I.

INTRODUCTION PARAGRAPH

Tuberculosis Tuberculosis is a contagious infection caused by Mycobacterium tuberculosis, which is carried through the air. Tuberculosis usually affects the lungs, but it can attack almost any area of the body. Since anti-tuberculosis antibiotics were developed in the 1940s, tuberculosis has been taken less seriously than it once was. A variety of factors, however, had made it a growing health concern, including shrinking public health resources, more people with weakened immune systems due to AIDS, increasing resistance to antibiotics and extreme poverty in many parts of the world. Worldwide, three million people die from tuberculosis every year. An estimated one out of every three people in the world has a dormant tuberculosis infection, although only five to 10 percent develop active tuberculosis. Symptoms When a microorganism infects a person's body, he or she usually becomes sick within one to two weeks, but not with tuberculosis. Except for very young children, people can have live bacteria "sleeping" inside their bodies for many years. The body's defense mechanisms prevented the bacteria from developing into full-scale tuberculosis, but have not killed the bacteria. These sleeping bacteria cannot be spread to other people. In the vast majority of people, the bacteria never cause problems. In five to 10 percent, however, the bacteria start to multiply and develop tuberculosis, usually within the first two years after infection. Although what causes the bacteria to become active is not known, it can happen because of an immune system weakened by advanced age, the use of corticosteroids or AIDS. In this phase, an infected person feels sick and can spread the disease to other people. The bacteria that cause tuberculosis can live only in people. It cannot be carried by animals, insects, and soil or nonliving objects. The bacteria spread only through the air when a person coughs sneezes or speaks. The bacteria can stay in the air for several hours, making it possible for many other people to become infected with tuberculosis. The signs of tuberculosis may not appear to be serious at first. They include: Coughing, which produces a small amount of green or yellow sputum in the morning? As the disease gets worse, the sputum may be streaked with small amounts of blood. Cold night sweats, which are heavy enough to wake a sleeper up and require a change of nightclothes or bed sheets Not feeling well in general A loss of energy and appetite Weight loss over time

Sudden shortness of breath along with chest pain may be a sign that air or fluid has entered the space between the lungs and the chest wall (pneumothorax). For many people this is the first sign that leads them to seek a diagnosis. When a tuberculosis infection first occurs, the bacteria may travel from the lungs to the lymph nodes that drain the lungs. If the body is able to bring the infection under control at this stage, the bacteria become dormant. A dangerous complication for young children, whose immune systems are weaker and bodies are smaller, is that the lymph nodes can swell large enough to press on the bronchial tubes, causing a cough and possibly a collapsed lung. Sometimes, the bacteria spread up the lymph system to the lymph nodes in the neck, in which case, the infection may break through the skin and let loose pus. In people with a fully functioning immune system, active tuberculosis is usually limited to the lungs (pulmonary tuberculosis). Tuberculosis that affects other parts of the body (extrapulmonary tuberculosis) comes from pulmonary tuberculosis that has spread through the blood. As in the lungs, the infection may not cause disease, but the bacteria may remain dormant in a very small scar. Latent organisms in these scars can reactivate later in life, leading to symptoms in the organs involved. In pregnant women, the tuberculosis bacteria may spread to the fetus and cause disease; however, such congenital tuberculosis is uncommon. If the tuberculosis infection occurs outside the lungs, it usually affects the kidneys and the lymph nodes. Symptoms of a tuberculosis infection elsewhere than the lungs tend to be vague and include: Fatigue Poor appetite Fevers that come and go Sweats Weight loss in some cases Pain

