BULACAN STATE UNIVERSITY

COLLEGE OF NURSING

Malolos Bulacan

This is the case of a fifty-one year old female diagnosed of Pneumonia vs. Pulmonary
Tuberculosis

Submitted by:

Labrador, Bernadette M

BSN 4A/3B

Submitted to:

Charina Faustino; R.N

INTRODUCTION

This is the case of a fifty-one year old female client residing at RMB Balagtas Bulacan, who was admitted at Gregorio Del Pilar District Hospital last August

3, 2010 and was diagnosed of having Pneumonia vs. Pulmonary Tuberculosis.

Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease caused by various strains of mycobacterium,

usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when

people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections

eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims.

The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight. Infection of other organs causes a wide range of

symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological

culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic

resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus

Calmette-Guérin vaccine.

A third of the world's populations are thought to be infected with M. tuberculosis, and new infections occur at a rate of about one per second. The proportion

of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still

increasing. In 2007 there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries. In
addition, more people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance

abuse, or AIDS. The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in

tuberculin tests, while only 5-10% of the US population test positive.

Pneumonia is an inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli)

and abnormal alveolar filling with fluid (consolidation and exudation). The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange.

Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its cause

may also be officially described as unknown when infectious causes have been excluded. Typical symptoms associated with pneumonia include cough, chest

pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial

pneumonia is treated with antibiotics. Pneumonia is common occurring in all age groups, and is a leading cause of death among the young, the old, and

the chronically ill. Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any complications,

and the person's underlying health.

CURRENT TRENDS ABOUT THE DISEASE CONDITION

According to the Department of Health (DOH) PTB is the 6th cause of mortality and morbidity in the Philippines as of 2008. This disease is can be acquired

easily by a person being in contact with an infected one, when you are living in a crowded area like the squatters area and when you have a poor nutrition. it is

commonly present in third world or developing countries like the Philippines. In 2007, mortality and morbidity statistics included 14.6 million chronic active cases,
8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting

tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse or AIDS. The distribution of tuberculosis is not uniform

across the globe with about 80% of the population in many Asian and African countries testing positive in tuberculin tests, while only 5-10% of the US population

testing positive.

OBJECTIVES

General

• To be able to established Nursing Care Plan for a client with Pulmonary Tuberculosis

Specific

• To be able to assess different signs and symptoms of Pulmonary Tuberculosis

• To be able to differentiate Pulmonary Tuberculosis from other disease with the presenting signs and symptoms.

• To be able to plan appropriate Nursing Interventions.

• To be able to provide appropriate Nursing Care for the client.

• To be able to evaluate the outcome of the nursing care.

PATIENT’S PROFILE

BIOGRAPHIC DATA

Date of Assessment: August 6, 2010

Name: Mrs. SRC

Address: RMB Balagtas Bulacan

Age: 51 years old

Birthday: August 21, 1958

Birthplace: Masbate

Position in the family: As a Mother

Nationality: Filipino

Sex: Female

Marital Status: Married

Occupation: Housewife

Religious Orientation: Catholic

Health Care Financing and usual source of medical care: With the help of her children and help by their neighbors.
Educational Attainment: Elementary Undergraduate

Date of Admission: August 3, 2010

Time of Admission: 08:30 pm

B. CHIEF COMPLAINT

Client stated that she experienced cough.

“Madalas akong inuubo kung kaya’t hinihingal ako at sumasakit ang aking sikmura pagkatapos kong maubo.” as verbalized by the client.

C. HISTORY OF PRESENT ILLNESS

The client was admitted at Gregorio Del Pilar District Hospital at exactly 8:30 pm of August 3, 2010. She brought to the hospital by her children

because of cough. Her symptoms occur after the rain falls; she also experienced colds, headache and also difficulty of breathing.

