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CARE OF A PATIENT WITH

TUBERCULOSIS

A Clinical Paper

Presented the

the Faculty of the College of Nursing

Cebu Normal University

In Partial Fulfillment

of the Requirements for the Degree

Bachelor of Science in Nursing

Laura Suzanne K. Suarez

October 2011


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Acknowledgment

The researcher would like to express her deepest gratitude to thefollowing for their overall contribution to the success of this study. Without them,this study may not have been conducted nor would it have been finished.

To L, my client, my thank you is not enough to express my heartfeltgratitude for allowing me to come into her life. Without her, this study will nothave tackled such a fascinating disorder. Her story will forever be embedded inmy memory.

To Ms. Bertilia F. Pragados, R.N. our research consultant, who hasoffered her time and effort in conducting consultations and answering questions.She has patiently guided and taught me in how to compose this case study andhow to go about in interacting with the client. Her expertise in the field ofpsychiatric nursing has greatly contributed to the success of this study.

To the Staff of Ward 12, for allowing the fourth year students of CebuNormal University to enter their institution and extending their warm welcomewhen we first arrived. Without their kindness and their patience, the experiencemay have lacked its luster.

To Mrs. Antonietta Obiedo R.N., our year level coordinator, for giving theus the opportunity to conduct this study therefore enabling me to enhance mynursing skills especially in the field of psychiatric nursing. Without her dedicationto the development of skills of the level four students, this case study will nothave been conducted.

To my Groupmates, Group 3, section A., for being themselves and making

this experience worthwhile. Without them, I may not have had as much fun as Idid.

To my Parents, for simply being there. Without their presence and theirsupport emotionally, and financially, I would have never had the strength andcourage to tackle this study.

Lastly and most importantly, To God, our Almighty Father, the creator ofall things. His love for everything and everyone has immensely helped mold meinto the person that I am today. The very fact that my faith in Him has greatlyinfluenced how I live my life makes Him the one who has most significantlycontributed to the success of this study.


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Table of Contents

TITLE PAGE

i

DEDICATION

ii

ACKNOWLEDGMENT

iii

TABLEOF CONTENTS

LISTOFTABLES

iv

LISTOFFIGURES

List of tables

ABSTRACT

CHAPTER 1 INTRODUCTION

1

Rationale and Background of the Study

Statement of the Problem

Objectives of the Study

Significance of the Study

Research Methodology

Research Locale

Research Design

Research Design

Research Instrument

Research Data Gathering Procedure


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CHAPTER 2 PATIENTS PROFILE

Background/History

Patients Vitae

Functional Health Patterns

Physical Assessment

Organ System Assessment

Interpretation of findings

CHAPTER 3 ANATOMY AND PHYSIOLOGY

CHAPTER 4 PSYCHOPATHOPHYSIOLOGY AND PSYCHODYNAMICS

CHAPTER 5 MANAGEMENT

Medical

Laboratory and Diagnostic Procedures: Ideal and Actual

Drug Study: Ideal/Actual

Surgical Perioperative: Ideal and Actual

Nursing

Summary of Nursing problems

Individualized NCP (Physiologic, Psychologic)

Independent Nursing Strategies

Dependent

Collaborative

FDAR Charting

Discharge Summary with collaborative Nursing Function

CHAPTER 6 EVALUATION AND RECOMMENDATION

Extent of Goal Achievement

Recommendations


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BIBLIOGRAPHY

APPENDICES

A. Assessment Tool

B. Clinical Pathway

C. Research Articles

CURRICULUM VITAE


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List ofTables

Table No. Title Page

No.

1.1 1st dx na results

1.2 2nd dx na resuls


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List ofFigures

Table No. Title Page

No.

