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Department of Health
Center for Health Development No.3
DR. PAULINO J. GARCIA MEMORIAL RESEARCH AND MEDICAL CENTER
Cabanatuan City
NURSING DEPARTMENT
CASE STUDY ON MILIARY TUBERCULOSIS

2. SUBMITTED BY:
RN HEALS IV
BERNARDEZ, DAWNERY JUANE
SANDOVAL, VHIRONICA
SANTIAGO, MICKEL
SANTA CRUZ, SHERWIN
I. Introduction
A. Background of the study
This whole case study is about to discussed Pulmonary Tuberculosis (TB). This case will
tackle about the disease, patient’s health and of course nursing intervention.
Miliary Tuberculosis (abbreviated TB for tubercle bacillus or Tuberculosis) is a common
and often deadly infectious disease caused by mycobacteria, in humans mainly Mycobacterium
tuberculosis. Tuberculosis usually attacks the lungs (as pulmonary TB) but can also affect the
central nervous system, the lymphatic system, the circulatory system, the genitourinary system,

3. the gastrointestinal system, bones, joints, and even the skin. Other mycobacteria such as
Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium
microti also cause tuberculosis, but these species are less common in humans.
Tuberculosis is spread through the air, when people who have the disease cough,
sneeze, or spit. Most infections in human beings will result in asymptomatic, latent infection,
and about one in ten latent infections will eventually progress to active disease, which, if left
untreated, kills more than half of its victims. The classic symptoms of tuberculosis are a chronic
cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs
causes a wide range of symptoms.
Demographic incidence
Tuberculosis (TB) is a deadly disease. It is the world’s No. 1 cause of death around the
world; about 3 million persons die of TB every year. It is one of the 10 top killer diseases in the
Philippines; 75 Filipinos die of TB every day.
B. Objective
General
The general objective of this case study is to broaden our knowledge about the disease
and develop skills on how to render the best possible care to a patient suffering from
Pulmonary Tuberculosis.
Specific
☺ To be able to define Tuberculosis as well as on how it is acquired, factors, signs and
symptoms.

4. ☺ To be able to know the pathophysiology of Tuberculosis.
☺ To be able to know the other problems that the client is suffering right now.
☺ To gain more information about patient’s condition.
☺ To apply skills learned to actual handling and caring of a patient who suffered from
Tuberculosis.
☺ To determine the possible nursing intervention that will be a great help in patient’s
prognosis.
☺ To be able to give the appropriate health teaching and better understanding of the
disease to the patient, family and significant others.
C. Scope and delimitation
The scope of this study will focus on Miliary Tuberculosis. The study covers the background
of the disease, the anatomy, pathology, mode of transmission, pathophysiology and as well as
its complications.
All information needed to come up with this case study was taken from patient, patient’s
family (mother and sister), patient’s chart, laboratory result, physical assessment, books and
internet.
D. Theoretical Framework
“FLORENCE NIGHTINGALE ENVIRONMENTAL THEORY”
ENVIRO
NMENT MR.
ADL
VentilationNutrition
Air

5. Florence Nightingale was born to a wealthy and intellectual family. She was known as
the Lady with the Lamp. She believed she was “called by God to help others … to improve the
well being of mankind”
Nightingale is viewed as the mother of modern nursing. She synthesized information
gathered in many of her life experiences to assist her in the development of modern nursing.
Her contribution to the nursing profession was her “Environmental Theory” in which the
nurse’s role is to place the client in the best position for nature to act upon him, thus
encouraging healing.
Nightingale viewed the manipulation of the physical environment as a major component
of nursing care. She identified ventilation and warmth, light, noise, variety, bed and bedding,
cleanliness of the rooms and walls, and nutrition as major areas of the environment the nurse
could control. When one or more aspects of the environment are out of balance, the client
must use increased energy to counter the environmental stress. These stresses drain the client
of energy needed for healing. These aspects of physical environment are also influenced by the
social and psychological environment of the individual.
II. Clinical summary
A. General data
Name: Mr. ADL
Age: 9 years old
BeddingCleanliness
Light

