Professional Documents
Culture Documents
Antineo
IV. BS Nursing
a. Definition of the Case
Multiple Drug Resistant Tuberculosis Case Scenario
A 45-year-old man presented with a concerned that he had been coughing up blood over the
previous 3 days. In addition to hemoptysis, he revealed that, since his previous visit, he had
continued to feel malaise, He had lost 4kg in weight, and had been experiencing night sweats.
The emergency room physician immediately transferred the patient for isolation in a local
hospital. Two months PTA the client had a 2-week history of coughing and breathlessness but
had no history of night sweats or haemoptysis. Crepitations were audible over the lung apices;
there were no other physical signs. He was given mucolytic for the treatment of the cough.
Upon enquiry, he was seen to be a smoker and alcoholic. Patient lived with his daughter. He
stated that he had received treatment for tuberculosis several times over the past 2 years. He
states that he has never completed more than six consecutive months of treatment.Several
investigations were performed to evaluate the patient's condition. His haemoglobin and white
cell count were normal but the CRP was 231 mg/l. A positive sputum smear test indicated that
the patients tuberculosis was still active. Chest X ray was conducted on this patient and minor
lesions at the apical segments of the upper lobe were seen. The chest radiograph revealed
progressive bilateral fibronodular disease with a miliary pattern This is a typical radiographic
representation of patients with tuberculosis. Three sputum smears were negative for AFB. On the
fifth day, growth in broth was detected for one out of three specimens. A gene probe for
tuberculosis was positive. Because of the patient's history of multiple prior incomplete courses
for therapy for TB, he was started on five drugs (INH, rifampin, PZA, ethambutol, and
ofloxacin). After 3 weeks, the susceptibility report was received demonstrating resistance to both
INH and rifampin.
I.
General
The general objective of this case study is to use the knowledge about Multi Drug
Resistant Tuberculosis in promoting awareness to the people so that they will seek for
medical care in order to prevent the development and progression of Multiple Drug
Resistant Pulmonary Tuberculosis
Specific:
Pulmonary Tuberculosis
To determine the possible nursing intervention that will be a great help in patients
prognosis.
To give the appropriate health teaching and better understanding of the disease to the
patient, family and significant others.
II.
Introduction:
joints, and even the skin. 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.
Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged.
Examples include when patients do not complete their full course of treatment; when health-care
providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs;
when the supply of drugs is not always available; or when the drugs are of poor quality.
Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid
and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB
disease.
The most important thing a person can do to prevent the spread of MDR TB is to take all of
their medications exactly as prescribed by their health care provider. No doses should be missed
and treatment should not be stopped early. Patients should tell their health care provider if they
are having trouble taking the medications. If patients plan to travel, they should talk to their
health care providers and make sure they have enough medicine to last while away. Health care
providers can help prevent MDR TB by quickly diagnosing cases, following recommended
treatment guidelines, monitoring patients response to treatment, and making sure therapy is
completed.
b. Etiology
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial
drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to
at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are
mismanagement of TB treatment and person-to-person transmission. Most people with TB are
cured by a strictly followed, 6-month drug regimen that is provided to patients with support and
supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective
formulations of drugs (such as use of single drugs, poor quality medicines or bad storage
conditions), and premature treatment interruption can cause drug resistance, which can then be
transmitted, especially in crowded settings such as prisons and hospitals.
c. Incidence
According to the World Health Orgaization (2012 )Tuberculosis (TB) is a deadly disease. It is the
worlds No. 1 cause of death around the world; about 3 million persons die of TB every year. In
2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000
people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India,
China, and the Russian Federation accounted for 45% of the 580 000 cases. It is one of the 10
top killer diseases in the Philippines; 75 Filipinos die of TB every day.
The Philippines is one of the highest tuberculosis (TB) burden countries in the world with
nationwide coverage of directly observed treatment, short-course (DOTS) achieved in 2003. This
study reports on the National TB Control Programme (NTP) surveillance data for the period
2003 to 2011. During this period, the number of TB symptomatics examined increased by 82%
with 94% completing the required three diagnostic sputum microscopy examinations. Of the 1
379 390 cases diagnosed and given TB treatment, 98.9% were pulmonary TB cases. Of these,
54.9% were new smear-positive cases, 39.3% new smear-negative cases and 4.7% were cases
previously treated. From 2008 to 2011, 50 030 TB cases were reported by non-NTP providers.