1.1 Schematic Diagram of the Pathophysiology of 20

Tuberculosis

1.2 Pathophysiology of Tuberculosis 25


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Abstract

Title: Care of a Patient with Rubeola Infection

Author: Endrex P. Nemenzo

School: Cebu Normal University

Degree: Bachelor of Science in Nursing

Adviser: Mr. Alain Kenneth S. Ragay, RN, MAN

Year Completed: School Year 200-2012

Statement of the Problem:

This case study aims to give a comprehensive information to the readersabout Rubeola infection. Blah blah blah blah blah blah.

Blah blah blah blah.

Methodology:

The study was conducted at VSMMC. And everything follows.

Findings:

C.A.Q. a female client, married. And everything follows.

Conclusion:

How you conclude your study

Recommendations:

The researcher recommends strict compliance to the treatment plan.


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ChapterI

Introduction

Rationale and Background of the Study

(include everything you wish to)

Statement of the Problem

This study is designed to understand the nature and course of the disease

process, from its causes to the signs and symptoms as manifested by the client.

It is designed to identify the different managements applicable for the patients

case.

Specifically, this study aims to answer the following questions:

1. What factors have caused the clients condition?

2. What is the pathophysiology of the disease as presented by the

patients clinical manifestations?

3. What are the responses of the patient towards the disease in

terms of :

3.1 Actual nursing needs

3.2 Potential nursing needs

4. What are the medical and surgical management of the patients

disease?

5. What are the nursing interventions appropriate for the patient

based on assessed needs?

Objectives of the Study


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The main goal of this study is to give comprehensive information the

readers about Status Asthmaticus. It delves further into the core of the illness, its

causes and effects and the problems that arise from this disease ad the

appropriate nursing management of such problem.

This study is specifically aimed to give thorough discussion of Status

Asthmaticus identifying its definition, the etiologic and precipitating factors,

anatomy and physiology of the organs involved, its pathophysiology, its

presenting signs and symptoms, the medical and surgical management and the

specific nursing care to be implemented to alleviate the patients condition.

Significance of the Study

The client suffering from status asthmaticus is aimed at deriving enough

knowledge of the said disease thereby increasing the awareness and skill in

dealing with client. Furthermore, conducting this study would prove beneficial to

the following people:

Patient

Patients Significant Others

Nurses

Student nurses

Society


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Future researchers

CHAPTER 2PATIENTS PROFILE

Background/History

Patients Profile

History of Present Illness

Assessment Findings

Patients VitaeFunctional Health PatternsPhysical Assessment

Organ System AssessmentInterpretation of findings


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CHAPTER 3

ANATOMY AND PHYSIOLOGY

Narrative nya ktung with diagram- ang diagram kai I reflect nya sa list of figures.:)


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CHAPTER 4

PSYCHOPATHOPHYSIOLOGY AND PSYCHODYNAMICS


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CHAPTER 5

MANAGEMENT

Medical

Laboratory and Diagnostic Procedures:IdealActual

Drug Study:IdealActual

Surgical :IdealActual

NursingSummary ofNursing problems

Ineffective Airway Clearance related to excessive secretions in the

tracheobronchial tree secondary to underlying disease condition.

with citations

Ineffective Breathing Pattern related to progressive bronchoconstriction

secondary to Status Asthmaticus

********five kabuok ang iyang DIAGNOSIS diri.. basin 5 jud pud ibutang.

Individualized NCP (Physiologic, Psychologic)Independent Nursing StrategiesDependent (2-3)Collaborative (1)FDAR ChartingDischarge Summary with collaborative Nursing Function


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CHAPTER 6

EVALUATION AND RECOMMENDATION

(INTROTXT) This case study was conducted to essentially focus on an extensive

presentation of the nature and therapeutic management of Status

Asthmaticussustained by a 54 year old female client.

Extent of Goal Achievement

Recommendations


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Bibliography

Books

Ackley et al. Nursin Diagnoss Handbook. 2nd ed. St. Louis Mosby yearbook,

Inc.