D. HISTORY OF PAST ILLNESS

Client stated that during her childhood she had experienced chickenpox and was not able to recall if she had experience to have mumps before. She

stated that there is an immunization given to her but cannot recall what it is. She said that she experienced cough since last year until now. And she takes

Solmux, Cefalexin, and Ambroxol to relieve it as she explained. But her symptoms didn’t exist until now, she also states that she has asthma; the medication

she takes is Ventolin. She included that she has no allergies to drug and foods. Mrs. SRC’s first hospitalization was due to her present condition which

having a cough.
E. FAMILY HEALTH ILLNESS HISTORY

Mrs. SRC stated that she cannot recall what the cause of death of her grandparents on both paternal and maternal side. She stated that her father and

mother died because of Lung problem. She has four (4) siblings and all of them doesn’t experiencing cough. Her husband was also admitted at the said

hospital because of Lung Problem according to the client. See the Family’s Genogram on the next page:
 FAMILY’S GENOGRAM

Paternal Side Maternal Side

Xxx Xxx Xxx

Xxx
+ + +
+

xxx xxx xxx E.C xxx xxx M.R xxx

+ +
xxx xxx
LP LP

R.C M.C B.C

S.C
M.C R.C
LP

LEGENDS:

S.C - Client LP -Lung Problem

+ -Deceased

-Female -Male
F. FUNCTIONAL HEALTH PATTERNS

Functional Health Pattern Prior to hospitalization During hospitalization

I. Health Perception Client stated that absence of any disease will be Client described that being healthy is being free from any

considered as healthy individual. She doesn’t smoke and illness and can do whatever she wants to do without any

drink liquor. She also stated that sometimes she disobey difficulties in doing things. Now, that she has been

rules pertaining of having a good health because of her hospitalized, she realized that being aware on one’s health

simple life. Client described that being healthy is being is really important in person’s life. And she will follow her

physically fit, eating a balance diet, taking care of health doctor’s advice.

problems when they are present, keeping up on hygiene

and having a good relationships with others.

II. Nutritional and Metabolic Pattern Client stated that she eats whatever foods he wants and Due to her condition Mrs. SRC maintains her diet. During

when it is available. And have no difficulty in eating, these days she loses her appetite but trying to eat nutritious

chewing and swallowing. foods and drinks at least 8 glasses of water each day.

August 4, 2010 Mrs. SRC cannot recall if

Client doesn’t recall her past meal.
what she ate on that day
August 5, 2010 Breakfast

Lugaw ½ cup

Water 500ml

Lunch

Lomi with miswa 2 cup

Rice 1 cup

Water 500ml

Dinner

Rice 1 cup

Sabaw ng sinigang na

baboy 1 cup

300ml of water
 August 6, 2010 Breakfast

Lugaw ½ cup

Milk 1 cup

Banana 1pc. Medium

Lunch

1 cup of rice

Adobong manok 2 pc.

small

200 ml of water

III. Elimination Pattern Client defecates twice a day with the characteristics of Client defecates once a day with soft, brown in color and

soft and semi-formed, cylindrical and brown in color. with normal odor.

She urinates for about 3-4 times a day. The client’s urine She urinates for about 3-4 times a day. The client’s urine is

is yellowish in color. yellowish in color.

There is no excess perspiration. There is no excess perspiration.

 There is no difficulty in defecation. There is no difficulty defecation.

IV. Activity- Exercise Pattern Client has a full self- care. Client has low activity level because of her health

condition. She feels that she doesn’t have sufficient

Perceived Ability for code level
strength and endurance to do things on her own. Client also
Prior Illness
requires help or assistance from her daughter in some of his
0 Feeding
ADLs.
0 Bathing

0 Toileting During Illness

0 Dressing I Feeding

0 Grooming II Bathing

0 Bed mobility II Toileting

I Dressing
Level 0: Full self- care
II Grooming
Level I: required use of equipment or device
II Bed mobility
Level II: required assistance or supervision from

another person

Level III: required assistance or supervision from

another person or device

 Level IV: Is dependent and does not participate

V. Sleep- Rest Pattern Client stated before the illness she sleeps at around 7pm- During her illness, Mrs. SRC stated that she have difficulty

8pm and wake up at 6:00am. She reported no problems of falling asleep at the first two days of admission it’s just

falling asleep because of her illness but also due to the hospital

environment. He slept at around 11:00 pm and wakes up at

around 3am. She also takes naps on the afternoon or

whenever she had the opportunity to sleep.