Other types of tuberculosis include: Tuberculosis meningitis, which affects the tissues that cover the brain. This is life threatening. Symptoms include fever, a headache that does not go away, stiffness in the neck, nausea and sleepiness that can develop into a coma. Tuberculoma, which affects the brain itself and forms a mass that causes headaches, seizures or muscle weakness Tuberculous pericarditis, which affects the membrane that covers the heart (pericardium). This type of tuberculosis causes the pericardium to thicken. Sometimeswhich affects the membrane that covers the heart (pericardium). This type of tuberculosis causes the pericardium to thicken. Sometimes fluid will leak from the layers of the pericardium into the space between the pericardium and the heart, making it harder for the heart to pump. It can cause swollen veins in the neck and difficulty breathing. Intestinal tuberculosis, which may not cause any symptoms but does create an abnormal mass of tissue that can be mistaken for cancer Miliary tuberculosis, which is a life-threatening type of tuberculosis that occurs when a large number of bacteria are spread throughout the body in the bloodstream. It gets its name from

the millions of tiny lesions formed, which are the size of millet, a tiny round seed. If it gets into the bone marrow, it can cause severe anemia and blood conditions that seem like leukemia. Causes and Risk Factors In the United States and other developed countries, tuberculosis is more likely to affect older people. In poorer countries, it is a disease of young adults. People of European ancestry are somewhat less likely to get tuberculosis because the bacterium for it has existed a long time in Europe. People from other parts of the world, where tuberculosis is a newer disease, are at greater risk of developing it. In the United States, tuberculosis is more common among African Americans, Native Americans and immigrants from non-European countries. Poverty, poor nutrition, crowded living conditions, exposure to tuberculosis and lack of access to medical care all increase the risk of developing tuberculosis. Diagnosis Because the symptoms of tuberculosis can start out as vague and flu-like, tuberculosis is often discovered from a chest X-ray done for another reason or a positive tuberculin skin test that was done for routine screening. When symptoms suggest tuberculosis, a doctor may recommend the following tests: A chest X-ray if it has not already been done. The results may show abnormalities but often look like those of many other diseases. An X-ray alone cannot confirm tuberculosis. A tuberculin skin test (also called a Mantoux test or purified protein derivative {PPD} test), if it has not already been done. This test shows that an infection by the bacteria has occurred at some point in the person's life, but it does not reveal if the infection is currently active. The test itself involves injecting a small amount of protein from tuberculosis bacteria between layers of the skin. About two days later the site is checked. If there is swelling larger than a certain size that feels firm when touched, the person has been infected with tuberculosis (the test is positive). Redness without swelling indicates that there is no infection. A sputum sample to be analyzed in a laboratory for the presence of tuberculosis bacteria. The sample may also be used to grow a culture of the bacteria to make sure the test results are accurate.

In the event that other conditions (such as lung cancer) are suspected, the doctor may order a bronchoscopy, which uses an instrument to examine the bronchial tubes and get samples of mucus or lung tissue. If there are signs of tuberculosis meningitis, a doctor may take a sample of spinal fluid (do a spinal tap) to analyze for bacteria. Treatment is usually started if there is even a suspicion of tuberculosis meningitis because the analysis takes time and the condition is life threatening. Treatment Just as tuberculosis is slow to develop symptoms, it is slow to respond to the many antibiotics that can be used against it. Antibiotics must be taken for six months or longer - long after a person feels completely well - or the disease tends to return. Because many people find it difficult to take their drugs for a long time or tend to stop taking them when they feel better, many doctors recommend that people

with tuberculosis receive their drugs from a healthcare worker (directly observed therapy, DOT). Because this assures that treatment is being received, DOT treatments are usually shorter and given only two to three times a week. Two or more antibiotics that work in different ways are normally given to help kill bacteria resistant to a particular drug. A third and fourth drug may be given during the first intense phase of treatment to make it shorter and more effective. Surgery is usually not needed, but it may be used when a person has a particularly drug resistant infection or to drain infection from the lungs. If tuberculous pericarditis makes it hard for the heart to pump, the pericardium may need to be removed. A tuberculoma in the brain may also need to be removed with surgery. MORTALITY: TEN Number and 5-Year Average (2000-2004) & 2005 LEADING rate/100,000 5 Year Average (2000-2004) Number Rate 66,412 83.3 50,886 63.9 38,578 48.4 32,989 41.4 33,455 42.0 27,211 34.2 18,015 22.6 13,584 17.0 (10) LEADING Population CAUSES Philippines

