Case Study:

Group 6:
Bulatao, Lesley Charmaine C.
Cabudoc, Maricar G.
Comilang, Janielle Lyn M.
Constante, Quolette M.
Dela Cruz, Rhealyn N.
Ebuenga, Allyssa O.
Espanueva, Gaylen C.
Fabon, Yvette Stephanie Nichol B.
Franco, Ma. Eliza Joy L.
Fuentes, Raquel F.
INTRODUCTION

Periumbilical abscess w/
disseminated TB
• This is a case of a 14 y/o male from Baclaran,
Parañaque, who came in for the fourth time at
National Children’s Hospital due to periumbilical
discharge. Patient was diagnosed with a case of
disseminated Tuberculosis on August 2009 and
was initially given 5 degree Antikoch’s but had
hepatotoxicity, thus treatment was discontinued
and replaced with 4 degree Antikoch’s instead.
The treatment was continued for 2 months.
Patient was given Streptomycin one tab OD,
Moriamin OD and Diberneride last admission
(October 2009).
• Miliary tuberculosis (or disseminated TB) is a
form of tuberculosis that is characterized by a
wide dissemination into the human body and by
the tiny size of the lesions (1–5 mm). Its name
comes from a distinctive pattern seen on a chest
X-ray of many tiny spots distributed throughout
the lung fields with the appearance similar to
millet seeds, thus the term "miliary" tuberculosis.
Miliary TB may infect any number of organs
including the lungs, liver, and spleen. It is a
complication of 1-3% of all TB cases.
Etiology
• Miliary tuberculosis is a form of tuberculous infection in
the lung that is the result of erosion of the infection into a
pulmonary vein. Once the bacteria reach the left side of
the heart and enter the systemic circulation, the result
may be to seed organs such as the liver and spleen with
said infection. Alternately the bacteria may enter the
lymph node(s), drain into a systemic vein and eventually
reach the right side of the heart. From the right side of
the heart, the bacteria may seed - or re-seed as the case
may be - the lungs, causing the eponymous "miliary"
appearance.
Signs and Symptoms
• A patient with miliary tuberculosis will tend to present
with non-specific signs such as low grade fever, cough,
and enlarged lymph nodes. Miliary tuberculosis can also
present with enlarged liver (40% of cases), enlarged
spleen (15%), inflammation of the pancreas (<5%), and
multiple organ dysfunction with adrenal insufficiency
(adrenal glands do not produce enough steroid
hormones to regulate organ function). Stool may also be
diarrheal in nature and appearance. The risk factors for
contracting miliary tuberculosis is if one is in direct
contact with a person who has it, if you live in unsanitary
conditions, and do not have a healthy diet. People in the
U.S. that are at a higher risk for contracting the disease
are persons living with HIV/AIDS, also the homeless.
Treatment
• Miliary TB is a serious condition. Cases of miliary TB in
patients who remain untreated are nearly 100% fatal.
About 25% of patients with miliary TB also have
tuberculous meningitis. The standard treatment
recommended by the WHO is with isoniazid and
rifampicin for six months, as well as ethambutol and
pyrazinamide for the first two months. If there is
evidence of meningitis, then treatment is extended to
twelve months. The US guidelines recommend nine
months' treatment. "Common medication side effects a
patient may have such as inflammation of the liver if a
patient is taking pyrazinamide, rifampin, and isoniazid. A
patient may also have drug resistance to medication,
relapse, respiratory failure, and Adult Respiratory
Distress Syndrome"
CASE ABSTRACT
 Last nov. 09, 2009,  a 14 year old boy from Baclaran
Parañaque, was run to the ER with complaint of peri
umbilical [Link] boy has been admitted 3 times
the on same institution .where in he was before
diagnosed for bronchial asthma in acute
exacerbation (BAIAE) and resolved BAIAE and recently,
for the 4th time on NCH, after having different diagnostic
testsuch as CBC with APC, blood culture, urinalysis, peri
umbilical culture, ASO and ESR he was considered
having peri umbilical abcess desciminated TB. After
wards, he was admitted hooked with D5NSS 500cc at
KVO with antibiotic prescribe and started. the day
after(nov.10, 2009) his antibiotic is continued and he was
placed on NPO for 8 hours for fluroscopy.
 Later on that day, he has been transfused with
380cc PRBC divided into two aliqouts every 4 hours with
6 hours interval. On her 3rd hospital day he has been
scheduled 8:30 am for fluroscopy/fistulogram of umbilical
area. Afterwards, he was tranfused with PRBC 190cc at
10:00 am for 4 hours. Later in the afternoon, his IV line
was infiltrated yet immediately reinserted on right arm by
Dr. Tan and on his 5th and 6th hospital day he was
trasfused with PRBC1 Unit for 4 hours(nov13,2009) and
PRBC 150cc  1 Unit for 4 hours also (nov14, 2009) and
on both day he recieved also albumin 3 vials each day
divided ito 3 with 30 mins intervals and also on the 14th
of nov he recieved furosimide IV push and he was
placed NPO post midnight together with 3 tablets of
dulcolax after dinner.
early in the morning on the 15th day of
nov. around 8:30 am, the client
undergo abdominal CT scan with oral
contrast. In the mid afternoon of that day
patient IV line infiltrated yet reinserted
immediately at right hand hooked back
PNSS 500cc at 300cc level x KVO by Dra.
[Link] the next day, patient received
albumin 25% per vial x 3 doses 1 hour
each dose.  
 After this, he received furosimide 40 mg IV
push. on nov 17 he was seen and examined by
Dr. Graspe with order to transfer to ward. after
the doctor order yesterday the client now(nov
18, 2009) had undergo some diagnostic test
such as CBC with platelet count, serum albumin,
serum electrolytes and chest x- ray APL and on
nov. 19,2009, client was transfused with PRBC
1U 270cc for 4 hours while the fresh frozen
plasma (FFP) 300cc for 4 hours has been
transfused on the next day. On nov. 22, 2009
the clients IV line dislodged thus, it was removed
and repalced with heplock at left forearm. for the
next few days he was still on heplock and his
lower extremities was still edematous.
On nov. 22, 2009 the clients IV line dislodged
thus, it was removed and repalced with heplock
at left forearm. for the next few days he was still
on heplock and his lower extremities was still
edematous. On 25th day of nov., he recieved
order from Dr. Buncan,that he is surgically
cleared for discharge. later on that day, he had
skin test of Vancomycin at right fore arm thus,
result is negative. and recently, nov 28,2009 he
was transfused with fresh frozen plasma (FFP)
400cc divided in 3 aliquots every 1 hour.
PHYSICAL ASSESSMENT
GENERAL DATA
1. General Information
Name: Arvin Cascon
Age: 14 y/o
Gender: Male
Admitting Diagnosis: Periumbilical Abcess
Disseminated T.B

