INTRODUCTION

The family is the smallest unit of the society and the natural fundamental core of the
community and consequently, it is considered as the primordial recipient of the nursing effort,
which is contributory to the development, and progress of the community through active
involvement and self – responsibilities of each constituent. It is composed of persons, male and
female, being molded to be as one, working hand in hand to maintain a good atmosphere among
the family members ( Pilliteri , 2015)

.Conducting a family case study is a means by which student nurse reaches and feels the
community through its basic structure the family. It is a tool in determining the health status of a
family through assessment and critical inspection. Through this health related problems are
identified, thus giving the student nurse a hint on where to act and how to intervene. It is also
means towards improving the health of the community, making them more productive. To come
up with the family case study gives a sense of fulfilment to a student nurse as she/he was given
the opportunity to share the skills, knowledge and time to alleviate and uplift the living condition
of a family.

Therefore, our group was assigned at Purok Tambacan Iligan City for a family case
study. The family that was chosen by our group is a picture of the majority of the family in this
community, a family living in a poor environmental condition without enough resources and
lacks knowledge on vital health information and experiences on other socioeconomic related
problems.

Tuberculosis ( TB) is a chronic ,recurrent infection disease that usually affects the lungs,
although any organs can be affected. Caused by Mycobacteruim tuberculosis. TB is uncommon
in the United States, especially among young adults if European Descent. ( LeMone, Burke
Bauldoff , 2014).
 TB is communicable disease caused by M. tuberculosis an aerobic, acid-fast
bacillus(AFB). TB is an airborne infection and generally acquired by inhalation of particle small
enough ( 1 to 5mm in diameter) to reach the alveolus. Droplets are emitted during talking,
coughing, laughing, sneezing, or singing. Infected droplet nucleic may be then inhaled by
susceptible person( host) . Before pulmonary infection can occur, the inhaled organism must
overcome the lung’s defense mechanism and penetrate lung tissue . Brief exposure to TB does
not usually cause infection. People most commonly infected are those who have repeated close
contact with an infected persons whose disease is not yet diagnosed. Such people may include
anyone who has repeated contacts with medically underserved clients, low-income population;
foreign born people, or residents of long term care facilities or institutional setting. Other high
risk population are intravenous drug users,homeless people and people who are occasionally
exposed to active TB( healthcare workers). ( Brunner and Suddarth’s , 2012)

The first time a client is infected with TB, the disease is said to be a primary infection.
Primary TB infection are usually located in the apices of the lungs or near the pleurae of the
lower lobes. Although a primary infection may be only microscopic ( and hence may not appear
on chest radiogram. A small area of bronchopneumonia develop in the lung tissue. Many of the
infecting tubercle bacilli may survive within these body cells and may be carried into regional
bronchopulmonary (hilar) lymph nodes via lymphatic system. The bacilli may even spread
throughout the body . Thus the infection , although small, spreads rapidly. The primary infection
site may or may not undergo a process of necrotic degeneration, called caseation because it
produces cavities filled with cheese-like mas tubercle bacilli, dead white blood cells and necrotic
lung tissue. In time, this material liquefies, may drain into tracheobronchial tree, and may be
coughed up. Most primary tubercles heals over a period of months by forming scars and then
calcified lesions also known as Ghon’s complex. This lesion may contain living bacilli that can
be reactivated, specially if the client becomes immunocompromised , even after may years, and
cause secondary infection. ( Brunner and Suddarth’s, 2012)

Approximately 10% of people infected with TB will continually develop active disease,
within their lifetime. The reason active TB develops in some clients instead of being controlled
by the acquired immune exposure and thereby remaining dominant) is poorly understood. Risk
factors include the following; repeated close contact with person who has active TB, advanced
age, HIV infection, immunosuppression, prolong corticosteroid therapy, living or hiking in high
– risk congregate areas ( prison, long term facilities), low body weight , substance abuse and
presence of the other diseases. (Brunner and Suddarths, 2012)

In addition to progressive primary disease, reinfection may also lead to a clinical form of
active TB, or second any infection. Primary sites of containing TB bacilli may remain latent for
years and then may be reactivated if the client’s resistance is lowered. Because reinfection is
possible and because dormant lesions may be reactivated, it is extremely important for clients
who had a TB infection to be reassessed periodically for new evidence of active disease.
(Brunner and Suddarths, 2012

Manifestation of primary progressive or reactivation TB often develop insidiously and

are initially nonspecific fatigue ,weight loss , anorexia ,low grade afternoon fever, and night
sweats are common .A dry cough develops ,which later becomes productive of purulent and or
blood –tinged sputum. It is often at this stage the patient seeks medical attention. . ( LeMone,
Burke Bauldoff , 2014).

