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T

PULMONARY TUBERCULOSIS

Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. The primary infectious agent, mycobacterium tuberculosis, is an acid-fast aerobic rod that grows slowly and is sensitive to heat and ultraviolet light. It is generally transmitted by the inhalation or ingestion of infected airborne particles & usually affects the lungs. The lung tissues react to the bacillus by producing protective cells that engulf the disease organism, forming tubercles. Untreated, the tubercles enlarge and merge to form larger tubercles that undergo caeseation, eventually sloughing off into the cavities of the lungs. Hemoptysis occurs as a result of cavitary spread.

Classification Class

0: no exposure; no infection Class 1: exposure; no infection Class 2: infection; no disease Class 3: disease; clinically active Class 4: disease; not clinically active Class 5: suspected disease; diagnosis pending

PROGNOSIS
Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and begin to multiply. In primary TB disease15% of casesthis occurs soon after infection. The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In patients co-infected with ''M. tuberculosis'' and HIV, the risk of reactivation increases to 10% per year.

SIGNS & SYMPTOMS


primary

pulmonary tuberculosis Symptoms include: loss of weight loss of energy poor appetite, Fever productive cough and night sweats most initial infections have no symptoms and people overcome them, they may develop dry cough, and abnormalities that may be seen on a chest x-ray.

Tuberculous pleuritis may occur in 10% of people who have the lung disease from tuberculosis. The pleural disease occurs from the rupture of a diseased area into the pleural space Symptoms: nonproductive cough chest pain fever.

miliary tuberculosis In a minority of people with weakened immune systems, TB bacteria may spread through their blood to various parts of the body. fever, weakness, loss of appetite, and weight loss.

CAUSES

TB spreads from person to person by airborne transmission. An infected person releases droplet nuclei (usually particles 1 to 5 m in diameter) through

Talking Coughing Sneezing Laughing Singing

COMPLICATIONS
Without

treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Brain. Tuberculosis in your brain can cause meningitis Liver or kidneys Heart

RISK FACTORS
HIV

infection low socio-economic status alcoholism crowded living conditions diseases that weaken the immune system migration from a country with a high number of cases health-care workers Immunocompromised Diabetes End-stage kidney disease Cancer treatment

TEST
Complete

history & physical examination Tuberculin skin test (mantoux test) Chest x-ray Acid-fast bacillus smear Sputum culture

TREATMENT
With 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, possible drug resistance, the form of TB (latent or active) and its location in the body. Most common TB drugs Isoniazid Rifampin (Rifadin, Rimactane) Ethambutol (Myambutol) Pyrazinamide Streptomycin

ANATOMY & PHYSIOLOGY


RESPIRATORY SYSTEM

Function of the respiratory system 1.oxygen transport 2.respiration 3.ventilation 4.pulmonary diffusion and perfusion 5.ventilation and perfusion balance and imbalance 6.gas exchange 7.carbon dioxide transport

UPPER RESPIRATORY TRACT Respiration is defined in two ways. In common usage respiration refers to the act of breathing inhaling and exhaling. Biologically speaking, respiration strictly means the uptake of oxygen by an organism, its use in the tissues, and the release of carbon dioxide. respiration has two main functions: to supply the cells of the body with the oxygen needed for metabolism and to remove carbon dioxide formed as a waste product from metabolism.

The upper respiratory tract conducts air from outside the body to the lower respiratory tract and helps protect the body from irritating substances. The upper respiratory tract consists of the following structures: nasal cavity mouth pharynx epiglottis larynx

THE MOUTH also known as the buccal cavity or the oral cavity, is the opening through which an human takes in food. THE PHARYNX Is a chamber shared by the digestive and respiratory systems. It extends between the internal nares and the entrances to the larynx and esophagus. A stratified squamous epithelium lines the pharynx.