2. Vital Signs
Temperature: 38.6
Respiratory rate: 21 cpm
Cardiac Rate: 106 bpm
Blood pressure: 90/60
3.1 Anthropometric Measurement
Height: 47cm
Weight: 6kg
Head Circumference: 52 cm
Chest Circumference: 74cm
Abdominal Circumference: 76cm

3.2 General Appearance

The patient shows sign of distress, conscious
and coherent. He is oriented to the place,
person, and time. Appears older to his age due
to illness.
4. Skin
The patient’s skin color is brown and fair, with the
presence of lesions on the lower extremities. The
texture is smooth, has a poor skin turgor and warm to
touch temperature.

5. Head
The patient head is normocephalic. The hairs are
evenly distributed. There is no presence of dandruffs
or scar. The face is symmetrical. The patient’s eyes
are symmetrical. Lids, eyebrows, eyelashes are evenly
distributed. Pale conjunctiva. Anicteric sclera. The
cornea and lens are clear. Pupil sizes are equal.
Patient is farsighted.
6. Ears
The ears are normoset, soft, pliable and at the level of
the outer cantus of the eye. There is no presence of
discharges on the ear canal. Able to hear sounds on
both ears.

7. Nose
Patient’s nose is smooth, nasolobial fold is symmetrical,
septum is located in the midline, no presence of nasal
discharge seen. Patent nostrils. Nasal mucosa is pink
and moist.