Cause

2005* No. 77,060 54,372 41,697 36,510 33,327 26,588 20,951 18,441 Rate 90.4 63.8 48.9 42.8 39.1 31.2 24.6 21.6

1. Diseases of the Heart 2. Diseases of the Vascular system 3. Malignant Neoplasm 4. Pneumonia 5. Accidents 6. Tuberculosis, all forms 7. Chronic lower respiratory diseases 8.Diabetes Mellitus 9. Certain conditions originating in the 14,477 18.2 12,368 14.5 perinatal period 10. Nephritis, nephrotic syndrome and 9.166 11.5 11,056 3.6 nephrosis Note: Excludes ill-defined and unknown causes (R00-R99) * reference ** External Causes of Mortality Last Update: June 29, 2009

of

mortality n=23,235 year

I. INTRODUCTION Tuberculosis is a common and often deadly infectious disease caused by mycobacteria, 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. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti also cause tuberculosis, but these species are less common. The typical symptoms of tuberculosis are a chronic cough with blood-tinged sputum, fever, night sweats and weight loss. Infection of other organs cause a wide range of symptoms. The diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Tuberculosis treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Gurin (BCG vaccine). Tuberculosis is spread through the air, when people who have the disease cough, sneeze or spit. One third of the world's current population have been infected with M. tuberculosis, and new infections occur at a rate of one per second.[1] However, most of these cases will not develop the full-blown disease; asymptomatic, latent infection is most common.

I.

Introduction

This whole case study is about to discussed Pulmonary Tuberculosis (TB) and few of Pneumothorax and Hydrothorax. This case will tackle about the disease, patients health and of course nursing intervention. Tuberculosis (abbreviated TB for tubercle bacillus or Tuberculosis) is a common and often deadly infectious disease caused by mycobacteria, in humans mainly Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti also cause tuberculosis, but these species are less common in humans. Tuberculosis is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in human beings will result in asymptomatic, latent infection, and about one in ten latent infections will eventually progress to active disease, which, if left untreated, kills more than half of its victims. The classic symptoms of tuberculosis are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms.

Demographic incidence Tuberculosis (TB) is a deadly disease. It is the worlds No. 1 cause of death around the world; about 3 million persons die of TB every year. It is one of the 10 top killer diseases in the Philippines; 75 Filipinos die of TB every day. Pneumothorax, or collapsed lung, is a potential medical emergency caused by accumulation of air or gas in the pleural cavity, occurring as a result of disease or injury, or spontaneously. Kind: Closed Pneumothorax Air escapes in pleural space from a puncture or tear in an internal respiratory structure such as bronchus, bronchioles, and alveoli. Classification: Spontaneous the cause is Unknown, could be result of another disease such as COPD, PTB and Cancer. Chest wall is intact; blebs/bulla is rapture causing collapse lungs. A hydrothorax is a condition that results from serous fluid accumulating in the pleural cavity.