Function: passageway for the respiratory and digestive tract. The throat or pharynx is divided in 3 regions: 1. Upper NASO-PHARYNX 2. Middle OROPHARYNX 3. Lower LARYNGOPHARYNX

THE LARYNX joins the laryngopharynx with the trachea major function is vocalization. Referred as the voice box the 3 main cartilages are: THYROID CARTILAGE ( Adamss apple ) EPIGLOTTIS CRICOID CARTILAGE. ARYTENOID CARTILAGES CORNICULATE CARTILAGES CUNEIFORM CARTILAGES. THE EPIGLOTTIS forms the entrance to the larynx; a valve flap of cartilage that covers the opening to the larynx during swallowing THE TRACHEA composed of smooth muscle wit C-shaped rings of cartilage serves as the passage between the larynx and the bronchi

LOWER RESPIRATORY TRACT

THE LUNGS paired elastic structures enclosed in the thoracic cage which is an airtight chamber with distensible The pleura serous membrane which lined the lungs and wall of the thorax

The alveoli it is where oxygen and carbon dioxide exchange takes place The bronchioles has no cartilages in their walls; contain submucosal glands which procedure mucus that covers the inside lining of the airways

NURSING HISTORY

DEMOGRAPHIC DATA NAME: LUCKY BOY ADDRESS: STO. DOMINGO, ECHAGUE, ISABELA AGE: 27 BIRTHDAY: APRIL 8, 1984 BIRTHPLACE: ECHAGUE, ISABELA RELIGION: ROMAN CATHOLIC SEX: MALE NATIONALITY: FILIPINO CC: AP: DOA: body weakness, hemoptysis, dypsnea Dr. Ifurung August 24, 2011

REASON FOR SEEKING HEALTH CARE 6 months PTA, pt. started to develop non-productive cough, which progressed to productive cough. He also noticed that he started to lose weight. A month ago, he experienced episodes of night sweats, he would wake up in the middle of his sleep because he feels irritated with the sudden change in his body temperature. 5 days PTA, he went to their barangay health center and had his check-up. The doctor said that he is positive with PTB and so he was referred to the nearest hospital. At first, he doubted the doctor so he ignored him. 4 days PTA, he had episodes of on and off fever, but he did not take any medicine. 2 days PTA, he experienced body weakness and hemoptysis. Last August 24, he decided to go to ECHAGUE DISTRICT HOSPITAL.

PAST HEALTH HISTORY Lucky Boy didnt complete his vaccination. When he was still a kid, he was diagnosed of asthma. He is not taking in any anti-asthmatic drug. When he is sick, he is not taking in any medicine, he prefers drinking water and sleeping. This in his first hospitalization. He has no known allergies. He never had surgery.

FAMILY HISTORY

LUCKY BOY DEAD FEMALE MALE CARDIAC DISEASE ASTHMA ALIVE & WELL

GORDONS FUNCTIONAL PATTERN

HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN

BEFORE HOSPITALIZATION: The patient perceived health as an important aspect of his life. Whenever he experienced pain in his body hes not taking any over the counter drug or herbal medicines. He prefers taking a rest and water therapy. He only takes vitamins. DURING HOSPITALIZATION: His perception about health changed. He realized that he should not take those simple pains that he is experiencing for granted because it can worsen if its not treated immediately.

NUTRITIONAL-METABOLIC PATTERN Before hospitalization: According to him, he usually eats two cups of rice, more than three matchbox-sized meat and softdrinks or just water every meal. He drinks 4-5 glasses of water everyday. Breads/biscuits with juice are his usual snack every afternoon. He is taking vitamin supplement. He is the one preparing their food at home. During hospitalization: Upon hospitalization he lost his appetite, in addition, he cant tolerate sitting for long period of time. He drinks 3-4 glasses of water everyday.

ELIMINATION PATTERN Before hospitalization The patient usually defecates once a day. He describes his stool as light brown in color. He doesnt use enemas or suppositories to promote bowel elimination. He had no bowel surgery before. He urinates 2-3 times a day. He describes his urine as yellow in color. He has no problems in urinating. During hospitalization He defecates three to four times a week, with semi-formed stool that is yellow to dark brown in color. No enema or suppositories to promote bowel elimination and he urinates once a day.