Unpublished Articles

Page, Bob (2004). Asthma Pathophysiology. Michigan EMS Expo 2004 NREMT-

P, CCEMT-P, I/C

Internet Sources

Neimark, NF. 2010. Mind/Body Solutions for Surgery retrieved September 04, 2010 at

http://www.thebodysoulconnection.com/Newsletter/issue7.html


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Appendix A

Assessment Tool

PHYSICAL ASSESSMENTFORM

NURSING ADMISSION AND ASSESSMENT

Name of Student: ______________________Clinical Assignment: ________________Name of Clinical Instructor: __________ Inclusive Dates: _______________________

A. General Admission Information

Name of Patient: ______________________Age: _________ Sex: ____________Date: __________ Time: _________ Mode: _____________Allergies: __________TPR: _________ BP: _________ HT: _____ WT: _______Diet: ________________

Sleeping Habits: _____________ CBC: Yes___ No___ Urinalysis: Yes___ No___Property: Glasses _____ Contact Lenses _______ Dentures ___Prosthesis ______ Ring __________ Watch Money ______Other _____________________________________________________Valuable to Business Office ____________________________________

Physical Appearance: ______________________________________________________________________________________________________________________________________________________________________________________Behavior Exhibited: ____________________________________________________

________________________________________________________________________________________________________________________________________Content of Conversation: _______________________________________________

____________________________________________________________________

_________________Physician In-charge

B. Admission Interview

1. Patient s perception of reason for admission:________________________________________________________________________________________________________________________

2. Patients symptoms as he/she sees them:__________________________________________________________________________________________________________________________

3. Problems in daily living created by symptoms (as patient views them)__________________________________________________________________________________________________________________________


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4. Past Medical History (especially as it relates to P.I.)a. Medical ___________________________________________________b. Surgical ___________________________________________________c. Allergies ___________________________________________________d. Medication _________________________________________________e. Traumatic Injuries ____________________________________________

f. Orthopedic _________________________________________________g. Other (psychiatric, etc.) _______________________________________

5. Habitsa. Smoking _________________Alcohol ____________Drugs _________b. Eating _____________________________________________________c. Social Activity _______________________Physical Exercise _________d. Rest/ Sleeping ______________________________________________

__________________________________________________________e. Sexual ____________________________________________________

__________________________________________________________f. Elimination ________________________________________________

6. Social Economic Historya. Native Language: __________________b. Education: ________________________c. Occupation ______________________________________________d. Financial Status (what is the impact of current hospitalization)

______________________________________________________________________________________________________________

e. Civil Status: Married_____ Single ______Divorced ______ Widow ______

f. Living Situation: Lives alone _________________________Live with others (specify): _________________

7. Family History: Heart Disease, Cancer, TB, Mental Illness and Others(specify)

__________________________________________________________________________________________________________________________

8. Primary Physicians Admitting Diagnosis (indicate P = Probable and C =Confirmed)


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C. Nursing Review ofSystems (circle the appropriate symptoms)

1. HEENT: Headaches Hearing Loss Visions DiplopiaEye pain Eye infection Blurring EpistaxisSinus pain Facial pain Bleedinggums Dentures

Sore throat Nasal-tracheal pain Other____________

2. CARDIO-RESPIRATORY: Chest pain (site) ________________________Chest pain with exertion Dyspnea on exertion Nocturnal dyspneaEdema Hypertension Palpation Known murmur Cough SputumHemoptysis Pleuritic pain DiaphoresisLast X-ray _______________________ EKG _________________________

3. GASTRO-INTESTINALThirst Nausea Vomiting HematemesisHeartburn Difficulty Swallowing Flatulence Constipation

Abdominal pain Jaundice Diarrhea Tarry StoolHemorrhoids Hernia Other__________________________

4. GENITO-URINARYDysuria Polyuria Frequency UrgencyNocturia Burning Hematuria Stonesa. Female Genital Tract Menstrual History: Age of onset ____________

Frequency ____________Regulation __________ Duration __________Date of last period ______________ Post menopausal bleeding _______

