A Case Presentation

Pulmonary
Tuberculosis
Presented by:
Ma. Kristia V. Carpio
BSN 4101
 Pulmonary TB is caused by the
bacterium Mycobacterium tuberculosis (M
tuberculosis). TB is contagious. This means the
bacteria is easily spread from an infected
person to someone else. You can get TB by
breathing in air droplets from a cough or
sneeze of an infected person. The resulting
lung infection is called primary TB. Most
people recover from primary TB infection
without further evidence of the disease. The
infection may stay inactive (dormant) for years.
In some people, it becomes active again
(reactivates). Most people who develop
symptoms of a TB infection first became
infected in the past. In some cases, the disease
becomes active within weeks after the primary
infection.
The following people are at high risk of
active TB or reactivation of TB:
 Older adults
 Infants
 People with weakened immune systems, for
example due to HIV , diabetes, or medicines that
weaken the immune system
Your risk of catching TB increases if you:
 Are around people who have TB
 Live in crowded or unclean living conditions
 Have poor nutrition
 The following factors can increase the rate of TB
infection in a population:
 Increase in HIV infections
 Increase in number of homeless people (poor
environment and nutrition)
 Drug-resistant strains of TB
 Being exposed to M.
tuberculosis doesn’t necessarily mean
you’ll get sick. Among the 2.2 billion
people who carry the germ, most have
latent TB. This means your immune
system protects you from getting sick.
People with latent pulmonary TB aren’t
contagious and have no symptoms, but
they must still be tested. It is possible
for latent TB to develop into active TB.
People with the germ have a 10 percent
lifetime risk of getting sick with TB.
When you start showing symptoms,
you may become contagious and have
pulmonary TB.
 Symptoms
If you or someone you know has
pulmonary TB, they will commonly:
 cough almost continuously
 Cough of blood
 have a consistent fever including low-
grade fevers
 have night sweats
 have chest pain
 have unexplained weight loss
 There may also be other symptoms of
pulmonary TB, such as fatigue Your
doctor will be able to give an accurate
diagnosis after reviewing all your
symptoms.
The risk for getting pulmonary TB is highest for people who are
in close contact with those who have TB. This includes being
around family or friends with TB or working in places like
medical facilities or institutions that house people with TB.
 These places are often:
 correctional facilities
 group homes
 nursing homes
 hospitals
 shelters
People also at risk for developing pulmonary TB disease are:
 older adults
 small children
 smokers
 people with an autoimmune disorder such as Lupus or rheumatoid
arthritis
 people with lifelong conditions, such as diabetes or kidney disease
 people who use drug injections
 people who are immuno compromised, such as those
taking chemotherapy, chronic steroids, or who have HIV or AIDS
 Tuberculosis remains a major
cause of death among Filipinos
(DOH). In report to House
Representative, Philippines is one of
the 30 nations with TB incidence.
In 2015. 14 000 Filipinos died from
Tuberculosis while 4.8 million
mostly poor, fell with TB.
Objective:
General Objectives:
To further understand and gain extensive knowledge regarding
the overview of the condition process and nursing implication
of Pulmonary Tuberculosis
Specific Objectives:
- To understand the pathophysiology and etiology of Pulmonary
Tuberculosis .
- To understand different parameters including the function
system involved.
- To learn the basic and appropriate nursing interventions,
treatment of plan and prognosis
- To learn about management and rehabilitation that optimize
health.