6. Religion: Roman Catholic
Civil Status: Single
Nationality: Filipino
Ethnic Group: Aeta
Admitting Diagnosis: Miliary Tuberculosis secondary to Malnutrition
Sources of Information: Patient, Patient chart and the Significant Others (Mother and
the sister)
Reliability: 90% Reliable
B. Chief complaint
The patient complained of difficulty of breathing.
C. History of present illness
The information that I gathered are second hand as they came from the patient mother
and sister. Due to unknown reason, the patient refused to be interviewed even though
based on my observation; he has a capability to answer my questions.
Last two months, the family observed Mr. ADL is loosing weight and decrease of
appetite but instead of eating foods he his more on vices. Then his condition became
worsened according to family’s observation.
A month prior to admission, the patient condition became more at it worst and his
cough became productive with intermittent spots of blood in the sputum upon coughing.
He also starting to have night sweat started becoming sluggish and spending lots of time
sleeping. He was advice by the family to have a check-up and visit the nearest hospital or
clinic but he refuse everything that his family’s concerned, as verbalized by Mr. ADL’s sister.

7. Based on the statement of his mother, two days prior to admission Mr. ADL experience
body weakness, fatigue, and on the day of admission last April 21, 2013 in Dr. PJGMRMC,
suddenly he was complaining of difficulty of breathing, one hour after he ate his lunch.
D. Past medical history
Referring to the statements made by his sister, Mr. ADL was diagnosed with Miliary
Tuberculosis last 2012, 1 year ago. He entered a rehabilitation program sponsored by the
local government in Nueva Ecija that will provide the beneficiates with 100% coverage on
the six months duration in curing the disease. The six months duration in curing the disease
became successful, he was cured by the medication given by the sponsored but due to poor
nutritional intake and unsanitary environment the disease from the past became active
again.
E. Familial history
Two of his uncle died from respiratory diseases, one is from Tuberculosis and another is
from lung cancer. His sister also said that it was Mr. ADL twice to be confined in a hospital
with a serious condition.
F. Psychosocial health
1. Psychosocial Health
a. Coping Pattern
Patient used silence; he is making an observation to the student nurse who is assigned
to him.

8. b. Interaction Pattern
The patient ignores my kind interview due to unknown reasons but he cooperated when
I obtain Vital Signs, afternoon care, giving medications, and physical assessment.
c. Cognitive Pattern
According to the mother, Mr. ADL knows already his condition because he already
suffered it before, last 2012, 1 year ago. But this time it is more complicated.
d. Self Concept
In my observation, the patient looks shy. He just mind his own self maybe because he is
still in pain.
e. Emotional Pattern
The patient looks sad and weak maybe because of the pain that he is experiencing right
now and the disease that he is suffering.
2. Socio-Cultural Health
a. Cultural Pattern
The patient was evidently proud of his ethnicity during their family’s conversation.
b. Recreation Pattern
Mr. ADL plays basketball with his friends; this is good for recreation. He also has a good
voice, according to his sister.
3. Spiritual Health
a. Religious Beliefs

9. Mr. ADL is a Roman Catholic, sometimes he visit the church, one ride of jeep from their
house, twice a month.
b. Values and valuing
Mr. ADL is close to his mother. He lives with his mother from the time he was born to
the time he is where right now. All good values that he has was educated by his mother
but during his adolescence stage he became abusive in his body, he became active with
many kinds of vices that are influenced by his friends, these is the reason why he got the
disease Tuberculosis.
G. Review of system
The data gathered are all coming from the mother as it was the patient subjective
complaint.
SYSTEM
General Generalized body weakness
Skin Dry
Head
Eyes & Ears
Nose Runny nose, with discharges
Throat & Mouth Dry mouth
Neck
Breast
Respiratory Difficulty of breathing, dyspnea upon exertion.
Cough
CVS Dyspnea upon exertion and chest pain
GIT Constipated at times, defecate every other
day.
GUT
Extremities Joint pain
Neurologic Weakness
Hematologic
Endocrine Excessive night sweating
Psychiatric Depression, Ignores kind interview