VI. Cognitive- Perceptual Alteration For her she believes that she is healthy even though she Client stated she feels that she is not in good physically

cannot eat those foods that are delicious. She loves her healthy and not emotionally healthy due to her condition.

family and her neighbors and reports that they are very She loves her family and her neighbors and reports that

supportive when their problem arises. they are very supportive when their problem arises.

Client doesn’t wear eyeglasses; Mrs. SRC has no Client doesn’t wear eyeglasses; Mrs. SRC has no difficulty

difficulty in learning and easy to learn things. And when in learning and easy to learn things. And when she feels

she feels any discomfort she usually sleeps and tells this any discomfort she usually sleeps and tells this to her

to her family about this. family about this.

VII. Self- perception and Self- concept Pattern There are no changes in her memory lately. She describes Client is cooperative, but she stated that many times she is

her self as simple wife who wants to experience irritable because of her condition. She reported that she

everything in his life. She usually finds happiness into the have no problem about her self-perception and self-

simple things surrounds her, especially when it is about concept. Since the illness started the client became worried

his family and her neighbors. because of what might happen to her and to her family

because they don’t have money to pay their expenses in the

hospital.

VIII. Role and Relationship Pattern Client stated that her family is a nuclear type. She likes to She misses her neighbors and her children also. Her

keep her family happy and healthy by showing love and daughter is the one who’s taking care of her and she is very

care. Decisions in the family were made between her and thankful that she had such a daughter. Her neighbors

her husband. She always kept an open communication helping them by giving them money for the hospital bill or

with her husband and children. Her relationships with her for the medicine that she takes.

neighbors are also good.

IX. Sexuality- Reproductive Pattern The client refused to talk about her sexual matters. The client refused to talk about sexual matters.
X. Coping- Stress Pattern She was telling to her daughter if she has discomfort. She Mrs.SRC keeps telling to her daughter whenever there is a

handles problems with her family. They can face any discomfort or pain because she feared what might happen

problems in their life, as the client stated. to her if she will hide what she feels.

XI. Values and Beliefs Pattern She doesn’t get all the things that he wants especially The only changes in her values belief is that she is much

when it regards to material things, because of insufficient attached now to God. And just letting her to decide of what

financial capacity for such materials and also because of will happen to her. And she also said that she thinks that it

the condition of her family. But she stated that even is a punishment of God.

though they are not that rich, still they are happy together

with her family. Religion is very important to her because

she believed that Jesus is only a man and that God is a

spirit. She also believes to quack doctors and herbal

healing sometimes.
ANATOMY AND PHYSIOLOGY
 We often complete the daily tasks of living without thinking about the respiratory system. We breathe in and

out and take for granted one of our most vital organ systems. The respiratory system provides the oxygen necessary to

sustain life. It consists of both upper and lower respiratory tracts. It is divided into two functions: conducting and

respiration.

The function of the respiratory system is to give us a surface area for exchanging gases between the air and our

circulating blood. It moves that air to and from the surfaces of the lungs while it protects the lungs from dehydration,

temperature changes and unwelcome pathogens. It also plays a part in making sounds such as talking, singing, other

nonverbal sounds and works with the central nervous system for the ability to smell.

Upper Respiratory Anatomy

The upper respiratory system consists of the nostrils (external nares), nasal cavity, nasal vestibule, nasal septum, both hard and soft palate, nasopharynx,

pharynx, larynx and trachea. Within the nostrils, course hairs protect us from dust, insects and sand. The hard palate serves to separate the oral and nasal cavities.

