Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

ISO 9001:2015 CERTIFIED
Cabanatuan City
College of Nursing
 
EDUARDO L. JOSON MEMORIAL HOSPITAL
PEDIATRIC WARD
 

PULMONARY TUBERCULOSIS
Presented by:
DATU, BEVERLY JANE L.
DE LARA, BIANCA JESMINE A.
DEL ROSARIO, TRIXIE D.C.
NEUST SN’21
 

 
JANELA F. GALAC, PhD, RN
Clinical Instructor
 
CHAPTER 1
 1.1 General Objectives

As a level 3 NEUST-CON student nurse, the overall goal of

the study was to become acquainted with realization,
understanding the constant overall disease, improve our
skills, and develop a positive attitude when dealing with
various patients, as well as performing the basic nursing skills
with confidence and competence, and providing appropriate
nursing management to a patient with Pulmonary
Tuberculosis.
 1.2 Specific Objectives
At the end of the clinical duty the students will be able to:
Perform a head-to-toe assessment to the patient, formulate a nursing diagnosis and
focus on the part affected by the Pulmonary Tuberculosis;
Comprehend the precipitating and predisposing factors that can possibly lead to
occurrence of Pulmonary Tuberculosis;
Obtain, document and provide a reliable medical history related to present condition.
Explain the anatomy and physiology of Respiratory;
Understand the pathophysiology of Pulmonary Tuberculosis;
Gain knowledge about the suggested medical management and its uses;
Formulate a specific Nursing Care Plan appropriate for the patient;
Formulate a drug study related to the medications for the patient’s condition;
Provide information about the discharge and home management plan.
 INTRODUCTION

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. If you have latent TB, your doctor might recommend
treatment with medication if you're at high risk of developing active TB. For
active tuberculosis, you must take antibiotics for at least six to nine months.
The exact drugs and length of treatment depend on your age, overall health,
and possible drug resistance and where the infection is in your body. According
to the World Health Organization, the 2020 global Tuberculosis report, the
Philippines has Asia's highest tuberculosis incidence rate, with 554 cases per
100,000 Filipinos. Among 196 nations with a high tuberculosis infection, the
mentioned country is rated ninth in the globe.
 INTRODUCTION

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, the
gastrointestinal system, bones, joints, and even the skin.
Tuberculosis 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.
 Client’s Data:

Name: Client X
Age: 50 years old
Gender: Male
Status: Single
Date of birth: April 14, 1971
Address:Sta Arcadia st, Cabanatuan City
Religion: Roman Catholic
Date & time of admission:
August 21,2021
Admitting Physician: Dr. X
PRESENTING COMPLAINTS

Cough.
Weight loss.
Fever.
Night sweats.
Hemoptysis.
Chest pain
Fatigue
 FAMILY HISTORY

No family history of any diseases related to Pulmonary

Tuberculosis.
 PAST HISTORY

Patient’s 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 him it was relieved by an intake of
paracetamol.
 DRUG HISTORY

Medication used:
Generic Name: Paracetamol
Brand Name: Biogesic
Adverse effects:
Low fever with nausea, stomach pain, and loss of appetite;
Dark urine, clay-colored stools; or
Jaundice (yellowing of the skin or eyes)
 ADMITTING HISTORY

On August 21, 2021 at around 9:00 AM, a 50-year-old

male client named X is admitted in the medical ward of
ELJH. According to the client he has a cough,
experiencing weight loss, fever, night sweats,
hemoptysis, fatigue and he also experienced stabbing
pain on his chest, according to the assessment it is 6/10,
and it radiates to his back. The client’s final diagnosis is
Pulmonary Tuberculosis.
 ADMITTING VITAL SIGNS

T: 38.1 C
P: 84 Beats/ mins
R: 36 Breaths/mins
BP: 90/70 mmHg
During the initial assessment, the client was caught onset
of coughing and clarifie that chest
pain is also presence.
 STATUS OF PRESENT ILLNESS

