection occurs when the immune system is able to contain the bacteria within the

granulomas, but not eliminate them completely. The bacteria remain dormant and cause no

symptoms, but can reactivate at any time if the immune system is weakened by factors such as

HIV, malnutrition, diabetes, or cancer. People with latent infection are not infectious and do not

need treatment, but they have a 5-10% lifetime risk of developing active disease.

Active disease occurs when the bacteria break out of the granulomas and multiply rapidly in the

lungs or other organs. This causes inflammation, tissue damage, and symptoms such as cough,

fever, weight loss, night sweats, and hemoptysis. People with active disease are infectious and

need treatment with a combination of antibiotics for at least six months to prevent drug

resistance and relapse.

The clinical manifestations of pulmonary TB depend on the stage and extent of the disease, and

may include cough, fever, weight loss, night sweats, hemoptysis, chest pain, and dyspnea.

Clinical Manifestations

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The clinical manifestations of pulmonary TB vary depending on the immune status of the host,

the extent of disease, and the presence of complications. Common symptoms include

1. Prolonged cough of more than three weeks,

2. Hemoptysis,

3. Chest pain,

4. Fever,

5. Night sweats, and

6. Weight loss.

These symptoms may be mild or absent in some cases, especially in immunocompromised

individuals or those with extrapulmonary or miliary TB.

Diagnostic Investigations

The diagnostic measures for pulmonary TB are recommended by the World Health Organization

and other health authorities include

1. Mantoux test: A test for TB infection, which can be done by a skin test or a blood test.

These tests measure the immune system's response to TB bacteria, but they cannot

confirm active TB disease.

2. A chest X-ray, which can show abnormal patches in the lungs that are typical of active

TB disease. However, a chest X-ray cannot rule out other causes of lung problems.

3. A sputum test, which involves collecting and examining the mucus that comes up when

a person coughs. This test can detect the presence and type of TB bacteria, as well as

their resistance to drugs. A sputum test can confirm the diagnosis of pulmonary TB and

guide the treatment.

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Complications of Pulmonary Tuberculosis

Fibrosis: Formation of scar tissue replacing healthy lung tissue, leading to reduced lung function

and difficulty breathing.

Cavities: Formation of air-filled spaces within the lungs due to necrosis (tissue death) and

caseation (cheese-like material buildup). These cavities can harbor Mtb bacteria and facilitate

their spread through coughing.

Pleural Effusion and Empyema: The pleura is a thin membrane lining the lungs and chest

cavity. PTB can inflame the pleura, leading to fluid accumulation in the space between the lung

and chest wall (pleural effusion). If the fluid becomes infected with pus, it can develop into

empyema, a potentially life-threatening condition.

Hemoptysis (Coughing Up Blood): Erosion of blood vessels by Mtb bacteria can cause

coughing up blood, a symptom requiring immediate medical attention.

Pneumothorax: Rupture of air sacs in the lungs due to PTB can lead to pneumothorax, a

collapsed lung. This can cause severe breathing difficulties and chest pain.

Spread to Other Organs (Extrapulmonary TB): In some cases, Mtb bacteria can spread

through the bloodstream or lymphatic system to other organs, causing extrapulmonary TB.

Common sites include the:

 Meninges (membranes surrounding the brain and spinal cord)

 Kidneys

 Bones and joints

 Pericardium (membrane surrounding the heart)

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APPLICATION OF THE NURSING PROCESS NURSING HISTORY

14
Nursing History

On January 1, 2022 at 11:20 am, Ms. R.S was admitted into female medical ward at the Abia

State University Teaching Hospital, Aba. Patient was fully conscious and well oriented to time,

place and person. Patient’s chief complaint were extreme pain while coughing and shortness of

breath. She also reported fever within the past few days. She was met with the attending doctor

and laboratory tests were ordered. She was also sent for a chest x-ray. The lab results showed

that inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

were raised at 72 mm/h and 65.4 mg/L. The chest X-ray was reported as abnormal: 'Patchy

shadowing seen in left upper lobe. She was diagnosed of Pulmonary TB.