8. Mouth and Pharynx

The lips are pinkish in color and slightly dry. Tongue is
found at the midline and can move freely. Gums and
buccal mucosa are pinkish in color, smooth and moist.
Uvula is on the midline. There is no presence of
inflammation of tonsils.
9. Neck
Patient’s neck moves freely. Trachea is located in the
midline. Cervical lymph nodes and thyroid are non-
palpable. There is no presence of masses.
10. Chest and Lungs
Patient’s chest is cylindrical with regular breathing
pattern.
Lung expansion is symmetrical and no retractions.
Respiratory movement is characterized as tachypneic.
There is a presence of crackles upon auscultation.
11. Heart
The precordium is flat. Apical pulse is located at the
fifth intercostals space left mid-clavicular line. Heart
rhythm is arrhythmic. Heart sound is adynamic
precordium and a tachycardia intensity.
No presence of extra sounds and negative murmurs.
12. Abdomen
Patient’s abdomen appears flat and with
presence of scars/lesions and abscess in
periumbilical area. A normoactive bowel
movement and flat sound.
13. Back and Lower Extremities
Nail and nail beds are pinkish with no
sign of inflammation. Decreased ROM
due to pedal edema. Foot edema is
visible. Spine is on the midline. Patient is
kyphosis and gait is uncoordinated.
Anatomy & Physiology:
The Cardiovascular System
The cardiovascular system is sometimes
called the circulatory system. It consists of the
heart, which is a muscular pumping device, and
a closed system of vessels called arteries, veins,
and capillaries. As the name implies, blood
contained in the circulatory system is pumped by
the heart around a closed circuit of vessels as it
passes again and again through the various
"circulations" of the body.
 The heart is enclosed by a sac known as the
pericardium. There are three layers of tissues
that form the heart wall. The outer layer of the
heart wall is the epicardium, the middle layer is
the myocardium, and the inner layer is the
endocardium. The internal cavity of the heart is
divided into four chambers:
· Right atrium
· Right ventricle
· Left atrium
· Left ventricle
 The two atria are thin-walled chambers that
receive blood from the veins. The two ventricles
are thick-walled chambers that forcefully pump
blood out of the heart. Differences in thickness
of the heart chamber walls are due to variations
in the amount of myocardium present, which
reflects the amount of force each chamber is
required to generate.
The right atrium receives deoxygenated
blood from systemic veins; the left atrium
receives oxygenated blood from thepulmonary
veins.
Pathway of Blood through the Heart
While it is convenient to describe the flow of
blood through the right side of the heart and then
through the left side, it is important to realize that
both atria contract at the same time and both
ventricles contract at the same time. The heart
works as two pumps, one on the right and one
on the left, working simultaneously. Blood flows
from the right atrium to the right ventricle, and
then is pumped to the lungs to receive oxygen.
From the lungs, the blood flows to the left atrium,
then to the left ventricle. From there it is pumped
to the systemic circulation.
Liver
 The liver is a vital organ present
in vertebrates and some other animals; it has a
wide range of functions, including detoxification,
protein synthesis, and production of biochemical
necessary for digestion. The liver is necessary
for survival; there is currently no way to
compensate for the absence of liver function.
This organ plays a major role in metabolism and
has a number of functions in the body,
including glycogen storage, decomposition
of red blood cells, plasma
protein synthesis, hormone production, and
detoxification.
 It lies below the diaphragm in the thoracic
region of the abdomen. It produces bile, an
alkaline compound which aids in digestion, via
the emulsification of lipids. It also performs and
regulates a wide variety of high-
volume biochemical reactions requiring highly
specialized tissues, including the synthesis and
