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St. Paul University Quezon City
College of Health and Sciences
First Semester A.Y. 2011-2012
Case Study
Pulmonary Tuberculosis Class III

2. Submitted by:
Submitted to:
Ms. Angeline Anastacio
Objectives
General objective:
The purpose of this study is to provide deeper theoretical and practical knowledge and
information about pulmonary tuberculosis class III.
Specific objectives:
 To provide preventive measures on how to prevent tuberculosis.
 To provide a framework of study regarding the subject that can serve as the foundation
of future studies.
 List actual symptoms that can happen during the course of the disease.
Introduction
Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis (M.
tuberculosis). You can get TB by breathing in air droplets from a cough or sneeze of an infected
person. This is called primary TB.
Most people who develop symptoms of a TB infection first became infected in the past.
However, in some cases, the disease may become active within weeks after the primary
infection.
Padaoan, Jesusa A.

3. Classification
Class I (TB exposure)
 (+) exposure
 (-) Mantoux tuberculin test
 (-) Signs and symptoms suggestive of TB
 (-) Chest radiograph
Class II (TB infection)
 (±) exposure
 (+) Mantoux tuberculin test
 (-) Signs and symptoms suggestive of TB
 (-) Chest radiograph
 Class III (TB disease)
o Has three or more of the ff. criteria
 (+) history of exposure to an adult/adolescent with active TB disease
 (+) Mantoux tuberculin test
 (+) signs and symptoms suggestive of TB
 Cough/wheezing > 2 weeks; fever > 2 weeks
 Painless cervical and/or other lymphadenopathy
 Poor weight gain; failure to make a quick return to normal after an infection
(measles, tonsillitis, whooping cough) or failure to respond to approriate
antibiotic therapy (pneumonia, otitis media)
 Abnormal Chest radiograph
 Laboratory findings suggestive of TB (histological, cytological, biochemical,
immunological or molecular)
 Class IV (TB inactive)
o A child/adolescent with or without history of previous TB and any of the ff:
 (±) previous chemotherapy
 (+) radiographic evidence of healed/calcified TB
 (+) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) smear/culture for M. tuberculosis
Symptoms
The primary stage of TB usually doesn't cause symptoms. When symptoms of pulmonary TB
occur, they may include:
 Cough (usually cough up mucus)
 Coughing up blood
 Excessive sweating, especially at night
 Fatigue
 Fever
 Unintentional weight loss

4. Treatment
The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of
active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of
the drugs are continued until lab tests show which medicines work best.
The most commonly used drugs include:
 Isoniazid
 Rifampin
 Pyrazinamide
 Ethambutol
You may need to take many different pills at different times of the day for 6 months or longer.
It is very important that you take the pills the way your health care provider instructed.
When people do not take their TB medications as recommended, the infection becomes much
more difficult to treat. The TB bacteria may become resistant to treatment, and sometimes, the
drugs no longer help treat the infection.
Patient’s Data
Patient’s Name: E.
Age: 54 years old
Gender: Male
Civil Status: Married
Nationality: Filipino
Religion: Roman Catholic
Ward: Isolation Room
Date of Admission: August 10, 2011
Final Diagnosis: Pulmonary Tuberculosis Class III
Nursing Assessment
Family Health History:
According to the patient, there is no history of any diseases in both the father and
mother side.
Past Health History:
Patient E. was admitted last June 2 and was diagnosed with Partial tuberculosis with
Pneumonia and Pulmonary disease. He went home against medical condition after 9 days of
being admitted.
Present Health History:

5. Prior to admission, the patient’s chief complaint was coughing and weight loss. He had a
low grade fever and dry cough.
Immunization record: The patient has a complete immunization record.
Gordon’s Assessment
Health Perception
Before hospitalization: The patient had partial tuberculosis with pneumonia and
pulmonary disease last June 2, 2011. He went home against medical advice after nine days of
seeking medical help. The patient smokes everyday and drinks alcohol almost everyday.
After hospitalization: The patient was brought to the hospital because the patient was
showing signs of dry cough and weight loss.
Interpretation: The patient has a poor health perception because when he was first
admitted in the hospital last June 2, 2011 he went home against medical advice. Going against
medical advice can aggravate the condition of the patient which is what happened to patient E.
Smoking and drinking alcohol can aggravate the patient’s condition.
Nutritional-Metabolic Pattern
Before hospitalization: The patient eats at least three times a day and he usually
prefers vegetables with his meals. He eats his vegetables with a cup and a half of rice. He drinks
at an estimate of 700 ml of water per day.
After hospitalization: The patient eats what the hospital provides for him and the
occasional food brought by his family members. He usually finishes the food served for him. He
drinks at around 1,400 ml of water.
Interpretation: The patient’s nutritional intake is almost the same before and after he
was admitted in the hospital. His fluid intake increased. Patient E should add more protein to
his diet.
Elimination Pattern
Before hospitalization: Patient E defecates at least two times every day. His stool is
usually brown in color (depends on what he ate that day). He urinates at least four times a day
and the color of his urine is from clear to amber yellow (depends on what he drank that day).

6. After hospitalization: The patient still defecates two times a day and his stool color is
still brown. He still urinates at least four times a day but the color of his urine changed to
orange because of his medications.
Interpretation: One of the side effects of TB medications is the change in urine color
which is normal for patient E because he is taking medications for TB.
Exercise-Activity Pattern
Before hospitalization: Patient E still works at the age of 54. He mentioned that he
exercise at least everyday for 15-30 minutes.
After hospitalization: The patient has not gone to work for almost two weeks. He still
manages to exercise by moving his arms around in a circular motion.
Interpretation: The patient is able to move and exercise. His good exercise pattern is
good for his health because blood can easily flow when exercising.
Sleep-rest pattern
Before hospitalization: The patient mentioned that he used to sleep for at least 8 hours
a day. He would be in bed at around 7 pm and he’ll wake up at around 3. He doesn’t take a nap
in the afternoon.
After Hospitalization: The patient is having a difficult time sleeping because nurses
would interrupt his sleep and his not comfortable in the hospital.
Interpretation: The patient has a normal sleeping pattern when before he was
hospitalized. He doesn’t get enough sleep when he was hospitalized which he needs in order to
get better.
Cognitive-Perceptual Pattern
Before hospitalization: Since patient E is the head of the family, he makes the decisions
in his house. He was alert and active and can take action when problems arise.
After hospitalization: The patient understands his situation the reason why he is
seeking medical care and why he needs it. He was alert when I conducted an interview with him
and he is well-oriented.
Interpretation: The patient has a normal mental status. Even though he’s still in the
hospital he can still makes decisions and can cooperate and understand well.

7. Self-Perception Pattern
Before hospitalization: The patient has a positive view of himself. He is contented with
what he has.
After hospitalization: When the patient was confined, he feels insecure of himself
because he doesn’t like getting sick. He sometimes thinks of committing suicide because of his
insecurity.
Interpretation: The patient has a low self-perception at the moment. He feels insecure
because of the illness that he currently has.
Role-Relationship Pattern
Before hospitalization: The patient lives with his wife and four children. He is the head
of the family and he makes decisions for their betterment.
After hospitalization: Patient E’s family members visit him all the time. They take turns
on who will take care of him. They always bring him “pasalubong” like pastries.
Interpretation: The patient has a very supportive family. He has a good relationship with
every member of the family.
Coping/Stress Tolerance
Before hospitalization: Whenever the patient is experiencing stress, he usually sits in a
quiet place and rests and tries to forget all his problems.
After hospitalization: The patient still feels insecure about his illness. He still sits on his
hospital bed and he still tries to forget all his problems.
Interpretation: Patient E is in an emotional state because of his illness.
Sexuality-Reproductive Pattern
Before hospitalization: The patient is married and has four children. The patient has a
normal sexual functioning.
After hospitalization: The patient is unable to make sexual contact with his wife
because of his current illness.