Tuberculosis (TB) is the sixth leading cause of morbidity and mortality in the Philippines; the
country is ninth out of the 22 highest TB-burden countries in the world and has one of the
highest burdens of multidrug-resistant TB. Annual treatment success rates were over 85% with
an average of 90%; the annual cure rates had an eight-year average of 82.1%.
d. General Signs and symptoms
The general symptoms of TB disease include feelings of sickness or weakness, weight loss,
fever, and night sweats. The symptoms of TB disease of the lungs may also include coughing,
chest pain, and coughing up blood.
e. Theoretical Framework
ENVIRONMENT
Ventilatio
client
Cleanline
ss
Beddi
ng
Light
In this theory the client can be defined as a person, family, or community that interacts
with different variables that are developmental, psychosocial, spiritual, physiological, and
psychosocial. The variables can be stressors or they can be restorative. These variables make up
the clients environment, which can be internal, external, or both. The Neuman Systems model
introduces the notion of perceived barriers that a person maintains in order to cope with a change
in environment or to preserve a wellness state.
The nurses role within the Systems Model is to recognize the patient as a unique
individual with their own goals, beliefs, values, and coping abilities. While implementing
primary, secondary, and tertiary interventions, the nurse works within a holistic view of the client
and in tandem with their protective barriers to help promote a return to health as defined by the
patient.
constantly changing, the nurse is also frequently evaluating and reevaluating interventions to
meet the needs of the client.
As a student nurse I can apply this interventin by wearing a mask and practicing aseptic
tecjniques in the client procedure bcause theses decresaes the occurrence of the disese
transmission, another thing thet I can do is to educate the client about his disease for the
promotion of health.
III.
Patientss Data
a. Patient Data
Name: Eufemia Bugoy y Cia
Age: 46 y/o
Birthplace: Pulangi, Albay
Sex: Female
Religion: Roman Catholic
Civil Status: Married
Address: Baras, Rizal
Date Admitted: September 19, 2008
Time Admitted: 2:10 am
Attending Physician: Dr. San Jose
b. Nursing History
i.
Chief Complaint:
The patient was admitted at Rizal Provincial Hospital last September 19, 2008 at
2:10 in the morning due to the complaint of difficulty of breathing (DOB). She was
attended at the Emergency department and had taken a clinical history and physical
assessment. She was transferred at the Medical Ward particularly in the isolation room of
the hospital for further evaluation of the complaint. She was attended by Dr. San Jose, a
resident physician of the said hospital.
ii.
Present Illness:
Patients condition started about 6 months prior to consultation, as onset of cough,
non-productive and an intermittent fever usually in the afternoon, moderate grade
temperature which are not documented. According to her it was relieved by an intake of
paracetamol.
One week prior to admission the patient experienced worsening of the condition,
she had productive cough non-bloody with whitish secretions. There is also difficulty of
breathing and vomiting. The patient cant eat properly because she has no appetite for
food. She also experience stabbing pain on her chest according to the assessment it is
6/10 and it radiates to his back. The patient only took paracetamol for her fever. On the
day of September 19, 2008 she was rushed to the hospital because of difficulty of
breathing. Previously when she started experiencing these conditions, she does not seek
for any medical care from the physician because according to her it is still tolerable.
iii.
Past History
The patient had upper respiratory tract infection when she was a child, she cannot
remember. Previously she was not hospitalized. She does not have complete
immunizations because according to her it is not available in their place during those
days, She has no history of hypertension and Diabetes mellitus. Whenever she had any
flu or cough, she uses herbal plants. She does not have any regular medical and dental
check-ups. She does not have allergies to what ever kind of foods and medications as far
as she knows. Whenever she had fever she takes Paracetamol and Bioflu. She does
experience any severe accidents.
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 familys 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 familys concerned, as verbalized by Mr. ADLs sister.