Upon admission, the client showed fatigue and has fever and
hemoptysis. The client stated that he is having chest pain and
experiencing weight loss and night sweats. Upon taking the vital
signs, pain scale, and BMI of the client, his body temperature is
38.1° C and respiratory rate of 36 cpm while his pain was
scored 6/10 and his weight is 55 kg and his height is 175 cm
which fall on the category of underweight. It is then confirmed
the client’s condition.
 PHYSICAL HEALTH ASSESSMENT

(Head to Toe Assessment)

General Conscious and coherent  
 
Body Parts Normal Findings Actual Assessment Result

The skin normally

Skin uniform, whitish pink  He has smooth, brown and lesion free skin but warm Abnormal
or brown in color to touch.
  depending on the
race of the client. No
strong odor should be
evident and the skin
should be lesion free Intermittent fever 
 
Eyes The eyes are  His eyes are aligned; his pupils are equally round and Abnormal
  normally aligned, reactive to light. Found hollowness
there should not Volume deficiency of fat
have excessive within the orbit
discharge from (the space inside of
lacrimal duct.
the bony eye
Pupils are normal
socket). This
and reacted to
condition of the
light
patient is related to
his nutritional
status, she is
malnourished.  
 
 It is located symmetrically  His nose is symmetric and straight; Uniform color with nasal Abnormal
Nose
in the middle of the face
flaring
and must not have presence
Nasal flaring
of lesion and masses; no
suggests airway
discharge or flaring.
obstruction. Nasal
discharge shows the
presence of mucus
secretions in the air
tract.

The lips and membranes  Bluish-black in color, dry and cracked lips; Abnormal
Mouth
should
  be pink and moist and to
The color of the lips
show
were result of
no evidence of lesions and
inflammation. smoking and may
suggest have cellular
dehydration. 
Chest • Symmetrical.  Chest is symmetrical, decreased Abnormal
  Bronchovesicular breath sound; Ronchi is presence
sounds and
It has appeared tachypnea and
unblemished skin.
adventitious sounds were heard during
Good capillary
auscultation.
refill.

Nails/Fingers/Toe • Symmetrical.  Cyanosis is presence Abnormal

s Absence of blue
finger nails, no
  The findings were related to present
lesion and
condition.
tenderness
This table shows the physical assessment indicates that all body
parts are normal except skin, eyes, nose, mouth, chest and nails.
CHAPTER 2
 DEFINITION

The microbe Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a contagious,

airborne infection that destroys body tissue. It is spread by tiny droplets spread by
coughing and sneezing, with the droplet remaining suspended in the air for several
hours. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However,
it can spread from there to other organs. Furthermore, transmission occurs when a
person inhales tuberculosis bacteria-containing droplet nuclei, which then enter the
upper respiratory tract via the mouth or nasal passages. They then make their way to
the bronchi, then to the lungs and alveoli.
There is a distinction between being infected with the tuberculosis bacterium and having
active tuberculosis disease. The stages of tuberculosis are exposure, which occurs when
a person comes into contact with or is exposed to another person who has TB, latent TB
infection, which occurs when a person has TB bacteria in his body but is asymptomatic of
the disease, and TB disease, which occurs when a person exhibits signs and symptoms of
an active infection.
 DEFINITION

Moreover, those with a weakened immune system and those who have
recently been infected with TB are at a higher risk of developing tuberculosis.
Pulmonary tuberculosis is curable if diagnosed early and treated with
antibiotics. However, if the disease is left untreated or not fully treated, it can
be fatal. Untreated pulmonary tuberculosis can cause long-term damage to the
lungs, brain, liver, heart, or spine
ANATOMY AND PHYSIOLOGY

(Notes, Anatomy Notes, 2019)

 ANATOMY AND PHYSIOLOGY
The primary functions of the respiratory system are to obtain oxygen from
the surrounding environment and deliver it to the cells, as well as to remove
carbon dioxide from the body produced by cellular metabolism.
The respiratory system consists of the lungs, the conducting airways, the
central nervous system components that control the respiratory muscles, and
the chest wall. The chest wall consists of the muscles of respiration—such as the
diaphragm, the intercostal muscles, and the abdominal muscles—and the rib
cage.
 ANATOMY AND PHYSIOLOGY
UPPER RESPIRATORY TRACT
Nose
It is the body’s primary organ of smell and also functions as part of the body’s
respiratory
system. Air comes through the nose.

