Introduction

Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium

tuberculosis, which most commonly affects the lungs. It is transmitted from person to
person via droplets from the throat and lungs of people with the active respiratory
disease.

In healthy people, infection with Mycobacterium tuberculosis often causes no

symptoms, since the person's immune system acts to “wall off” the bacteria. The
symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest
pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a
six-month course of antibiotics. (World Health Organization)

The Philippines ranks ninth on the list of 22 high-burden tuberculosis (TB) countries in
the world, according to the World Health Organization’s (WHO’s) Global TB Report
2009. After China, it had the second highest number of cases in the WHO Western
Pacific Region in 2007, and TB is the sixth greatest cause of morbidity and mortality in
the country. In 2007, approximately 100 Filipinos died each day from the disease, but
significant strides have been made in increasing case detection and treatment. In 2004,
the country achieved a TB case detection rate of 72 percent, exceeding WHO’s target of
70 percent, and reached 75 percent in 2007. The DOTS (the internationally
recommended strategy for TB control) treatment success rate reached WHO’s target of
85 percent in 1999 and has remained around 88 percent since then.

Tuberculosis in children has not been given much attention until 1993 when the World
Health Organization recognized the burden of tuberculosis in children. Most cases in
children are due to the spread of tuberculosis from sputum positive adults. In
industrialized countries, the frequency of tuberculosis will be less than 10 per 100,000
populations, though in slum dwellers, this may rise to 60/100,000. In the Philippines, a
prevalence study in a rural community involving 240 children showed that 52.1% who
got exposed to sputum positive adults and only 43.1% with exposure to adults with PTB
based on positive chest x-ray findings, were positive purified protein derivative (PPD)
reactors.

Our Case is all about Mr. Julieto Amante, a 14 years old Male, who was diagnosed with
Pulmonary Tuberculosis and developed Ascites.
OBJECTIVE OF THE STUDY

The objective of the study is to provide quality nursing care to assigned patient utilizing
the knowledge based on nursing process and critical thinking skills. This care study
aims to guide the student nurses in providing client-centered nursing care while
applying critical thinking in all phases of nursing care – from assessment to evaluation.

Furthermore, awareness and knowledge of the patient’s disease condition and its
corresponding pathophysiology that is vital in providing suitable intervention to the
client. With accurate application of physical assessment, actual and potential health
problems are being detected and resolved through the nursing care plan.

This study is directed towards health maintenance by utilizing skills and knowledge, the
client is being protected from any complications and potential disease condition.
Thereby, rendering proper intervention and nursing actions, could certainly alleviate the
clients health problem.

SCOPE AND LIMITATIONS OF THE STUDY

The primary concern of the study is health maintenance and detection of actual
and potential health problem that could further exacerbate the client’s disease condition.
Nursing process is utilized including the appropriate use of nursing care plan.
Nevertheless, the client’s history of present illness including family history is being
scrutinized to detect any possible health problem or knowledge deficit regarding family
care.

Moreover, information and details regarding the patient’s disease such as the
pathophysiology, precipitating and predisposing factors, clinical manifestations, signs
and symptoms are being considered before intervention done. Nonetheless, health
teachings are given to client as part of discharge plan. Furthermore, the limitation of the
study lies on providing financial support. Proper nursing intervention and health
teaching are skills given to be able to provide quality nursing care. Intervention to major
illness and operation are referred to another levels of care.
Furthermore, the limitation of the study lies on the time given to do the study where we
had 42 hours of assessment and implementing nursing interventions.

Health History

A. Profile of the Patient

Patient’s name: Mr. JA

Sex: Male

Age: 14 years old

Civil Status: Single

Birth Place: Canitoan, Cagayan de Oro city

Nationality: Filipino

Religion: Ispiritista

Occupation: Student

Address: Zone 1, Canitoan, Cagayan de Oro city

Date/Time Admitted: December 26, 2010/5:45 pm

Chief Complaints: Abdominal Enlargement

Admitting Diagnosis : Liver Pathology: secondary Anemia

Attending Physician : ????

Allergies : No Known Food Drugs Allergies

Vital signs

BP: 90/60

Temperature: 37.3° C

Pulse: 143 bpm

Respiration : 32 cpm

B. Family and Personal past Health History

There is no history of tuberculosis and hypertension among family members, non-

smoker and non-drinker. With a positive history of Community Acquired Pneumonia,
diagnosed at JRG Hospital last October, 2010.

C. History of Present Illness

2 weeks prior to admission, there is the onset of swelling of both feet and patient suffers
from oliguria.
5 days prior to admission, there is a gradual enlargement of the abdomen. No
complaints of urination and defecation problems, patient is afebrile and patient has a
feeling of fullness.

D. Chief Complaints
Abdominal Enlargement
HEALTH TEACHINGS AND REFERRAL

For the patient who has been diagnosed with Tuberculosis, it is vital for the nurse to
reinforce teachings provided by specialists and referring the patient for follow-up after
discharge in order to achieve continuous state of well-being.

For the Medications- The patient is advised to follow and take the prescribed
medication regimen necessary for his fast and effective treatment and recovery. Patient
teachings are also imparted regarding on precaution and side effects of the
medications.

For the Exercise- The patient is advised to ambulate or at least, perform sitting position
in order to promote peristalsis to prevent constipation. Also, high back rest is performed
to provide comfort in breathing and promote effective lung expansion. Deep breathing
exercise is also encouraged. Avoid a stressful activity and continue to a healthy
interaction with the other member of the family and friends.

For the treatment- Instructed the mother to follow the treatment given by the physician,
which includes the proper administration of the medications, the time the
medication be given and the diet that the patient must have. That
treatment is necessary for the complete recovery of the patient. Also,
advised the mother to keep his child relax in order to recover in his
present condition. Instructed the mother to minimize the patient from
exposure to an open environment such as dusty and smoked area which
airborne microorganisms are present that can be a high risk factor that
may cause severity of his condition.

For the outpatient- Parents of the patient were advice to bring the patient to the
hospital to have a followed-up check-up by the doctors ordered and
schedule.
For the diet- Health teachings on DIET given with emphasis on the mother:

• Reduce intake of fatty foods.

• Reduce intake of foods rich in sodium.

• Provide nutritious foods rich in vitamins and minerals.

• Provide fibrous foods to aid constipation.

• Encourage to eat green and leafy vegetables and fruits.