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 August 21, 2009 in Rizal Provincial
Hospital, suddenly he was complaining of difficulty of breathing, one hour after he ate his
lunch.
b. Measurement
FIDINGS
NORMAL
VALUES
ANALYSIS/
INTERPRETATION
(Ht, wt)
Height: 55
Weight: 101 lbs
BMI
Vital Signs
Temp: 36.0 C
PR: 90 bpm
RR: 29 bpm
BP: 100/70 mmHg
Temp: 37 C
PR: 60-100 bpm
RR: 16-20 bpm
BP: 120/80 mmHg
NORMAL
FINDINGS
Rounded
(normocephalic,
with frontal,
parietal and
occipital
prominences)
ACTUAL
FINDINGS
ANALYSIS/
INTERPRETATION
b. Hair
Evenly
Evenly
distributed; thick distributed
hair; silky
resilient hair; no
infestation or
infection; variable
amount of body
hair
c. Face
Symmetric facial
features,
palpebral fissures
equal in size,
symmetric
nasolabial folds
Symmetric
facial features
Normal findings
Shape is round;
size equal
Round,
uniform in size
Normal findings
Protects eyes,
anteriorly meet at
the medial and
lateral corners of
eye.
Close
symmetrical
Normal findings
4.3 Conjunctiva
Delicate
Smooth and
membrane; covers pale
part of the outer
surface of the
d. Eye/vision
4.1 Eyeball
Undernourished, lack
of vitamins
eyeball
4.4 Sclera
Outermost tunic,
thick white
connective tissue.
Appears white
Normal findings
4.5 Pupils
Pupils constrict
when looking at
near objects,
pupils converge
when object is
moved towards
the nose
Normal pupil
constriction
Normal findings
Hair evenly
distributed, intact
skin
Hair evenly
distributed,
intact skin
Normal findings
Equal movement
Equal
movement
Normal findings
When looking
straight ahead
clients can see
objects in
periphery
Normal peripheral
vision
Able to read
newspaper
Able to read
newspaper
Normal visual
findings
Same color as
facial skin, pinna
recoils after it is
folded
Same color as
facial skin,
pinna recoils
after it is
folded
b. External canal
Wet and
sticking
cerumen with
transparent
color
Normal findings
c. Hearing acuity
Responds to
moderately loud
voice tone
Symmetric,
Responds to
Normal findings
moderately
loud voice tone
No deformity, (+) dyspnea, patient
b. Visual acuity
C. EARS
a. Pinna
D. NOSE
normal breathing,
able to identify
familiar smell
(+) difficulty
of breathing.
With runny
nose
Dark gums
b. Teeth
32 adult teeth
smooth, white
yellowish shiny
tooth enamel
Yellowish with
few cavities
and some
missing teeth
c. Tongue
Central position,
pale in color
Central
position, pale
in color
No remarkable
findings
d. Palate-hard/soft
Pale in color
No remarkable
findings
e. Oropharynx/ Tonsil
Pale posterior
wall
Hollow in
appearance
Lymph nodes
freely movable
(+) difficulty
of breathing,
with abnormal
sound in the
right lower
lobe
No remarkable
findings
Indicates malnutrition,
due to weight loss
Normal findings
E. MOUTH/LIPS
a. Gums
F. CHEECKS
B. NECK
C. CHEST
a. Anterior
b. Posterior
Lymph nodes
freely movable
Quiet rhythmic
and effortless
respirations; full
symmetric
excursions
Localized pain
around
thoracostomy
site.
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
D. HEART
E. BREAST
F. ABDOMEN
Full and
symmetric
Full and
symmetric
Flat, rounded
(convex) or
scaphoids
Flat,
scaphoidal in
shape
G. UPPER EXTREMETIES
H. LOWER EXTREMETIES
Equal in size on
both sides of the
body; no muscle
atrophy; normally
firm; smooth
coordinated
movements
Equal in sixe on
both sides of the
body; no muscle
atrophy; normally
firm; smooth
coordinated
movements
Equal in size
but muscular
atrophy
evident.
Unable to
move freely
due to pain in
incision site.
With muscular
atrophy
evident.
Occationally
stands up for
short time. (2
days post-op)
loss.
Client is not well
nourished
Struggling movements
due to wounds,
incision pain.
Client is not well
nourished
Weakness and pain
hinder client from
actively moving
around.
