NUTRITION AND INFECTION CONTROL

(PTB PATIENTS)

Health Teaching Plan

Submitted By:

Solis, Genette M.
BSN-III A4
4/19/17

Submitted To:
Maam Joyce Kiat-ong

DESCRIPTION OF THE LEARNER:

 Virginia Marinas, an 80 years old, female who has pulmonary tuberculosis was admitted to Baguio General Hospital Medical Center on 4/16/17 due to
persistent hemoptysis, weakness and difficulty of breathing. Patient was diagnosed with Pulmonary Tuberculosis category I related to relapse.She's Roman Catholic
and can understand English, Tagalog and Ilocano. She preferred English and Tagalog as a medium of instruction.The patient is currently residing at Pozorrubio,
Pangasinan and living with her daughter and grandchildren. Virginia finished high-school in public school. Shes fan of reading printed materials and watching
television. The patient learns most when her environment is quiet and has good ventilation.She has difficulty of hearing soft voices but able to communicate and
interact well. Furthermore, patient verbalized his interest to learn about nutrition that is needed to her present condition since according to her she believed that a
good diet will truly affect her health for her faster recovery. Virginia was also concerned to infection control because according to she doesnt want to spread the
infection to other people especially to her family.

SUBJECTIVE CUES:
Ano po ba ang mga dapat kong kainin ngayong may TB ako?
Wala po bang bawal na kainin?
Diba nakakahawa tong sakit ko? Bawal na bang lumapit sakin ang pamilya ko? Natatakot ako.
Paano ko po maiiwasang makahawa sa mga tao lalo na sa pamilya ko?

OBJECTIVE CUES:
The patient seems interested to the topic of proper nutrition to her present condition and infection control.
Has good social interaction and communication
Difficulty of hearing soft voices
Looks anxious because of her condition.
Has poor sanitation and hygienic practice
*she just spit her phlegm in a plastic bag
*shes not washing her hand before she eats
Paleness observed in her lips and palm.
Has poor appetite and foods rich in fat and carbohydrates is her food preference like meat, beef, rice, chocolate.
Has limited ROM
Weakness observe
LEARNING NEEDS: To know proper nutrition for Tuberculosis and infection control to avoid the spread of infection.
LEARNING STYLE:The patient can learn easily and remember the information through the use of visual aids such as pictures and flyers.
LEARNING DIAGNOSIS: Knowledge Deficit: proper nutrition for Tuberculosis and infection control related to lack of information
________________________________________________________________________________________________________
GOALS:The client will be able to discuss accurate nutrition for Tuberculosis and proper infection control to avoid the spread of infection.

OBJECTIVES:

BEHAVIORAL TOPIC OUTLINE TEACHING TIME ALLOTMENT METHOD OF EVALUATION

LEARNING STRATEGIES AND RESOURCES
OBJECTIVES NEEDED

After 20 minutes of
discussion about
nutrition for Tuberculosis
and infection control, the
client will be able to:

A. COGNITIVE
DOMAIN

1. Justify the benefits of Benefits of good nutrition to a person with tuberculosis Lecture 1 minute Instant Feedback
proper nutrition to a PTB Flyers that contains The client will be able to give
patient. *While the treatment of active tuberculosis is very long term up to benefit of proper nutrition importance of good nutrition based
a year of daily antibiotics you can help yourself feel better sooner for PTB patient. on her own understanding and she
and help your body fight off the disease by making sure youre will be able to discuss that good
getting the right nutrition. Your body needs healthy nutrients now nutrition will boost her immune
more than ever. system to fight against TB.
2.Discuss the Tuberculosis and poor nutrition
One on one Instant Feedback
disadvantages of poor 2 minutes
nutrition *People who are malnourished or underweight are more likely to discussion Flyers that contains Question and answer
get tuberculosis and are also more susceptible to re-infection information about the
or relapse of TB after treatment. Malnutrition leads to decreased disadvantages of poor The client should be able to tell
immunity that may worsen the disease process, and your body needs nutrition that poor nutrition will lead to:
to be as strong as possible to defend itself against those tough
tuberculosis bacteria. Re-infection and relapse of TB
*Its a vicious cycle: Poor nutrition can actually encourage the Aggravation of infection
persistence of active tuberculosis disease, and active tuberculosis
leads to worsening malnutrition. So to keep your body primed to
fight TB, you have to feed it right

