TUBERCULOSIS CARE PLAN SONI.docx

7/29/2019 TUBERCULOSIS CARE PLAN SONI.docx

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SUBMITTED TO - SUBMITTED BY-

Ms. Sucheta Yangad Mr. Sanvar mal soni

Asso. Prof.(med-surg) Msc. final year

(med-surg)

Submitted on- 18th

Feb. 2013


2/23

HISTORY OF THE PATIENT

IDENTIFICATION DATA

Name of the patient : Mr. Prashant Khatri

Age : 50 years

Gender : Male

Bed No. : 08

Ward : Male Pulmology Ward

IPD No. : 47954

OPD No. : 1200059

Date of admission : 03/12/2012

Educational status : 8th standard

Occupation : watchman

Monthly income : Rs. 10,000/ month

Religion : Hindu

Mother tongue : Marathi

Marital status : Married

Address : Ram nagar, moshi, Pune.

Diagnosis : Pulmonary Tuberculosis.

CHIEF COMPLAINTS AND PRESENT MEDICAL HISTORY

Mr. Prashant was admitted on 3rd Dec. 2012 at 12 pm with complaints of

Breathlessness since 9 days. Cough with expectorant since 1 month. Anorexia. Mild fever since one month. Weight loss. Sweating at night. Fatigue.


3/23

PAST MEDICAL HISTORY

Patient had the history of dry cough and fever 2 years ago.

Pt had no other history of other major disease.

PAST SURGICAL HISTORY

Client had no history of surgery.

FAMILY HISTORY

Family tree: father mother

Sister sister

Patient wife

son Daughter son

FAMILY INFROMATION

Family income per year : Rs.80,000 approximately.

Family interpersonal relationship : All the family members have weak IPR.

Family history of illness : patient`s mother had the history of Pulmonary

tuberculosis.

Patients mother had the history of Pulmonary Tuberculosis. There was no family history of

any other illness like cancer, arthritis or neurological disorders were not found.

Sr.

No

Name of Family

Members

Relationship

with patient

Age

(yrs.)Education Occupation

Marital

Status

Health

status

1 Mr. kailash khatri Father 79 Illiterate Farmer Married Healthy

2 Mrs.Rajni khatri Mother 75 Illiterate House wife Married TB

2 Mrs. Shanjna Wife 47 10t pass House wife Married Healthy

3 Mrs. Suhana Sister 46 Graduate Teacher Married Healthy

4 Mrs. shanti Sister 43 10t pass Housewife Married Healthy

5 Mr. shekhar khatri Son 28 Graduate Teacher Married Healthy

6 Mr. rahul khatri Son 26 12t pass Salesman Married Healthy

7 Ms. rekha Daughter 24 Graduate student Married Healthy


4/23

DIETARY HISTORY-

Patient used to take mixveg diet. He used to take chicken once in a month. He did not use to

take green leafy vegetables properly and other veg diet. He used to take meals in lunch time

and dinner. He used to take breakfast in morning. He used to take tea four to five times in a

day.

SOCIOECONOMIC STATUS

A) HOUSING Type of house - Small house with 2 rooms made up of bricks. Lighting Lack of proper lighting facility. Ventilation1 window and 2 doors for ventilation. Water facilityNot proper, family used to bring water from municipal tap. SanitationLack of sanitation and hygiene.

B) FOOD HYGIENE PRACTICESLack of food hygiene. Not washing hands before cooking and not washing vegetables

also before cooking food. Cook food in unhygienic condition.

C) PERSONAL HYGIENE PRACTICESNot maintaining personal hygiene. Not taking bath daily. Not washing hands and

cutting nails etc.

D) COMMUNITY RESOURCESResources like transportation are available by bus and train.

Educational resources are available up to higher education.

E) RELIGIOUS PRACTICESClient and his family strongly believe in the god and they worship regularly. They

visit temple sometimes.

F) FAMILY INCOME & EXPENDITUREFood Rs.2000 per monthClothing Rs.500 per month

Education 1000 per month

Health Rs.1000 per month

HEALTH HABITS

Personal hygiene

Patient did not use to practice hygienic condition. He used to take meal without washing hand

sometimes. He did not use to bath daily.


5/23

Activity and exercises-

Patient did not use to go for morning walk and other exercises.

Sleep and rest

Patient used to take sleep 8 hours in night and have some difficulty sometimes during sleep.

Elimination

Patient have no difficulty in passing urine and stool 1 years ago.

Since 1 year he is having difficulty in bowel elimination. Sometimes he has complaints of

constipation.

Habits

Patient used to smoke since 25 years, he used to smoke 20-25 bidi per day.

Patient also used to take alcohol since 10 years. He used to drink 180 ml of desi daru per day.

Allergies and medications

Client doesnt have any allergies from medicines, food, dyes etc.


