TUBERCULOSIS

FARAJ MUHAMMAD ABDULKARIM

BSCN/2020/45784
MEDICAL CASE STUDY
MACHAKOS LEVEL 5
Medical ward case study
By Faraj Muhammad Abdulkarim
BSCN/2020/45784
TUBERCULOSIS

Is lower respiratory tract infection caused by

Mycobacterium tuberculosis which is transmitted through
air in infectious particles called droplet nuclei.
Types of tuberculosis
Pulmonary tuberculosis: affects only the lungs
Extrapulmonary tuberculosis: affects body systems outside
the lungs, like abdomen, glands, bones and nervous
system .
Pathogenesis

An individual inhales an infectious droplet nuclei of Mycobacterium

tuberculosis .When inhaled the bacillus is small enough to travel
directly to the alveoli. Soon after entering the lung, the bacilli are
phagocytosed by alveolar macrophages but resist killing apparently
because cell wall lipids of Mycobacterium tuberculosis block fusion of
phagosomes and lysosomes .Although the macrophages that first
ingested the Mycobacterium tuberculosis cannot kill the organisms,
they initiate a cell mediated immune response that eventually
contains the infection.
As the tubercle multiply, the infected macrophages degrade the
mycobacteria and present their antigens to T lymphocytes. The sensitized T
lymphocytes in turn stimulate the macrophages to increase their
concentration of lytic enzymes and ability to kill the Mycobacterium. When
released , the lytic enzymes also damage the lung tissues. When the lung
tissues are damaged ,there will be an increase in vascular permeability
causing fluid to shift from the vascular space into the lungs causing fluid
congestion in the lungs .
Signs and symptoms of tuberculosis

1.Persistent productive cough

2.Weight loss or failure to gain weight
3.Fever
4.Fatigue
5.Wheezing
6.Decreased breath sounds
7.Hemoptysis (coughing of blood from the respiratory
tract)
Investigations

1) Chest x-ray to determine presence and extent of

disease. Chest x-ray shows active or calcified lesions
2)Tuberculin test (Mantoux test)used to detect presence
or absence of mycobacterium tuberculosis infection
3)Sputum culture which turns positive when
Mycobacterium bacilli are grown
Treatment
*It involves the use of isoniazide,rifampicin ,pyrazinamide and ethambutol
*Therapy for active tuberculosis usually involves a six month regimen
consisting of isoniazid, rifampin, pyrazinamide and ethambutol for the first
two months, and isoniazid and rifampin for the remaining four months.
*The first two months of treatment is known as the intensive phase of
tuberculosis treatment
*The four months of treatment is known as continuation phase of
tuberculosis treatment.
BIOGRAPHICDATA
Name: John Wambua
Age:31 years
Sex: Male
Residence: Machakos
Religion: Christian
Date of admission:16/12/22
Religion: Christian
Ip no: 423821
Informant: Father
HOW I MET MY PATIENT
I met my patient on 16th December when he was bought to the
ward by this father having difficulties in breathing, coughing,
general body weakness and fever
 CHIEF COMPLAIN
 

1.Cough

2.fever
3.fast breathing
 
 
HISTORY OF PRESENTILLNESS
 

The patient was referral from Medstar health Centre and was brought to hospital
by father in a sick looking condition.
The patient had complains of non productive cough which lasted for one week and
fever which also has been going on for a week.
The patient also presented with weight loss and was on nutritional support while
Medstar clinic
 PASTMEDICAL AND SURGICAL HISTORY
 
The patient is a referral from Medstar clinic and was diagnosed with
tuberculosis and malnutrition .
The patient also has history of swelling of the neck
 

The patient has no history of contact with known TB

patient . There is no history of any blood transfusion

No history of any surgery done to the patient No history of
any drug allergies or food allergies
FAMILY HISTORY

The is the 5th born in a family of ten and both parents are alive

and present . There is no history of any chronic illness in the family

SOCIAL - ECONOMIC HISTORY
 
The patients father works as a security guard
 
The parents are Christians.
 