Nostril/Nasal Cavities
The nasal cavity refers to the interior of the nose, or the structure which opens
exteriorly at
the nostrils. The cavity is entirely lined by the nasal mucosa which form the physical
barriers of
the body’s immune system.
 ANATOMY AND PHYSIOLOGY
Sinuses
The sinuses are small cavities that are lined with mucous membrane within the bones
of the
skull. Their main function is to produce a mucus that moisturizes the inside of the
nose.
Pharynx
The pharynx is a tube-like passage that connects the posterior nasal and oral cavities to
the
larynx and esophagus. Air enters the superior portion, the nasopharynx, from the nasal
cavity and
then descends through the oropharynx and laryngopharynx to enter the larynx below.
 ANATOMY AND PHYSIOLOGY
LOWER RESPIRATORY TRACT
 Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location of the Adam’s apple
which in reality is the thyroid gland and houses the vocal cords.
 Epiglottis
It is a small flap of tissue that covers the air-only passage when we swallow, preventing food and liquid
from entering the lungs. It is also known as the "guardian of the airways" because it protects the superior
opening of the larynx.
 Trachea
The trachea or windpipe is a tube that connects the larynx to the upper part of the chest and transports
air between the larynx and the lungs.
 Lungs
The lungs are the organ where gas exchange takes place. The lungs are made up of silicate tissues that are
extremely thin. The bronchi subside at the lungs, becoming progressively smaller as they branch through
the lung tissue until they reach the tiny air sacks of the lungs known as the alveoli.
 ANATOMY AND PHYSIOLOGY
 Bronchi
The right and left main (primary) bronchi are formed by the division of the trachea. Each main bronchus runs
obliquely before it plunges into the medial depression of the lung on its own side. The right main bronchus is
wider, shorter, and straighter than the left.
 Bronchioles
The bronchi subside creating a network of smaller branches, with the smallest one being the bronchioles.
There are more than one million bronchioles in each lung that represent the conducting system for air to
travel from the trachea to the alveolar ducts and alveoli.
 Alveolar ducts
Alveolar ducts are tiny ducts that connect the respiratory bronchioles to alveolar sacs, each of which contains
collection of alveoli. They are the end ducts of the branching airways that fill the
lungs.
 Alveoli
Alveoli are small mucus-lined pouches made of flattened epithelial cells where the lungs and blood exchange
oxygen and carbon dioxide during the process of breathing in and breathing out.
Pathophysiology of Pulmonary Tuberculosis
PATHOPHYSIOLOGY
(Book-based)
PATHOPHYSIOLOGY
(Client-Based)
 RISK FACTORS
Immunosuppressive Conditions- HIV coinfection is the most potent
immunosuppressive risk factor for developing active TB disease.
Malnutrition- Studies have shown that malnutrition (both micro- and macro-
deficiency) increases the risk of TB because of an impaired immune response. TB
disease can itself lead to malnourishment because of decreasing appetite and
changes in metabolic processes.
Young Age- Children are at higher risk of contracting TB infection and disease.
Studies have shown that 60–80% exposed to sputum smear-positive case became
infected compared to only 30–40% who are exposed to a sputum smear-negative
source case.
Diabetes- Diabetes has been shown to increase the risk of active TB disease.
Social Workers- Social workers are one that has increased risk of exposure to TB.
 RISK FACTORS
Social Workers- Social workers are one that has increased risk of exposure to TB.
Tobacco Smoke- The association between smoking and TB has been studied in
several systematic reviews the effects of smoking on TB, showed that the
relative risk of TB disease was high among smokers in comparison to nonsmokers
and that there was clear evidence that smoking causes remained a risk factor for
TB infection and disease, with additional risk of death in persons with active TB.
 CLINICAL MANIFESTATION
Book Based Client Based

• Cough up Phlegm  Cough

 Weight loss
• Malaise  Fever
• Consistent Fever  Hemoptysis
 Chest pain
• Weight loss
 Fatigue
• Sweats  Sore throat
•Anorexia
Source: Heemskerk D, Caws M, Marais B, et al. (2015). Tuberculosis in Adults and Children
 MEDICAL MANAGMENT
Pulmonary tuberculosis is treated primarily with antituberculosis agents for 6 to 12
months.

