Question

Respiratory Disorders

Mr Suliasi, a 53-year-old male retired FMF baker, is admitted to the TB ward at the Toomey Hospital because of productive cough of more than 2 weeks, hemoptysis, anorexia, and weight loss. His temperature is slightly elevated every afternoon. After performing a Mantoux skin test, he is considered as a patient suspected with pulmonary tuberculosis.

Using the information about Mr Suliasi,

-discuss your management of the patient with evidence to support your management.

-Describe at least 5 signs and symptoms and the rationale.

-Identify 3 common investigations (Labs) and special investigations (Radiology) that will be carried out in this situation and the result (evidence-based)

-Describe the treatment (trade and generic names), identify the indication for use, route (Intravenous/oral), and its side effects in a tabular form.

Drug	Indication	Route	Side effects

-Identify 5 therapeutic interventions and rationale (nursing/medical/surgical) that you will carry out in the ward for this patient in order of priority.

Answer 1

Management.

• treatment does not have to take place in a hospital setting,but hospitalization to intiate therapy provides an oppertunity for intensive patient education.If hospitalized Negative preassure room is essential.
• Antituberculosis treatment regimen.-It should include two drugs to which the organism is susceptible given high frequency wuth primary drug resistance develops when a single drug administerd.Extended therapy is needed because prolonged generation time of mycobacteria.
• DOTS therapY
• First line medication include Isoniazid,Pyrazinamide,Rifampicin,Streptomycin
• Second line management include , Capreomycin,Ethionamide,Kanamycin,Para amino cyclic acid
• other medications -Aminosalicyalte sodium ,Rifabutin,

SIGNS AND SYMPTOMS

• Fatigue-
• Lethargy
• Anorexia
• Weight loss
• Low grade fever
• Night sweats
• Persistent cough
• Hemoptysis

Investigations

• Chest radiography -It may reveal focal infiltrates,nodules,lesions,pleural effusions,and lymphadenopathy.In primary infection middle and lower lobe infiltrates mostly.Reactiavtion disease involves in the upper lobe.
• A presumptive diagnosis of pulmonary TB can be done with Posithi Flurochrome or acid-fast bacteria smear in sputum.However nontuberculosis mycobacteria and some Nocardia species also identified in this.
• Use of radimetric culture system and species specific DNA probes can provide a faster result.
• Drud susceptibilty testing must be done

Drug-Generic name	Trade name	Route	Indication	Side effects
Isoniazid	INH,Laniazid,Nydrazid	Oral	For the prevention and treatment of Tuberculosis	Hypersensityvity reaction,Peripheral neuritis,Neurotoxicity,Dry mouth,dizziness,vision changes,Hepatitis.
pyrazinamide	Pyrazinamide	oral	For the treatment in active tuberculosis	Nausea,stomach upset,vomitting,fatigue
Ethambutol	Myambutol	Oral	It is used to treat bacterial infections .	Optic neuritis,,vision changes.
Streptomycin		oral	used to treat bacterial infections.	Vertigo,nausea ,vomitting,loss of appetite.

Therapeutic interventions.

• The clent must be placed in a negative praessure room.
• Follow standered precaution.Isolation must be continued.