I. Introduction Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and sneezing. An estimated 200,000 to 600,000 Filipinos have active TB. This condition makes the person sick and contagious to others. Active TB can occur in the first few weeks after infection with the bacteria, or it can occur a few years later. A particular case of tuberculosis was studied by our group at Sitio Batangas, Sta. Rosa, Nueva Ecija where our class was stationed over a period of one month. His was of pulmonary (lung) tuberculosis, a peculiar disease for the few residents of the area. We as students of the medical laboratory field wanted to understand this disease, its impact to the community, and how to prevent and control its spread. For these reasons, our group conducted this study. Facts about Tuberculosis Tuberculosis is a bacterial infection that is most often found in the lungs. Most people who are exposed to TB never develop symptoms, because the bacteria can live in an inactive form in the body. But if the immune system weakens, such as in people with HIV or elderly adults, TB bacteria can become active. In their active state, TB bacteria cause death of tissue in the organs they infect. Active TB disease can be fatal if left untreated. Inhalation of a single viable organism has been shown to lead to infection, although close contact is usually necessary for acquisition of infection. With regard to M. Tuberculosis, 15% to 20 % of persons who become infected develop disease. A report according to the World Health Organizations (WHO) ranks the Philippines at number 15 at the top tuberculosis high-burden countries worldwide. Afghanistan and Bangladesh ranks as number 1 and 2 respectively. Common presenting symptoms include low grade fevers, night sweats, fatigue, anorexia (lose of apposite), and weight loss. If a patient is with pulmonary tuberculosis, a productive cough is usually present, along with fevers, chills, myalgias (aches) and sweating which are signs and symptoms similar for not only influenza but also acute bronchitis or pneumonia. Other organs besides the lungs can be involved following infection with M. tuberculosis complex organisms in a small percentage of patients and includes the following: genitourinary tract, lymph nodes, central nervous system (meningitis), bone and joint (arthritis and osteoporosis), peritoneum, pericardium, larynx.

Introduction Pulmonary tuberculosis, a chronic sub-acute or acute respiratory disease commonly affecting the lungs characterized by the formation of tubercles in the tissues which tend to undergo cessation, necrosis and calcification. It is also known as poor mans disease or consumption disease. The causative agent in this disease is Mycobacterium Tuberculosis, a rod shaped bacteria. The disease is transmitted by deliberate inoculation of microorganisms by droplet. This disease is transmitted to other people through the inhalation of organisms directly into the lungs from contaminated air. According to the department of Health (DOH) PTB is the 6th cause of mortality and morbidity in the Philippines as of 2007. (Navales, Handbook of Common Communicable and Infectious disease revised edition, pages 280-281.) This disease is can be acquired easily by person being in contact with an infected one, when you are living in a crowded area like the squatters area and when you have poor nutrition. It is commonly present in third world or developing countries like the Philippines. In 2004, mortality and morbidity statistics included 14.6 million chronic active cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or AIDS. The distribution of tuberculosis is not uniform across the globe with about 80% of the population in many Asian and African countries testing positive in tuberculin tests, while only 5-10% of the US population testing positive. (http://en.wikipedia.org/wiki/Pulmonary_tuberculosis)