ACTIVITY-EXERCISE PATTERN Before hospitalization Before he was hospitalized he can do anything that he wants. He is the one cleaning their house every morning which served as his exercise in the morning. In the afternoon he used to play basketball at their community center near their house. During hospitalization Due to body weakness he has limited body movements. He can only sit and walk around his room.

SLEEP-REST PATTERN Before hospitalization The patient does not have good sleep since his cough started. He seldom takes a nap during daytime. Because he was the one doing all the house hold chores and taking care of his grandmother who was bed ridden he had only few time to rest. During hospitalization Upon hospitalization his sleep-rest pattern was just the same because even if he was disturbed by the nurses taking vital signs and giving his medicines, he can still go back to sleep.

SEXUAL-REPRODUCTIVE PATTERN Lucky Boy is in Freuds last stage of psychosexual theory the Genital Stage. Before he was diagnosed with his condition, he has a girlfriend and they are having sexual contact. But when he was diagnosed with TB, his girlfriend broke up with him.

COGNITIVE-PERCEPTUAL PATTERN:

BEFORE HOSPITALIZATION: Patient Lucky boy is a BSBA graduate. He worked at CDO as a baggage carrier. He has no difficulty in visualizing, smelling, hearing, smelling and feeling. He is not using assistive devices like eye glass. DURING ILLNESS: A month ago, he decided to resign because his body is weak and he cannot tolerate the cold temperature inside the walk-in refrigerator. He also felt a little sad because he can no longer help his family. He is the breadwinner.

ROLE RELATIONSHIP PATTERN


Lucky boy is the oldest among two children in the family. His father died when he was 10 years old. After his fathers death his mother married another man and he had a step sister. He lives at his grandparents house. He has a good relationship with his family. When his girlfriend knew about his condition she broke up with him. He is active in their community especially when there is a basketball tournament.

SELF-PERCEPTION SELF-CONCEPT PATTERN

BEFORE HOSPITALIZATION: Lucky boy has a strong personality; he is independent, responsible and a very loving grandson. He believes that he is still strong even if he has asthma. According to him, despite his childhood illness, he can still work because he has good immune system. DURING HOSPITALIZATION: He still has his strong personality. At first, he has doubts about his diagnosis. But later on, he realized that his condition will only worsen if he continues denying this fact. Thats why he became cooperative with the healthcare team and he followed his physicians orders because he knows that it will still be his benefit.

COPING STRESS TOLERANCE PATTERN

BEFORE HOSPITALIZATION: Patient relieves stress by listening to music and going out with his friends. Because he was separated from his parents at such an early age, he grew up with a strong personality. He seldom cry. When he has problems, he talks to his friends. DURING HOSPITALIZATION: When the doctor told him about his condition he was shocked because all he knows was that its all about his childhood asthma, but he accepted it because theres nothing he can do and he believes that everything happens for a reason.

VALUE-BELIEF PATTERN:

BEFORE HOSPITALIZATION: He is a Roman Catholic. He only attends to masses occasionally; but he has a strong faith in God. DURING HOSPITALIZATION: His faith to God became stronger. He prays every night asking God to help him in his condition.

PHYSICAL ASSESSMENT
August 25 & 26, 2011

Physical Examination August 25 & 26, 2011 NAME OF CLIENT: Lucky Boy UNIT/WARD: Isolation (Bed 1) AGE: 27 SEX: Male VITAL SIGNS Temperature: 36.8C Pulse Rate: 84 Respiratory Rate: 26 Blood Pressure: 110/70 GENERAL SURVEY Anthropometric Measurement: Height: 57

CIVIL STATUS: Single

Weight: 32 kg

General appearance: Physical Development: Behavior: Gait:

Appearance looks according to age Cooperative Slightly kyphotic posture, coordinated movement