8. Interpretation: The patient is feeling unsatisfied sexually because he hasn’t made sexual
contact with his wife because of his illness.
Value-Belief Pattern
Before hospitalization: Patient E is a Roman Catholic, he also rarely goes to church. But
he mentioned that his faith is only with God and he prays everyday.
After hospitalization: Patient E continues to pray everyday. He even reads the bible
during his alone time in the hospital
Interpretation: Patient E has a strong faith in God.
Physical Assessment
Assessment Findings Interpretation
Appearance and mental
status
Body built, height and weight
Posture and gait, standing,
sitting and walking
Overall hygiene and grooming
Body and breath odor
Well-oriented and not drowsy
Proportional, low weight
Positive limping gait
Clean, neat
No body odor; no breath odor
Normal
Due to excessive coughing
Due to Polio
Normal
Normal
Facial expression No distress noted Normal
Quantity of speech, quality,
and organization
Understandable, moderate
pace; clear tone and
inflection; exhibits thought
Normal

9. association
Temperature
Skin
Skin turgor
Texture
36.8
Skin snaps back after 3-4
Seconds
Smooth
Normal
Normal
Normal
Nails
Fingernail plate shape
Color
Capillary refill
Hair
Distribution
Texture
Convex curature
Pink
Returns to pink when
pressure is released 3-4 sec
Evenly distributed
Smooth and straight
Normal
Normal
Normal
Normal
Normal
Skull and Face
Size, shape and symmetry
Facial feature
Facial movements
Rounded, smooth skull
contour
Symmetric facial feature
Symmetric facial movements
Normal
Normal
Normal
Eyes
Eyelashes
Eyebrows
Eyelids
Equally distributed; curved
slightly outward
Hair evenly distributed
Skin intact; no discoloration
Normal
Normal
Normal

10. Conjunctiva Transparent with light pink
color
Normal
Sclera
Cornea
Pupils
Iris
Ears
White
Transparent, shiny
Brown, constricts briskly
Brown
Normal
Normal
Normal
Normal
Ear Canal opening Free of lesions Normal
Nose
Shape, size, color
Nares
Mouth
Lips
Gums
Smooth, symmetric with same
color as the face
Oval, symmetric
Pink, moist, symmetric
Slightly red in color, moist and
slightly loose fit against each
tooth
Normal
Normal
Normal
Due to smoking
Tongue
Teeth
Moist, slightly rough on dorsal
surface medium or dull red
Shiny and yellow of enamel
Normal
Due to smoking habits.

11. Neck
Symmetric, muscles,
alignment of trachea
Neck rolls
Neck, slightly hyper extended,
without masses or asymmetry
Neck moves free without
discomfort
Normal
Normal
Thyroid gland
Trachea
Thorax and Lungs
Neck moves freely without
discomfort
Rises freely with swallowing
Normal
Normal
Shape and symmetry of the
thorax
Spinal alignment
Breathing patterns
Chest symmetric
Spine vertically aligned
Adventitious breath sounds
(crackles)
Normal
Normal
Due to pulmonary tuberculosis
Abdomen
Skin integrity
Symmetry
Palpation of the abdomen
Bladder
Unblemished skin, uniform
color
Rounded
No tenderness
Not palpable
Normal
Normal
Normal
Normal

12. Upper extremities (right and
left)
Radial pulse
Skin integrity
Equal pulsation
Intact condition of the skin in
the right arm, with no bruises
at the mid-arm on both arms,
no presence of edema on the
left arm
Normal
Normal
Lower extremities(right and
left)
Symmetry
Skin integrity
Skin color
Bilaterally symmetrical and
equal
Right and left legs to feet with
no presence of edema, no
lesions
Same as the other part of the
body
Normal
Normal
Normal
Anatomy and Physiology
The Respiratory System