3. State foods for a Question and answer

tuberculosis patient. 5 ideal food for patient with tuberculosis Picture 5 minutes Instant Feedback
analysis Pictures that contains The client will be able to give
1. Calorie dense foods: example of each ideal examples of foods that contain
The best foods for TB patients would need to be high in calorie and food. each nutrient.
nutrient rich to meet up rising metabolic demands and to prevent
further weight loss. Calorie dense foods include banana, cereal a.) Fully met: able to give 3
porridge, Coconut milk, Avocados, Pasta, nuts etc. or more example of each
nutrient.
2. Protein rich foods: b.) Partially met: able to give
Increased protein needs are met by including ground nut, dry fruit 1-2 examples of each
and nut mixes. If not able to eat due to poor appetite, the dry fruits nutrient.
and nuts can be powdered finely and mixed into a milkshake to give c.) Not met: not able to give
more energy and protein. Fish, white meat,Eggs, tofu, soya chunks example of each nutrient.
are other protein rich foods that are easily absorbed as well. These
can be diced into small pieces or grated and added to soups or
 porridges or milkshakes.

3. Vitamin A, E, C:
Some of the best foods for TB patients include the yellow orange
fruits and vegetables such as orange, mango, papaya, sweet
pumpkin, carrots which are rich in Vitamin A, while Vitamin C is
obtained from fresh fruits including guava, amla, orange, tomato,
sweet lime, lemon, capsicum. Vitamin E is usually found in wheat
germ, nuts, seeds and vegetable oils.

4. B complex vitamins:
Most B complex vitamins are found in whole grain cereals and
pulses, nuts and seeds. For non-vegetarians, B complex can be
obtained from eggs, fish, especially sea fish like salmon, tuna,
mackerel, sardines, chicken and lean cuts of meat.

5. Selenium and zinc:

Brazil nuts are the best source of selenium. Else, fortified eggs are
also available these days. Mushrooms and most nuts and seeds
including sunflower seeds, chia seeds, pumpkin seeds, sesame, flax
are also good sources of both selenium and zinc. Non vegetarian
options include oysters, fish and chicken.

4. Identify the foods to

avoid by PTB patient. FOODS TO AVOID BY PTB PATIENT

1. Greasy Foods 3 minutes Question and answer

Flyers that contains Instant Feedback
Greasy foods, such as fried beef and chicken, bacon, french fries and The client will be able to give
example of foods to avoid
onion rings, contribute hefty amounts of saturated fat -fats associated
by patient. examples of foods to avoid.
with high cholesterol and increased risk for diabetes and heart
disease. Greasy foods can also exacerbate symptoms that accompany
a.) Fully met: able to give 3 or more
TB, such as diarrhea, abdominal cramping and fatigue, according to
example of food to avoid.
the World Health Organization. This is problematic in numerous b.) Partially met: able to give 1-2
ways, since severe diarrhea can lead to severe dehydration and examples of food to avoid.
related complications. For best results, choose baked, broiled and c.) Not met: not able to give example
steamed foods prepared without butter, high-fat cheese or creamy of food to avoid.
sauces.

2. Trans-fatty foods

Trans-fatty acids, or trans fats, are fats created through a process in

which hydrogen is added to vegetable oil. Unlike the plant-based
oils they derive from, trans fats can cause unhealthy cholesterol
levels and inflammation. Eliminating trans-fatty acids from your diet
may help reduce TB symptoms, notes UMMC. To avoid these
unhealthy fats, avoid margarine; shortening; commercially prepared
cookies, cakes, pastries and crackers; and all foods that list partially
hydrogenated vegetable oil as an ingredient. Replace these typically
low-moisture, low-nutrient foods with fresh foods, such as fruits and
vegetables, for heightened benefits.