breakdown of small and complex molecules,
many of which are necessary for normal vital
functions. Medical terms related to the liver often
start in hepato- or hepatic from the Greek word
for liver
Basic info on Structure
The liver is the largest glandular organ with a weight of
about 1.5 kg (3.3 lb). It is reddish brown organ with four
lobes of unequal size and shape. The liver is on the right
side of the abdominal cavity just below the diaphragm
and is connected to two large blood vessels, one called
the hepatic artery and one called the portal vein.
The hepatic artery carries blood from the aorta whereas
the portal vein carries blood containing digested food
from the small intestine. These blood vessels subdivide
into capillaries which then lead to a lobule. Each lobule is
made up of thousands of hepatic cells which are the
basic metabolic cells.
• An adult human liver normally weighs
between 1.4–1.6 kg (3.1–3.5 lb) and is a
soft, pinkish-brown, triangular organ. It is
both the
largest internal organ (the skin being the
largest organ overall) and the
largest gland in the human body.
• It is located in the right upper quadrant of
the abdominal cavity, resting just below
the diaphragm. The liver lies to the right of
the stomach and overlies the gallbladder.
Biliary flow
• The term biliary tree is derived from the arboreal
branches of the bile ducts. The bile produced in the liver
is collected in bile canaliculi, which merge to form bile
ducts. Within the liver, these ducts are
called intrahepatic (within the liver) bile ducts, and once
they exit the liver they are
considered extrahepatic (outside the liver). The
intrahepatic ducts eventually drain into the right and
left hepatic ducts, which merge to form the common
hepatic duct. The cystic duct from the gallbladder joins
with thecommon hepatic duct to form the common bile
duct.
• Bile can either drain directly into the duodenum via
the common bile duct or be temporarily stored in
the gallbladder via thecystic duct. The common bile duct
and the pancreatic duct enter the second part of the
duodenum together at the ampulla of Vater.
Spleen
The spleen is an organ found in virtually
all vertebrate with important roles in regards to red blood
cells and the immune [Link] humans, it is located in
the left upper quadrant of the abdomen. It removes
old red blood cells and holds a reserve in case
ofhemorrhagic shock, while recycling iron. It
synthesizes antibodies in its white pulp and removes,
from blood and lymph node circulation, antibody-coated
bacteria along with antibody-coated blood cells.
Recently, it has been found to contain, in its reserve, half
of the body's monocytes, within the red pulp, that, upon
moving to injured tissue (such as the heart), turns into
dendritic cells and macrophages while aiding "wound
healing", or the healing of [Link] is one of the
centers of activity of the reticuloendothelial system and
can be considered analogous to a large lymph node as
its absence leads to a predisposition of certain infections.
 The Spleen, in healthy adult humans, is
approximately 11 centimetres (4.3 in) in length. It usually
weighs 150 grams (5.3 oz) and lies beneath the 9th to
the 12th thorasic [Link] the thymus, the spleen
possesses only efferent lymphatic [Link] spleen is
part of the lymphatic [Link] germinal centers are
supplied by arterioles called penicilliary radicles.
The spleen is unique in respect to its development
within the gut. While most of the gut viscera are
endodermally derived (with the exception of the neural-
crest derived suprarenal gland), the spleen is derived
from mesenchymal tissue. Specifically, the spleen forms
within, and from, the dorsal mesentery. However, it still
shares the same blood supply—the celiac trunk--as the
foregut organs.
AREA Function Composition
red pulp Mechanical filtration of red blood cells. Reserve "sinuses" (or "sinusoids") which are
of monocytes filled with blood
"splenic cords" of reticular fibers
"marginal zone" bordering on white
pulp