Significance of Case Study

It gives an in-depth look at an individual patient. Good
way for nursing students to test the knowledge they've
acquired in the in a more realistic, clinical way. It is also a
useful learning tool; it forces students to reflect on the entire
course of treatment for a patient, ranging from obtaining
important information to diagnosis to treating the medical
condition.
 Patient Profile
Name: MAB
Address: San Agustin Sto. Tomas Batangas
Age: 28 years old
Religion: Catholic
Civil Status: Single
Occupation: fisherman
Nationality: Filipino
Birth Place: Bicol Laet
Date Admitted: February 05 2018
Time Admitted : 06: 59 AM
Source of Information: Chart and realtives
Admitting Diagnosis: or Pulmonale Pulmonary
Tuberculosis
Attending Physician: Dr. Emmanuel J.
Landicho M.D.
Chief Complaint:
The patient was admitted at
Batangas Medical Center, February 05
2018 around 7 o’clock in the morning
with chief complain of DOB and
abdominal pain. He was attended at
Emergency Department and had taken
a clinical history and physical
assessment. He was transferred at
Pulmonary Ward for further Evaluation
of complain. He was attended by Dr.
Emmanuel J. Landicho MD, a resident
physician at said hospital.
History:
a. Present illness:
The information that I gathered is from patient’s sister.
This is a case study of 28 years old male from Bicol Laet but
currently residing at Sto. Tomas Batangas who was admitted
at Batangas Medical Center February 05 2018 around 7
o’clock in the morning with chief complain of DOB and
abdominal pain.
Patient diagnosed of Pulmonary Tuberculosis last October
2017. he entered a rehabilitation program sponsored by
Local Government in Sto. Tomas Batangas. Until now, the
patient is in process of treatment 4 Months. According to his
sister, when the patient is in therapy she observed that the
patient is loosing his weight.
Days prior to admission, the patient abdomen become
bloated and having diffuculty of breathing, urination and
defecaation. Based on the statement, patient cxondition
become worsen that;s why she decided to confined her
brother at Batangas Medical Center. The patient diagnosed
Cor Pulmonale Pulmonary Tuberculosis.
b. Past Medical History
Referring to the statement made by his
sister the patient present history of
confinement is her first admission to the
institution but he had some fever, cough,
colds during his childhood days. The sister
verbalized that patient does not have any
serious illness or medical problem
encountered.
c. Family History
Last 2010, 18 years ago, when his
farther died from asthma. Patient’s mother
is having pulmonary Tuberculosis. They are
all 9 in the family. 3 of siblings having also
Tuberculosis and 1 had an asthma.
His sister also verbalized that two of his
uncle died from respiratory distress, one is
from TB and other one is lung cancer.
D. Socio-economic History
according to the sister, patient is fisherman.
The client is residing at Bicol Laet but his sister
decided to transfer within Batangas City due to
economic status at Bicol. All of them is currently
residing at Sto. Tomas Batangas. Patient is living
with his sister and helping expenses on their
home. The patient family is in low socio economic
status so most of expenses in treatment is
sponsored by Local Government of Sto. Tomas
Batangas.
E. Developmental History
Patient started his schooling at Laet
Elementary school but she stop his study when he
was in Grade 5 due to financial Status. Patient
started to help his family, but the patient did not
continue his schooling because of low income.
F. Maternal History
Patient is still single.
G. Nutritional History
According to the sister, patient
usually eating dishes cooked at
home but he does not eat 3x a day
because they do not have enough
money to buy food/ patient’s body
build is below normal, indication
of malnutrition.
Physical Assessment
Pathophysiology
Diagnostic Procedures
 Doctors diagnose active tuberculosis (TB) in
the lungs(pulmonary TB) by using a medical history
and physical exam, and by checking your symptoms
(such as an ongoing cough, fatigue, fever, or night
sweats). Doctors will also look at the results of a:
 Sputum culture- Testing mucus from
the lungs (sputum culture is the best way to
diagnose active TB. But a sputum culture can take 1
to 8 weeks to provide results.
 Sputum cytology.
 Chest X-ray. A chest X-ray usually is done if you
have:
◦ A positive tuberculin skin test (also called a TB skin
test PPD test, or Mantoux test).
◦ Symptoms of active TB, such as a
persistent cough, fatigue, fever, or night sweats.

An uncertain reaction to the tuberculin skin test

because of a weakened immune system, or to a
previous bacille Calmette-Guerin (BCG) vaccination.
Diagnosing latent TB in the lungs