First line treatment. First-line agents for the treatment of tuberculosis are isoniazid
(INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide.
Active TB. For most adults with active TB, the recommended dosing includes the
administration of all four drugs daily for 2 months, followed by 4 months of INH and RIF
Treatment guidelines. Recommended treatment guidelines for newly diagnosed cases
of pulmonary TB have two parts: an initial treatment phase and a continuation phase.
Initial phase. The initial phase consists of a multiple-medication regimen of INH,
rifampin, Pyrazinamide, and ethambutol and lasts for 8 weeks.
 MEDICAL MANAGMENT
Continuation phase. The continuation phase of treatment includes INH and rifampin
or INH and rifapentine, and lasts for an additional 4 or 7 months.
Prophylactic isoniazid. Prophylactic INH treatment involves taking daily doses for 6
to 12 months.
DOT. Directly observed therapy may be selected, wherein the assigned health care
provider directly observes the administration of the drug.
 NURSING MANAGEMENT

Nursing Management for the patient include:

Promoting airway clearance. The nurse instructs the patient about correct
positioning to facilitate drainage and to increase fluid intake to promote systemic
hydration.
Adherence to the treatment regimen. The nurse should teach the patient that TB is a
communicable disease and taking medications is the most effective means of
preventing transmission.
Promoting activity and adequate nutrition. The nurse plans a progressive activity
schedule that focuses on increasing activity tolerance and muscle strength and a
nutritional plan that allows for small, frequent meals.
Preventing spreading of tuberculosis infection. The nurse carefully instructs the
patient about important hygienic measures including mouth care, covering the mouth
and nose when coughing and sneezing, proper disposal of tissues, and handwashing.
 NURSING MANAGEMENT

Disposal. Place a covered trash can nearby or tape a lined bag to the
side of the bed to dispose of used tissues.
Monitor adverse effects. Be alert for adverse effects of medications.
CHAPTER 3
 Diagnostic Tests (Book Based)

Tests that may be done include:

CBC
XRAY
Sputum Culture
Urinalysis
 LABORATORY RESULT

Table 1. Sample CBC Test Result Diagnosed in Pulmonary

Tuberculosis.
Complete Blood Count (CBC)
  Normal Results Interpretation Clinical
Significance

WBC 5.00 - 11.00 g/L 12.00 g/L Not Normal Elevated WBC count to fight
infection

RBC 4.50 – 5.20 L 4.00 L Not Normal Risk of anemia and

nutritional deficiency

Hgb 13.5 – 17.5 g/L 12.6 g/L Not Normal Risk of anemia
 
Platelet
      No risk of
thrombocytopenia
200 – 400 g/L 351 10 g/L Normal
 LABORATORY RESULT

FRONTAL CHEST XRAY

Figure 1. Presence of Pulmonary Tuberculosis

The chest x-ray (figure 1) showed the rounded opacity to be

persistent. A 50-year-old male client with fever and productive
cough has a focal opacity in the left lower lobe that looks like
pneumonia. This is a primary case of pulmonary tuberculosis in an
adult. The clinical findings of fever, cough and elevated WBC
count raise infection to the top of our differential. Familiarity of
pulmonary condition is necessary for accurate interpretation of
chest radiographs. Features on chest x-ray are a non-segmental,
homogenous consolidation predominantly involving one lobe with
air Broncho grams.
 LABORATORY RESULT