13. Overview
Cells in the body require oxygen to survive. Vital functions of the body are carried out as the
body is continuously supplied with oxygen. Without therespiratory systemexchange of gases in
the alveoli will not be made possible and systemic distribution of oxygen will not be made
possible. The transportation of oxygen in the different parts of the body is accomplished by the
blood of the cardiovascular system. However, it is the respiratory system that carries in oxygen
to the body and transports oxygen from the tissue cells to the blood. Thus, cardiovascular
system and respiratory system works hand in hand with each other. A problem in the
cardiovascular system would affect the other and vice versa.
Functional Anatomy of the Respiratory System
Nose
The nose is the only external part of the respiratory system and is the part where the air passes
through. During inhalation and exhalation, air enters the nose by passing through the external
nares or nostrils. Nasal cavity is found inside the nose and is divided by a nasal septum. The
receptors for the sense of smell, olfactory receptors are found in the mucosa of the slit-like
superior part of the nasal cavity which is located beneath the ethmoid bone. Respiratory
mucosa lines the rest of the nasal cavity and rests on a rich network of thin-walled veins that
warms the air passing by.
Pharynx
The pharynx is a 13 cm long muscular tube that is commonly called the throat. This muscular
passageway serves as a common food and air pathway. This structure is continuous with the
nasal cavity anteriorly via the internal nares.
Parts of pharynx:

14. 1. Nasopharynx – the superior portion of the pharynx. The pharyngotympanic tubes that drain
the middle ear open in this area. This is the main reason why children who have otitis media
may follow a sore throat or other tyoes of pharyngeal infections since the two mucosae of
these regions are continuous.
2. Oropharynx – middle part
3. Laryngopharynx – part of pharynx that enters the larynx.
When food enters the oral cavity, it travels to the oropharynx and laryngopharynx. However,
instead of entering the larynx, the food is directed into the esophagus and not to the larynx.
Tonsils – clusters of lymphatic tissues found in the pharynx.
Larynx
The larynx is the one that routes the air and food into their proper channels. Also termed as the
voice box, it plays an important role in speech.
Glottis – the slit-like passageway between the vocal folds.
Trachea
Also called the windpipe, the trachea is about 10 to 12 cm long or about 4 incheas and travels
dwon from the larynx to the fifth thoracic vertebra. This structure is reinforced with C-shaped
rings of hyaline cartilage and these rings are very important for the following purposes:
1. The open parts of the rings abut the esophagus that allows the structure to expand
anteriorly when a person swallows a large size of food.
2. The solid portions of the C-rings are supporting the walls of the trachea to keep it patent or
open even though pressure changes during breathing.
The trachea is lined with ciliated mucosa that primarily serves for this purpose: To propel
mucus loaded with dust particles and other debris away from the lungs towards the throat
where it can either be swallowed or spat out.
Main Bronchi
The main bronchi, both the right and the left, are both formed by tracheal divisions. There is a
slight difference between the right and left main bronchi. The right one is wider, shorter and
straighter than the left. This is the most common site for an inhaled foreign object to become
lodged. When air reaches the bronchi, it is already warmed, cleansed of most impurities and
well humidified.
Lungs
The lungs are fairly large organs that occupy the most of the thoracic cavity. The most central
part of the thoracic cavity, the mediastinum, is not occupied by the lungs as this area houses
the heart.
Apex – the narrow superior portion of each lung and is located just below the clavicle
Base – the resting area of the lung. This is a broad lung area that rests on the diaphragm.
Divisions of the Lungs
The lungs are divided into lobes by the presence of fissures. The left lung has two lobes while
the right lung has three.
Pleural Layers
Visceral pleura – also termed as the pulmonary pleura and covers each surface of the lings.
Parietal pleura – covers the walls of the thoracic cavity.
Pleural fluid – a slippery serous secretion that allows the lungs to slide along over the thorax
wall during breathing movements and causes the two pleural layers to cling together.