10. H. Physical assessment
a. General appearance/survey:
Patient appeared weak looking but was somehow coherent in a high fowlers position.
Mr. ADL ignores my kind interview but he is willing to cooperate when it comes in taking vital
signs, physical assessment and giving medication which is important. The patient’s skin was dry
especially on the lower extremities. IVF of D5NM 500 was attached to his right hand.
b. Measurement
FIDINGS NORMAL VALUES ANALYSIS/
INTERPRETATION
(Ht, wt) Height: 3’5”
Weight: 25 lbs
BMI BMI below normal as a result
of malnutrition
Vital Signs Temp: 37.50 C
PR: 90 bpm
RR: 35 bpm
BP: 90/60 mmHg
Temp: 37 C
PR: 60-100 bpm
RR: 16-20 bpm
BP: 120/80 mmHg
With some abnormal
findings in the respiratory
rate.
Increase RR; difficulty of
breathing (decrease Oxygen
supply in the body)
c. Head to toe Assessment
BODY PARTS NORMAL
FINDINGS
ACTUAL
FINDINGS
ANALYSIS/
INTERPRETATION
A. HEAD
a. Skull Rounded
(normocephalic,
with frontal,
parietal and
occipital
prominences)
Normocephalic Normal findings

11. b. Hair
c. Face
d. Eye/vision
4.1 Eyeball
4.2 Lid margins
4.3 Conjunctiva
4.4 Sclera
4.5 Pupils
4.6 Eyebrow, lashes, color,
Evenly
distributed; thick
hair; silky resilient
hair; no
infestation or
infection; variable
amount of body
hair
Symmetric facial
features,
palpebral fissures
equal in size,
symmetric
nasolabial folds
Shape is round;
size equal
Protects eyes,
anteriorly meet at
the medial and
lateral corners of
eye.
Delicate
membrane;
covers part of the
outer surface of
the eyeball
Outermost tunic,
thick white
connective tissue.
Pupils constrict
when looking at
near objects,
pupils converge
when object is
moved towards
the nose
Hair evenly
Evenly
distributed
Symmetric
facial features
Round,
uniform in size
Close
symmetrical
Smooth and
pale
Appears white
Normal pupil
constriction
Hair evenly
Typical hair type of
men
Normal findings
Normal findings
Normal findings
Undernourished,
lack of vitamins
Normal findings
Normal findings
Normal findings

12. symmetry, quality of hair,
placement
4.7 Eye movement in all directions
distributed, intact
skin
Equal movement
distributed,
intact skin
Equal
movement
Normal findings
B. VISION TESTING
a. Visual field
b. Visual acuity
When looking
straight ahead
clients can see
objects in
periphery
Able to read
newspaper
Client can see
from his
periphery
Able to read
newspaper
Normal peripheral
vision
Normal visual
findings
C. EARS
a. Pinna
b. External canal
c. Hearing acuity
Same color as
facial skin, pinna
recoils after it is
folded
Dry ear wax
grayish-tan color
or sticky wet
cerumen in
various shades of
brown/ pearly
gray color;
semitransparent
Responds to
moderately loud
voice tone
Same color as
facial skin,
pinna recoils
after it is
folded
Wet and
sticking
cerumen with
transparent
color
Responds to
moderately
loud voice
tone
Normal ear features
Normal findings
Normal findings
D. NOSE Symmetric,
normal breathing,
able to identify
familiar smell
No deformity,
(+) difficulty of
breathing.
With runny
nose
(+) dyspnea, patient
have cough which
reflex is not the only
way to protect our
airways which
causes patient to
have runny nose.
E. MOUTH/LIPS
a. Gums Pink gums; moist
firm texture
Dark gums Gums darkened due
to smoking history