3. Refined carbohydrates
Refined carbohydrates such as flour and sugar provide empty
calories, or calories devoid of nutrients. While modest amounts of
refined carbohydrate sources may not cause harm, particularly if
you're limited to low-fiber foods due to diarrhea, UMMC
recommends that most TB patients avoid these foods for improved
wellness and symptoms. Common sources of refined carbohydrates
include enriched breads, cereals, pasta and baked goods; instant rice;
and foods and beverages rich in added sugars, such as regular soft
drinks, candy, sorbet, frosting, pancake syrup, jam and jelly. For
additional benefits, replace refined carbohydrate sources with fiber-
rich foods, such as whole grains and starchy vegetables.

4. Caffeine and Alcohol

Caffeine and alcohol can make resting and sleeping difficult, which
can delay healing from TB. Excessive caffeine or alcohol
 consumption may also have a diuretic, or fluid-flushing, effect and
prevent you from consuming healthier beverages, such as water,
low-fat milk or pure juices. UMMC recommends that TB patients
consume caffeine-free green tea - a valuable source of antioxidants
-- in place of regular green tea for improved wellness.

B. PSYCHOMOTOR
DOMAIN

1. Demonstrate the
correct hand washing.
Proper hand washing technique Clients and especially Demonstration 5 minutes Redemonstration
staff should be encouraged to wash their hands after contact Picture Pictures showing the The client is able to redemonstrate
with respiratory secretions. M. tuberculosis cannot be Analysis proper hand-washing the proper handwashing
spread from the hands, but other serious lung infections techniques techniques.
can.

Redemonstration
The client should be able to
2. Demonstrate the ways
to control the infection of
Tuberculosis
INFECTION CONTROL Demonstration 3 minutes redemonstrate it hygienically.
Instructing the above designated persons identified through
screening in respiratory hygiene/cough etiquette. This includes
instructing them to cover their nose and mouth when coughing
for sneezing, and when possible providing face masks or tissues
to assist them in covering their mouths.

Follow these steps to stop the spread of germs:

a. Cover your mouth and nose when you cough, sneeze or blow
your nose to tissue paper..
b. Put used tissue in the garbage.
c. If you don't have a tissue, cough or sneeze into your sleeve, not
in your hands.
d. Clean your hands with soap and water or hand sanitizer
(minimum 70% alcohol-based).

Face masks help prevent the spread of M. tuberculosis from the

patient to others. The face mask can capture large wet particles
near the mouth and nose of the patient, preventing the bacteria
from being released into the environment. Face masks could be
provided to persons who have a positive symptom screen to
wear until they leave the facility. Cloth masks can be sterilized
and reused.
Placing TB suspects and cases in a separate well-ventilated
waiting area such as a sheltered open-air space is ideal in warm
climates.
C. Affective Domain

1. Justify the Hygiene and Infection Control

importance of Discussion 1 minute Instant Feedback
hygiene and One of the most important steps to avoid getting sick and Flyer contains importance Question and answer
infection control to a of infection control and The client will be able to give
spreading germs.
PTB patient. hygiene. the reasons why infection
To prevent worsening of the disease process
control and hygiene is
Prevents acquiring other illnesses that can aggravate the
important to her and to her
condition of patient. family and other people.
Keeping a good standard of hygiene helps to prevent the
development and spread of infections and illnesses.

2. State the advantages

of proper nutrition to *While the treatment of active tuberculosis is very long term up to Instant Feedback
Interactive 1 minute
a PTB patient. a year of daily antibiotics you can help yourself feel better sooner The client will be able to give
lecture Flyers that contains
and help your body fight off the disease by making sure youre importance of good nutrition based
benefit of proper nutrition
getting the right nutrition. Your body needs healthy nutrients now on her own understanding and she
for PTB patient.
more than ever. will be able to discuss that good
nutrition will boost her immune
system to fight against TB.
REFERENCES:

Allen, G. (2008). Infection control (1st ed.). New York: Elsevier.

Smith, S. (2009). A review of hand-washing techniques in primary care and community settings. Journal Of Clinical Nursing, 18(6), 786-
790. http://dx.doi.org/10.1111/j.1365-2702.2008.02546.
GETZ, H. (2009). NUTRITION AND TUBERCULOSIS. Nutrition Reviews, 5(4), 97-98. http://dx.doi.org/10.1111/j.1753-4887.1947.tb04137.x
 WHO and tuberculosis control. (2012). Tubercle, 31(6), 121. http://dx.doi.org/10.1016/s0041-3879(50)80101-0