Composed of nodules,
called Malpighian corpuscles. These
are composed of:

white pulp Active immune response through humoral and "lymphoid follicles" (or "follicles"),
cell-mediated pathways. rich in B-lymphocytes
"periarteriolar lymphoid sheaths"
(PALS), rich in T-lymphocytes
Other functions of the spleen are less prominent, especially in the
healthy adult:

• Other functions of the spleen are less prominent,

especially in the healthy adult:
• Production of opsonins, properdin, and tuftsin.
• Creation of red blood cells. While the bone
marrow is the primary site of hematopoeisis in
the adult, the spleen has important
hematopoietic functions up until the fifth month
of gestation. After birth, erythropoietic functions
cease, except in some hematologic disorders.
As a major lymphoid organ and a central player
in the reticuloendothelial system, the spleen
retains the ability to produce lymphocytes and,
as such, remains an hematopoietic organ.
• Storage of red blood cells and other formed
elements. In horses roughly 30% of the red
blood cells are stored there. The red blood cells
can be released when needed. In humans, it
does not act as a reservoir of blood cells. It can
also store platelets in case of an emergency.
• Storage of half the body's monocytes so that
upon injury they can migrate to the injured tissue
and transform into dendritic
cells and macrophages and so assist wound
healing.
Kidney
• The kidneys are paired organs, which have the
production of urine as their primary function. They are an
essential part of the urinary system, but have several
secondary functions concerned
with homeostatic functions. These include the regulation
of electrolytes, acid-base balance, and blood pressure.
In producing urine, the kidneys excrete wastes such
as urea andammonium; the kidneys also are responsible
for the reabsorption of glucose and amino acids. Finally,
the kidneys are important in the production
of hormones including vitamin
D, renin and erythropoietin.
• Located behind the abdominal cavity in
the retroperitoneum, the kidneys receive
blood from the paired renal arteries, and
drain into the paired renal veins. Each
kidney excretes urine into a ureter, itself a
paired structure that empties into
the urinary bladder
• The kidney has a bean-shaped structure, each
kidney has concave and convex surfaces. The
concave surface, the renal hilum, is the point at
which the renal artery enters the organ, and
the renal vein and ureter leave. The kidney is
surrounded by toughfibrous tissue, the renal
capsule, which is itself surrounded
by perinephric fat, renal fascia and paranephric
fat. The anterior (front) border of these tissues is
the peritoneum, while the posterior (rear) border
is the transversalis fascia.
• The substance, or parenchyma, of the kidney is divided
into two major structures: superficial is the renal
cortex and deep is therenal medulla. Grossly, these
structures take the shape of 8 to 18 cone-shaped renal
lobes, each containing renal cortexsurrounding a portion
of medulla called a renal pyramid (of Malphigi). Between
the renal pyramids are projections of cortex called renal
columns. Nephrons, the urine-producing functional
structures of the kidney, span the cortex and medulla.
The initial filtering portion of a nephron is the renal
corpuscle, located in the cortex, which is followed by
a renal tubule that passes from the cortex deep into the
medullary pyramids. Part of the renal cortex, a medullary
ray is a collection of renal tubules that drain into a
single collecting duct.
• The tip, or papilla, of each pyramid empties urine into
a minor calyx, minor calyces empty into major calyces,
and major calyces empty into the renal pelvis, which
becomes the ureter.
Circulatory system
• The circulatory system is an organ system that passes
nutrients (such as amino acids and electrolytes), gases,
hormones, blood cells, , etc. to and from cells in the body
to help fight diseases and help stabilize body
temperature and pH to maintain homeostasis. This
system may be seen strictly as a blood distribution
network, but some consider the circulatory system as
composed of the cardiovascular system, which
distributes blood, and the lymphatic system, which
distributes lymph. While humans, as well as
other vertebrates, have a closed cardiovascular
system (meaning that the blood never leaves the
network of arteries, veins and capillaries),
some invertebrate groups have an open cardiovascular
system. The most primitive animal phyla lack circulatory
system. The lymphatic system, on the other hand, is an
open system.
• The main components of the human circulatory
system are the heart, the blood, and the blood vessels.
The circulatory system includes: the pulmonary
circulation, a "loop" through the lungs where system and
the lymphatic system collectively make up the circulatory
system. blood is oxygenated; and the systemic
circulation, a "loop" through the rest of the body to
provide oxygenated blood. An average adult contains
five to six quarts (roughly 4.7 to 5.7 liters) of blood, which
consists of plasma, red blood cells, white blood cells,
and platelets. Also, the digestive system works with the
circulatory system to provide the nutrients the system
needs to keep the heart pumping.
• Two types of fluids move through the circulatory system:
blood and lymph. The blood, heart, and blood vessels
form the cardiovascular system. The lymph, lymph
nodes, and lymph vessels form the lymphatic system.
The cardiovascular
Pulmonary circulation
• The Pulmonary circulation is the portion of the
cardiovascular system which transports oxygen-
depleted blood away from the heart, to the lungs, and
returns oxygenated blood back to the heart.
• Oxygen deprived blood from the vena cava enters
the right atrium of the heart and flows through
the tricuspid valve into the right ventricle, from which it is
pumped through the pulmonary semilunar valve into
the pulmonary arteries which go to the [Link]
veins return the now oxygen-rich blood to the heart,
where it enters the left atrium before flowing through
the mitral valve into the left ventricle. Then, oxygen-rich
blood from the left ventricle is pumped out via the aorta,
and on to the rest of the body.
Systemic circulation
• Systemic circulation is the portion of the
cardiovascular system which transports
oxygenated blood away from the heart, to
the rest of the body, and returns oxygen-
depleted blood back to the heart. Systemic
circulation is, distance-wise, much longer
thanpulmonary circulation, transporting
blood to every part of the body except the
lungs.
Coronary circulation
• The coronary circulatory system provides
a blood supply to the heart. As it provides
oxygenated blood to the heart, it is by
definition a part of the systemic circulatory
system.
Pathology and
Physiology
Laboratory
Examination Date Result Normal Significance
done Values
Blood typing Nov. 21, 2009 Patients Blood
and Type: A
Crossmatching RH Group: (+)