13. b. Teeth
c. Tongue
d. Palate-hard/soft
e. Oropharynx/ Tonsil
32 adult teeth
smooth, white
yellowish shiny
tooth enamel
Central position,
pale in color
Pink and smooth;
freely movable
Pink and smooth
posterior wall
Yellowish with
few cavities
and some
missing teeth
Central
position, pale
in color
Pale in color
Pale posterior
wall
Needs dental work
No remarkable
findings
No remarkable
findings
No remarkable
findings
F. CHEECKS Hollow in
appearance
Indicates
malnutrition, due to
weight loss
G. NECK Lymph nodes
freely movable
Lymph nodes
freely movable
Normal findings
H. CHEST
a. Anterior
b. Posterior
I. HEART
J. BREAST
Quiet rhythmic
and effortless
respirations; full
symmetric
excursions
Full and
symmetric
(+) difficulty of
breathing,
with abnormal
sound in the
right lower
lobe
Localized pain
around
thoracostomy
site.
Full and
symmetric
Presence of crackles
caused by fluid often
associated with
inflammation or
infection of the
alveoli.
Indicates respiratory
problems such us
TB,
Pneumohydrothorax
No air leak on
drainage system:
manageable incision
pain.
Normal findings
K. ABDOMEN Flat, rounded
(convex) or
scaphoids
Distended,
scaphoidal in
shape
Client is not well
nourished.
It is also due to
weight loss.
L. UPPER EXTREMETIES Equal in size on Equal in size Client is not well

14. both sides of the
body; no muscle
atrophy; normally
firm; smooth
coordinated
movements
but muscular
atrophy
evident.
nourished
M. LOWER EXTREMETIES Equal in sixe on
both sides of the
body; no muscle
atrophy; normally
firm; smooth
coordinated
movements
With muscular
atrophy
evident.
Client is not well
nourished
Weakness hinder
client from actively
moving around.
I. Activities of daily living
Before
Hospitalization
During
Hospitalization
Analysis/
Interpretation
a. Fluid &
Nutrition
b. Elimination
Skipping meals most
of the time, according
to the significant
others.
His fluid preferences
are water, softdrinks.
Mr. ADL drinks 3-4
glass of water a day.
He is more on bread
in the morning;
vegetables and fish
most of their meals.
Mr. ADL usually voids
large amount of
urine, 5-7 x a day.
Moderate decrease of
the appetite; can
consume about ½ of
the foods given.
Diet as tolerated was
advised to Mr. ADL
Usually voids 2-4
times a day.
Due to medication
given as side effects
such as; Combivent
and Rifampicin, there
is a decrease of
appetite.
The pt was trained to
take DAT diet to
sustain his nutritional
needs.

15. c. Hygiene &
Comfort
d. Rest & Sleep
Defecates at least
once a day.
The patient takes a
bath once a day and
brushes his teeth
twice a day.
The patient sleeps
more or less than 5
hours a day.
Mr. ADL defecates
every other day.
Restricted on bed; the
patient can’t take a
bath due to weakness
All hygienic activities
are assisted by SO.
The patient sleeps
irregularly. 30
minutes of sleeps
then awake again.
There is a decrease
bowel movement due
to decrease appetite.
Dependence related
to restricted mobility
due to weakness
Due to inadequate
rest the patient may
have decrease body
resistance.
J. Laboratory / Diagnostic Exam
a. Hematology report April 21, 2013
Test Results Normal Value Analysis
Hemoglobin 110 g/L 140 – 170 g/L Decrease
Insufficient oxygen
circulating in the
bloodstream.
Indicates Anemia due
to malnutrition.
Hematocrit 0.33 0.40 – 0.50 Decrease
Insufficient oxygen
circulating in the
bloodstream.
Indicates Anemia due
to malnutrition.
WBC 15.2 x 10 5.0 – 10.0 x 10 Increase
Leukocytosis
Indicates infection
Neutrophils 0.78 0.45 – 0.65 Increase
Acute bacterial
infection
Lymphocytes 0.21 0.25 – 0.40 Decrease
low absolutely
lymphocyte

16. concentration,
associated with
increase rates of
infection
Monocytes 0.01 0.02 – 0.06 Decrease
Depleted in
overwhelming
bacterial infection
Platelets 320 150 - 450 Normal
b. Chest X-ray April 21, 2013
Impression: Miliary Tuberculosis
c.Urinalysis April 21, 2013
Color: Yellow
Transparency: S/I Fubid
Chemical Strips
Reaction: 5.2
Specific Gravity: 1.025 (above normal) – dehydration and
contamination
Albumin: Trace
Microscopic
WBC 8-12
RBC 1-3
Epithelial Cells Rare
Mucus treads Moderate
Amorphous Urates Plenty

