Case Study on

Biopsychosocial Approach
Prepared by: GROUP 3
CASE
A 50-year-old farmer, complaining of hemoptysis is subsequently
diagnosed to have pulmonary tuberculosis.

He has to take anti-Koch’s medication for 6 months. However, he

cannot afford to buy medicines. He is the breadwinner of a family
of six.

Analyze the intrasystem changes in this family using the

biopsychosocial approach. Construct the algorithm following the
continuum of systems.
Event One: Diagnosis of Pulmonary Tuberculosis
Event One: Diagnosis of Pulmonary Tuberculosis

SYSTEM HIERARCHY INTRASYSTEM CHANGES

Community His co-farmer advised him to go to there  local hospital for a
medical check-up 
Family His children saw him coughing blood so they told him to get a
check-up because it might be Tuberculosis.
Two Persons His wife accompanied him to the hospital for a check up.
Medical worker explained to the patient the course of his
treatment and the things that he will be expecting during the
time of his medication.
Person Symptoms: Cough that last for more than 3days, Coughing of
blood, shortness of breath, fever, loss of appetite, weight lose,
and night sweats
He developed anxiety due to his situation.
Event One: Diagnosis of Pulmonary Tuberculosis

Nervous System Brain damage can result from the infection that may lead to
abnormal behavior, mental impairments, motor type
paralysis, and seizures.
Norepinephrine and serotonin levels may be decreased due
to depressed mood.
Organ System Lesion, fibrosis, pleural effusion, patchy, opacification on the
upper right at mid-zone lung with fibrotic shadows , scarring
of the lung
Tissue Tissue fibrosis, necrosis, granulomatous
Cell Form granuloma
Molecule Recruitment of Macrophages, highly differentiated cells,
epithelioid cells and foamy cells. 
 
Event Two: Taking of Medications for 6 Months
Event Two: Taking of Medications for 6 Months

SYSTEM INTRASYSTEM CHANGES

HIERARCHY
Community TB DOTs nurse strictly monitors the patient to take the
medicine/drugs. TB DOTs center provides free drugs or
treatment for patients who have Pulmonary tuberculosis.
They encouraged him to stay at home, take rest and get
well
Family Altered roles, brothers or one of the family will take the role
as a farmer or seek any alternative job to sustain the
family. 
Two Persons Wife will provide healthy food and strict guidance for him
not to do his vices (if there are some).
Person Feeling of guilt and burdensome due to his condition.
Event Two: Taking of Medications for 6 Months

SYSTEM INTRASYSTEM CHANGES

HIERARCHY
Nervous System If proper medication was taken within the span of 6 months
then there will be less to no damage on the nervous system.
If the results of the medications were effective. Making a
positive effect on the mood and arousal state of the patient,
the levels of norepinephrine and serotonin which is
responsible for mood and arousal is normal.
Organ System The main side effects are stomach upsets and discomfort,
nausea and loss of appetite. Vomiting and diarrhea may
occur although this is rare.
Positive scarring of the lungs, increase anatomic dead
space.
Event Two: Taking of Medications for 6 Months
SYSTEM INTRASYSTEM CHANGES
HIERARCHY
Tissue Damaged tissue cannot function, or the infection destroys patients' lung
tissue, causing them to cough up the bacteria, which then spread
through the air and can be inhaled by others.
The lung tissue affected by TB bacilli first becomes hard, making the
oxygen exchange impossible which results to fibrosis. 

Cell Cells that make up the lung tissue die which results to necrosis.
Molecule Tumor necrosis factor-alpha, nitrogen intermediates, reactive oxygen,
and the constituents of cytotoxic cells (perforin, granzymes) whose
 
function it is to eliminate M. tuberculosis could also contribute to the
collateral damage of the host and the development of caseating
necrosis. Therefore, much of the tuberculosis pathology results from the
infected host's immune response to the tubercle bacilli.
Alternative
Event 2:
Inability to Afford
medications
 Event Two: Inability to Afford medications

SYSTEM HIERARCHY INTRASYSTEM CHANGES

Community He will be referred to the TB-DOTS to avail treatment and free
medications for pulmonary tuberculosis
Other members of the family will be assessed for symptoms of TB.
Family Altered roles of family members -- mother or eldest child will be the
breadwinner; reassignment of tasks; some or all children will stop
schooling; financial and emotional burden; shame by the whole family
due to stigma associated with TB, especially in rural area
Two Persons Total dependency on wife or eldest child
Person Frustration, fear for his family and death, hopelessness, shame,
isolation, depression
Inability to work in the farm
Event Two: Inability to Afford medications