Introduction In the course of the last seventy five years remarkable progress has been made in the early diagnosis of tuberculosis its prevention and treatment. The discovery of Mycobacterium Tuberculosis by Robert Hoch in1982 as the causative organism is a land mark in the history of tuberculosis. It became evident that tuberculosis was neither a hereditary disease nor a constitutional one and that the germ causing the disease could be demonstrated under the microscope in the sputum of patients suffering from pulmonary tuberculosis (Tuberculosis of lungs). The discovery of X-rays by professor Roentgen in 1895 further facilitated the diagnosis of early cases with dry cough and sputum. Today X-ray photography has been an established practice allowing the medical profession to discover early and latent pulmonary lesions and at a time when their treatment guarantees in a large number of cases a complete cure. The tuberculosis test since the first decade of this century has provided itself an invaluable tool in diagnosis and epidemiological study when refined in 1907 and 1908 by the method of pirquet, Hamburger and mantouX vigorous investigations in the chemotherapy of tuberculosis led to the introduction of Strepromycin in 1944 which was followed by the discovery of drugs such as Para-aminosalicyclic acid hydrazide in 1952. For the first time in the history of the long drawn out fight against the disease we are in a position to oppose the tubercle bacillus by specific drugs. Along with chemotherapy thoracic surgery too has progressively developed and they have revolutionalised the treatment of tuberculosis within the last decade besides B.C.G. Vaccination today hold promise for a certain amount of protection to uninfected persons likely to be undeely exposed. The road from Lister to Pasteur and Pasteur to loch from loch to fleming and wakesman marks the stages of conquests over various bacterial diseases. A number of countries today can justly be proved of the fact that by planned and sustained efforts they have succeeded in reducing tuberculosis mortality and morbidity rate. It is hoped that in the near future they will be able to eradicated the disease altogether. But where do we in Indian stand in the fight against tuberculosis? Since the dawn of history tuberculosis known as Kshayaroga, has preyed upon human lives in our country. In the earlier years of tuberculosis control in India emphasis was only on treating the individual patient rather than on controlling the diseases in the community. However the individual relief was slow due to absence of any really effective treatment patients were usually advised open air treatment in a dry climate, this was restricted mainly due to early cases where there was some hope for recovery. Little was done for the patients with advanced disease for they were regarded as hopeless and incurable. In the absence of alternative methods of treatment open air treatment in Sanatoria were built on hills or near sea showers to provide plenty of fresh air to patients. Owing to prohibitive cost of treatment in such sanatoria they were not usually accessible to the poorer section of society that suffered from the disease very often a few philanthropic bodies and individual provided some facilities for the care of the poor tuberculosis patient in sanatoria. Some Christian missionaries in the country were pioneers in providing open air institutions for the isolation and treatment of tuberculosis. In methods of diagnosis and treatment India was for behind until fairly recently. Up to about 1920 the diagnosis of tuberculosis was by the ordinary physical examination X-rays were used but rare Y. the typical tuberculosis cases demonstrated to medical students who were of the chronic fibrotic type with omaciation and clubbing of fingers, patients who were often confined to huts on the out skirts of a general hospital and rarely visited by the doctors medical students except for demonstration purposes. With regards to treatment there was an atmosphere of hopelessness and there was an abnormal almost morbid fear of infection. Treatment was almost nill except for good food open air and dry climatic. It was only after 1920 that artificial pheumothorax widely used in the west from 1905 was tried in India and only from 1905 was tried in India and only from 1932 that thoracoplasty and similar operations were introduced. As these

modern method of treatment became very popular the need for specialization was felt and tuberculosis diseases diploma was instituted in madras in 1939 later followed by several another universities. The discovery of anti-bacterial drugs and their use since 1945 in India gradually brought in a ray of hope about combating the disease. To this must be added the development of chest surgery and the increased use of lung resections. Public opinion was also moving in the direction of finding out ways and means of controlling the diseases. The result was the formation of tuberculosis Association of India in 1939 to educate the public about the seriousness of the disease. By 1945 it presented a memorandum emphasizing the need to consider tuberculosis as a major health problem by the health survey and the developing committee of the Government of India. The government soon appointed a full time advisor in tuberculosis control has been evolved. Simultaneously international organizations such as the WHD and the UNICEF which were taking interest in tuberculosis as a world problem gave a stimulation o the B.C.G programme in different countries. It was in 1948 that the B.C.G campaign was first introduced in India on a small scale and from1951 onwards it has been extended on a max scale. For the Indian BCG campaign the country produces its own vaccine and tuberculin dilutions in the BCG vaccine laboratory in Guindy, Madras/Chennai. About 209 million persons have been tested so far and about 75 millions vaccinated. In spite of various obstacles and handicaps the campaign is going on and has achived something yet much remain to be done. But should the battle be fought on hemidial front only? For long tuberculosis has been regarded as an isolated medical problem. It is high time we started looking at its psychological components also. Medical measures are important no doubt for the diagnosis and treatment of the disease but there are certain equally important non remedial aspects of tuberculosis which need due consideration. In recent years there has dawned some understanding that environment also plays a significant parts in illness. A great impetus to the scientific understanding of environment was given in the late 19th century when the new technique of bacteriology was discovered and applied people came to realize that germs which lay in the environment of the individual could give rise to various diseases. With the growth of chemistry still more disease become casually related to external agents. All this however did not take in account the patient as a whole. It was the unhealthy throat or the leg or some other limb alone that seed to succumb to the forces of pathology. In spite of all the process made by me dicine in the course of centuries it is astonishing that medical men until a few years ago could not think of illness in terms of the organism as a whole scientific work in biology and psychology also demonstrated that function are less localized than was formerly believed and that the organism functions as a whole. Medicine of today in order to be effective, requires consideration of the total needs and back ground of the individual biological, intellectual, psychological, social, physical, economic, spiritual and cultural. For the sake f spiritual these may be classified into personal and environmental factors. Modern medicine has to regards illness as a vital reaction or mode of behaviour of a person to environmental factors and thus take into account personal and environmental factors in dealing with the illness of the patients and introducing preventive measures. Symptoms and Diagnosis In pulmonary tuberculosis the infection usually takes place through inhalation. Tuberculosis bacill that are inhaled reach the bronchial tubes and penetrate the mocul membrane lining the bronchi. Then they find their way into tissues immediately underneath and step a tiny focus of inflammation. The immediate response of the body to the first attack of tubercle bacilli is dispatch of special body blood cells to the site of infection to surround and if possible to destroy the invading germs in most of us this process takes places without our being aware of it. To radical changes however occur in the body about a month and half after such a subclinical infection. The body acquires additional resistance to the tubercle bacillus and the skin becomes allergic to tuberculin.