17. c. Urinalysis April 22, 2013
Color: Yellowish brown
Consistency: Soft
Microscopic: No Ova, parasite seen
WBC 4-8
RBC 0-1
Bacteria Plenty – bacterial infection
d. Radiological Report April 23, 2013
Impression: Miliary Tuberculosis
N. Course in the ward
Date/Time Focus Data, Action, Response
April 21, 2013 2pm
7pm
Admission Admitted a 9 years old male accompanied by
relatives with a complained of difficulty of
breathing.
Vital signs are taken and recorded with a BP: 90/60
mmHg, HR: 81 bpm, RR: 35 bpm
Seen and examined by Dra. Olay
Consent signed and secured
IVF of D5NM 500 inserted and regulated with 31
gtts/min
Laboratory requested
To radiology department on the way to pedia ward
accompanied by undersigned
Endorsed

18. 7:30pm
8pm
11pm
Post transfer
Elevated body
temperature
In from ER per wheelchair cuddled by mother with
an IVF of D5NM @ 400ml level
Conscious and coherent
Vital signs are taken and recorded with blood
pressure of 90/60 mmHg
D febrile 38.5
A : tepid sponge bath done
R : temperature subsided to 37.5
NPO was advice
Endorsed
11pm
7 am
Received on bed with an IVF @ 300cc level
Vital signs taken and recorded BP: 90/60 mmHg,
PR: 90 bpm, RR: 29 bpm Temperature: 36.6 C
With abnormal RR: 29 bpm
Diet as tolerated maintained
Due medication given and recorded
Cefuroxime 100mg TIV after negative skin test
Rifampicin 1 tablet before dinner
Vital signs recheck with no significance finding
Needs attended
Endorsed
April 22, 2013 7am
3 pm
Received on bed alert, coherent, cooperative.
With an IVF of D5NM
Vital signs taken and recorded
Afternoon care rendered
Health teaching done
Medication given
Needs attended
No other complaints
Endorsed

19. III. Clinical discussion of the disease
A. Anatomy and physiology

20. UPPER RESPIRATORY TRACT
Respiration is defined in two ways. In common usage, respiration refers to the act of
breathing, or inhaling and exhaling. Biologically speaking, respiration strictly means the uptake
of oxygen by an organism, its use in the tissues, and the release of carbon dioxide. By either
definition, respiration has two main functions: to supply the cells of the body with the oxygen
needed for metabolism and to remove carbon dioxide formed as a waste product from
metabolism. This lesson describes the components of the upper respiratory tract.
The upper respiratory tract conducts air from outside the body to the lower respiratory
tract and helps protect the body from irritating substances. The upper respiratory tract consists
of the following structures:
The nasal cavity, mouth, pharynx, piglottis, larynx, and upper trachea; the oesophagus
leads to the digestive tract.
One of the features of both the upper and lower respiratory tracts is the mucociliary
apparatus that protects the airways from irritating substances, and is composed of the ciliated
cells and mucus-producing glands in the nasal epithelium. The glands produce a layer of mucus
that traps unwanted particles as they are inhaled. These are swept toward the posterior
pharynx, from where they are swallowed, spat out, sneezed, or blown out.
Air passes through each of the structures of the upper respiratory tract on its way to the
lower respiratory tract. When a person at rest inhales, air enters via the nose and mouth. The
nasal cavity filters, warms, and humidifies air. The pharynx or throat is a tube like structure that