 A tuberculin skin test will show if

you have ever had a TB infection.
 Rapid blood tests help detect latent
TB. They can help diagnose TB when
results from a tuberculin skin test
are uncertain. These tests also can
tell if a person who has had a BCG
vaccination has a TB infection. A
rapid test requires only one visit to
the doctor or clinic, instead of two
visits as required for the tuberculin
skin test. Rapid blood tests are also
called interferon-gamma release
assays (IGRAs).
Diagnosing TB outside the lungs
Diagnosing TB in other parts of the body
(extrapulmonary TB) requires more testing. Tests
include:
 Biopsy. A sample of the affected area is taken out
and sent to a lab to look for TB-causing bacteria.
 Urine culture. This test looks for TB infection in
the kidneys(renal TB).
 Lumbar puncture. A sample of fluid around the
spine is taken to look for a TB infection in
the brain(TB meningitis.
 CT scan. This test is used to diagnose TB that has
spread throughout the body (miliary TB) and to
detect lung cavities caused by TB.
 MRI. This test looks for TB in the brain or the
spine.
Medical Management
Pulmonary TB is treated primarily with
chemotherapeutic agents (anti tuberculosis agents) for 6 to 12
months. Prolonged treatment duration is necessary to ensure
eradication of the organisms and to prevent relapse. A
worldwide concern and challenge in TB therapy is the
continuing (since the 1950s) and increasing resistance of M.
tuberculosis to TB medications. Several types of drug
resistance must be considered when planning effective
therapy
 • Primary drug resistance: resistance to one of the first-
line anti tuberculosis agents in a person who has not had
previous treatment
 • Secondary or acquired drug resistance: resistance to
one or more anti tuberculosis agents in a patient
undergoing therapy
 • Multidrug resistance: resistance to two agents, isoniazid
(INH) and rifampin. The populations at highest risk for
multidrug resistance are those who are HIV-positive,
institutionalized, or homeless. The increasing prevalence of
drug resistance points out the need to begin TB treatment
with four or more medications, to ensure completion of
therapy, and to develop and evaluate new pharmacologic
management
 Medications used for TB may be divided
into first and second line drugs. First line
drugs are almost always initially prescribed
until culture and sensitivity laboratory reports
are available. Clients with previous history of
incomplete chemotherapy may have developed
resistant organisms. The duration of treatment
varies. It has two phase approach
 An intensive phase using two or three drugs
aimed at destroying large numbers of rapidly
multiplying organisms.
 A maintenance phase usually with two drugs
directed at eliminating most remaining bacilli.
 The length of each phase depends on the
success of treatment and the client’s
compliance. Some courses are as short as 6
months others last 24 months. The average is
9 to 12 months.
Surgical Management
Surgery is rarely used to
treat tuberculosis (TB). But it may be used
to treat extensively drug-resistant TB
(XDR-TB) or to treat complications of an
infection in the lungs or another part of
the body.
 Surgery is used to:
 Repair lung damage, such as serious
bleeding that cannot be stopped any
other way, or repeated lung infections
other than TB.
 Remove a pocket of bacteria that cannot
be killed with long-term medicine
treatment.
Nursing Care Plan
Prognosis
Without treatment, the mortality rate of TB
exceeds 50 % however TB is treatable disease.
Tb is curable disease. Progress of TB from
infection to illness involves overcoming of immune
system defenses by bacteria. As bacteria start to
multiply, it affects immune system and finally
overwhelms it to cure disease. Appropriate
therapy with anti tubercular drugs, treatment is
possible and so is cure.

Patient MAB confined at Pulmonary Ward at

Batangas Medical Center after giving first aid at
Emergency Department. The patient was weak
and difficulty of breathing as a result of
confinement at said hospital. The patient 6
months therapy is still ongoing.
Health Teaching
Prevent the spread of TB
Having TB means that tuberculosis bacteria are
multiplying in your body and can be spread to other people.
After taking TB medicine for a period of time, you will no
longer be able to spread the disease. Your healthcare
provider can tell you at what point this is true for you. To
help prevent spreading the disease until then:
 Make sure that your family, friends, and the people you
work with are tested.
 Avoid close contact with others until your healthcare
provider says it is OK.
 Keep your hands clean. Be sure to wash them every time
you use them to cover your mouth when you cough.
 When you cough or sneeze, take steps to prevent the
spread of TB:
◦ Cover your mouth and nose with a tissue.
◦ Put your used tissue in a closed bag and throw it away.
◦ If you don't have a tissue, cough or sneeze into your upper
sleeve or elbow, not your hands.
◦ Wash your hands often with soap and warm water for 20
seconds. If soap and water are not available, use an alcohol-
based hand gel.
Home care
 Take your medicine exactly as directed. Continue
taking it even if you start to feel better. You will take
medicine for at least 6 months and maybe longer.
Not taking your medicine for the full course may
lead you to get sick again. It also increases the
chance of drug-resistant TB. Drug-resistant TB
means that one or more of the usual medicines for
TB don’t work.
 If you are taking birth control pills, use an
additional backup method of birth control. Some TB
medicines may interfere with the pill’s effectiveness.
 Check with your healthcare provider before taking
any over-the-counter medicines.
 Sleep in a room alone and with good air flow
(ventilation).
 Limit your activity to avoid feeling tired. Plan
frequent rest periods.
 Keep your healthcare appointments. You will need to
be checked regularly for several months to a year to
make sure you are free from TB bacteria.
When to seek medical care
 Chest pain or shortness of breath
 Blue lips or fingernails
 Otherwise, call your healthcare
provider if you have any of the
following:
 Fever of 100.4°F (38°C) or higher, or
as directed by your provider
 Bloody material (sputum) that is
coughed up from your lungs and
into your mouth
 Worsening or recurring night sweats
 Increased coughing
Thank you 