Though primary tuberculosis occurs mostly in children it occurs in adults also. It is regarded in general as a bengn disease that would heal spontaneously in fact there are however a number of cases of complications in primary tuberculosis that require active treatment including rest appropriate diet & hygienic measures secondary or clinical tuberculosis is that form of pulmonary tuberculosis which results from secondary infection with tuberculosis bacilli. In primary tuberculosis signs and symptoms are usually indefinite or absent if the patient is seen during the height of the acute inflammatory reaction which ordinerly eastsonly a few weeks a slight rise in the afternoon temperature with a feeling of malaise and failure to gain weight satisfactory are usually present. As a rule initial lesion in primary tuberculosis is singly only occasionally it is multiple in some cases specially in older children the primary lesson does not remain localized but spreads and infiltrates the surrounding fissues, and it becomes difficult to distinguish it from the typical infiltration of lungs in secondary tuberculosis. The latter type of tuberculosis shows a marked tendency to progress and to involve increasing area of the lung tissue in a destructive process. The onset of secondary pulmonary tuberculosis takes many different forms but is usually somewhat insidious. Amongst the early systems are less of weight, loss if appetite night sweats fever and a combination of these or present at some stage if illness generally throughout. At first it often a dry, short ineffective cough with very little expectatoration. As the disease develops it becomes easier and the sputum is more The development of active tuberculosis leads to a consolidated area in the lungs. If this does not scar quickly a cavity may form. It may be mentioned here that unlike most inflammations a tuberculous. Inflammation is accompanied by a decerase in the blood supply to the inflamed part. In secondary tuberculosis as an spitting of blood may occure as an early feature on appear only late in the disease. The tuberculosis protion of the lung erodes in to a blood vessel. When there is heamo rhage. Pain in the chest occurs in some cases. As the disease progress the patient become emaciated the cough is constant and the fever and sweat become pronounced. The above in brief is the picture of the much dreaded disease known as tuberculosis. Owing to the insidious nature of the disease the diagnosis is often preceded by a period of varying length during which patients present symptoms which are suggestive but not necessarily typical of tuberculosis.