21. connects the back of the nasal cavity and mouth to the larynx, a passageway for air, and the
esophagus, a passageway for food. The pharynx serves as a common hallway for the respiratory
and digestive tracts, allowing both air and food to pass through before entering the appropriate
passageways.
The pharynx contains a specialised flap-like structure called the epiglottis that lowers
over the larynx to prevent the inhalation of food and liquid into the lower respiratory tract.
The larynx, or voice box, is a unique structure that contains the vocal cords, which are
essential for human speech. Small and triangular in shape, the larynx extends from the
epiglottis to the trachea. The larynx helps control movement of the epiglottis. In addition, the
larynx has specialised muscular folds that close it off and also prevent food, foreign objects, and
secretions such as saliva from entering the lower respiratory tract.
LOWER RESPIRATORY TRACT
The lower respiratory tract begins with the trachea, which is just below the larynx. The
trachea, or windpipe, is a hollow, flexible, but sturdy air tube that contains C-shaped cartilage in
its walls. The inner portion of the trachea is called the lumen.
The first branching point of the respiratory tree occurs at the lower end of the trachea,
which divides into two larger airways of the lower respiratory tract called the right bronchus
and left bronchus. The wall of each bronchus contains substantial amounts of cartilage that
help keep the airway open. Each bronchus enters a lung at a site called the hilum. The bronchi
branch sequentially into secondary bronchi and tertiary bronchi.
The tertiary bronchi branch into the bronchioles. The bronchioles branch several times
until they arrive at the terminal bronchioles, each of which subsequently branches into two or
more respiratory bronchioles.
The respiratory bronchiole leads into alveolar ducts and alveoli. The alveoli are bubble-
like, elastic, thin-walled structures that are responsible for the lungs’ most vital function: the
exchange of oxygen and carbon dioxide.
Each structure of the lower respiratory tract, beginning with the trachea, divides into
smaller branches. This branching pattern occurs multiple times, creating multiple branches. In
this way, the lower respiratory tract resembles an “upside-down” tree that begins with one
trachea “trunk” and ends with more than 250 million alveoli “leaves”. Because of this
resemblance, the lower respiratory tract is often referred to as the respiratory tree.

22. IV. Nursing problem list
• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Risk for Infection
• Imbalanced Nutrition; less than Body Requirements
• Activity Intolerance
• Impaired Physical Mobility
• Anxiety
Nursing Priority:
1. Ineffective Airway Clearance
2. Risk for infection
3. Impaired Physical Mobility

23. VI. Drug Study
Generic Name: CEFUROXIME 200 mg TIV q8 hours ANST (-)
Brand Name: CEFTIN
Classification Action Indication Adverse Effect Nursing Consideration
2ND
generation
cephalosporin
A 2nd
generation
cephalosporin that binds to
bacterial cell membranes
and inhibits cell wall
synthesis.
Treatment of susceptible
infection due to group B
streptococcus, E. coli, H.
influenza etc.
Allergic reaction, oral
candidiasis, mild diarrhea,
mild abdominal cramping.
Ask the patient if he has a
history of allergies to drugs,
particularly to cephalosporin
and penicillin.
Generic Name: IPRATROPIUM BROMIDE q4 hours
Brand Name: COMBIVENT, DOUNEB
Classification Action Indication Adverse Effect Nursing Consideration
Anti-cholinergic
bronchodilator
An anti-cholinergic that
blocks the action of
acetylcholine at
parasympathetic sites in
bronchial smooth muscles.
Maintenance treatment of
bronchospasm due to chronic
obstruction pulmonary disease
(COPD), bronchitis, emphysema,
asthma.
Hypotension, insomnia,
metallic or unpleasant
taste, palpitations, urine
reaction.
Monitor Vital signs
Monitor intake and output
Generic Name: RIFAMPICIN 2 Tablets before lunch and 1 tablet before dinner
Brand Name: MYRIN-P FORTE
Classification Action Indication Adverse Effect Nursing Consideration
Antituberculosis Inhibits RNA synthesis,
decreases tubercle bacilli
replication
Initial phase treatment and
retreatment of all forms of TB in
category I and II patients caused
by susceptible strains of
mycobacterium.
Disorder of the blood and
lymphatic system,
immune system,
metabolism and
nutrition, CNS, eye, GI,
skin and tissues, renal,
fever, dryness of mouth.
Explain to the patient to
expect a orange color of
urine.
Monitor I & O.