I.
Category
Normal Findings
Actual Findings
Mental Status
Level of
Consciousness
Alert
Alert
Normal
Oriented
Normal
Normal
Orientation
Coherent
Normal
Language test
Able to remember
Recall
Cranial Nerves
CN 1
Olfactory
Normal
CN 11
Optic
CN III, IV, VI
Occulomotor
Trochlear
Abducens
(+) Extraoccular
Movement (EOM);
Lateral Upward and
downward; pupils
reactive to light.
CN V
Trigeminal
CN VII
Facial
CN XI
Accessory (Spinal)
Able to shrug
shoulders against
resistance and able
to turn the head side
and against
resistance.
CN XII
Hypoglossal
Normal
Normal
CN VIII
Vestibulocochlear
CN IX, X
Glossopharyngeal
Vagus
Normal
Normal
Normal
Normal
Normal
Muscle Strength
MNT Grading
System:
Left Arm
(+5) Active motion
against full
resistance
Right Arm
(+5) Active motion
against full
resistance
Left Leg
Right Leg
(http://en.wikipedia.org/wiki/Muscle_weakness)
Abnormal
Abnormal
Abnormal
She does not have a regular exercise, instead she cleans the house and washes the
clothes of her family.
The patient is malnourished.
She takes a bath once a day and brushes her teeth once a day.
She does use lotion, shampoo and soap.
She washes her hands regularly but not always using soap.
When she feels discomfort in her body she also goes to the manghihilot because it is
available on their area and it is more approachable.
She often forgot to cover her mouth and nose when someone sneezes and coughs in
front of her.
A person has a disease when she eats little amount of food, when she is weak.
Health for her is important for proper functioning.
Whenever she is sick, she gets money from her children especially to the eldest,
which is working abroad.
She wears slippers while inside their house. She feels that her hygienic practices are
adequate, and she feels clean and neat.
The patient is non-smoker and she does not drink any alcoholic beverages.
She denies the use any illicit drugs.
Measure for personal cleanliness and grooming, called personal hygiene, promote physical
and psychological well-being. Various studies have confirmed that improved personal
hygiene practices reduce illness rates. (Larson, 2002; Larson and Aiello, 2001).
Personal hygiene practices vary widely among people. The time of the day one bathes
and how often one shampoo or changes the bed linens, and sleeping garments are
relatively unimportant. What is important is that personal care be carried out conveniently
and frequently enough to promote personal hygiene.
health
overall
are
directly
implicated
to
nutrient
deficiencies.
(http://en.wikipedia.org/wiki/Malnourishment)
The main purpose of washing hands is to cleanse the hands of pathogens (including
bacteria or viruses) and chemicals which can cause personal harm or disease, particularly
diarrhea and pneumonia. To maintain good hygiene, hands should always be washed after
using the toilet, changing a diaper, tending to someone who is sick, or handling raw meat,
fish, or poultry, or any other situation leading to potential contamination. Hands should
also be washed before eating, handling or cooking food. Conventionally, the use of soap
and warm running water and the washing of all surfaces thoroughly, including under
fingernails is seen as necessary. Alcohol rub sanitizers kill bacteria, multi-drug resistant
bacteria (MRSA and VRE), tuberculosis, and viruses (including HIV, herpes, RSV,
rhinovirus,
vaccinia,
influenza,
and
hepatitis)
and
fungus.
(http://en.wikipedia.org/wiki/Hand_washing)
Herbalists treat many conditions such as asthma, eczema, premenstrual syndrome,
rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, and irritable
bowel syndrome, among others. Herbal preparations are best taken under the guidance of
a trained professional. Be sure to consult with your doctor or an herbalist before self-
treating. Some common herbs and their uses are discussed below. Please see our
monographs on individual herbs for detailed descriptions of uses as well as risks, side
effects, and potential interactions. (http://www.umm.edu/altmed/articles/herbal-medicine000351.htm)
Nutritional Metabolic Pattern
She is not choosy when it comes to any cook and kind of food.
During snack time, she usually eats banana because it is affordable and readily
available in their place.
When her cough started, she is not eating the appropriate amount of food.