Her vital signs were checked and recorded as;

1. Temperature - 38.5 degrees Celsius

2. Pulse - 98 beats per minute

3. Respiration - 18 cycles per minute

4. Blood Pressure - 130/80 mmHg

5. Oxygen saturation (SPO2) - 90%

Patient’s temperature recorded 38.5 degrees Celsius and patient was very warm to touch. She

was placed on bed rest, her heavy clothes were removed and less heavy one was put on, nearby

windows were opened, she was tepid sponged and vital signs were monitored every 30 minutes

after each tepid sponging.

Treatments prescribed were;

15
 1. Isoniazid 400 mg OD

2. Meloxicam 15 mg OD

3. Cetrizine 10 mg OD

4. Chlorpheniramin maleate 5 mg TID

5. B-complex 1 capsule.OD

Nursing management of Pulmonary Tuberculosis

Nursing management of pulmonary tuberculosis involves various aspects, such as infection

control, airway clearance, gas exchange, nutrition, medication, and education.

1. The nurse should implement measures to prevent the transmission of the disease, such as

wearing personal protective equipment, isolating the patient, and teaching the patient

about cough etiquette and hygiene.

2. The nurse should also monitor the patient's respiratory status, encourage deep breathing

and coughing exercises, and provide adequate hydration and humidification.

3. The nurse should assess the patient's oxygenation, administer oxygen therapy as

prescribed, and report any signs of hypoxia or respiratory failure.

4. The nurse should also promote optimal nutritional balance by providing high-calorie,

high-protein meals and supplements, and monitoring the patient's weight and intake and

output.

5. The nurse should ensure adherence to the medication regimen by explaining the

importance of completing the course of therapy, observing the patient taking the drugs,

and managing any side effects.

16
 6. The nurse should also provide education and support to the patient and family about the

disease, its treatment, its complications, and its prevention.

Nursing Diagnosis For Ms R. S

1. Ineffective airway clearance related to increased secretions, bronchospasm,

inflammation, and infection of the respiratory tract evidenced by shortness of breath.

2. Imbalanced nutrition: less than body requirements related to decreased appetite, increased

metabolic demands, malabsorption, and medication side effects evidenced by weight loss.

3. Anxiety related to disease condition evidenced by patient’s curiosity.

17
 NURSING CARE PLAN FOR Ms. R. S

S/N Nursing Diagnosis Nursing Objectives Nursing Intervention Scientific Rationale Evaluation
Ineffective airway The patient will maintain - Encourage deep Effective airway The patient

clearance related to a patent airway as breathing exercises and clearance reduces risk maintained a

increased secretions, evidenced by clear breath effective coughing of respiratory patent airway as

bronchospasm, sounds, normal techniques. complications. evidenced by

inflammation, and respiratory rate and - Position patient in clear breath

infection of the rhythm, effective semi-Fowler’s position sounds, normal

respiratory tract coughing and to facilitate lung respiratory rate

evidenced by shortness expectoration of sputum, expansion. and rhythm,

of breath and absence of dyspnea - Administer effective

or cyanosis within 10-30 bronchodilators and coughing and

minute of nursing mucolytic agents as expectoration of

intervention prescribed. sputum, and

- Monitor respiratory absence of

rate, breath sounds, and dyspnea or

sputum characteristics cyanosis after

18
 10-30 minute of

nursing

intervention

Imbalanced nutrition: The patient will achieve - Assess patient’s Adequate nutrition The patient

less than body and maintain optimal nutritional status and supports immune maintained

decreased appetite, nutritional status as dietary preferences. function and helps optimal

increased metabolic evidenced by weight - Encourage small, combat infection. nutritional

demands, malabsorption, gain, improved frequent meals rich in status as

and medication side laboratory values, and protein and calories. evidenced by

effects evidenced by absence of signs and - Monitor weight weight gain,

weight loss symptoms of regularly. improved

malnutrition within 3 – 7 - Collaborate with laboratory

days of hospitalization. dietitian for values, and

individualized meal absence of signs

plan. and symptoms

of malnutrition

after 3 – 7 days

19
 of

hospitalization.

