Primary Koch‘s Infectionby: Dann Louie Z. Praxides Introduction Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis. Although TB can be treated, cured, and can be prevented if persons at risk take certain drugs, scientists have never come close to wiping it out. Few diseases have caused so much distressing illness for centuries and claimed so many lives. Tuberculosis was popularly known as consumption for a long time. Scientists know it as an infection caused by M. tuberculosis. In 1882, the microbiologist Robert Koch discovered the tubercle bacillus, at a time when one of every seven deaths in Europe was caused by TB. Because antibiotics were unknown, the only means of controlling the spread of infection was to isolate patients in private sanitoria or hospitals limited to patients with TB—a practice that continues to this day in many countries. The net effect of this pattern of treatment was to separate the study of tuberculosis from mainstream medicine. Entire organizations were set up to study not only the disease as it affected individual patients, but its impact on the society as a whole. At the turn of the twentieth century more than 80% of the population in the United States were infected before age 20, and tuberculosis was the single most common cause of death. By 1938 there were more than 700 TB hospitals in this country. Objectives: OBJECTIVES As a Nurse: a. To gain knowledge about the case of my patient, Primary Koch‘s infection. b. To impart knowledge to the significant others about her case. c. To provide quality and effective nursing interventions to the patient. d. To encourage the client and her significant others to comply with the nurses‘ and doctors‘ health teaching and interventions. To the Patient: a. To know, understand and accept important matters about her condition. b. To cope up with her present condition. c. To help obtain timely recovery. d. To help her to learn the important things about PKI. m. Weight: 18. Camarines Norte Age: 8 years old. Nationality: Filipino Religion: Roman Catholic Occupation: Student. Date of admission: 08-14-2011 Time of admission: 4:50 p.1 kgs. Birthday: April 13. 2003 Blood Type: ―O‖ .Patient Profile Name: Princess Address: Mercedes. symmetrical eyebrows. Eyes: eyebrows symmetrically aligned. no tenderness. proportion to the body Scalp: white in color. pupil is black No discharge. no lesion. equal movement Pupillary size of 3. wavy and evenly distributed. with dandruff Hair: white in color. With slight periorbital puffiness noted. lids close symmetrically.Review of system Head: rounded and symmetrical absence of nodules. no lumps. Ears: auricle aligned with outer canthus of the eye . oily. moist pale lips and buccal mucosa Mouth: dry mucous membrane. Nose: not tender. uniform temperature Crackles sound upon auscultation Extremities: No presence of edema Skin: Pallor No lesion. moisture in skin folds and axillae Poor skin turgor . Neck: aligned symmetrically with the body. Respiratory: RR: 35 c/min. no abrasion. no lesion symmetric and straight with discharges (yellowish in color in appearance) Nasal septum intact and midline Pharynx: soft. Skin intact. History of present illness Date of Admission: 08-14-2011 Attending Physician: Dra. Labarro Chief Concern: Hemoptysis Admitting Diagnosis:Primary Koch‘s Infection . Immunization Fully vaccinated as verbalized by the mother of the client.HISTORY OF PAST ILLNESSES A. Uses OTC meds Paracetamol (Biogesic) – Fever 2. Medication History 1. . Colds 3. Fever B. Childhood Illnesses 1. Herbal Medicine Lagundi – colds C. Cough 2. Mother: Amelia Hypertension .HISTORY OF FAMILY ILLNESSES Father: Cesar Recurrent colds. Cesar‘s father died because of PTB Has PTB. Injuries/ Accident in the past: Patient had not experience injuries or accident in the past. .PERSONAL HEALTH HISTORY Allergies: No known allergies on foods and drugs. Family health history: Experienced Hypertension and PTB Home and Environment: Resides at Mercedes Camarines Norte Source of Income: Producing and Selling dried fish. nakakaisang pinggan po ako. at dinala po ako dito sa hospital. NUTRITIONAL METABOLIC PATTERN -‖madami po ako kumain dati. ‖ . may dugong kasama. madami pa din po ako kumain. sinabi ko kagad kay mama. pero ngayon di ko na po iniisip kasi may gamot na po ako‘‘. katulad lang po dito.Gordon‘s Functional Health Pattern HEALTH PERCEPTION PATTERN -‖nabigla po ako ng pag ubo ko. SLEEP PATTERN -‖nang nasa bahay po ako.ELIMINATION PATTERN -‖parehas lang po ako kung gano kadalas umihi at mag dumi nung nasa bahay pa po ako‖. pero ngayon po dito po sa hospital nahihirapan po ako matulog kasi po mainit at di po . ACTIVITY -EXERCISE PATTERN -‖naglalakad po ako tuwing umaga papuntang school‖. maayos po akong nakakatulog. katulad ni papa. kaya umubo din po ako ng may dugong kasama‖. VALUE-BELIEF PATTERN -‖nagsisimba naman po kami nila mama kapag sabado ng umaga. pero ngayon po.COGNITIVE PERCEPTUAL PATTERN -‖ ‗di ko po alam kung bakit umubo po ako ng dugo. SELF-PERCEPTION PATTERN -‖siguro po ay may sakit din po ako.‖. hindi na po kami . 70 150 – 450 x O+ .LABORATORY RESULT HEMATOLOGY August 15.20 – 0.25 0.36 – 0.37 12. 