According to her husband, she usually eats 4 spoons of rice with viand only. It is
due to her cough.
changes in their energy needs, based on their level of physical activity, and balance their
energy intake accordingly. (http://www.faqs.org/nutrition/A-Ap/Adult-Nutrition.html)
Inadequate nutrition is associated with marked weight loss, generalized muscle
weakness, altered functional ability, increased susceptibility to infection, impaired
pulmonary function and prolonged length of hospitalization. (Kozier et.al, Fundamentals
of Nursing 7th ed. Page 1190).
Elimination
She defecates twice a week and sometimes she feels pain and difficulty.
According to her the characteristic of her stool is hard, dry and colored dark
brown.
She feels pain at her abdomen on the hypogastric and umbilical area.
She urinates 7x a day and does not feel any pain and difficulty.
Previously her defecation pattern is daily, but when her condition exacerbated, it
is also affected.
Activity stimulates peristalsis, thus facilitating the movement of chime along the
colon. (Fundamentals of Nursing 5th edition by Taylor, page 1229).
A persons urinary habits depend on social culture, personal habits and physical
abilities. Urine collects in the bladder contains between 250 to 450 ml of urine. (Kozier
et.al, Fundamentals of Nursing 7th ed. Page 1256).
The excretory function of the kidney diminishes with age but usually not significant
below normal levels unless disease intervenes. With age, the number of functioning
nephrons decreases to some degree, impairing the kidneys filtering abilities. The amount
of flood intake affects the urinary frequency of an individual. Foods high in sodium or
fluids high in sodium ca cause fluid retention because water are retained to maintain the
normal concentration of the electrolyte. (Kozier et.al, Fundamentals of Nursing 7th ed.
Page 1258-1259).
Activity and Exercise
She does not have any work, she is a plain house wife, who is in-charge of her
children.
Her usual activity is cleaning the house, cooking and washing the clothes of her
children.
When she cleans, it is usually for 1 hour because she gets easily tired.
When after all the chores are done she will rest and watch television.
However, she is aware that her activity is not enough, and she recognizes the
importance of having regular exercise.
The human body was designed for motion, and regular exercise is necessary
for its healthy functioning. Individuals who choose inactive lifestyles or who are forced
into inactivity by illness or injury placed themselves at high risk for serious health
problems.
(Fundamentals of Nursing 5th edition by Taylor, page 1116)
Vigorous physical activity is not always needed to achieve positive result.
(Fundamentals of Nursing 5th edition by Taylor, page 1117)
Lack of exercise, inactivity, or immobility related to illness, or injury place a person
at high risk for serious health problems. Immobility can affect the major body systems.
Like the benefits, a person receives from exercise, complications resulting from
immobility differ occurrence and severity based on the patients age and overall health
status. (Kozier et.al, Fundamentals of Nursing 7th ed. Page 1118).
The wonderful tool of exercise can help teens become fit and healthy. Performing some
form of physical activity daily will significantly boost your basal metabolic ratethe
number of calories your body burns in order to keep you alive. By having a high
metabolism, you burn calories 24 hours a dayeven while you sleep! You can literally
turn your body into a fat-burning machine!
This has many benefits: With a strong metabolism comes a strong immune system.
When you burn fat, the toxins are released into the bloodstream, and are quickly carried
out of the body through sweat. This inoculates you against the probability of developing
cancerous and diseased cells. Therefore, hard exercisethat makes you sweatis very
good for you.
Exercise also helps to regulate the amount of insulin released into the bloodstream.
Insulin is commonly referred to as the fat-making hormone. Its job is to metabolize
blood sugar into energy. But too much insulin in the bloodstream keeps your body from
burning stored fat. Years of an overworked pancreasthe organ that produces insulin
can lead to onset (type 2) diabetes. However, if you useburnmore calories than
you consume, you significantly reduce the chances of developing this disease.
Exercise can also help control other problems, such as: Sleep apnea, moodiness,
stress, decreased energy, cardiovascular disease, high cholesterol and others. There are
too many benefits to list here. But be assured that this tool can help you become a fit,
stronger, disease-free, and overall healthier person. The main goal of aerobic exercise is
to keep the heart elevated for an extended period of time for the purpose of strengthening
the heart and lungs. The most common aerobic exercise is walking. Running is the
quickest way to lose weight, because it burns many calories. It also tones your calves and
thighs. However, to avoid extreme muscle aches or injuries, do not begin a running
routine until you have performed two to three months of aerobic walking.
