Bahin Case Study

7/29/2019 Bahin Case Study

1/7

Nursing Management of Patient with Pregnancy Induced

Hypertension

a 24 year old Army servant named CAA Christopher Bahin,

was diagnosed of Left Pleural Effusion, probably secondary to

pulmonary tuberculosis and an anterior chest wall mass on his

admission. An anticipated pain on his chest was present because

of

the wound from thoracentesis.

Prior to his admission, he experienced difficulty of breathing,

shortness of breath, easy fatigability, weight loss, and a non-

productive cough. Due to the persistence of symptoms, he

consulted

a station hospital where he was managed as a case of Pleural

Effusion secondary to Pulmonary Tuberculosis. He underwent five

times of thoracentesis and drained a 1200-1500cc occasion of

serosanguinous pleural fluid.

Pathophysiology

A tuberculous pleural effusion that occurs in the absence of

radiologically apparent TB may be the sequel to a primary infection

or it may represent reactivation TB. The pathogenesis of a

tuberculous pleural effusion is thought to be related to the rupture

of a subpleural caseous focus in the lung into the pleural space.

The basis for this is the observation by Stead et al. that they could


2/7

demonstrate a caseous tuberculous focus in the lung contiguous

to

the diseased pleura in 12 of 15 patients with tuberculous pleuritis.

The three other patients in this study had parenchymal disease

although they did not have caseous foci adjacent to the pleura. It is

believed that delayed hypersensitivity plays a large role in the

pathogenesis of tuberculous pleural effusion. The hypersensitivity

reaction is initiated when tuberculous protein gains access to the

pleural space. Evidence for the role of hypersensitivity includes the

following: When tuberculous protein is injected into the pleural

spaces of guinea pigs sensitized to purified protein derivative, an

exudative pleural effusion rapidly develops. When the sensitized

guinea pigs are given antilymphocyte serum, the development of

the

pleural effusion is suppressed.The mycobacterial cultures of the

pleural fluid from most patients with tuberculous pleural effusions

are negative. The tuberculous pleural effusion develops when the

delayed hypersensitivity reaction increases the permeability of the

pleural capillaries to protein and then the increased protein levels

in the pleural fluid result in a much higher rate of pleural fluid

formation. In addition, the lymphocytic pleuritis obstructs the

lymphatics in the parietal pleura, which leads to decreased pleural

fluid clearance from the pleural space. The pleural effusion results

from the combination of the increased pleural fluid formation and

the decreased pleural fluid removal.

History

P.E., a 24 year old Army servant named CAA Christopher Bahin,

was diagnosed of Left Pleural Effusion, probably secondary to


3/7

pulmonary tuberculosis and an anterior chest wall mass on his

admission. An anticipated pain on his chest was present because

of

the wound from thoracentesis.

2 months prior to admission, patient started to experience

difficulty

of breathing described as shortness of breath and easy fatigability,

weight loss, anorexia and non productive cough. Persistence of

symptoms prompted consult case of pleural effusion secondary to

pulmonary tuberculosis. He was started on anti-Kochs medication

and also given IV antibiotics for pneumonia. He underwent five (5)

times thoracentesis and drained 1200-1500cc/ occasion of

serosanguinous pleural fluidPersistence prompted transfer in

AFPMC.

Nursing Physical Assessment

We have noted for the patients vital signs and all as such are as

follows;

Blood pressure: 100/70normal

Temperature: 36.2 deg. Celciusnormal

Pulse: 83 BPMnormal

Respiratory rate: 30 CPMabnormal

Related Treatments:

The doctor ordered the following for the patient:

Regular diet Multivitamins + EAA cap at 1cap OD


4/7

1NH + RIF + EMB + PZA tab at 4tabs ODBB Celecoxib 200g/cap at 1cap BID PRN Paracetamol 500mg tab at 1tab Co-amoxiclav 1.2g TIV then 600mg IV q 8hrs. Tramadol 25mg TIV q 8hrs. PRN for pain

Nursing Care Plan:

*Short Term Goals

> to eliminate pain which the patient feels periodically from the

thoracentesis wound.

*Long Term Goals

> to prevent discomfort of the patient until he is able to function

normally.

Nursing Interventions:

>Observe changes in the clients cough, sputum, respiratory depth,

and breath sounds, and note complaints of chest pain.

>Position the client appropriately.

>Some agency protocols recommend that the client lie on the

unaffected side with the head of the bed elevated 30 degrees for at

least 30 minutes because this position facilitates expansion of the

affected lung and eases respirations.


5/7

>Position the patient in a side-lying position with the unaffected

side

down for an hour or longer.

>Include date and time performed; the primary care providers

name; the amount, color, and clarity of fluid drained; and nursing

assessments and interventions provided.

>Transport the specimens to the laboratory.

>The dressing over the puncture site will be monitored for bleeding

or other drainage. Monitor patients blood pressure, pulse, and

breathing until are stable.

>Document all relevant information.y

>Administer Tramadol 25mg TIV q 8hrs. PRN for pain

Evaluation:

After an hour of proper nursing interventions, following the

managements listed above, the Sir Christopher Bahin was

responding well to the medication given for pain and to thepositioning implemented to for his own comfort. Vital signs were

normal, especially, the patients respiratory rate decreased near to

normal. Sir Bahin reports of comfort after doing proper nursing

interventions.


6/7

Recommendations:

I highly recommend to the future researchers that a case like this

of

CAA Christopher Bahin should have proper nursing interventions

which focus on the promotion patients comfort especially that

which is concerned of the patients difficulty of breathing(shortness

of breath) and pain from the patients thoracentesis wound,

moreover, not putting the patients other concerns about the

disease

at stake.


7/7

Manalo Maiko Dan T.

BSN 3A2-8/ Group 30

Dr. Ferriol

AFPMC

Documents

Bahin Case Study