SPUTUM CULTURE
  RESULT POSITIVE RESULT NEGATVE

M. pneumonia   ✔

S. pneumonia   ✓

Grp. A steptococcus   ✓

S. aureus   ✓

M. tuberculosis ✔  

Mycobacteriaceae ✔  
 LABORATORY RESULT

URINALYSIS
Specimen Free catch  

Color Yellow
Appearance Cloudy
Specific Gravity 1.038
pH 7.0
Protein Negative
Glucose Negative
Ketones Negative
Bilirubin 1+
Blood Bacteria
Bacteria Positive
CHAPTER 4
NURSING CARE PLAN
 ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION INTERVENTION EVALUATION
SUBJECTIVE: Ineffective After the nursing SHORT TERM: INDEPENDENT: Promoted airway
interventions, the After 4 hours of Establish rapport Note ability to clearance.
“Nahihirapan na airway nursing o Building rapport aims to expectorate mucus  
akong huminga at clearance patient will and cough  
demonstrate the interventions, the get the client’s trust and
parang pagod na related to client will cooperation to render an effectively; document The client performed
following: demonstrate effective nursing care. character, amount of expectoration without
pagod pa ako retained sputum, presence of assistance.
behaviors of
kahit walang secretions and -Maintain patent improve or maintain Assess respiratory function hemoptysis  
ginagawa kaya fatigue as airway. clear airway. noting breath sounds, rate, o To determine  
ability to protect Demonstrated behaviors
nagpadala na ako evidence by rhythm, and depth, and use
airway. in improving or
sa hospital.” abnormal -Expectorate of accessory muscles.
LONG TERM: o to determine accumulation maintaining clear airway.
respiratory rate, secretions without Clear secretions from  
assistance. After 5 days of of secretions and  
OBJECTIVE: rhythm, depth, nursing respiratory distress. mouth and trachea;
suction as necessary Adhered to treatment
Fatigue abnormal interventions, the regimen.
-Demonstrate client will Demonstrate to the patient o Prevents
Fever breath sounds behaviors to obstruction and  
demonstrate the proper ways of coughing  
Hemoptysis (wheezes), improve or maintain absence or and breathing. aspiration. Promoted activity and
Dyspnea dyspnea, and clear airway. reduction of o The most convenient way Suctioning may be adequate nutrition.
congestion with to remove most secretions necessary if  
Respiratory: 36 hemoptysis breath sounds clear, is coughing.. Deep patient is unable
-Participate in Prevented spread of
cpm treatment regimen respirations breathing, on the other to expectorate tuberculosis infection.
noiseless, and hand, promotes secretions.
within the level of improved oxygen oxygenation before
ability/situation. exchange. controlled coughing. Goal was partially met.
-Identify potential
complications and
initiate appropriate
action.
Place patient in semi or high-Fowler’s DEPENDENT:
position. Maintain humidified
o Positioning helps maximize lung oxygen as prescribed.
expansion and decreases o Increasing humidity of
respiratory effort. Maximal inspired air will reduce
ventilation may open atelectatic thickness of secretions
areas and promote movement of and aid their removal.
secretions into larger airways for
expectoration.
Give medications as
Encourage patient to increase fluid prescribed, such as
intake to 3 liters per day within the antibiotics, mucolytic
limits of cardiac reserve and renal agents,
function. bronchodilators,
o Fluids help minimize mucosal expectorant s, noting
drying and maximize ciliary action effectiveness and side
to move secretions. effects.
o A variety of
Provide well ventilated environment. medications are
o To improve comfort and breathing prepared to manage
pattern specific problems.
Most promote
Observe for signs of respiratory clearance of airway
distress. secretions and may
o For timely intervention. reduce airway
resistance.
 ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION INTERVENTION EVALUATION
SUBJECTIVE: Hyperthermia After 30- 40 minutes SHORT TERM: INDEPENDENT: Advice the client to After 30-40 minutes of
related to of nursing After 30- 40 Establish rapport make a gargle with nursing intervention,
“Naku hindi na minutes of nursing o Building rapport aims to get warm water and salt. the client’s body
nawala ang lagnat inflammatory interventions, the o This relieves the
response as client’s body interventions, the the client’s trust and temperature decreases
ko, pabalik-balik client’s body cooperation to render an client’s sore throat from 38 C to less than
evidenced by temperature will be temperature will effective nursing care although this is 37.7 C in cooperation
na lang” as warm to touch able to decrease only short-lived.
be able to of:
verbalized by the skin and from 38 C to less decrease from 38 Identify underlying cause (in o Assessing for the
client. temperature of than 37.7 C in C to less than 37.7 our case it is due to Educate the client causative/ contributi
38.1 C cooperation of: inflammatory response cause regarding the possible
  C
causes of PTB.
ng factor/s and be
by the disease process) able to participate in
OBJECTIVE: o To know for the right o The information one interventi on.
-Flushed skin; • Assessing for the will be able to help
causative/c treatment to be given.
in preventing PTB o Assist with measures
warm to touch ontributing to reoccur. to reduce body
-Increase body Do tepid sponge bath to lower temperatu re and
factor/s and be the client’s body temperature participate in
temperature able to participate o To facilitate the body in interventi ons.
DEPENDENT
higher than in one interventio cooling down and provide Administer o Promoting health
normal range n. comfort. antipyretics as care wellness.
-Increased • Assist with ordered; paracetamol
measures to Eliminate excess clothing or 500 mg/tab 1 tab q4 The following
respiration, reduce body covers. prn T>37.8 intervention helps in
RR= 36 cpm temperatur e and o Exposing skin to room air o To reduce fever. decreasing patient’s
-The patient is decreases warmth and Follow the body temperature,
participate in increases evaporative frequency of maintaining it in normal
sweating interventio ns. cooling. medication range and monitoring in
-T: 38.1˚C • Promoting health because progress of the
care wellness. Promote oral fluid intake. temperature may condition.
o Without proper nutrition rise again due to
and hydration, the oral infection Goal was met
mucosa is more vulnerable
to damage
DEPENDENT:  
Provide high-calorie diet,
or parenteral nutrition.
o To meet increased
metabolic demands.
CHAPTER 5
 DRUG STUDY
Drug name Mechanism of Dosage Indications Contraindication Adverse Nursing
action s reactions Consideration
Generic Name: To inhibit bacterial DNA-  Adult: 10 mg/kg For the treatment of contraindicated in • Headache Before:
dependent RNA Tuberculosis and patients with a history of • loss of consciousness. -Observe the 12 rights of
Rifampin polymerase, which appears Tuberculosis related hypersensitivity to • yellowing of the skin or drug administration
  to occur as a result of drug Route: Oral mycobacterial infections. rifampin or any of the eyes During:
binding in the polymerase components, or to any of • reddish brown -Administer drug orally.
  subunit deep within the Frequency the rifamycins.
discoloration of the -Ensure that the client will
skin, saliva, urine, feces,
Brand Name: DNA/RNA : OD sweat, and tears.
drink his medication.
-Make the client take the
Rifadin channel, facilitating direct
blocking of the elongating
medication on an empty
  stomach. Take at least 1
RNA. This effect is thought hour before or 2 hours after
  to be concentration related. meals.
Classification: After:
-Advise the client to
Antitubercular continue taking the
Agents medication until the full
prescribed amount is
finished.
-Disposed container of drug
properly
-Monitor any adverse
effects. 
 