6/23

PHYSICAL ASSESSMENT

GENERAL APPEARANCE

Level of Consciousness: - Conscious Orientation: - Oriented to time, place and person. Activity: - patient is less active Body Built: - Thin Breath odour- foul smell Sign of distress- patient is confused and asking again and again about his

disease.

Hygiene and grooming- patient does not use to groom independently.

ANTHROPOMETRIC MEASUREMENT

1. Height: 58 2. Weight: 56 kg

VITAL SIGNS

1. Temperature: 99.8F 2. Pulse: 80/min 3. Respiration: 26/min4. Blood Pressure: 126/76 mmHg

INTEGUMENTORY SYSTEM

Skin color- Brown Dermatitis- No skin infections Allergies- No skin allergies Lesions/Abrasions- Absent. Tenderness /Redness- No redness and tenderness. Surgical scar- Surgical scar not present. Abnormal growth- No abnormal growth. Cyanosis - Not present Jaundice - Not present. Hyperpigmentation- Not present.

HEAD

Hair: - Equally Distributed

Color of Hair: - Black and grey


7/23

Scalp: - Dandruff present. Pediculosis: - Present Sinus area- no inflammation. Nodes- not present.

FACE

Face: - Symmetrical Facial Puffiness: - Absent.

EYES

Eye Brows: - Symmetrical Eye Lid/Lashes: - No Redness/ Swelling/Discharge/Lesions Eye Ball: - Normal Conjunctiva: - Normal/ No Lesions Sclera: - White Puncta: - Red and not swollen Cornea: - Normal Iris: - Flat Eye Discharge - Absent Use of glasses - No Pupils- Equally Reacting To Light and normal size Visual Acuity- Normal

SINUS

Maxillary sinus infection - No Frontal sinus infection - No

EARS

Size & shape- Normal & symmetrical. Position And Alignment- Normal. Redness- Absent


8/23

Discharge - Absent Cerumen- Present Lesions- Absent Foreign Body - Absent Hearing Acuity- Normal Use of Hearing Aids- No

NOSE

External structures Symmetrical

Nasal Septum- Not deviated

Nasal Polyps- Absent Nasal Discharge- Absent

ORAL CAVITY

LIPS- lips are dry.. Cleft Lips- No cleft lips. Stomatitis- Absent Number of Teeth- 32teeth. Dentures - Absent Dental Carries- Present Odour of Mouth- Foul Smell Gums Weak Palate and uvula- no inflammation. Taste - Patients able to identify the taste.

NECK

General structure- normal Trachea - normal Thyroid - not palpable. Nodes - Enlarged lymph node. Muscles - normal strength


9/23

CHEST AND RESPIRATORY SYSTEM

Respiratory Rate- 26 per min. Thoracic Cage - Normal shape. Anterioposterior to transverse diameter in

ratio of 1:2

POSTERIOR THORAX

Inspection

Shape and Summetry Normal shape. Anterioposterior to transverse diameter inratio of 1:2

Skin Color and Condition- Normal Exaggerated spine curvature- spine straight aligned

palpation

Skin is intact, uniform temperature. Chest wall intact, tenderness present over thoracic cavity. No presence of masses. Chest expansion- decreased chest expansion (2 cm) Fremitus- decreased tactile fremitus.

Percussion Resonance- asymmetry Diaphragmatic Excursion- restricted lung excurtion (2 cm).

Auscultation

Breathing Sound- Crackles (rales) at inspiration. Respiratory Pattern- Rapid breathing with effort.

ANTERIOR THORAX

Costal angle is 70 degree. Skin is intact on anterior chest side. Crackles (rales) at inspiration. Percussion: flatness of chest sound present decreased expiratory excursion. Dyspnea: present (shortness of breath present)


10/23

CARDIO VASCULAR SYSTEM

Pulse- 80/minPrecordium

No heaves or lift present on palpation. Aortic pulsation absent. Point of maximal impulse 5t intercostal space, midclavicular line Heart Sound S1 , S2 Heard Abnormal Heart Sound Not present. Murmurs Absent Carotid Pulse Rate - 80/min Blood Pressure- 126/76 mmHg

Carotid pulse

Normal pulsation, symmetric volume.No sound present on auscultation.

Jugular vein

Not distended.Peripheral pulses-

Symmetric volume, rate and rhythm.ABDOMEN AND INGUINAL AREA

Abdominal Girth- 78 cm Diarrhea / Constipation- Absent. Counter and tone- symmetric. Scar marks- not present.. Liver- not palpable. Spleen- not palpable. Kidneys- not palpable, normal. Bladder- normal. Hernias- absent. Masses- absent.


11/23

Inspection

Size- Protuberant Flat Symmetry Normal Scar- No scar present Lesions and redness- not present..

Palpation

Tenderness- No tenderness Fluid Collection- Absent Mass/Soft- No palpable mass.

