Case study of a patient with tuberculosis

15 Case study of a patient with tuberculosis



Maria Mercer



Chapter aims




• To provide you with a case study of a patient who has been diagnosed with pulmonary tuberculosis (TB) together with the rationale for care


• To encourage you to research and deepen your knowledge of TB



Introduction


This chapter provides you with an example of the nursing care that a patient with pulmonary TB might require. The case study has been written by a TB nurse specialist and provides you with a patient profile to enable you to understand the context of the patient. The case study aims to guide you through the assessment, nursing action and evaluation of a patient with pulmonary TB together with the rationale for care.



image Activity


In Chapter 1 you were asked to revise the normal anatomy and physiology of the respiratory system (see Montague et al 2005) and a brief definition of TB was given. Before reading the case study below, find out how pulmonary TB would affect the respiratory system and what symptoms a patient with TB might present with.


The following article may help you:



William VG (2006). Tuberculosis: clinical features, diagnosis and management. Nursing Standard 20(22):49–53. Online. Available at:http://nursingstandard.rcnpublishing.co.uk/archive/article-tuberculosis-clinical-features-diagnosis-and-management (accessed July 2011).



Patient profile


Mr Patel is a 21-year-old gentleman who lives in a shared flat with friends and studies English at a local college. He is a new arrival to the UK having arrived from Bangladesh in October 2009. There are six adults, including Mr Patel, who share a two-bedroom flat. They share three adults to a room. He was referred to accident and emergency (A&E) via his GP with a 2-month history of a productive cough (no episodes of haemoptysis), associated fevers, drenching night sweats, loss of appetite and a 5-kg weight loss. In the last 7 days his symptoms have worsened and warranted the admission via A&E.



Assessment on admission


Mr Patel has a pyrexia of 38.5°C, he is cachectic and has pleuritic chest pain. His respiratory rate is slightly raised at 18 per minute and he has a tachycardia of 114 beats per minute. Blood pressure is normal. Inflammatory markers – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – are raised at 72 mm/h and 65.4 mg/L. A chest X-ray has been reported as abnormal: ‘Patchy shadowing seen in left upper lobe? Pulmonary TB.’



image Activity


See Appendix 4 in Holland et al (2008) for possible questions to consider during the assessment stage of care planning.



Mr Patel’s problems


Based on your assessment of Mr Patel, the following problems should form the basis of your care plan:



• Mr Patel has a potential diagnosis of pulmonary TB which can be an infectious disease and public health risk.


• Mr Patel feels stigmatised because of respiratory isolation measures and the potential diagnosis of TB.


• Mr Patel has a temperature, raised inflammatory markers, a slightly elevated respiratory rate and a tachycardia.


• Mr Patel is nutritionally compromised because of a 5-kg weight loss due to anorexia.


• Mr Patel has pleuritic chest pain associated with coughing and expectoration of sputum.



Mr Patel’s nursing care plans




1. Problem: Mr Patel has an infection. Pulmonary TB is felt to be the primary diagnosis.


Goal: To limit transmission of TB to other patients and staff and ensure prompt treatment is commenced.






















Nursing action Rationale
Mr Patel to be isolated in a side room with bathroom facilities with respiratory isolation measures in place immediately
The door to the side room must be shut at all times
Appropriate face masks (FFP2 or FFP3, depending on risk assessment – refer to infection control/TB policy) should be worn when entering Mr Patel’s room and he should wear the appropriate face mask if he needs to leave the side room for investigations
Gloves and aprons do not need to be worn unless handling bodily secretions
Liaise with bed managers and infection control team to expedite bed availability as necessary		 To reduce the risk of TB transmission to other patients and staff
Collect three consecutive sputum specimens for acid-fast bacilli (AFB)
Send one sputum specimen urgently on day of admission		 To ascertain diagnosis and ensure the appropriate treatment is commenced promptly
Ensure Mr Patel is aware that sputum specimens need to be collected consecutively. Label 3 sputum pots clearly and leave in side room. Instruct Mr Patel to inform the nurse caring for him when the sputum for each day is ready so it can be collected and sent to the Laboratory as soon as possible. To ascertain diagnosis and ensure the appropriate treatment is commenced promptly.
Contact the TB nurses to perform a Mantoux test if prescribed by the medical staff. To facilitate prompt diagnosis and obtain specialist nursing advice and support
Ensure effective communication with Mr Patel explaining why the above measures are necessary and providing reassurance and support To alleviate fear and anxiety

Evaluation:

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  2. Revision and future learning
  3. The end of the journey
  4. Medicines management

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Feb 25, 2017 | Posted by in NURSING | Comments Off on Case study of a patient with tuberculosis

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