Age __________ Symptoms _________________________________b. G ________________ P __________________ Ab ________________c. Male Genital Tract Penile discharges Lesions

Pain Testicularswelling

Other ______________________________Last Serology Test __________________

5. MUSCULO-SKELETALMuscle pain Extremity pain Joint pain Back painJoint swelling Neck pain Stiffness Limited motionRedness Sprains DeformityOthers _______________________________________________X-rays _______________________________________________________

6. NERVOUSConvulsions Syncope Dizziness Vertigo

Tremor Speech difficulty Limp paralysis ParesthesiaMuscle atrophyEEG _________________________________________________________Other _______________________________________________________


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7. ENDOCRINE

Goiter Tremor Heat or ColdintoleranceExopthalmus Voice change PolydipsiaChange in body contour Infertility Other ____________

8. EMOTIONAL

Anxiety Depression Fear Anger Frustration Other (specify) ____Notes:________________________________________________________

__________________________________________________________________________________________________________________________

D. Nursing Observation1. HEENT

a. Symmetry _________________________________________________

b. Eyes and Pupils _____________________________________________c. Ears ______________________________________________________d. Mouth and Throat ___________________________________________e. Lymph nodes _______________________________________________

2. RESPIRATORYa. Depth and Rate

_______________________________________________________b. Breath Sounds ______________________________________________c. Chest expansion ____________________________________________

3. CARDIO- VASCULAR

a. Blood Pressure (R)_____(L)______ Lying _______Standing __________b. Apical pulse rate and regularity _________________________________c. Pedal pulses rate per minute (R)________________(L)______________d. Neck vein distension _________________________________________

4. CHESTa. Anterior chest _______________________________________________b. Posterior chest ______________________________________________c. Breasts ___________________________________________________

1. Breasts and Axillae _______________________________________2. Anterior Thorax __________________________________________3. Posterior Thorax _________________________________________

5. GASTRO-INTESTINALa. Bowel Sounds ______________________________________________b. Tenderness or rigidity

_______________________________________________________

6. URINARYa. Bladder ____________________________________________________


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7. SKELETALa. Joints

_______________________________________________________b. Range of Motions

_______________________________________________________

8. NEUROa. Motor Function

1. Facial __________________________________________________2. Extremities ______________________________________________

b. Sensory Function (equal or not equal)c. Equilibrium

1. Balance ________________________________________________2. Finger to nose ___________________________________________

d. Reflexes (equal or not equal)1. Knees ________________________Arms_____________________

9. CRANIAL NERVE FUNCTION

a. Olfactory nerve: (sensory)1. Sense of smell (coffee, vanilla. Etc.)

1.1 Anosmia ______________________________________1.2 Hyperosmia ___________________________________

b. Optic nerve: (sensory)1. Sense of vision (Snellens chart, newspaper)

1.1 Myopia ______________________________________________1.2 Hyperopia ____________________________________________

c. Oculomotor: (motor)1. Extra-ocular movements/ Pupil reaction to light

1.1 Right eye ________________ 1.2 Left eye _____________

d. Trochlear: (motor)1. Assess direction of gaze, upward and downward movement of eyeball

_______________________________________________________e. Trigeminal: (motor)

1. Presence of corneal reflexes ___________________________1.1 Right eye _______________ 1.2 Left eye__________________

2. Ability to clench teeth ____________________________________f. Abducens: (motor)

1. Assess direction of gaze, lateral movements of the eyeballs1.1 Right eye _______________ 1.2 Left eye ___________________

g. Facial: (Sensory and motor)1. Sense of taste: Using back of tongue

1.1 Salty ___________________ 1.2 Sweet ____________________2. Facial Expression

2.1 Smile _______________2.2 Puff out cheeks ______________2.3 Frown _______________2.4 Raise lower eyebrows __________

h. Auditory nerve: (motor)1. Sense of hearing

1.1 Right ear _______________1.2 Left ear ____________________


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Appendix B

Clinical Pathway


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Endorsement

August 20, 2010

- Bipolar disorder, most recent episode Mixed Psychotic Features

- Suicide, homicide, escape precaution

- Do not allow near stairs

August 31, 2010

- Bipolar disorder, most recent episode Mixed Psychotic Features

- May Go Home with referral

- For pregnancy test this morning

September 01, 2010

- May Go Home

FDAR

1.