No enlargement of liver, spleen.

Percussion

Ascitis / Peritonitis- Absent No Gas /Fluid Collection Tympanic sound present over the stomach area. Dullness sound over the liver.

Auscultation

Bowel Sounds- properly heard.GENITO URINARY

Frequency of Urination- normal. Color- Pale yellow. No complaints of Anuria / Hematuria / Dysuria / Incontinence. Catheter Present- No Urethral Discharge- No

MUSCULO SKELETAL SYSTEM

Range of Motion- Normal ROM. Joint Swelling / Pain- no inflammation. Weakness- Present. Extrimity strength- Equal extremity strength. Edema- not present.


12/23

NERVOUS SYSTEM

Level of consciousness Conscious, coherent and responsive Orientation Oriented to time, place and person

Emotional state Calm, but upon exertion he feels dizzy and answersquestions inappropriately.

Language Marathi Motor coordination Reflexes

Normal coordination.

Normal


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INVESTIGATIONS .

DIAGNOSTIC STUDIES

SR

NO.

NAME OF

INVESTIGATION

NORMAL

VALUE

PATIENT

VALUE

REMARK

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Haemoglobin

WBC count

Neutrophils

Lymphocytes

Eosinophil

Monocytes

Basophils

Random blood sugar

Blood group

HIV

Serum sodium

Serum potassium

Serum creatinine

Serum chloride

12-16 gm%

4000-

11000/cumm

40-75 %

20-45 %

0-5 %

0-5%

0-2%

70-120 mg%

---

---

135-145 mEq/L

3.5-4.5 mEq/L

0.8-1.4 mg/dl

96-106 mEq/L

12 gm%

15000/cumm

60 %

35 %

04 %

02%

00 %

76mg%

B positive

Negative

138 mEq/L

4.9 mEq/L

0.9 mg/dl

103 mEq/L

Normal

Elevated

Normal

---

---

Normal

Normal

Normal

Normal

Chest X-ray

Fluid around a lung (pleural effusion) Consolidation of lung tissues. Nodular shadow.

TB Skin Test:

7mm mark at injection site.


14/23

Nursing diagnosis:

Impaired breathing pattern related to pleural congestion as evidenced by dyspnea Activity intolerance related to dyspnea as evidenced by decreased walking. Impaired sleeping pattern related to dyspnea as manifested by disturbed sleep. Fear related to disease prognosis as evidenced by anxious depression Imbalanced nutritional status less then body requirement related to lo intake of food

as manifested by refused to take food

Deficient knowledge related to treatment, follow up as evidenced by lack of

awareness.


15/23

DAILY PROGRESS OF PATIENT:

Day-1

- Maintained rapport with the patient- Thorough assessment include physical examination and history collection- Checked the vital signs.- Nebulization therapy given- Deep breathing and coughing exercises given health education givenDay-2.

- Assessed the patient general condition- Checked the vital signs- temp-99.2f,pulse-80b/m,resp-26b/m,BP -126/80mmhg.- Deep breathing and coughing exercise done- Administered the oxygen supply- Fowlers position given- Psychological support given- Medication give to the patient as prescribed.Day3

- Assessed the patient general condition- Checked the vital signs stable- Deep breathing and coughing exercise done- Steam inhalation given to the patient.- Nebulisation given to the patient.- Patient improved breathing pattern.Day-4

- General condition is fair. Intermittent oxygen supply administered. Deep breathing andcoughing exercise done.

- Medication given as prescribed.- Patient improving the breathing pattern, respiratory rate is 22/min.- Oxygen saturation is 98%.


16/23

Day5

- General condition better. Patient slept well at last night. Routine medication given.Fowlers position maintained

- Repeater the deep breathing and coughing exercise.- Steam inhalation given to the patient 4 times a day.- Nebulised the patient.- Patient feel comfortable.- Repeat X ray done, decreased consolidation.Day6

- General condition improved. Vital signs stable- Health education given.- Patient discharged from the hospital with prescription.


17/23

DIET FOR THE PATIENT

However patient need to be very careful about his dietary choices while recovering from this

condition. There is a high risk of malnutrition in adults suffering from this condition.

Moreover, the deficiency of protein can have a negative impact on bodys ability to fight off

tuberculosis.