 DRUG STUDY
Drug name Mechanism of Dosage Indications Contraindication Adverse Nursing
action s reactions Consideration
Generic Name: Isoniazid is a prodrug and Adult: 5mg/kg For the treatment of all Isoniazid is • Peripheral  Before:
must be activated by up to 300 mg forms of tuberculosis in contraindicated in neuropathy -Observe the 12 rights of
Isoniazid bacterial catalase. which organisms are patients who develop • Loss of appetite drug administration
  Specficially, activation is susceptible. severe hypersensitivity • Nausea -Explain the importance and
  causative factors of the
associated with reduction of Route: Oral reactions, including
• Vomiting medication.
Brand Name: the mycobacterial ferric drug- induced hepatitis;
isoniazid- •
Stomach pain During:
Isonarif, KatG catalase- peroxidase Frequency previous -Ensure that the client will
by hydrazine and reaction : OD associated hepatic • Weakness drink his medication.
Isotamine, with oxygen to form an injury; severe adverse Take this medication by
Isotamine B, oxyferrous enzyme reactions to isoniazid mouth on an empty stomach
Rifamate, Rifater complex. Once activated, such as drug fever, chills, (1 hour before or 2 hours
isoniazid inhibits the arthritis; and acute liver after meals) as directed by
  synthesis of mycoloic acids, disease of any etiology. the doctor.
  an essential component of
After:
-Disposed container of drug
  the bacterial cell wall. properly
Classification: -Monitor any adverse effects
Antimycobac Advise the client not to stop
the medication until
terials prescribed by the doctor.
--Instruct the client not to
take this medicine in larger
or smaller amounts or for
longer than recommended.
 DRUG STUDY
Drug name Mechanism of Dosage Indications Contraindication Adverse Nursing
action s reactions Consideration
Generic Name: Pyrazinamide diffuses into Adult: 15 to For the initial treatment of Pyrazinamide is • nausea,  Before:
active M. tuberculosis that 30mg/kg active tuberculosis in adults -Observe the 12 rights of
Pyrazinamide contraindicated in drug administration
express pyrazinamidase and children when persons: with severe • upset stomach,
enzyme that converts combined with other -Monitor client’s vital signs
hepatic damage; who vomiting, -Explain the importance and
pyrazinamide to the active Route: Oral antituberculo us agents.
Brand Name: form pyrazinoic acid. have shown • loss of appetite, causative factors of the
medication.
Rifater, Pyrazinoic acid can leak out Frequency hypersensitivity to it; -Check the patient's medical
• mild muscle or
Tebrazid under acidic conditions to
be converted to the
: OD with acute gout.
joint pain, or.
record for an allergy or
contraindication to the
protonated conjugate acid, prescribed medication.
which is readily diffused • fatigue During:
back into the bacilli and -Administer drug orally.
Classification: accumulate intracellularly. -Ensure that the client will
Antitubercular drink his medication.
-Make the client take this
Agents. medication by mouth with or
without food as directed by
the physician.
After:
-Disposed container of drug
properly
-Monitor any adverse effects
-Advise the client to take the
medicine at the same time.
DRUG STUDY
Nursing Consideration