BODY PART

TECHNIQUE

NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

SKIN Color Texture Temperature & moisture Turgor

inspection palpation Palpation Palpation

varies smooth, soft warm, moist skin pinch goes back immediately no lesions

fair smooth warm to touch moist skin pinch goes back w/in 1-2 sec no lesions

normal normal Normal d/t weight loss and muscle wasting normal

Lesion

palpation

HAIR Color Amount & distribution Texture

inspection Inspection palpation

varies Varies varies

black evenly distributed fine and pliant

normal Normal normal

SCALP Symmetry Texture Lesions

palpation Palpation palpation

symmetrical smooth, firm (-) lesion

symmetrical smooth, firm and moist no lesions

normal Normal normal

BODY PART NAIL Color Shape Texture Capillary refill

TECHNIQUE Inspection Inspection Palpation palpation

NORMAL pinkish nail bed 160 nail bed round, hard, immobile goes back immediately

ACTUAL pale nail beds 160 nail bed

INTERPRETATION

d/t decreased hgb Normal

round, hard, Normal immobile delayed return of d/t altered tissue color (2-3 sec) perfusion

FACE Color Lesions

Inspection palpation

Varies none

fair, apt on skin color no palpable lesion

Normal normal

NECK Appearance Movement

Inspection
inspection

Symmetrical
controlled ROM

Symmetrical
controlled ROM

Normal
normal

BODY PART
LYMPH NODES size & shape

TECHNIQUE

NORMAL FINDINGS
non-palpable

ACTUAL FINDINGS
palpable, enlarged and tender L submandibular lymph node

INTERPRETATION

palpation

Indicates infection

EYE Eyelids Inspection symmetrical blinking pinkish Conjunctiva Cornea Iris & Pupil inspection inspection inspection transparent PERRLA light pink transparent and moist PERRLA d/t Hgb normal Normal symmetrical blinking Normal

EXTERNAL EAR Size & shape Position Lesions & tenderness Mastoid process Palpation non-tender non tender Normal inspection inspection Palpation equal in level with eye no lesions, non-tender equal in level w/ eye no lesions, non-tender normal normal Normal

INTERNAL EAR Auditory canal inspection varies w/o discharge Normal

BODY PART MOUTH Lips

TECHNIQUE

NORMAL FINDINGS color varies, moist, smooth, intact, no lesions

ACTUAL FINDINGS

INTERPRETATIO N

inspection & palpation

moist, smooth, intact and Associated to no lesions, pale anemia

Buccal Mucosa

Inspection

smooth, moist, no lesions pinkish, moist

Smooth

Normal

Gums

inspection & palpation Inspection

pinkish, moist

Normal

Teeth

pearly white, hard

16 pairs, w/ cavities on R poor dental hygiene upper first molar tooth and L lower first premolar tooth moist, smooth and symmetrical hard palate: pale pink; moist soft palate: pink; moist slightly reddish tonsils Normal Normal

Tongue Hard & soft palate

Inspection Inspection

symmetrical, moist, smooth Varies

Tonsil & Uvula

inspection

tonsils are not inflamed, uvulamidline

d/t coughing

BODY PART

TECHNIQUE

NORMAL FINDINGS color same as face, smooth, symmetrical, septum midline

ACTUAL FINDINGS color same as face, smooth, symmetrical, septum midline (+) Nasal flaring

INTERPRETATION

EXTERNAL NOSE Inspection Appearance

normal

Dyspnea normal normal

INTERNAL NOSE Appearance Patency

inspection palpation

moist, no lesions, no moist, no lesions or obstruction obstruction patent nares R is more patent

THORACIC & LUNG inspection color chest expansion Inspection

fair Symmetrical

AP lateral diameter Sensation Fremitus Breath sounds

Inspection Palpation Palpation auscultation

1:2 ratio no pain, swelling vibration decreases on peripheries normal breath sounds

fair symmetrical and equal (+) use of accessory muscles 1:2 ratio no tenderness vibration on LLL coarse crackles heard on LLL

normal normal

d/t 02 supply
Normal normal d/t presence of secretions d/t presence on secretions, associated w/ TB