I. Introduction Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and sneezing. An estimated 200,000 to 600,000 Filipinos have active TB. This condition makes the person sick and contagious to others. Active TB can occur in the first few weeks after infection with the bacteria, or it can occur a few years later. A particular case of tuberculosis was studied by our group at Sitio Batangas, Sta. Rosa, Nueva Ecija where our class was stationed over a period of one month. His was of pulmonary (lung) tuberculosis, a peculiar disease for the few residents of the area. We as students of the medical laboratory field wanted to understand this disease, its impact to the community, and how to prevent and control its spread. For these reasons, our group conducted this study. Facts about Tuberculosis Tuberculosis is a bacterial infection that is most often found in the lungs. Most people who are exposed to TB never develop symptoms, because the bacteria can live in an inactive form in the body. But if the immune system weakens, such as in people with HIV or elderly adults, TB bacteria can become active. In their active state, TB bacteria cause death of tissue in the organs they infect. Active TB disease can be fatal if left untreated. Inhalation of a single viable organism has been shown to lead to infection, although close contact is usually necessary for acquisition of infection. With regard to M. Tuberculosis, 15% to 20 % of persons who become infected develop disease. A report according to the World Health Organizations (WHO) ranks the Philippines at number 15 at the top tuberculosis high-burden countries worldwide. Afghanistan and Bangladesh ranks as number 1 and 2 respectively. Common presenting symptoms include low grade fevers, night sweats, fatigue, anorexia (lose of apposite), and weight loss. If a patient is with pulmonary tuberculosis, a productive cough is usually present, along with fevers, chills, myalgias (aches) and sweating which are signs and symptoms similar for not only influenza but also acute bronchitis or pneumonia. Other organs besides the lungs can be involved following infection with M. tuberculosis complex organisms in a small percentage of patients and includes the following: genitourinary tract, lymph nodes, central nervous system (meningitis), bone and joint (arthritis and osteoporosis), peritoneum, pericardium, larynx.

SUMMARY OF THE CASE

Scope of the Study The study focuses on surgical Ward patient, admitted at Polymedic General Hospital, Cagayan de Oro City, having the diagnosis of Pulmonary Tuberculosis. Nature, causes, signs & symptoms, pathophysiology, medical management, nursing management, and prognosis of the disease. Involves the ideal and actual nursing intervention appropriate to address the needs of Mrs. Nelia S. Castillano, the drug study of the medications given to her, the health teachings as well as referrals for Mrs. Nelia S. Castillano Assessment of Mrs. Nelia S. Castillano personal health history, and history of present illness.

Limitation of the Study Limited only to the history of the patient which is comprised of the patients profile, family and personal health history, chief complaint and history of present illness. Information being collected from the patient during the patient assessment and from her watchers. The patient was only taken cared of for 2 days, starting from the 2nd day of her admission at Polymedic Genaral Hospital, Cagayan de Oro City.

A. Scope and Limitation of the Study This study is focused on the nursing aspect of care to those patients who have Pulmonary Tuberculosis. This study will only be used in the nursing profession. The researchers only focused their attention on the medications, diagnostics, care plan, pathophysiology and discharge planning. This study is not limited to the PTB patients only, but it is for all people who are interested in PTB. We are more focused on primary prevention through health education because primary prevention is the true prevention

A. Scope and delimitation The scope of this study will focus on Pulmonary Tuberculosis with a few discussions of pneumothorax and hydrothorax. The study covers the background of the disease, the anatomy, pathology, mode of transmission, pathophysiology and as well as its complications. All information needed to come up with this case study was taken from patient, patients family (mother and sister), patients chart, laboratory result, physical assessment, books and internet.

Scope of the Study Most of the tuberculosis patients are socially isolated and economically strangulated and psychologically exploited by the society. So far the above cause they always keep themselves off the mainstream of society and from socially and economically new structure for their livelihood. So in this study the researcher wanted to find out their family background and to explore the change that has brought about in their present families and the researcher was also interested their psychological view towards the past and the present. Limitation of The Study Despite the proper planning and execution of the study certain handicaps which might have crippled up the study are the following. 1. Time factor was a main problem for the study. 2. The members being illiterate were not able to express the factors details. 3. Some of them were not able to answer some questions 4. The disinterested or frustrated tuberculosis patients did not give the full information and some of the answer from them were vague, irregular and with the element of carelessness.