Focus: Dance Therapy

D: Received client sitting on bench near entrance, good mood noted, client is cooperative, desire to express

self noted.

A: Encouraged client to join the dance therapy, guided client to mess hall, accompanied client to her position

in the group, established contract with client in proper behavior during therapy, instructed to follow

therapists instructions, encouraged to express personal feelings before and after dance therapy, monitored

reaction of client.

R: Nalipay ko, as verbalized

2.

Focus: Music Therapy

D: Received client sitting in mess hall, good mood noted, desire to express self noted, cooperativeness

noted.

A: Encouraged client to join the dance therapy, accompanied client to proper sitting, established contract

with client in proper behavior during therapy, instructed to follow therapists instructions, encouraged toexpress personal feelings before and after music therapy, monitored reaction of client.

R: Client participated in music therapy and rendered her own version of a song she wanted to sing.

Appendix C


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Research Articles

Research Articles

Title: Bipolar disorder in late life: clinical characteristics in a sample of older

adults admitted for manic episodeAuthors: Alessandra Benedetti, Pietro Scarpellini, Francesco Casamassima,

Lorenzo Lattanzi, Maria Liberti, Laura Musetti and Giovanni Battista CassanoDepartment of Psychiatry, Neurobiology, Pharmacology and Biotechnologies,

University of Pisa, Via Roma, 67, Pisa, Italy

Abstract

BackgroundAlthough manic episodes in older adults are not rare, little published data exist on

late-life manic episodes. Resistance to treatment and concomitant neurological lesionsare frequent correlates of elderly mania. The aim of this study was to investigate the

prevalence of hospitalizations due to mania in patients older than 64 years through aperiod of 5 years in an Italian public psychiatric ward. Moreover, we aimed at describingclinical presentation of elderly manic episodes.

Methods A retrospective chart review was conducted in order to describe clinical

presentation of 20 elderly patients hospitalized for manic episode; moreover, wecompared age at onset, the presence of family history for mood disorders, psychosisand irritability between the elderly group and a matched group of 20 younger manicinpatients.

ResultsSeven percent of the whole inpatient elderly people suffered from mania. Half of

those patients had a mood disorder age at onset after 50 years and 5 patients were attheir first manic episode. Geriatric- and adulthood mania showed similar clinicalpresentation but younger people had more frequently a mood disorders family history.

ConclusionHalf of our older manic inpatients consisted of "classic" bipolar patients with an

extension of clinical manifestations into later life; the other half of our sample washeterogeneous, even though it was not possible to identify clearly which patients mayhave had vascular lesions related to the onset of mania.

Source:Depp CA, Jin H, Mohamed S, Kaskow J, Moore DJ, Jeste DV: Bipolar disorder in

middle-aged and elderly adults: is age of onset important? J Nerv Ment Dis 2004 ,192(11):796-9.


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Title: Nutritional supplement effective against bipolar disorder - Literature Review& Commentary

Author:Townsend Letter for Doctors and Patients, May, 2003 by Alan R. Gaby

Abstract:

Fourteen patients (aged 19-46 years) with a DSM-IV diagnosis of bipolardisorder, who were taking a mean of 2.7 psychotropic medications each, were treatedfor 6 months with a broad-based nutritional supplement (E.M. Power ), containing thefollowing (daily doses): vitamin A (3,333 IU), vitamin C (250 mg), vitamin D (400 IU),vitamin E (100 IU), thiamine (5 mg), riboflavin (5.5 mg), niacinamide (25 mg), pyridoxine(7 mg), folic acid (400 mcg), vitamin B12 (250 mcg), biotin (25 mcg), pantothenic acid (6mg), calcium (550 mg), magnesium (250 mg), iron (6 mg), phosphorus (350 mg), iodine(75 meg), zinc (20 mg), selenium (100 meg), copper (3 mg), manganese (4 mg),chromium (250 meg), molybdenum (66 meg), potassium (100 mg), and a proprietaryblend (doses not specified) of DL-phenylalanine, L-glutamine, citrus bioflavonoids, grapeseeds, choline, inositol, Ginkgo biloba, L-methionine, germanium, boron, vanadium, and

nickel. At baseline and periodically thereafter, patients were assessed with the HamiltonRating Sc ale for Depression (HAM-D), the Brief Psychiatric Rating Scale (BPRS), andthe Young Mania Rating Scale (YMRS). For the 11 patients who completed the trial, themean HAMD decreased (improved) from 19.0 at baseline to 5.4 at the last visit (71%improvement; p < 01); the mean BPRS score decreased (improved) by 79%; p < 0.05);the mean YMRS score decreased (improved) by 60% (p < 0.01); and the need forpsychotropic medications decreased by 63% (p < 0.01). In two cases, the supplementreplaced psychotropic medication and the patients remained well. The only reported sideeffect was nausea, which was infrequent, minor, and transient. In general, improvementbegan within two weeks of starting the nutritional supplement.

Comment: This open-label study suggests that a broad-spectrum nutritional

supplement can reduce the severity of illness in some patients with bipolar disorder.Although there was no control group in this study, the magnitude of the improvementwas greater than one might expect from a placebo effect alone. Other investigators havealso found this supplement to be effective for bipolar disorder (J Clin Psychiatry2001;62:933-935). This product should be used cautiously, as it may potentiate theeffect of antipsychotic drugs, possibly increasing their toxicity. Additional research isneeded to determine the optimal way to transition patients from psychotropic drugs tonutritional therapy. E.M. Power was originally manufactured by Evince International; it iscurrently manufactured by Synergy Group of Canada (1-888-878-3467). The monthlyretail cost is $68.00.

Source: Kaplan BJ, et al. Effective mood stabilization with a chelated mineral

supplement: an open-label trial in bipolar disorder. J Clin Psychiatry 2001;62:936-944.


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Title: Risk factors in relation to an emergence of bipolar disorder: a systematicreview

Author: Kenji J TsuchiyaMajella Byrne, Preben B Mortensen

Abstract:

Keywords:

y affective disorder;y bipolar disorder;y demographic factors;y epidemiologic methods;y risk factor;y socioeconomic factors

Objective: There is a consensus that genetic factors are important in thecausation of bipolar disorder (BPD); however, little is known about other risk factors inthe aetiology of BPD. Our aim was to review the literature on such risk factors riskfactors other than family history of affective disorders as predictors for the initial onsetof BPD.

Methods: We conducted a literature search using the MEDLINE, PsycINFOand EMBASE databases. We selected factors of interest including demographic factors,factors related to birth, personal, social and family backgrounds, and history of medicalconditions. The relevant studies were extracted systematically according to a searchprotocol.

Results: We identified approximately 100 studies that addressed theassociations between antecedent environmental factors and a later risk for BPD.Suggestive findings have been provided regarding pregnancy and obstetriccomplications, winterspring birth, stressful life events, traumatic brain injuries andmultiple sclerosis. However, evidence is still inconclusive. Childbirth is likely to be a riskfactor. The inconsistency across studies and methodological issues inherent in the studydesigns are also discussed.

Conclusion: Owing to a paucity of studies and methodological issues, riskfactors of BPD other than family history of affective disorders have generally beenneither confirmed nor excluded. We call for further research

Source:

Kenji J Tsuchiya, MD Tokyo Metropolitan Tama Center for Mental Health, Nakazawa2.1.3, Tama, Tokyo 2060036, Japan.

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FINAL FORMAT-With Samples