15. Bronchioles – smallest air-conducting passageways.
Bronchial tree or respiratory tree – a network formed due to the branching and rebranching of
the respiratory passageways within the lungs.
Alveoli – air sacs. This is the only area where exchange of gases takes place. Millions of
clustered alveoli resembles bunches of grapes and these structures make up the bulk of the
lungs.
Respiratory Zone – this part includes the respiratory bronchioles, alveolar ducts, alveolar sacs,
alveoli.
Physiology of Respiration
The respiratory primarily supplies oxygen to the body and disposes of carbon dioxide through
exhalation. Four events chronologically occur, for respiration to take place.
1. Pulmonary ventilation – this process is commonly termed as breathing. With pulmonary
ventilation, air must move out into and out of the lungs so that the alveoli of the lungs are
continuously drained and filled with air.
2. External respiration – this is the exchange of gases or the loading of oxygen and the
unloading of carbon dioxide between the pulmonary blood and alveoli.
3. Respiratory gas transport – this is the process where the oxygen and carbon dioxide is
transported to the and from the lungs and tissue cells of the body through the bloodstream.
4. Internal respiration – in internal respiration the exchange of gases is taking place between
the blood and tissue cells.
Mechanics of Breathing
Breathing, also called pulmonary ventilation is a mechanical process that completely depends
on the volume changes occurring in the thoracic cavity. Thus, a when volume changes pressure
also changes, and this would lead to the flow of gases equalizing with the pressure.
Inspiration – also called inhalation. This is the act of allowing air to enter the body. Air is
flowing into the lungs with this process. Inspiratory muscles are involved with inspiration which
includes:
1. The diaphragm
2. External intercostals
These muscles contract when air is flowing in and thoracic cavity increases. When the
diaphragm contracts it slides inferiorly and is depressed. As a result the thoracic cavity
increases. The contraction of the external intercostal muscles lifts the rib cage and thrusts the
sternum forward. This increases the anteroposterior and lateral dimensions of the thorax.
Expiration – also called expiration. It the process of breathing out air as it leaves the lungs. This
process causes the gases to flow out to equalize the pressure inside and outside the lungs.
Under normal circumstances, the process of expiration is effortless.
Laboratory Results
Blood Chemistry
Result Reference Interpretation
Glucose 5.02 3.85-6.4 mmol/L Normal
BUN 3.78 2.86-7.20 mmol/L Normal

16. Creatinin 108.4 80-115 umol/L Normal
Uric Acid 232.1 M – 210-420 umol/L
T – 150-350 umol/L
Normal
Normal
Triglycerides 0.95 0.0-2.30 mmol/L Normal
Total Cholesterol 4.52 0.0-5.20 mmol/L Normal
HDL 2.52 0.78-2.21 mmol/L HDL-cholesterol is
“good” cholesterol,
in that risk of
cardiovascular
disease decreases
with increase of
HDL.
LDL 1.81 2.5-4.5 mmol/L Low levelsare seenin
depression,
malnutrition,liver
insufficiency,
malignancies,anemia
and infection.
VLDL 0.19 0.0-0.46 mmol Normal
SGOT 24.66 0-35 u/L Normal
SGPT 11.0 0-42 u/L Normal
Radiographic Findings
FF- up study since 02 June 11 shows both lungs are still hyper aerated, progression of
the previous varisized thin walled cystic lucencies are seen in the entire left lung, right upper to
midlungs.
The tracheal air column is tracted to the right.
Heart is not enlarged
Aorta is not dilated
Diaphragm & Left sular are intact
The rest of the visualized chest structures are unremarkable.