PHYSICAL EXAMINATION
General appearance
The patient is sick looking and appears to have anxiety .
On inspection , the patient appears wasted
Hair and scalp
The hair is kempt
The hair is sparsely distributed and is brown in color
The hair is soft , thin and brittle
The scalp has lesions on inspection
Skull
On inspection , it's normal in size
On palpation , there's no lumps or lesions felt
Absence of distended veins
Face
On inspection, the patient is sick looking
On palpation of the mandibles there are no presence of masses
There was voluntary muscle movements
Eyes
On inspection the sclera is white , absence of jaundice
On inspection there's conjunctival pallor
The eyes are normal in shape
The pupils are equal in sizes
Absence of keratoconjunctivitis
Absence of corneal opacities
The eyes are moist
Nose
It's centrally located
Absence of any abnormal discharges
Absence of scars on the nose
The nasal septum is centrally located and the nostrils are of equal sizes
Ears
On inspection, the size of the ears are equal
Absence of abnormal discharges
The patient responds when he's called , normal hearing
Mouth
On inspection, the lips re moist
Absence of cyanosis
On inspection, the teeth are in present with complete dental formula,
no dental carries
Absence of odor
Neck
On inspection, there are no scars
The trachea is centrally located
The neck is not webbed, no enlarged lymph nodes
UPPER extremities
On inspection, the arms appear wasted
They are warm
Cyanosis is absent
Chest
On inspection, the scars are absent
It is symmetrical and rises symmetrical during each breath
On palpation of the chest , no masses felt
On percussion, normal resonance is heard over all lung fields
Heart
On auscultation, S¹ and S²heard
Respiratory
On inspection the patient uses accessory muscles when breathing
On palpation of the chest , there are no masses felt
On auscultation, crepitations were heard
Abdomen
On inspection, no scars no lesions are seen
On auscultation, normal bowel sounds are heard in all quadrants
On palpation, no organomegaly nor masses
On Percussion, there is negative fluid thrill, no ascites
Genitalia
On inspection , no ambiguity, well developed, no discharge
Pubic hair well distributed
On palpation, no masses were felt
Lower limbs
Both limbs are of equal sizes
Absence of edema
 Absence of varicose veins
The lower limbs appeared wasted
VITALS TAKEN
Spo2 off oxygen: 83%
Spo2 on oxygen : 96%
Temperature: 38.0⁰c
RR : 30b/min
Pulse: 146 beats / min
Weight:42kg
INVESTIGATION DONE
Full hemogram: hb of 8.2 g/dl
Chest x-ray: revealed Ptb
Esr: 110mmol/ltr
MEDICATION GIVEN
1.Ethambutol
Class: Anti Tb
MOA it is bacteriostatic .it impairs synthesis of cell wall of mycobacterium
DOSAGE :2 tablets per oral ..once a day
2. Rifampicin
Class, anti tb
Moa: bactericidal. Inhibit Rna polymerase
Dosage: tablets, per oral, once daily
Side effects: rashes, hypertoxicity
3. Pyrazinamide

Class: anti tb
Moa: it is bactericidal
Dosage: tablets, per oral, once a day
Side effects: fever, joint pain, swelling.
4. Ceftazidime

Class: cephalosporin 3rd generation

Moa' it is bactericidal, Inhibits bacterial cell wall synthesis
Dosage: Igm, 1V, 8 hourly
Side effects' diarrhea, rashes, vomiting
Floxapen
Class: beta lactam antibiotic penicillin
Moa: it is bactericidal, inhibits bacterial cell wall synthesis
Dosage: 1g, IV,8 hourly
Side effects: vomiting, diarrhea, rashes .
assessment Nursing diagnosis objectives Plan of action Implementation Evaluation
SPO2 of 85% off Ineffective To increase the To administer 2 liters of oxygen After 24 hours of
oxygen breathing pattern SpO2 up to 92% off 2litres of oxygen administered as nursing
Use of accessory related to lung oxygen by the end through nasal prescribed, nasal intervention the
muscles inflammation ,secre of 24 hours prongs prongs so as to SP02 rose to
tions and decrease improve the oxygen 94percent.
lung capacity due saturation levels
to scarred tissue as  
evidenced by an
SpO2 of 85% off
oxygen

Limbs are wasted, Imbalanced To increase muscle Advice the patient Protein diet given After 24hours of
muscle wasting , nutrition less than mass and 0.2 grams to eat a high during lunch nursing
hair appears body requirements of weight daily protein diet Weight increases intervention , the
brownish related to Monitor weight of day by day patient has
decreased intake of the patient daily increased weight by
protein diet as   0.5 kgs
evidenced by
muscle wasting
assessment Nursing objectives Plan of action Implementation Evaluation
diagnosis
Body temp of Ineffective To maintain Administer Paracetamol The patient had
38.0 degrees thermoregulatio body temp antipyretics to 1gm given a body temp of
Celsius n related to within normal in reduce body 36.5 degrees
inflammation as the next 1 hour temp Celsius after 1
evidenced by Vitals taken hour
temp pf 38 Monitor vitals
degrees hourly

Risk for To prevent Administer Ceftazidime 1gm The patient had

nosocomial patient from prophylactic administered no nosocomial
infection related getting antibiotics  infection till
to prolonged nosocomial discharge
hospital stay infection
REFERENCES
BRUNNER AND SUDDARTH'S TEXTBOOK
OF MEDICAL-SURGICAL NURSING
THANK YOU