(http://www.thercg.org/youth/articles/0201-tioe.html)
Cognitive-perceptual
According to her she is sensitive to the feelings of the people around her.
Cognition
is greatly affected by education. Those who study and develop their skills have better
cognitive performances because they have been provided with different information and
chances to develop their self. Perception is affected by the sensory diseases. Presence of
any sensory abnormalities affects or halters perception that would affect proper
communication. (Black, Medical Surgical Nursing7th edition, page 1880).
Cognition involves a persons intelligence, perceptual ability and ability to process
information. It represents a progression of mental abilities from illogical to logical
thinking, from simple to complex problem solving and from concrete to abstract ideas.
(Kozier et.al, Fundamentals of Nursing 7th ed. Page 359).
Sleep and Rest
She usually sits because according to her she can breath more easily.
hours. When compared with a control group, the sleep-deprived rats' blood tests indicated
a 20% decrease in white blood cell count, a significant change in the immune system.
Scientists have shown numerous ways in which sleep is related to memory. In a study
conducted by Turner, Drummond, Salamat, and Brown[28] working memory was shown
to be affected by sleep deprivation. Working memory is important because it keeps
information active for further processing and supports higher-level cognitive functions
such as decision making, reasoning, and episodic memory. Turner et al. allowed 18
women and 22 men to sleep only 26 minutes per night over a 4-day period. Subjects were
given initial cognitive tests while well rested and then tested again twice a day during the
4 days of sleep deprivation. On the final test the average working memory span of the
sleep deprived group had dropped by 38% in comparison to the control group.
(http://en.wikipedia.org/wiki/Sleep)
Self-perception
As a mother, she sometimes feels sad because she cannot do the previous things
like going with her husband in the farm.
Her strength is her family, when there are any circumstances that involving any
family member she is concerned and make some moves.
She is simple.
Self concept is ones mental image of oneself. A positive self
concept is essential to a persons mental and physical health. Individuals with a positive
self concept are better able to develop and maintain interpersonal relationship and resist
psychological and physical illness.
Self concept involves all of these self perceptions, that is, appearance, values and
beliefs that influences behaviors and that are referred to when using the words I or me.
Body image is ho the person perceives the size, appearance and functioning of the body.
If a persons body image closely resembles ones ideal body, the individual is more likely
to think positively about the physical and non-physical concept of self.
Self concept is also affected by role-strains. People undergoing role-strains are
frustrated because they feel or made to feel inadequate or unsuited to a role.
Illness and trauma can also affect the self-concept. People responds to different
stressors such as illness and alterations in function related to aging in a variety of ways:
acceptance, denial, withdrawal and depression are common. (Kozier et.al, Fundamentals
of Nursing 7th ed. Pages 957-962).
Role-relationship
She has a harmonious relationship with her brothers and sisters. Whenever there
are any problems, they are helping each other.
only by a persons genetalia but also by attitudes and feelings. It can also be defined as
learned behaviors in how a person reacts to his or her own sexuality and by how one
behaves in relationships with others.
(Fundamentals of Nursing 5th edition by Taylor, page 931)
Sexuality is a crucial part of a persons identity. Sex is central to who we are, to our
emotional well-being and to the quality of our lives. The world health organization
defined sexual health as the integration of the somatic, emotional, intellectual and social
aspect of sexual beings in ways that are positively enriching and that enhances
personality, communication and love. (Kozier et.al, Fundamentals of Nursing 7th ed.
Pages 973).
During the middle adulthood both men and women experience decreased hormone
production causing the climacteric, usually called menopausal in women. These events
often affect the individuals self-concept, body image and sexual identity.
Women through the menopausal period experiences hot flushes, vasomotor instability,
sleep disturbances, vaginal dryness, genital tract atrophy, mood changes and skin, hair
changes. The incidence of osteoporosis and cardiovascular lipid changes also increases.
The climacteric in the males is no as dramatic in the females; changes are more gradual.