The Risk for infection by M.tb is affected by characteristics of the infectious person, the
extent of air contamination ,duration of exposure, and susceptibility of the host. The number of
microbes in the sputum ,frequency and the force of coughing affect the production of droplet
nuclei. In small, closed or poorly ventilated space ,droplet nuclei become more concentrated
,increasing the risk exposure. Prolonged contact, such as living the same household, increases the
risk. Less –than- optimal immune function ,a problem for people in lower socioeconomic groups
,injection drug users, the homeless, alcoholics ,and people with HIV infection, increases the
susceptibilityof the host.

According to World Health Organization (WHO) 2016. this year announced that TB was
one of the top 10 causes of death worldwide in 2015, responsible for more deaths than HIV and
malaria. In the same year, an estimated 1.8 million people died from TB, of which 0.4 million
were co-infected with HIV. Worldwide, 10.4 million people fell ill with TB. The report
highlighted the need for countries to move much faster to prevent, detect, and treat the disease if
they are to meet global targets. The Philippines is among the 22 high-burdened countries in the
world according the WHO.TB is the 6th leading cause of illness and the 6th leading cause of
deaths among the Filipinos. Most TB patients belong to the economically productive age group (
15-54 years old according to 2nd National Prevalence survey in 2005.

Directly- observed treatment short is a comprehensive strategy endorsed by the World

Health Organization ( WHO ) and International Union Against Tuberculosis and Lung Disease (
IUATLD ) to detect and cure TB patients. It aims to control TB by reducing the annual risk of
infection ( prevalence and mortality rates).The National TB Program ( NTP ) is the
Governments’s commitment to address the TB problem in the country. The NTP is being
implemented nationwide in all government health centers and governments hospitals. Its
objectives are to detect Tb cases ( at least 70 % ) and cure them ( at least 85 %). Achieving and
sustaining targets will eventually results to the decline of the TB problem in the Philippines.
(Castro,C.2012).

Short-course regimens of chemotherapy for pulmonary tuberculosis lasting either 6

months or 8 months are now used in almost all national tuberculosis programmes. These
regimens are all based on an initial intensive phase, in which four drugs are given for at least 2
months, and a continuation phase, with two drugs given for 4 months or 6 months. The currently
used initial intensive phase, which in all cases includes isoniazid, rifampicin, and
pyrazinamide,is based on an extensive series of clinical trials and the postulates of Mitchison and
Dickinson of different bacterial populations, each with differing susceptibility to rifampicin or
pyrazinamide, depending on their metabolic state.1 The fourth drug can be either streptomycin or
ethambutol. The continuation phase is either 4 months of rifampicin and isoniazid or 6 months of
ethambutol and isoniazid or, less commonly,6 months of thioacetazone and isoniazid.The DOTS
strategy promoted by WHO was developed by the International Union Against Tuberculosis and
Lung Disease (IUATLD) together with national tuberculosis programmes. It used a daily
regimen of streptomycin, isoniazid, rifampicin, and pyrazinamide for 2 months followed by 6
months of thioacetazone and isoniazid for patients with newly diagnosed smear positive disease.
This regimen was chosen to reduce theprobability of promoting additional drug resistance in any
patient with organisms already resistant to either isoniazid or rifampicin.During the past decade,
two changes have led to reappraisal of the recommended regimens. First, the emergence of the
epidemic of HIV infection and AIDS contributed to a massive increase in the number of cases of
tuberculosis worldwide. Second, the emergence of rifampicin-resistant organisms has been noted
worldwide.2 To prevent the acquisition of rifampicin resistance, both the IUATLD and WHO
recommend that regimens including rifampicin should be prescribed only if they can be
administered directly so that the drugs are observed to have been swallowed.In addition, HIV-
infected patients are at increased risk of severe, in some cases fatal, dermatological toxic effects
from thioacetazone.5 The danger posed by injections in transmission of HIV has also been
recognised. These factors have resulted in a change in the WHO recommendations; streptomycin
has been replaced with ethambutol in the initial intensive phaseof regimens for patients with
newly diagnosed smear positive disease, and thioacetazone has been replaced with ethambutol in
the continuation phase of the 8-month regimen.However, the 8-month ethambutol regimen had
never been tested against the daily rifampicin-based 6-month regimen, which is known to be
highly effective with relapse rates of 5% or less in many clinical trials.The objectives of this
randomised controlled trial were to assess, in patients with newly diagnosed smear-positive
pulmonary tuberculosis, whether the bacteriological results obtained with the two 8-month
regimens of chemotherapy based on ethambutol and isoniazid are equivalent to those of the 6-
month regimen based on isoniazid and rifampicin. (David Bell, Vicky Leckie, and Mike
McKendrick)

The purpose of this case presentation is for us to discover the process of the problem
identified, how it is being acquired, clinical manifestation which some was being experienced by
our patient and how the environment and the condition of the family relates to the problem. By
doing so, we will be able to know the appropriate nursing care for our patient as well as the
family. This study will help us student to comprehend not only the disease mentioned but also
for the commonalities and differences among other diseases.