Anxiety related to Patient will exhibit signs - Establish trusting Reducing anxiety Patient
improves overall well-
disease condition of reduced anxiety levels nurse-patient exhibited signs
being and adherence to
evidenced by patient’s evidenced by calmness relationship. of reduced
treatment.
curiosity and less curiosity through - Educate patient about anxiety levels

the period of TB, treatment, and evidenced by

hospitalization. infection control calmness and

measures. less curiosity

- Encourage relaxation through the

techniques (e.g., deep period of

breathing, guided hospitalization.

imagery)

PHARMACOLOGICAL REVIEW OF DRUGS

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1. Isoniazid 400 mg OD

2. Meloxicam 15 mg OD

3. Cetrizine 10 mg OD

4. Chlorpheniramin maleate 5 mg TID

5. B-complex 1 capsule.OD

21
Name of Drug Class Indication Dosage/Route Side Effects Contraindication Nursing

Responsibility

Isoniazid Anti- Treatment of Oral: Peripheral Hypersensitivity to Monitor liver

tuebrculous tuberculosis 400 mg once neuropathy isoniazid or other function (AST,

drug (TB) infection daily (usually Hepatotoxicity hydrazides ALT) regularly

- Prophylaxis on an empty Rash, Active liver disease Educate patient

for latent TB stomach) GI upset Severe renal about potential

infection Hypersensitivity impairment side effects

reactions Alcohol use Administer

Drug vitamin B6

interactions (pyridoxine) to

prevent

neuropathy if

needed

Meloxicam Nonsteroidal - Pain and Oral - GI upset Active peptic ulcer Administer with

anti- inflammation 15 mg once (ulcers, disease food or milk to

22
 inflammatory associated with daily bleeding) History of GI reduce GI

drug (NSAID) osteoarthritis, Cardiovascular bleeding irritation

rheumatoid events (MI, Severe heart failure Monitor renal

arthritis, etc. stroke) Allergy to NSAIDs function and

Renal blood pressure

impairment Educate patient

Hypersensitivity about potential

reactions risks

Cetirizine Antihistamine - Allergic Oral Drowsiness Hypersensitivity to - Advise patient

(second- rhinitis 10 mg once (less than older cetirizine or not to drive or

generation) - Chronic daily antihistamines) hydroxyzine operate heavy

urticaria (hives) Dry mouth Severe renal machinery if

Headache impairment drowsiness

occurs

Encourage

adequate

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 hydration

Monitor renal

function

Chlorpheniramine Antihistamine - Allergic Oral Drowsiness Hypersensitivity to - Monitor for

maleate (first- rhinitis 5 mg three times Dry mouth chlorpheniramine or adverse effects

generation) - Symptomatic daily Blurred vision other antihistamine (sedation, dry

relief of allergic Urinary Acute asthma attack mouth)

reactions retention Glaucoma - Encourage

fluid intake

- Caution in

elderly patients

B-complex Vitamin Prevention or Oral - Generally - Hypersensitivity to - Educate patient

supplement treatment of 1 capsule once well-tolerated any component of about the

vitamin B daily (water-soluble the B-complex importance of B

deficiencies vitamins) vitamins

(e.g., B1, B2, - Monitor for

B6, B12) signs of

24
 deficiency

improvement

25
Progress and Discharge Summary

On January 1, 2022, Ms. R.S was admitted into the Abia State University Teaching Hospital,

Aba, with complaints of pleuritic chest pain, fever and shortness of breath. She was met by the

doctor and laboratory test and chest x-ray were ordered. She was then diagnosed of pulomonary

tuberculosis. Ms. R.S was admitted into the hospital bed were she received adequate rest as well

as other nursing and medical managements.