-Monitor any adverse effects

-Advise the client to take the
medicine at the same time.
-Instruct the client to continue
taking this medication until the
full prescribed amount is finished.
 -Instruct the client to notify their
physicians promptly if they
experience any adverse effects of
the drug.
 
 DRUG STUDY
Drug name Mechanism of Dosage Indications Contraindication Adverse Nursing
action s reactions Consideration
Generic Name: Ethambutol diffuses into Adult: 25mg/kg Ethambutol is indicated in Ethambutol is • Headache,  Before:
Mycobacterium cells. Once combination with other contraindicated in • Loss of appetite -Observe the 12 rights of
Ethambutol inside the cell, ethambutol anti- tuberculosis drugs in drug administration
inhibits the arabinosyltransf Route: Oral the treatment of pulmonary
patients who are • upset stomach, or -Monitor client’s vital signs
known to be nausea/vomiting -Explain the importance and
erases preventing formation tuberculosis. Ethambutol is
Brand Name: of the cell wall components Frequency commonly used in hypersensitive to this causative factors of the
Myambutol arabinogalactan and : OD combination with isoniazid, drug. It is also medication.
-Check the patient's medical
lipoarabinomann an, and rifampin, and pyrazinamide contraindicated in record for an allergy or
preventing cell division. patients with known contraindication to the
Decreased concentrations optic neuritis unless prescribed medication.
Classification: of arabinogalactan in the
clinical judgment During:
cell wall reduces the -Ensure that the client will
Antimycobac number of binding sites for determines that it drink his medication.
terial mycolic acid, leading to the may be used. -Take the medication with
antibiotics. accumulation of mycolic food to avoid upsetting the
acid, trehalose stomach.
monomycolate, and -Ensure that the client take
trehalose dimycolate. the medication exactly as
directed by the physician.
DRUG STUDY
Nursing Consideration