To avoid such problems, patient need to follow a proper pulmonarytuberculosis diet. The key

element of a good diet for pulmonary tuberculosis patients is good nutrition. The eating plan

should follow with adequate amounts of vitamins, minerals, protein, fiber and other essential

nutrients. Given below are the daily recommended amounts to consider when planning a

pulmonary tuberculosis diet

Given below are some of the healthy foods to include in a pulmonary tuberculosis diet

Whole grains, especially whole wheat pasta, brown rice, whole wheat bread and breakfastcereals

Brightly colored vegetables that are rich in antioxidants, such as carrots, squash, sweetpotatoes, peppers and tomatoes

Dark, leafy greens. Fruits that are high in vitamins and antioxidants, especially oranges, lemons, melons,

grapefruit, berries, pumpkins and cherries

Fatty fish varieties that are high in omega-3 fatty acids, which include herring, halibut,albacore tuna, sardines, salmon, flounder and mackerel

Dairy products like skim milk and plain yogurt and low-fat cheese Unsaturated fats such as olive oil Iron-rich sources of food, which include eggs (especially the yolk), meat, poultry, nuts and

beans

DAILY DIET MENU PLAN FOR TUBERCULOSIS PATIENT.

I. An all-fruit diet for three days. Take three meals a day of fresh juicy fruits at five-hourly

intervals.

II. A fruit and milk diet for further 10 days, adding a cup of milk to each fruit meal.

III.Thereafter, adopt a well-balanced diet, on the following lines:-
http://www.diethealthclub.com/health-issues-and-diet/tuberculosis/diet.htmlhttp://www.diethealthclub.com/health-issues-and-diet/tuberculosis/diet.htmlhttp://www.diethealthclub.com/health-issues-and-diet/tuberculosis/diet.htmlhttp://www.diethealthclub.com/http://www.diethealthclub.com/http://www.diethealthclub.com/http://www.diethealthclub.com/http://www.diethealthclub.com/health-issues-and-diet/tuberculosis/diet.html


18/23

1. Upon arising: A glass of lukewarm water mixed with half a freshly-squeezed lime and a

teaspoon of honey.

2. Breakfast: Fresh fruit, a glass of milk, sweetened with honey, and few nuts, especially

almonds.

3. Lunch: A bowl of freshly-prepared steamed vegetables, whole wheat wheat tortilla with

butter and a glass of butter milk.

4. Mid-afternoon: A glass of fruit juice or sugarcane juice.

5. Dinner: Raw vegetable salad and sprouts with vegetable oil and limejuice dressing,

followed by a hot course, if desired.

6. Bedtime Snack: A glass of milk with few dates.

AVOID: Tea, coffee, sugar, white flour and products made from them, refined foods, fried

foods, flesh foods, alcohol and smoking.

B - OTHER MEASURES

1. Wet chest pack for one hour every morning on an empty stomach.

2. Neutral immersion bath for one hour at bedtime.

3. Fresh air, breathing and other light exercises and yogasanas.

4. Adequate rest and proper sleep.

5. Avoid all worries and mental tensions.


19/23

HEALTH EDUCATION AND DISCHARGE PLANNING

Client was given health education on various aspects of health, disease condition, its

diagnosis, treatment and follow-up during his stay in the hospital and at the time of discharge.

1) DISEASE CONDITION

Client was explained about the causes of the Pulmonary Tuberculosis. He was explained about the severity of the disease. He was guided for the prevention of the same condition in the future and maintains

food hygiene at home.

Special instructions were given on food hygiene.2) MEDICATIONS

Patient was explained about the importance of medications. he was explained about the route, time and dosage of medications. Side effects were told to be reported to the doctor. Follow-up of the treatment was advised. He was advised not to give any medications without doctors order.

3) NUTRITIONAL THERAPY

Advised the patient to take more fluid diet. Eat more fiber by eating at least 5 servings of fruits and vegetables every day. Advised the patient to take high protein diet Advised the patient to follow up hygienic practices.

4) BREATHING EXERCISES:

Advised the patient to do deep breathing and coughing exercises Explained the patient how to do breathing exercises.

5)HEALTH TEACHING

Encouraged client to do at least 30 minutes of walking a day as a form of exercise. Instructed to adjustments in diet, medication and exercise can be made accordingly. Encouraged to stick to the monitoring protocol prescribed by the doctor.


20/23

Safety precaution should be maintained to prevent foot injury such as do not wearopen shoes or walk barefoot.

Adjust of activities to avoid over exertion and fatigue, allow rest periods


21/23

BIBLIOGRAPHY

1. Black. M. Joyce, Medical surgical Nursing,8th edition, Vol.-2nd, SaundarsPublications, 2009, Pp.1604-1609.

2. Boon A. Nicholas, Davidsons Principles & Practice Of Medicine, 20 th edition,Churchill Livingstone Publication, 2006, Pp.695-703.

3. Bennett John V.,Hospital Infectuions 4th edition, Lippincott ,1998, Pp.515-532.4. Chintamani, Lewiss, Medical surgical nursing, Mosby publications, Pp.569-574.5. Saunders manual of medical and surgical nursing, Joan luckmann, Sounders

Company. 389-920.

6. CIMS. Updated prescriber hand book, 2002; Jan: 76, 74, 206, 306.7. Patient file.


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Dietary

management


23/23

Progress

notes

Documents

TUBERCULOSIS CARE PLAN SONI.docx