2011 Hct WBC Differential Count Lymphocyte Neutrophil Platelet Count 103/l Type 0.75 154 0.48 5 – 10 x 109/L 0.1 x 109/L 0.40 0.25 – 0. URINALYSIS August 15. Gravity: Microscopic Findings Pus Cells: Epithelial: RBC: Yellow clear 1. 2011 Chemical Findings Color: Transparency: Spec.032 1-2 Few 0-2 . hexagonal divisions of the lungs that are the smallest subdivision visible to the naked eye. the two are not identical. where oxygen diffuses into blood and is exchanged for carbon dioxide in the hemoglobin of theerythrocytes. The bronchi continue to divide within the lung. Human lungs are located in two cavities on either side of the heart. with three lobes on the right and two on the left. The individual alveoli are tightly wrapped in blood vessels and it is here that gas exchange actually occurs. The oxygen-rich blood returns to the heart via the pulmonary veins to be pumped back into systemic circulation. The medial border of the right lung is nearly vertical.Anatomy and Physiology Anatomy In humans. Both are separated into lobes by fissures. which lead to alveolar sacs. Deoxygenated blood from the heart is pumped through the pulmonary artery to the lungs. and after multiple divisions. the trachea divides into the two main bronchi that enter the roots of the lungs. Alveolar sacs are made up of clusters of alveoli like individual grapes within a bunch. The connective tissue that divides lobules is often blackened in smokers. Though similar in appearance. The bronchial tree continues branching until it reaches the level of terminal bronchioles. while the left lung contains a cardiac notch. The lobes are further divided into segments and then into lobules. The cardiac notch is a concave impression molded to accommodate the shape of the heart. give rise to bronchioles. . Lungs are to a certain extent 'overbuilt' and have a tremendous reserve volume as compared to the oxygen exchange requirements when at rest. and the visceral pleura lies on the surface of the lungs. Inflammation of the lungs is known as pneumonia inflammation of the pleura surrounding the lungs is known as pleurisy. The parietal pleura lies against the rib cage. with the other compensating for its loss. allowing the body to match its CO2/O2 exchange requirements. The environment of the lung is very moist. it is possible for humans to live with only one lung. Additionally. in situations like these only a small portion of the lungs are actually perfused with blood for gas exchange. which consists of two pleurae. . Each lobe is surrounded by a pleural cavity. due to the excess capacity. In between the pleura is pleural fluid. The pleural cavity helps the lubricate the lungs. As oxygen requirements increase due to exercise. a greater volume of the lungs is perfused. Destruction of too many alveoli over time leads to the condition emphysema which is associated with extreme shortness of breath. which makes it hospitable for bacteria. as well as providing surface tension to keep the lung surface in contact with the rib cage. Such excess capacity is one of the reasons that individuals can smoke for years without having a noticeable decrease in lung function while still or moving slowly. Many respiratory illnesses are the result of bacterial or viral infection of the lungs. blood vessels and lung interstitium. it often includes any form of lung tissue. May serve as a layer of soft. However. alveolar duct and terminal bronchioles. it can be measured with a spirometer. In combination with other physiological measurements. . Non respiratory functions In addition to their function in respiration. bronchi. the vital capacity can help make a diagnosis of underlying lung disease. which the lungs flank and nearly enclose. The lung parenchyma is strictly used to refer solely to alveolar tissue with respiratory bronchioles. shock-absorbent protection for the heart. the lungs also: Alter the pH of blood by facilitating alterations in the partial pressure of carbon dioxide. also including bronchioles. Vital capacity is the maximum volume of air that a person can exhale after maximum inhalation. Convert angiotensin I to angiotensin II by the action of angiotensinconverting-enzyme. Age -Immunosuppressant -.HIV or aids infection Precipitating Factors: -Occupation -Repeated close contact with infected persons -recurrence of infection Exposure or inhalation of droplet nuclei .prolonged corticosteroid therapy -systemic infection -.Pathophysiology Predisposing Factors: . dead WBC‘s. necrotic lung tissue) Drainage of necrotic materials into the tracheobronchial tree. (coughing. Necrotic degeneration begins (production of cavities filled with cheese-like mass of tubercle bacilli.Tubercle bacilli invasion in the apices of the lungs or near the lower lobes. Arrest of a phagosome which result to bacilli replication. formation of lesions) Primary Infection (the original outbreak of an illness against which the body has had no opportunity to build antibodies) . (An infection that is currently producing symptoms or in which the causative organism of the disease is rapidly reproducing) Signs and symptoms: . Tubercle Bacilli immunity develops (2-6 weeks after