Sexual response love and play involve peoples emotional, psychologic, physical and
spiritual make up, which plays a significant role in the satisfaction. Sexual desires
fluctuates within each person and varies from person to person. If people suppresses or
block out conscous sexual desires, they may not experience any physiological respose.
(Kozier et.al, Fundamentals of Nursing 7th ed. Pages 975,980).
Coping-stress
Whenever she has problem, she asks guidance from our Lord
When she experiences coughing and difficulty of breathing she just relaxes and
breathes deeply.
Coping
mechanisms
which are behaviors used to decrease stress and anxiety. Many coping behaviors are
learned, based on ones family past experiences, and socio-cultural influences and
expectations.
(Fundamentals of Nursing 5th edition by Taylor, page 855)
Value-belief
Whenever there are Christian events, like Holy week, she participates in the
For her education is very important to her children, so she and her husband is
doing all the efforts to send their children to school.
condition that exists when the universal spiritual needs for meaning and purpose, love
and belonging, and forgiveness are met. O Briens conceptual model of spiritual wellbeing in illness identified three empirical referents of spiritual well-being: personal faith,
religious practice and spiritual contentment. Spiritual beliefs are of special importance to
nurses because of the many ways they can influence a patients level of health and selfcare behaviors. (Kozier et.al, Fundamentals of Nursing 7th ed. Pages 975,979).
Spiritual well-being is manifested by a generally feeling of being alive, purposeful
and fulfilled. People nurture or enhance their spirituality in many ways. Some focus on
development of the inner self or world; others focus on the expression of their spiritual
energy with others or outer world. Relating to ones inner self or soul may be achieved
through conducting an inner dialogue with a higher power or with ones self through
prayer or medications. The expression of a persons spiritual energy to others is
manifested in loving relationship with and service to others, joy and laughter and
participation in religious services and associated fellow gatherings and activities and by
expression of compassion, empathy, forgiveness and hope. (Kozier et.al, Fundamentals of
Nursing 7th ed. Pages 996).
a. Course in the ward
Laboratory requested by the attending physician such as; Urine analysis, Ultrasound of
right lung, BUN and Creatinine, and chest X-ray
Transferred to Charity Medical Ward, bed 22
Endorsed
4:00pm
Cefuroxime 200mg TIV after negative skin test
7:00pm
Rifampicin 1 tablet before dinner
Vital signs recheck with no significance finding
Needs attended
Endorsed
August 25, 2009
2:00pm 10:00pm
Received on bed alert, coherent, cooperative.
With an IVF of D5NM 1L + 1 ampule of Moriavit @ 700cc level and regulated with 31
gtts/min on the right hand
Vital signs taken and recorded
Afternoon care rendered
Health teaching done
Medication given
Needs attended
No other complaints
Endorsed
The upper respiratory tract conducts air from outside the body to the
lower respiratory tract and helps protect the body from irritating
substances. The
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
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 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
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
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
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
d. Pathophysiology
e. Laboratory Examinations
a. Hematology report
Test
Hemoglobin
Results
110 g/L
Analysis
Decrease
Insufficient oxygen
circulating in the
bloodstream.
Hematocrit
0.33
0.40 0.50
WBC
15.2 x 10
5.0 10.0 x 10
Neutrophils
0.78
0.45 0.65
Lymphocytes
0.21
0.25 0.40
Monocytes
0.01
0.02 0.06
Platelets
320
150 - 450
b. Chest X-ray
Chemical Strips
Reaction:
Specific Gravity:
Albumin:
5.2
1.025 (above normal) dehydration and
contamination
Trace
Microscopic
WBC
RBC
Epithelial Cells
Mucus treads
Amorphous Urates
8-12
1-3
Rare
Moderate
Plenty
f. Drug Study
g. Nursing Care Plan
h. Discharge Planning (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.
E- Exercise
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.
Advise the client to turn your head when coughing. Keep tissues with
you and cover your mouth when you cough then throws the tissues
D- Diet
High protein diet for tissue repair - meat and green leafy vegetables.
S- Spiritual practice
Mr. ADLs religion is Catholic, encourage the patient pray daily, go to
church regularly and increase his faith with God Almighty.
Barabara Gould