Nervous Tuberculosis of the nervous system can attack the meninges, brain, spinal cord, cranial and
System peripheral nerves, ears and eyes.
Sometimes, the bacteria will travel to the meninges, which are the membranes surrounding
the brain and spinal cord. Infected meninges can result in a life-threatening condition known
as meningeal tuberculosis. Meningeal tuberculosis is also known as tubercular meningitis or
TB meningitis.   
Infection with TB can also increase the incidence of psychiatric disorders in the patient,
which may be a result of mixture of causes such as the presence of medical illness, stigma,
and discrimination. 
Organ Lung damage and impairment characterized by pulmonary cavity lesions and fibrosis.
System
Rupture of a large tuberculous lesion into the pleural space may cause empyema with or
without bronchopleural fistula and sometimes causes pneumothorax.
Reduced lung capacity resulting to persistent breathlessness
Widening of the airways called as bronchiectasis
 Event Two: Inability to Afford medications

Tissue Granulomas will form, and necrosis or tissue damage will take place. If left untreated, M.
tuberculosis can actually create a hole in the lungs.
Eventually, the damaged lung tissue will cause him to cough up the bacteria, which will then
spread through the air and possibly be inhaled by others.
According to (WebMD, 2020) TB can cause complications by causing inflammation to the tissues
around the heart.
Cell M. tuberculosis will enter macrophages through phagocytosis and will then disassemble the
phagosomal membrane. Mtb will now have access to the cytosol. Innate and adaptive immune
responses will then be initiated. 
Macrophages will aggregate forming granulomas. Infection will progress  and continued immune
response will cause caseous necrosis or apoptosis of macrophages and epithelial cells
Molecule There will be increased production of interferon-gamma, which will induce production of nitric oxide
and mobilization of antimicrobial peptides. Interferon-gamma will also stimulate autophagy.
 
Subsequently, there will be DNA damage and increased problems in cytokinesis and DNA repair.  
Event Three: Recovery from Pulmonary Tuberculosis
Event Three: Recovery from Pulmonary
Tuberculosis
SYSTEM HIERARCHY INTRASYSTEM CHANGES
Community Trust in the community; support of medical team; social support
Family He will be able to provide again for his family -- realignment and
readjustment of roles; children can go back to school; the family
will not be stigmatized anymore
Two Persons Gratitude to the wife for the help and support; trust and
confidence
Person Asymptomatic; improved self-awareness and actualization;
improved self-confidence;
He will be able to go back to work again
He will go back to socializing with other people.
His body will be healthy again.
 Event Three: Recovery from Pulmonary
Tuberculosis

Nervous System Restoration of homeostatic control of the nervous system. 

Beginning of recovery from psychological problems brought about by the
infection with TB.
Organ System Scarred lungs
Recovery of efficient lung functioning, but total lung functioning may not be
restored back 
Tissue The patient's tissues will recover but scars will remain. As time goes by, the
scars will eventually disappear, and the tissues will fully heal. 
M. tuberculosis cannot anymore create severe complications to the patient that
would cause death.
M. tuberculosis  will no longer destroy the tissues, particularly in the lungs.
The patient will no longer be actively spreading the TB bacteria. 
Event Three: Recovery from Pulmonary
Tuberculosis

Cell Bacteria will be eliminated from the body. There

will also be reduction in the percentage of CD4+ T
cells and other immunologically active cells.
Phagocytic cells will now begin clearing tissue
debris, and mitotic activity will immediately
commence to replace the damaged cells 
Molecule After intensive anti-TB treatment, serum levels of
IL-1β, soluble interleukin-2 receptor, IL-6, and
 
tumour necrosis factor- α will decrease
significantly. Additionally, serum levels of IL-1β
and IL-6 will also be recovered.
 REFERENCES:

• https://www.msdmanuals.com/professional/inf • https://academic.oup.com/femspd/article/75/7/
ectious-diseases/mycobacteria/tuberculosis-tb ftx087/4033034

• https://www.google.com.ph/amp/s/www.livemi • https://journals.sagepub.com/doi/10.1177/030
nt.com/science/health/tb-causes-lung-damage 0060518773258
-even-after-successful-treatment-lancet-study/
amp-1565491565189.html • https://err.ersjournals.com/content/27/147/170
077
• https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C6676936/ • https://www.tbonline.info/posts/2016/3/31/pul
monary-tb
• https://www.sciencedirect.com/science/article/
pii/S221255311630245X
Submitted by: Submitted to:
Aleluya, Mark Kevin Dr. Gloria Fabrigas

Calvero, Geraldine
Correa, Auryll Nino
Dy, Janro
Insigne, Ma.Xenia
Macamay, Cindy Mae
Miraflores, Ma.Glyceres
Moomtaz Ahmad, Ayesha Sharmaine
Pacoma, Arielle Jean
Urmeneta, Ian Clifford