BODY PART HEART Visible pulses

TECHNIQUE

NORMAL FINDINGS non-visible jugular vein palpable pulses

ACTUAL FINDINGS non-visible

INTERPRETATION

Inspection

Normal

Pulses

Palpation

normal palpable carotid, brachial, radial, popliteal and dorsalis pedis pulses

ABDOMEN Skin Integrity

Inspection Inspection

Varies no rashes

paler than skin color no rashes or lesions

Normal Normal

Contour
Bowel sound Tympany

Inspection
Auscultation Percussion

rounded or flat
5-35 bsm no tympany over bowels no masses

Flat
10 sounds/min (-) tympany

Normal
Normal Normal

Masses

palpation

no mass

normal

BODY PART

TECHNIQUE

NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

MUSKULOSKELETAL Stance

Inspection

distributed weight can stand on both legs steady gait steady gait in walking

Normal

Gait

Inspection

Normal

Posture

Inspection

erect posture

slightly d/t discomfort in kyphotic posture breathing

Extremities

palpation

no pain, swelling

no pain or swelling

Normal

Bony prominences

palpation

palpable landmarks

palpable c7, no pain on TMJ and mastoid process

normal

LABORATORY RESULTS

URINALYSIS 8-24-11 MICROSCOPIC


COLOR TRANSPARENCY VOLUME SPECIFIC GRAVITY PH WBC RBC

RESULT
Straw yellow Clear 15 ml 1.020 5.5 0-2 0-1

NORMAL Straw yellow Clear 10-15 1.010-0.025 4.6-8

INTERPRETATION Normal Normal Normal Normal Normal

0-1
0-1

It indicates infection
Normal

HEMATOLOGY 8-24-11 PARAMETER Hemoglobin Hematocrit WBC Plt Neutrophils Lymphocytes Monocytes NORMAL VALUE 140-170 g/L .40-.51 5.0-10.0 140-440 55-65 25-40 2-8 RESULT 110 .37 11.2 395 63 36 61 INTERPRETATION O2 supply May indicate anemia Indicates infection Normal Normal Normal Indicates infection

RADIOLOGY

8-24-11 CHEST AP
Infiltrates are seen in the left upper lung. Right lung field is clear. Heart is not enlarged, aorta is not calcified. Diaphragm and sulci are intact

IMPRESSION: PTB, Left upper lung

COURSE IN THE WARD

Date and Time 8/24/11 10:35 am

Doctors Order Please admit to isolation room Consent for admission TPR q shift and record DAT diet For CBC, UA and CXR D5LR 1L x 8

Rationale To prevent spread of disease For legal purposes For baseline data and assessment

For diagnostic purposes To facilitate nourishment and route for drug administration Ceftriaxone 1g q 12 ANST Used to treat respiratory tract infection. Nebulization w/ salbutamol q 6 For bronchodilatory effect and to loosen consistency of secretions Paracetamol 300 mg q 4 RTC To decrease pyrogens in T: >38 C circulation Ambroxol 1 tab BID To loosen mucus for easy expectoration Monitor v/s q 1 For baseline data and assessment 02 @ 2-3 LPM for DOB For supplemental oxygen

Date and Time

Doctors Order

Rationale

8/25/11

Quadmax 3 tabs OD
Continue meds

Pharmacologic therapy for TB

8/26/11

Clarithromycin 1 tab BID Antibiotic treatment for Paracetamol 500 mg 1 tab LRTI q 4 Continue Meds

8/27/11

May go home Instruct home meds

For proper or correct intake of medications

NCP

ASSESSMENT

NUSING SCIENTIFIC DIAGNOSIS EXPLANATION Ineffective airway clearance related to retained and excessive secretions in the respiratory tract secondary to bacterial infection Accumulation of bacteria in the lungs

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Nahihirapan akong huminga Objective: (+) Crackles on LLL (+) nasal flaring (+)productive cough RR: 30 cpm

Inflammation in the alveoli

Exudation

Blockage in airway

After 30-45 min of nursing interventions, the patient will be able to demonstrate patent airway as evidenced by: (-) nasal flaring RR w/in the normal range

>Monitored and recorded V/s >Elevated HOB at high fowlers position

>for baseline data >to decrease pressure on the diaphragm and enhancing drainage >to maximize coughing effort