During her period of hospitalization, the following nursing problems were diagnosed and treated

promptly;

- Ineffective airway clearance related to increased secretions, bronchospasm,

inflammation, and infection of the respiratory tract evidenced by shortness of breath.

- Imbalanced nutrition: less than body requirements related to decreased appetite, increased

metabolic demands, malabsorption, and medication side effects evidenced by weight loss.

- Anxiety related to disease condition evidenced by patient’s curiosity.

She was also on the drug regimen prescribed by the doctor which she adhered to under the

nurse’s observation.

The following drugs were prescribed

1. Isoniazid 400 mg OD

2. Meloxicam 15 mg OD

3. Cetrizine 10 mg OD

4. Chlorpheniramin maleate 5 mg TID

5. B-complex 1 capsule.OD

26
Advice on Discharge

 The patient and relative were instructed to religiously facilitate patient in taking the

prescribed home medication on time as ordered. She was also instructed to visit the

nearest health center immediately after discharge for the TB medications that are

available for free.

 She was also encouraged to take vitamin supplements, as ordered, particularly pyridoxine

(vitamin B6) to prevent peripheral neuropathy in patients taking isoniazid.

 It was explained to the patient the importance of continuing to take medications for the

prescribed time because bacilli multiply very slowly and thus can only be eradicated over

a long period of time.

 Patient was also encouraged to complete full course of therapy even if patient feels better

to treat disease effectively

 Patient was encouraged to rest and avoid exertion.

 Patient was also instructed to improve ventilation in the home by opening the windows in

room of affected person, and keeping bedroom door closed as much as possible.

 Patient was instructed to cover mouth with fresh tissue when coughing or sneezing and to

dispose of tissues promptly in plastic bags.

 Follow-up chest x-rays was encouraged for rest of life to evaluate for recurrence.

 The relatives and friends were instructed to do prophylaxis with isoniazid for persons

infected with the tubercle bacillus without active disease to prevent disease from

occurring, or to people at high risk of becoming infected.

27
Summary

Ms R.S was admitted into the Abia State University Teaching Hospital with chief complaints of

pleuritic chest pain, fever and shortness of breath. After much investigations, she was diagnosed

with pulmonary diagnoses by the doctor. She received adequate care from the nurses and showed

signs of improvement. On discharge, she was instructed to carefully adhere to the drug regimen

prescribed and to cover mouth with tissue when sneezing.

Conclusion

The study has equipped me with knowledge on how to care for a patient as an individual.

Through this study, I have been able to put into practice actual and holistic nursing care as learnt

theoretically. The study provided a therapeutic environment for nursing patient as an individual

and has promoted a good nurse-patient (family) relationship as well as broadened my knowledge

on pulmonary tuberculosis, its prevention, management and treatment. It has also helped me to

practice my skills acquired in the classroom theoretically. It has deepened my relationship with

patients, families and the people in a given community as a whole. It is my recommendation that

all students are given the opportunity to embark on the patient/family care study to implement

the nursing process in order to render individualized comprehensive care to patients/families. It

also helped the patient and family to gain adequate knowledge about pulmonary tuberculosis, its

causes, treatment and preventions. In brief, I really enjoyed every bit of writing this script despite

the challenges encountered.

28
Implication to Nursing

This client care study on pulmonary tuberculosis will help the nursing profession by provide the

adequate information about the proper management and care for PTB patients. It will also

educate people especially those with PTB to seek medical care in order to prevent PTB.

Recommendations

 Health Education on pulmonary tuberculosis should be provided especially to individuals

who are at risk of contracting PTB like those who live in crowded areas in order to

promote prevention of PTB.

 Individuals should be encouraged by the primary health care centers to go for medical

check-up from time to time.

29
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Diagnostic Algorithm of Tuberculosis | SpringerLink.

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Kaufmann, S. H. (2002). The pathogenesis of tuberculosis. In Tuberculosis (pp. 341-397).

Springer, Berlin, Heidelberg.

Pulmonary, Pleural and Mediastinal TB: Clinical Aspects and ... - Springer.
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