Screening test
done:
HEPA B Nov. 21, 2009 Non Reactive
HEPA C Nov. 21, 2009 Non Reactive
HIV 1&2 Nov. 21, 2009 Non Reactive
Malaria Nov. 21, 2009 Negative
Syphilis Nov. 21, 2009 Non Reactive
 Examination Date Result Normal Values Significance
done
Mucus threads Moderate Is a normal
finding in the
urine.
Squamous Few Presence of
squamous cells
may mean that
the sample is not
as pure as it it
needs to be.
Spec. grav. 1.020 1.015-1.025 Normal
Sugar Negative Negative Normal
Protein Trace Negative Proteinuria
suggest renal
failure.
Complete Blood Sept. 3, 2009
Count
Hemoglobin 143 140-170gm/L Normal
Hematocrit 0.43 0.41-0.51 Normal
RBC count 4.76 4.60-5..20 Normal
WBC count 5.9 4.50-11.00 Normal
Platelet count Adequate 200.00-400.00 Normal
DRUG STUDY
Name of Classification Dosage/ Route Mechanism of Indication Nursing
Drug frequency action responsibilities
Isoniazid Anti-tubercular 250mg 1 tab PO Bacterial action Prevention Asses patient for
OD AC against of signs and
susceptible tuberculosi symptoms of
organism. s in anaphylaxis
patients
exposed to
active
disease.

Name of Classification Dosage/ Route Mechanism of Indication Nursing

Drug frequency action responsibilities

Rifampicin Anti-tubercular 200mg/5ml PO Bactericidal Used in Asses lung

OD 2 hours action against combinatio sounds,
after susceptible n with other character and
breakfast organism. agents in amount of
the sputum
manageme periodically
nt of throughout
tuberculosi therapy.
s.
 Name of Classification Dosage/ Route Mechanism of Indication Nursing
Drug frequency action responsibilities

Amikacin Anti-infective 350mg OD PO Bactericidal Treatment Thrapeutic blood

action against of serious levels should be
susceptible gram monitored
organism. negative periodically
bacillary during therapy.
infections

Name of Classification Dosage/ Route Mechanism of Indication Nursing

Drug frequency action responsibilities

Imipenem Anti-infective 500mg q8 IV Bactericidal Treatment Observe patient

action against of lower for signs and
susceptible respiratory symptoms of
organism. tract anaphylaxis.
infection.
Name of Classification Dosage/ Route Mechanism of Indication Nursing
Drug frequency action responsibilities
Vancomyc Anti-infective 350mg q6 IV Bactericidal Treatment Monitor IV
in action against of closely.
susceptible potentially Vancomycin is
organism. life irritating, it
threatening causes necrosis
infections. and pain. Rotate
infusion site.

Name of Classification Dosage/ Route Mechanism of Indication Nursing

Drug frequency action responsibilities

Meropene Anti-infective 500mg q8 IV Bactericidal Treatment Observe patient

m action against for for signs and
susceptible pneumonia symptom of
disease. , anaphylaxis.
peritonitis,
etc.
Name of Classification Dosage/ Route Mechanism of Indication Nursing
Drug frequency action responsibilities
Dulcolax Laxative, 1 to 2 tab @ PO Promote Treatment Monitor patient
purgative night. evacuation of for condition and
bowel. constipatio provide
n. education.