>demonstrated effective coughing and deep-breathing techniques >turned the patient side to side every 2 hours >instructed patient to avoid bronchial irritants such as fumes and contact with persons who are smoking >encouraged with pursed-lip breathing exercise >encouraged to increased fluid intake

>to prevent complication >Bronchial irritants cause bronchoconstriction and increased mucus production, >means to cope with and control dyspnea and reduce airtrapping >hydration helps decrease the viscosity of secretions facilitating expectoration >for supplemental 02 >for bronchodiation

After 30 min of nursing interventions the patient was able to demonstrate patent airway as evidenced by: (-) nasal flaring RR: 22 cpm

8-25-11

>administered 02 @ 2 LPM as ordered >Nebulized w/ salbutamol (q 6)

ASSESSMENT

NUSING DIAGNOSIS

SCIENTIFIC EXPLANATION supply of 02 Compression of alveoli Stimulation of pain receptors Chest pain Ineffective breathing pattern

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Objective: >(+)crackles on LLL >(+) productive cough >(+)use of accessory muscle >presence of nasal flaring >RR:30

Ineffective breathing pattern related to discomfort upon respiration

After 1 -2 hours of nursing intervention patient will establish effective breathing pattern as manifested by >(-) nasal flaring >decrease in RR (26 or lower) >no or minimal use of accessory muscle

>monitored and recorded vital signs especially RR >provide rest periods

>to have a baseline data

>positioned patient in high fowlers >Maintained 02 @ 2LPM >Nebulization w/ salbutamol q 6

>to prevent fatigue and 02 demand To have a maximum lung expansion >for supplemental 02 >for brochodilaton and to loosen secretions

After 2 hours of nursing intervention patient was able to establish effective breathing pattern as manifested by >(-) nasal flaring >normal respiration, RR:24 cpm >no use of accessory muscle.

8-25-11

ASSESSMENT

NUSING DIAGNOSIS

SCIENTIFIC EXPLANATION

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Hindi maganda yung panlasa ko tsaka parang wala akong gustong kainin
Objective: >Lack of interest in food >altered taste >loss of appetite

Imbalanced Nutrition: Less than Body Requirements related to lack of interest in food, & altered taste

Presence of microorganisms Microorgaisms release toxins affecting the taste center Anorexia Imbalanced Nutrition

After 30 minutes-1hour of nursing intervention patient will be able to verbalize understanding on the importance of nutrition especially on his present health condition
.

>Determined clients ability to chew, swallow and taste food


>Let pt discuss eating habits, including food preferences >Identified oral drugs with unpleasant taste and odor >encouraged pt to verbalize preferred foods to SO

>To identify factors which affects clients ingestion of nutrients >To identify foods appealing to clients taste

>it may affect appetite and food intake >so the SO can bring foods that will stimulate pts appetite. >for him to understand and have a concrete idea on why he needs to eat high caloric foods

After 45 minutes of interventions, patient was able to verbalize understanding of importance of eating nutritious foods as evidenced by verbalizing Ay kasjay gayam, ammu kon, pilitik ti mangan.

>discussed w/ the pt. that his condition requires a lot of energy consuming processes

8-26-11

ASSESSMENT

NUSING DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective:

Objective: >(+) diagnosis of PTB >expectorates in an open container >the SOs are not observing precautions on infection control

Potential for spread of infection related to insufficient knowledge on the mode of transmission of the disease and lack of information about the universal precautions

After 30 minutes to 1 hour of nursing interventions, patient together with the SOs will be able to verbalize understanding and identify interventions to prevent risk of cross contamination

>discussed the disease process the pt. is going through

>discussed potential spread of infection via airborne droplet during coughing, sneezing, talking and laughing >monitored clients visitors

>instructed pt. to cough and expectorate into tissue or a container with a lid >explained necessity of temporary infection control measures like isolation

>helps pt. realize and accept necessity of adhering to medication regimen >help pt. & SO to take steps to preventing infection to others like wearing of mask >to limit exposure, thus reduce crosscontamination >to prevent spread of infection

After 45 min of nursing interventions, patient and SO were able to identify ways to prevent risk of spread of infection

8-26-11

>may help reduce the pts. Sense of isolation

ASSESSMENT

NUSING DIAGNOSIS Knowledge deficit related to unfamiliarity with the disease and incomplete information presented

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Pano ba inumin yung mga gamot ko at para saan ba mga yun, ang dami naman Objective: >requesting for information

After 30 minutes to 1 hour of nursing intervention pt. will be able to verbalize understanding of disease process and treatment needs.