24. Nursing Care Plan
A s s e s s m e n t D i a g n o s i s P l a n n i n g I n t e r v e n t i o n E v a l u a t i o n
Lack of energy
Weakness
Poor oral intake
Fatigue related to
malnutrition and
disease process
After a week of
confinement, the
patient will be able
to report/ exhibit
strength.
A s s e s s v i t a l s i g n s
Provide supplement
oxygen as indicated.
Referred to
comprehensive
rehabilitation program
or nutritionist
The patient still having
body weakness
Helps reduce fatigue
Due to patient status,
PEG (percutaneous
endoscopic
gastrostomy)
was not done

25. A s s e s s m e n t D i a g n o s i s P l a n n i n g I n t e r v e n t i o n E v a l u a t i o n
Difficulty of breathing
RR of 24rpm
Oxygen saturation of
94 %
Ineffective breathing
pattern
A f t e r a w e e k o f
confinement, the patient
will be able to exhibit
improved ventilation and
adequate oxygenation.
Note rate and depth of
respiration and use of
accessory muscles
Auscultate chest
Elevate head of bed or
client appropriately
Administer nebulization as
ordered
Oxygen Administration
Suction secretions as
needed
Difficulty of breathing was
lessen
Crackles heard in breath
Sounds
Difficulty of breathing was
lessen
Difficulty of breathing was
lessen
Oxygen saturation
increased
Clears airway

26. A s s e s s m e n t D i a g n o s i s P l a n n i n g I n t e r v e n t i o n E v a l u a t i o n
Limitation of movement
Uncoordinated
movements
of upper extremities
Immobility of lower
extremities
Self care deficit, bathing/
hygiene; dressing/
grooming
After a week of
confinement, the patients’
relatives or watchers will
be able to perform skills
and activities that are
necessary for the patient.
Perform hygiene practices
(bathing, shampooing,
etc.)
.
Teach relatives also on
how to perform hygiene
to their patient
Encouraging family to
show physical and
emotional support for the
patient in a way that the
patient can understand
The relatives were able to
demonstrate the teachings
given to them.

27. VII. Discharge Plan (METHODS)
M- Medications
Medications should be taken as ordered and prescribed by the physician to avoid
complications and help mange the condition of the patient. There are a lot of main anti-
Tuberculosis medications such us: Isoniazid, Fifampicin, Ethambutol and Pyrazinamide.
E- Exercise
• Instruct the patient to have a time for deep breathing exercise everyday for several
times at home to helps achieved maximal lung expansion and for relaxation.
• Start with exercises that you are already comfortable doing. Starting slowly makes it less
likely that you will injure yourself.
• Immediately stop any activities that might causes undue fatigue, increased shortness of
breath or chest pain.
T- Treatment
• Remind the importance of taking the medication in the right time and dose.
• Sleep in a room with good ventilation.
• Limit your activity to avoid fatigue. Frequent rest is advice.
• Maintained wound integrity on the surgical site.
H- Health Teachings
• Advise to take the medication on time and with the right dosage.
• Semi-fowlers position is advice most of the time for breathing relaxation.
• Avoid close contact with others until the doctor finds it Okay.

28. • Advise the client to turn your head when coughing. Keep tissues with you and cover
your mouth when you cough then throws the tissues used in the plastic bag.
• Keep your hands clean. Maintain proper hygiene.
• Isolate techniques is one of the best way to prevent the speared of the bacteria;
separation of dining ware.
• Advise the relatives to clean the environment regularly since it is one of the factor that
contribute to the speared of bacteria.
• Discuss to the client and significant others the cardinal signs of infection such as;
redness, heat, induration, swelling and separation of drainage.
O- Out- patient follow- up
Most of the treatment to cure Pulmonary Tuberculosis can be given at home but must be
taken as explained by the health care worker. The family has the responsibility to check the
status of the patient and the progress of it.
D- Diet
• Diet as tolerated is advice by the attending physician, to sustain his nutritional needs.
• High protein diet for tissue repair - meat and green leafy vegetables.
S- Spiritual practice
Mr. ADL’s religion is Catholic, encourage the patient pray daily, go to church regularly and
increase his faith with God Almighty.