Name of Classification Dosage/ Route Mechanism of Indication Nursing

Drug frequency action responsibilities

Vit. B Vitamin 5ml OD AC PO Replacement Treatment Monitor patient

of vitamins in of vitamin for signs and
patient who deficiency. symptoms of
are deficient or anaphylaxis
at risk of contains thiamin.
deficiency.
Nursing Care Plan
 Assessment Diagnosis Planning Nursing Evaluation
Interventions
SUBJECTIVE: -Ineffective airway -After 1 hour of -Avoidance of -After 1 hour of
“Di sya clearance related nursing irritants: smoking, nursing interventions,
makahinga ng to accumulated interventions, the allergens, industrial the patients airway
maayos dahil secretions in the patient’s airway chemicals to avoid was clear from
mayroong lungs will be clear from further irritation of secretions
nakabarang secretions the lungs
-goal met
plema” as -Increase fluid
verbalized by intake to thin
the mother. mucus and make it
OBJECTIVE: easier to
-crackles sound expectorate
is noted during -Positioning to
auscultation facilitate breathing
-presence of (Fowler’s or
sputum in Orthopneic) to
coughing improve air
-restlessness circulation
-looks distress -Deep breathing
exercise to improve
-lethargy breathing
-nasal flaring
-diaphoresis
Assessment Diagnosis Planning Nursing Evaluation
Interventions
-Avoidance of
extreme heat and
cold to avoid
further cough
-Activity as
tolerated to lead a
fairly active life
-Advise to do back
clapping before
and after
nebulization
-kept rested
-Providing frequent
mouth care for
comfort
-Observing
respiratory status
and indicators of
the effectiveness
of therapy to note
some
improvement on
breathing
Assessment Diagnosis Planning Nursing Evaluation
Interventions
-Observing
respiratory status
and indicators of
the effectiveness
of therapy to note
some
improvement on
breathing
-Use of meds as
indicated:
bronchodilators,
expectorants,
liquefying agents
to improve
breathing and air
circulation
Assessment Diagnosis Planning Nursing Evaluation
Interventions
SUBJECTIVE: Ineffective After 1 hour of Assess After 1 hour of
“Gusto ko na individual coping nursing effectiveness of nursing intervention
umuwi” as related to unmet intervention will coping strategies was able to identify
verbalized by expectation as be able to by observing ineffective coping
the patient. manifested by identify behaviors, ability behaviors and
expressed ineffective to verbalize consequences by
concern of going coping behaviors feelings and means of
OBJECTIVE: home and concerns and verbalization and
-anxious- consequences willingness to promotion of
expressed and verbalize participate in the expression of feelings
concern of awareness of treatment plan. and fears like denial.
going home- own coping  Assist patient to
tensed abilities identify specific
stressors and
possible strategies
for coping with
them.
Promote
expression of
feelings and fears
e.g. denial and
anger.
Provide quiet
environment, and
calm activities and
comfort measures
Assessment Diagnosis Planning Nursing Evaluation
Interventions
Assessment Diagnosis Planning Nursing Evaluation
Interventions
EVALUATION AND
DISCHARGE PLAN
Medication
Isoniazid 250mg ½ OD PO, Rifampicin
200 mg/5ml OD 2hrs Breakfast OD, PO,
Amikacin 350 mg OD PO and Vitamin B
Complex
Exercise
Advise significant others to perform range
of motion. Encourage patient to perform
hand stretching.
Treatment
Continue chemotheraphy, follow the dosage and
frequency prescribed. Follow aseptic technique
in performing wound dressing.

Health Teaching
Perform handwashing, practice food sanitation,
separate the client’s utensils used for eating to
avoid the transmission of bacteria to other
members of the family. Always have general
cleaning in house to eliminate respiratory
droplets in the surroundings.
OPD
Visit physician once a week to monitor health
status of the patient.
Diet
Follow the computed diet prescribed and always
take or eat nutritional foods avoid too salty and
sweet.
Spiritual
Always pray to God for fast recovery. Go to
mass every Sunday, Have faith in God.
Always believe in the greatness of God, our
creator. Be optimistic that illness will be cured.