There is a protective mucous membrane that lines the naval cavities and other parts of the respiratory tract. It is secreted over the exposed surfaces and then the cilia

sweep that mucus and any microorganisms or debris to the pharynx, so it is swallowed and then destroyed in stomach acids.
 Lower Respiratory Anatomy

The trachea branches off into what is known as the bronchi (more commonly called bronchial tubes). These two main bronchi have branches forming the

bronchial tree. Where it enters the lung, there is then secondary bronchus. In each lung, the secondary bronchi divide into tertiary bronchi and in turn these divide

repeatedly into smaller bronchioles. The bronchioles control the ratio of resistance to airflow and distribution of air in our lungs. The bronchioles open into the

alveolar ducts. Alveolar sacs are at the end of the ducts. These sacs are chambers that are connected to several individual alveoli, which make up the exchange

surface of the lungs.

The Lungs

The human respiratory system has two lungs, which contain lobes separated by deep fissures. Surprisingly, the right lung has three lobes while the left one

has only two lobes. The lungs are made up of elastic fibers that give it the ability to handle large changes in air volume. The pleural cavity is where the lungs are

located. The diaphragm is the muscle that makes up the floor of the thoracic cavity and plays a major role in the pressure and volume of air moving in and out of the

lungs.

Our lungs filter and deliver oxygen that is necessary for healthy red blood cells. It is important that we keep the respiratory tract healthy through proper rest,

hydration, diet and exercise.

PATHOPHYSIOLOGY
Modifiable
Non modifiable
 Nature of work
 Gender
 Low nutritional

Depressed immune system Inhaled Mycobacterium

bacilli/airborne transmission
through nasal entry

Pass down the bronchial tree and

transmitted to the alveoli

Deposited and begin to multiply

Transported through bronchi

 Inflammatory reaction occur

(DOB, cough)

Phagocytes (neutrophils and

macrophages) engulf many of
the bacteria

Accumulation of exudates in
the alveoli that can cause
recurrence of
bronchopneumonia

DRUG STUDY

DRUG NAME DATE ORDERED/ ROUTE/ GENERAL ACTION/ INDICATION/ NURSING IMPLICATION
DATE TAKEN/ DOSAGE/ CLASSIFICATION/ PURPOSE
GIVEN FREQUENCY MECHANISM OF
ACTION
Cefuroxime August 4, 2010 750 mg TIV q 8° Action:
Bind to bacterial cell wall
membrane, causing cell
death. Bactericidal action
against bacteria.
Classification:
Anti- infective
Treatment of the  Assess for infection (v/s,
following infections appearance of sputum, urine
caused by susceptible at beginning and during
organisms. Respiratory therapy.
tract infection.  Before initiating therapy,
obtain a history to
determine previous use of
and reactions to penicillin
or cephalosporin. Person
with a negative history of
penicillin sensitivity may
still have an allergic
response.
 Obtain specimens for
culture and sensitivity
before initiating therapy.
First dose may be given
before receiving results.
 Observe patient for signs
and symptoms of
anaphylaxis (rash, pruritus,
 wheezing) discontinue the
drug and notify physician or
the other health care
professional immediately if
these symptoms occur.

Salbutamol neb. August 6, 2010 2.5-10mg q 4° Acton: Used as a  Assess lung sounds,. Pulse
Binds to beta2- bronchodilator to and BP before
adrenergic receptors in control and prevent administration and during
airway smooth muscle, reversible airway peak of medication. Note
leading to activation a obstruction caused by amount, color and character
adenyl cyclase. asthma. Used as a of sputum produced.
quick-relief agent for Monitor pulmonary
Classification: acute bronchospasm function test before
bronchodilators and for prevention of initiating therapy and
exercise-induced periodically during therapy
bronchospasm. to determine effectiveness
of medication.

 Shake inhaler well and

allow at least 1 minute
between inhalations of
 aerosol medication.