17. Interpretation:
Hyperaerated lungs mean that lung area is less dense than normal. This may be indicative of COPD if
it includes a flattened diaphragm. This is because with COPD the airways collapse thus trapping air
behind them causing the lungs then to dilate, become hyperinflated.
Urinalysis
Interpretation
Color: Yellow Normal
Transparency: Clear Normal
Specific Gravity:1.015 Normal
Reaction to:
Albumin: (-)
Sugar: (-)
Normal
Normal
RBC: 0-2/hpf Normal
WBC:0-2/hpf Normal
Urates: fair Normal
Epithelial Cells: fair Normal
Hematology
Interpretation
Hemoglobin
No. Of conc. 107g/L Normal
Hematorcrit – 34X10/L Normal
Leukocytes – 9.7X10/L Normal
Thrombocytes – 298X10L Normal
Neutrophils- 0.76 (0.55-0.65) An increased percentage of neutrophils may
be due to:
 Acute infection
 Acute stress
 Eclampsia
 Gout
 Myelocytic leukemia
 Rheumatoid arthritis
 Rheumatic fever
 Thyroiditis
 Trauma
Lymphocytes - ) 0.24 (0.25-0.35) A decreased percentage of lymphocytes may
be due to:
 Chemotherapy
 HIV infection
 Leukemia

18.  Radiation therapy or exposure
 Sepsis
Pathophysiology
Pulmonary Tuberculosis
PredisposingFactors: PrecipitatingFactors:
 Age
 Life style - Occupation (e.g Health Workers)
 Immunosuppression - Repeated closecontactw/
infected persons
o Prolonged corticosteroid therapy - Indefinitesubstanceabusevia IV
 Systemic Infection: - recurrence of infection
o Diabetes Mellitus
o End-stage Renal Disease
o HIV or AIDS infection
Exposure or inhalation of infected
Aerosol through droplet nuclei
(exposure to infected clients by coughing,
sneezing, talking)
Tubercle bacilli invasion in the apices of the
Lungs or near the pleurae of the lower lobes
Bronchopneumonia develops in the lung tissue
(Phagocytosed tubercle bacilli are ingested by macrophages)
 bacterial cell wall binds with macrophages
 arrest of a phagosome which results to bacilli replication
Necrotic Degeneration occurs
(production of cavities filled with cheese-like
mass of tubercle bacilli, dead WBCs, necrotic lung tissue)

19. drainage of necrotic materials into the
tracheobronchial tree
(eruption of coughing, formation of lesions)
PRIMARY INFECTION
Lesions may calcify (Ghon’s Complex)
and form scars and may heal
over a period of time
Tubercle bacilli immunity develops
(2 to 6 weeks after infection)
(maintains in the body as long as living
bacilli remains in the body)
Acquired immunity leads to further growth
Of bacilli and development of ACTIVE INFECTION
SIGNS AND SYMPTOMS
Pulmonary Symptoms: General Symptoms:
 Dyspnea - Fatigue
 Non-productive or productive cough - anorexia
 Hemoptysis (blood tinge sputum) - Weight loss
 Chest pain that may be pleuritic or dull - low grade fever with
chillsand
 Chest tightness sweats (often at night)
 Crackles may be present on auscultation
With Medical Intervention Without Medical intervention

20.  Early detection/ diagnosisof the dse Reactivation of the tubercle bacilli
 Multi-antibacterial therapy (Due to repeated exposure to
infected
 Fixed- dose therapy Individuals,Immunosuppression)
 TB DOTS (Direct Observed Therapy) SECONDARY INFECTION
 BCG vaccination
Severe occurrenceof lesions in the
lungs
No Recurrence Recurrence
Cavitation in the lungs occurs
Good Prognosis Bad Prognosis
Active infection is spread throughout
the body systems
(infiltration of tubercle bacilli in other
organs)
 TB of the Bones
 Pott’s Disease
 Renal TB
SEVERE OCCURRENCE OF INFECTION
Clientbecomes clinically ill
BAD PROGNOSIS
DEATH
Drug Study
Drug Indication Contraindication Nursing
Responsibilities
1.INH 15 + RIF 15+
PZA 400+ Ethambutol
(2 tabs OD before
breakfast)
-Adjunctive treatment
for tuberculosis when
primary and
secondary anti
-Contraindicated to
patients
hypersensitive to
drug an in those with
-instruct the patients
to take drug as
prescribed, exactly as
directed, even after