>assessed pts ability to understand and level of participation >explained the expected action and the reason for prolonged treatment

>identified the learning barriers

8-27-11

>explained in laymans terms

>started explaining on what the client already knows

>to determine the way on how to explain the treatment and disease process >enhances cooperation with therapeutic regimen and may prevent discontinuation as pts condition improve >low level of cognition may be a major reason for misinterpretatio n of information >for the client to understand the informations accurately >to gain pts interest

After 1 hour of nursing intervention pt. will be able to verbalize understanding of disease process and treatment needs.

DRUG STUDY

DRUG

CLASSIFICATION

INDICATION

CONTRAINDICATI ON Allergies

ACTION

SIDE EFFECT

NURSING CONSIDERATIONS advice patient to drink plenty of fluids, particularly hot fluids to facilitate moist air passages avoid exposure to things that can irritate

GENERIC NAME: AMBROXOL HCL BRAND NAME: AMBROXOL DOSAGE: 1 tab TID (30 mg)

Mucolytic

Acute and Chronic disorders of the respiratory tract associated with pathologically thickened mucus and impaired mucus transport

Mucolytic whichchanges the structure of Bronchial secretions by reduction and fragmentation of the Mucopolysacchar ide fibers, leading to reduce viscosity of Mucous, thus

Mild GI side effects (nausea, indigestion and diarrhea) Rash

expectoration is facilitated

the throat such as smoke should be taken with food

NAME

CLASSIFICA TION

ACTION

INDICATION

CONTRAINDIC ATION

SIDE EFFECTS

NURSING CONSIDERATIONS

GENERIC NAME: CLARITHROMYCIN

Macrolide antibiotic

Clarithromycin prevents bacteria from growing by interfering with their protein synthesis. Clarithromycin binds to the subunit 50S of the bacterial ribosom e and thus inhibits the translation of peptides

uneven heartbeats, chest pain shortness of breath diarrhea nausea stomach pain low fever loss of appetite dark urine claycolored stools jaundice

allergies liver or kidney disease muscle disease (myasthenia gravis) heart rhythm (QT prolongation )

glossitis stomatitis oral moniliasis anorexia vomiting pancreatitis tongue discoloration thrombocyto penia leukopenia neutropenia dizziness

Should be taken after meals Inform the client that skipping doses might lead to resistance. Monitor renal and liver function.

NAME

CLASSIFICATION

ACTION

INDICATION

CONTRAINDICATIO N

SIDE EFFECTS

NURSING CONSIDERATIONS should be given before meals Instruct pt to report any sign of discomfort It decreases the action of paracetamol. It should be given 2 hours after paracetamol intake.

GENERIC NAME:
Ethambutol, Isoniazid, Pyrazinamide, Rifampicin BRAND NAME: QUADTAB

Antituberculosis

DOSAGE: Rifampicin 150 mg, INH 75 mg, pyrazinamide 400 mg, ethambutol HCl 275 mg 3 tabs OD (6AM)

It inhibits the synthesis of mycolic acid in the mycobacterial cell wall which leads to cell death. It kills actively growing tubercle bacilli. It inhibits the synthesis of cellular metabolites leading to cell starvation and cell death.

For the treatment of both smearpositive pulmonary and extrapulmonary tuberculosis adults in the intensive initial phase of treatment

Hypersensitivity optic neuritis abnormal uric acid values liver dysfunction

Headache Drowsiness fatigue ataxia dizziness mental confusion visual disturbances muscular weakness pain in extremities and generalized numbness Heartburn epigastric distress anorexia nausea vomiting diarrhea

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