 Compressed air/oxygen
flow should be 6-
10L/minute; a single
treatment of 3ml lasts about
10 minute.
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “nahihirapan akong Ineffective airway Short term:  Monitor  Indicative of Short term:
huminga” as verbalized clearance related respiration and respiratory
by the client. to asthma After 1 hour of nursing After 1 hour of nursing
breathe sounds, distress or
intervention, client will intervention, client was able
noting rate and accumulation
O: be able to maintain to maintain airway patency.
sounds. of secretions.
airway patency.
 the patient is Long term:
 Evaluate client  To determine
coughing Long term:
cough/gag ability to After 2 days of nursing
 difficulty After 2 days of nursing reflex. protect own intervention, client was able
vocalizing intervention, client will airway. to clear secretions readily.
be able to clear secretions
 To open or
readily.  Position head
maintain open
appropriate for
airway in at
condition.
rest.

 To take
 Elevate head of advantage of
bed and change gravity of
position q 2°. lower pressure
on the
 diaphragm.

 To maximize
effort.
 Encourage deep
breathing
exercise.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: Ø Activity Short term:  Note client  Symptoms Short term:

intolerance related reports of may be result
O: to generalized After 3 hour of nursing After 3 hour of nursing
weakness, to intolerance
weakness intervention, client will intervention, client was able
 Fatigue fatigue, pain, of activity.
be able to identify to identify techniques to
difficulty
techniques to enhance enhance activity intolerance.
 Weak in accomplishing
activity intolerance.
appearance tasks.
Long term:
 Adjust activities Long term:
After 2 days of nursing
intervention, client will  To prevent After 2 days of nursing
be able to increase in over excretion intervention, client was able
 Plan care to
activity intolerance. to increase in activity
carefully  To reduce intolerance.
balance rest fatigue

periods with
 activities.

 Assist with  To protect

client from
activities and
injury.
monitor client’s
use of assistive
device.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “sumasakit ang Acute Pain Short term: Demonstrate individualized To help lessen the pain. Short term:
sikmura ko pagkatapos relaxation technique.
kong maubo”as After 3-4 hours of After 3-4 hours of nursing
verbalzied by the client nursing intervention, the Observe for non verbal intervention, the patient's pain
patient's pain scale will To assess the client scale was decreased from 7/10
cues of discomfort. properly To protect client
O: decrease from 7/10 to to 4/10.
4/10. from injury.
 Guarding Long term:
Long term: Instruct patient to inform To prevent underlying
behavior
nurse if pain relief is not condition. After 1-2 hours of nursing
 Observed After 1-2 hours of achieved. intervention the patient was
evidenced of nursing intervention the verbalized absence of pain.
pain patient will verbalize Inform patient of procedure To prevent further
that may increase pain and
  With pain scale absence of pain offer suggestions of complication.
of 7/10 coping.

Encourage to perform
breathing exercises. To reduce pain

DISCHARGE PLANNING

M- Instructed the patient to continue medication as ordered:

Continue taking anti –TB drugs. The intensive phase is for 2 months and the maintenance phase is for 4 months. Medicines are readily available at the health

center.

E- Instructed the patient to practice deep breathing exercise and coughing exercises. Resume previous activities. Prevent extraneous work. Have a regular

physical exercise like brisk walking for 30 minutes daily. For financial insufficiency, there are government drug stores available. The patient may continue her

work.
T- Follow faithfully the regimen for tuberculosis, especially the medications. Have a regular sputum test ordered by the doctor.

H-

o Encourage patient to increase fluid intake

o Encourage to eat nutritious foods

o Encourage to have adequate rest and sleep

o Instruct to position on semi-fowler’s

o Emphasize hygiene before and after handling foods

o Always cover the mouth and the nose when exposed to person who coughs or sneezes.

o Should not spit anywhere, instead spit in a single container to prevent transfer of M. Tuberculosis.

O- Instruct to have a regular check up at the nearest health center, at least once a week to monitor the progress of the treatment.

D-

o Diet should be high caloric

 o Instruct to drink a lot of water

o Eat nutritious foods like rich in vitamin C to strengthen immune system.

S- Always pray for the guidance of the Lord. Spiritual health affects the wellness of an individual greatly. Strengthen relationship with Lord by showing love

and respect to the other people.