21. 2.Ferrous Sulfide (2
tabs OD pre-
breakfast)
3.Paracetamol
500mg/tab (q4 PRN
for fever T>= 37.8C)
4.Multi-vitamins
(Appebon) 1 tab OD
after breakfast
tuberculotic can’t be
used or have failed.
-For patients with iron
deficiency anemia
- Mild pain or fever
- Treatment and
prevention of vitamin
deficiencies.
severe hepatic
disease or acute gout.
- Contraindicated to
patients who are
receiving blood
transfusion and
anemia not due to
iron deficiency.
- Contraindicated to
patients with
hypersensitivity to
drugs.
-Patient who are
hypersensitive to the
drug.
feeling better
-tell patient that drug
may cause orange
brown stain in the
urine, feces, sputum
and saliva.
-Advise client to take
the medication 30
minutes before
breakfast.
-Advise client that
drug is best taken on
an empty stomach.
-Use cautiously when
using in long term
basis.
-GI upset may be
related to dose.
-Use cautiously in
patients with chronic
alcohol use.
-Use liquid form for
children and patients
who have difficulty in
swallowing.
-May produce false
positive reading in
glucose blood levels
-Assess patient’s signs
of nutrition deficiency
-instruct to notify
physician if side effect
occurs
-Encourage to comply
with the medications.

22. 5.Heraclene (at
bedtime)
- poor appetite in
infant, children &
adult, adjuvant to
treatment of TB &
other chronic
ailments,
convalescence from
acute infection or
surgery, faulty
nutrition in older
people.
-Contraindicated to
patients that is
hypersensitive to
drugs.
- May
Administer drug with
regards to meal.
Nursing Care Plan
Assessment Diagnosis Inference Planning Implementation Rationale Evaluation
Subjective:
The patient
verbalized,
“Ubo ako ng
ubo pero
wala
naming
plemang
lumalabas.”
Objective:
-Crackles
heard upon
auscultation
.
-has wide
shallow
eyes.
Ineffective
airway
clearance
related to
retained
secretions
secondary
to bacterial
infection as
evidenced
by crackles
heard upon
auscultation
.
Bacterial
infection of
the
respiratory
system.
Inflammato
ry response
Retained
secretions
in the
respiratory
tract.
After 8
hours of
nursing
interventio
n, the
patient will
be able to
maintain a
patent
airway
through
the
mobilizatio
n of
secretions
as
evidenced
by
productive
cough
-CheckVital signs
-Monitor
respirationsand
breathsounds.
-Encourage deep
breathingand
coughing
exercises.
-Increase fluid
intake.
-Support
reductionor
-Baseline
data
-May
indicate
respiratory
distress or
accumulati
on of
secretions
-to
maximize
breathing
effort.
-Hydration
can help
liquefy
viscous
secretions.
And
improve
secretion
clearance.
-to
improve
lung
After 8
hours of
nursing
interventio
n, the
patient
was able to
maintain
an
effective
airway
clearance
as
evidenced
by
expectorati
on of
yellow
secretions.