After:
-Disposed container of drug
properly
-Monitor any adverse effects
-Advise the client to take the
medicine at the same time.
-Instruct the client to continue
taking this medication until the
full prescribed amount is finished.
-Instruct the client to notify their
physicians promptly if they
experience any adverse effects of
the drug.
 
CHAPTER 6
 EVALUATION AND FINDINGS

After conducting this study, the nursing students were able to understand the importance of
utilizing a nursing process by providing clinical care and management for the patient. The results
of the laboratory testing revealed that the client's health issues were Pulmonary Tuberculosis.
The study has benefited in improving the quality of nursing care and patient management.
The study was conducted by making it possible to understand the conditions that trigger
Pulmonary Tuberculosis. The researchers become aware that Pulmonary Tuberculosis is a
common and often deadly infectious disease caused by mycobacteria, in humans mainly
Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect the
central nervous system, the lymphatic system, the circulatory system, the genitourinary system,
the gastrointestinal system, bones, joints, and even the skin. fortunately, Pulmonary TB is
curable with treatment, but if left untreated or not fully treated, the disease often causes life-
threatening concerns. Moreover, the Treatment for tuberculosis usually involves taking
antibiotics for several months.
 EVALUATION AND FINDINGS

Accurate and early identification is essential for improving patient

care. The correct treatment will only be provided if the health care
provider has the right knowledge, abilities, and attitude for the
management of Pulmonary Tuberculosis. Understanding the reason or
factors of pulmonary tuberculosis, as well as the process that the client
is going through, enables nurses to provide holistic care and relieve the
client's concerns and worries.
 RECOMMENDATIONS

Medication
Medications should be taken as ordered and prescribed by the physician to avoid
complications and help manage the condition of the patient. There are a lot of main anti-
Tuberculosis medications such as Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide.

Exercise
Instruct the client to have a time for deep breathing exercise daily for several times at
home to help achieved maximal lung expansion and for relaxation.
Advise the client to start with exercises that the client is already comfortable doing.
Starting slowly makes it less likely that the client will injure himself.
Caution the client to immediately stop any activities that might cause undue fatigue,
increased shortness of breath, or chest pain.
 RECOMMENDATIONS

Treatment
Remind the client about the importance of taking the medication in the right time and dose.
Sleep in a room with good ventilation.
Frequent rest is advised.

Health Teaching
Advice the client to take the medication on time and with the right dosage.
Avoid close contact with others until the doctor agrees.

Advice the client to cough and sneeze into tissues and to dispose of all secretions in a separate trash can.
Advice the client to perform hand washing frequently. Proper hygiene must be exercised.
 Isolation is the best technique to prevent the spread of bacteria. Wear a mask when going outside of the
room and separate dining wares to be used.
Advice the relatives of the client to clean the room regularly and provide a good ventilation.
Discuss to the client and significant others the cardinal signs of infection such as redness, heat, induration, swelling and
separation of drainage.
 RECOMMENDATIONS

OPD Check-up
Keep all follow-up appointments. It’s important to have doctor monitor the client’s progress.
Advised the client to consult a physician. Advise the client to watch out for adverse effects of
medications and to report them to the physician immediately.
Discuss to the relatives of the client to check the status of the client and its progress.

Diet
Diet as tolerated is advice by the attending physician, to sustain his nutritional needs.
High protein diet for tissue repair like meat and green leafy vegetables.
Spiritual
Encourage the client to read the Bible on a regular basis. So that his soul can be fed and
nurtured. Pray to God when you're feeling down, anxious, and hopeless