Question

Case: Tuberculosis

I.P. is a 50-year-old female who presents to the emergency room with productive cough and fever. Sputum results are positive for tuberculosis.

Subjective data

• Patient states cough started 10 days ago, getting worse
• Reports feeling tired and no appetite for days
• Smokes 1 pack a day for 33 years
• Married with two children, ages 12, 14
• Takes a “sugar” pill to help with diabetes
• Works as home health aide

Objective data

• Vital signs: T 38 C, P 64, R 12, BP 120/64
• Weight: 145 lb (Last ED visit 6 months ago documented weight at 155 lb.)
• Height: 5'4"
• Sputum positive for tuberculosis
• Chest x-ray shows infiltrates right and left lower lobe

Medications: ASA 81 mg per day, metoprolol 25 mg per day, Simvastatin 20 mg per day, Metformin 500 mg BID, multivitamin 1 per day

Questions

1. Are vital signs within normal limits? Why or why not?
2. What other equipment is necessary to assess this patient?
3. Create a problem list from data.
4. How should you measure the patient’s oxygen levels?
5. What teaching and nursing interventions should you consider for this patient?

Answer 1

Q1

ANSWER: In the vital signs, the patient is having an abnormal temperature that is 38 ^o C which is more than the normal ( 37 ^o C) that indicate fever. Pulse is 64 beats per minute that is under normal range, respiration is 12 and blood pressure is 120 /64 are also normal. The normal range of pulse is 60-100, respiration is 12-18, and blood pressure 120/80.

Q2

Answer: the other equipment that is necessary to assess the patient is glucometer to check the blood glucose level because the patient is also having history of diabetes. This will helps to identify the patient's blood glucose level is under control or not after taking the sugar pills.

Q3

Answer: the problem list from the data are

the patient complaint of

-cough for 10 days and now getting worse

- feeling tired

-lack of appetite

- diabetes

- From the objective data patient have a fever, sputum positive for tuberculosis and chest x ray shows infiltrate right and lower left lobe.

Q4

Answer: The oxygen level can be measure by using pulse oximeter or by doing ABG analysis. Pulse oximeter in non invasive technique in which the pulse oxymeter is attach to the finger and reading will come automatically in the screen. ABG analysis is an invasive procedure, in this the arterial blood is collected and the SPO₂ level is monitored by sending the blood in the laboratory.

Q5

The teaching and the nursing intervention to be considered includes

- Assess the vital signs, oxygen level, blood glucose level

- Provide the patient in fowler position to maintain more comfortable position and make proper breathing pattern.

- Administer medication as per advice by the physician.

- use of PPE should be done to prevent spreading of tuberculosis

- Isolate the patient seperately.

- Educate the patient to stop smoking

- Explain the details about the new diagnosis that is tuberculosis.

- Educate regarding the treatment of the tuberculosis and advice not to skip the tuberculosis medication because once if it is skip need to start again the medication course from the begining.

- Advice to prevent contact with other people as much as possible and advice to use mask if going outside to prevent spreading to other.

- Advice to maintain high nutritious diet to maintain the health.