infection) (maintains in the body as long as living bacilli remains in the body) Acquired immunity leads to further growth of bacilli and development of active infection.Lesions may calcify and forms scars and may heal over a period of time. Pulmonary Symptoms: -dyspnea -non productive cough or productive cough -Hemoptysis -Chest pain -Chest tightness -Crackles may be present on auscultation. General Symptoms: -fatigue -anorexia -weight loss due to NV. With medical interventions: interventions: -early detection of the dse. -multi-antibacterial therapy. -TB DOTS individual Without medical -reactivation of the tubercle Bacilli (due to repeated exposure to infected . -low grade fever with chills and sweats often at night. Active infection is spread throughout the body systems. »TB of the bones »Pott‘s disease »Renal TB .Severe occurrence of lesions in the lungs No recurence: Good prognosis Recurrence: Bad prognosis Cavitation in the lungs occurs. (infiltration of tubercle bacilli in other organs. Severe occurrence of infection Bad prognosis Death . gonnorrhoeae infections -prophylaxis for sexually transmitted disease. Indication: -respiratory tract. skin and soft tissue infection -bacterial meningitis -GI or urinary tract infection -endocarditis -N. q 6o Action: Destroys bacteria by inhibiting bacterial cell wall synthesis during microbial multiplication. .Medical management Ampicillin 500 mg. anxiety. dyspnea. hypoxia. frequent servings of food and drinking plenty of fluids. diarrhea. confusion and dizziness. Precautions: Use cautiously in patient with severe renal insufficiency. Respi: wheezing. .Contraindications: Hypersensitivity to penicillin. -advise patient to minimize GI upset by eating small. Adverse reaction: CNS: lethargy. abdominal pain. Patient teaching: -instruct patient to immediately report sign and symptoms of hypersensitivity. hallucinations. GI: nausea and vomiting. T.Advised patient/SO‘s to strictly adhere to the therapeutic regimen -advised to avoid inhaling smokes came from their source of income.Multi Vitamin C 5mL OD E. -advised patient and SO to cover their mouth whenever they are coughing or sneezing.encouraged to do simple exercise like walking when going to the school.Discharge summary M.instructed the patient to came back after 1 week . O. -advised to have adequate rest and sleep. -encouraged the client to participate minimally in ADL. -advised to increase oral fluid intake of the client.-advised to eat nutritious foods rich in vitamin C such as fruits and vegetables. .Encouraged to tighten her faith to God and worship Him.D. S. NCP Assessment: S. O. -Crackle sound upon auscultation.―nahihirapan po akong huminga‖ as verbalized by the client.RR: 35 c/min. Planning: After 1-3 hours of nursing interventions the client will be able to expectorate secretions and alleviate difficulty of breathing Interventions: » monitor client‘s respiration rate for baseline data » encourage deep breathing and coughing exercise to the client to maximize lung expansion. .with yellowish colored nasal secretions. . Diagnosis: Ineffective airway clearance related to retained secretions. » advised to take foods rich in vitamin c such as fruits and vegetables and avoid foods rich in sugar like candies and pastries because sugar attracts microorganism. Evaluation: After 1-3 hours of nursing interventions the client was able to expectorate secretions and alleviate difficulty of breathing. » auscultated breath sounds to ascertain client‘s status and note progress of nursing interventions. » administer meds prescribed by the physician.» advised to increase oral fluid intake to liquefy secretions. » advised to have adequate rest and sleep. RR: 28 c/min. » positioned the client on moderate high back rest to maximize lung expansion. . Planning: Within the shift of nursing interventions the client fluid volume will be maintain at functional level. O.Assessment: S. Diagnosis: Fluid volume deficit related to nausea and vomiting secondary to frequent coughing.poor skin turgor -with dry skin and mucous membrane noted. .―parang pagod po ako at palaging nauuhaw‖ as verbalized by the client. -PR: 120 b/min. -mild weakness noted. -properly regulated IVF of the client. PR: 100 b/min. -advised to used hypoallergenic soap to the client to maintain skin integrity and prevent excessive dryness. moist mucous membrane and good skin turgor. . -encouraged to apply lotions to moisturize the client‘s skin. -advised to wear loose clothing.Interventions: -assess vital signs for baseline data and comparison. -advised to increase oral fluid intake. Evaluation: Within the shift of nursing interventions the client fluid volume will be maintain at functional level as evidence by stable vital sign. -advised the SO to prepare beverages and foods high in fluid content. -drowsiness noted -unable to do simple activity such as feeding herself. Planning: . O.slow movement and reaction upon interaction.Assessment: S. Diagnosis: Fatigue related to weight loss secondary to vomiting.―mabilis po akong napapagod at parang nawawalan po ako ng lakas‖ as verbalized by the client. 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