23. cessationof
smoking.
-Auscultate
breathsounds
function.
-To
ascertain
status and
note
progress.
Assessment Diagnosis Inference Planning Implementation Rationale Evaluation
Subjective:
“Nagtataka
lang ako kung
bakit ang
payat ko
kahit ang
lakas ko
kumain.” As
verbalized by
the patient.
Objective:
-Weight:
46kg
-Appears
weak
-Minimal
subcutaneou
s fat.
Imbalanced
Nutrition:
Less than
Body
Requirement
s related to
inability to
ingest food
because of
prolonged
cough as
evidenced by
decreased
BMI.
Pulmonary
Tuberculosis
Causes dry
cough
Body obtains
energy in a
form of
protein,
calories and
fat.
Weight loss
After 8
hours of
nursing
intervent
ion, the
patient
will be
able to
demonstr
ate
progressi
ve weight
gain
toward
goal.
-Assess weight
-Evaluate total
food intake
-Use flavouring
agents
-Encourage
small, frequent
meals, with
foods high in
protein and
carbohydrates.
-Baseline
data
-Changes
could be
made in
the
client’s
diet.
-To
enhance
food
satisfacti
on.
-
Maximize
s nutrient
intake
without
undue
energy
expendit
ure from
eating
large
After 8
hours of
nursing
interventio
n, the
patient
was able
demonstra
te
progressive
weight gain
toward
goal.

24. -Weigh regularly
meals.
-To
monitor
effective
ness of
efforts.
Assessment Diagnosis Inference Planning Implementation Rationale Evaluation
Subjective:
“Madals
akong
umiinom at
nag-yoyosi
ako.”As
verbalized
by the
patient
Objective:
-Yellow-
stained
teeth
-Gums are
slightly red
-Slightly
loose gums.
Ineffective
health
maintenan
ce related
to inability
to make
appropriat
e
judgments
as
evidenced
by
smoking.
Smoking
and alcohol
abuse
Vasoconstri
ction of the
veins
Accumulatio
n of
secretions
After 8
hours of
nursing
interventio
n, the
patient will
be able to
(plan)
adopt
lifestyle
changes.
-Evaluate for
substance use
-Discuss with
client beliefs
about health and
reasons for not
following
prescribed plan
of care.
-Develop a plan
for self care
-Provide
participatory
guidance
-Help client plan
realistic goals
-To note
ability to
self help
-Determine
client’s
view about
current
situation
and
potential
for change.
-Ability to
adapt and
organize
care
activities.
-To
maintain
and
manage
effective
health
practices.
-For future
reference/r
After 8
hours of
nursing
interventio
n, the
patient
was able to
(plan)
adopt
lifestyle
changes.

25. evision as
appropriat
e.
Problem List
1. Ineffective airway clearance related to retained secretions in the respiratory tract
secondary to bacterial infection as evidenced by crackles upon auscultation
2. Imbalanced Nutrition: Less than Body Requirements related to inability to ingest food
because of prolonged cough as evidenced by decreased BMI.
3. Ineffective health maintenance related to inability to make appropriate judgments as
evidenced by smoking.
Discharge Planning
 Continue Taking the Anti-TB drugs.
 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
 Follow faithfully the regimen for tuberculosis, especially the medications. Have
a regular sputum test, as ordered by the doctor
 You should practice hand washing regularly. Always cover the mouth and the
nose when exposed to person who coughs or sneezes. You should not spit
anywhere, instead spit in a single container to prevent transfer of M.
Tuberculosis.
 Always have a regular check up at your nearest health center, at least once a
week to monitor the progress of the treatment. The client should report
immediately to the physician if there is difficulty of breathing, there is
productive cough more than 5 days and there is chest pain and experiencing
fatigue
 The diet should be high caloric. Always drink a lot of water. Also eat fruits and
vegetables. Don’t escape meals. If there are any food supplements available,
consult it with the doctor. Eat vitamin c rich food to strengthen immune
systems.
 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 people around you.
Recommendation
The patient should stop smoking and drinking alcohol because it will only aggravate his
condition.

26. Reference:
http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
http://www.slideshare.net/crisbertc/pulmonary-tuberculosis-1062451
http://nursingcrib.com/anatomy-and-physiology/anatomy-and-physiology-of-respiratory-
system/
http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm
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