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P.O BOX: 875, BAMENDA.
MOTTO: HOPE IS THE KEY
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE AWARDS OF HIGHER NATIONAL DIPLOMA (HND) IN
NURSING
April 2018
A CASE STUDY REPORT ON TUBERCULOSIS IN AN HIV POSITIVE CARRIED OUT DURING AN INTERNSHIP AT THE MBENGWI DISTRICT HOSPITAL FROM 8 DECEMBER 2017
TO 8 JANUARY 2018
SUPERVISED BY:
Dr Mfonfu Daniel
PRESENTED BY:
TUNGA HILDA ANNE
REPUBLIQUE DU CAMEROUN --------------------------- PAIX-TRAVAIL-PATTIE ---------------------------------- MINISTERE DE L’ENSEIGNEMENT SUPERIEUR ---------------------------- DIRECTION DE L’ENSEIGNEMENT SUPERIEUR PRIVE ---------------------------------------
REPUBLIC OF CAMEROON ----------------------------- PEACE-WORK-FATHERLAND ------------------------------------- MINISTRY OF HIGHER EDUCATION --------------------------------- DEPARTMENT OF PRIVATE EDUCATION -----------------------------------
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CERTIFICATION
This is to certify that, this report was written and presented by Tunga Hilda
Anne of the department of Nursing at Capitol Higher Institute of Health
Sciences and Beauty Therapies Bamenda as a partial fulfillment of the
requirement for the award of a Higher National Diploma (HND).
Student_______________________Signature____________ date_________
Supervisor_____________________Signature____________ date_________
Dean of studies ________________Signature____________ date_________
President of Jury _______________ Signature____________ date__________
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DEDICATION
I dedicate this piece of work to the Almighty God who gave me the grace to
be alive to become what I am and to allow me do this work.
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ACKNOWLEDGEMENT
I acknowledge all those who supported me spiritually, academically, morally,
socially, financially and materially.
My supervisor Dr.Mfonfu for the time he sacrificed to read and correct
this work.
My parents and my children; Bradley, Nuela, Bryan and Braddel. Also
Nuela and Randy for their educational motivation and financial
support.
Madame Fozing Helen, Madame Apo Gladys, Mr.Asaah K Fombi for
their advice.
The Capitol Higher Institute of Health Sciences and Beauty Therapies
for making me to be what I am today.
My lecturers for the knowledge they have transmitted to me.
The staff of Mbengwi District Hospital, especially those of the
UPEC/TB unit who cooperated when I was carrying put this case
study.
All my friends who supported me in one way or the others.
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List of Tables
Table 1: Table showing the staffing of the MDH.................................................9
Table 2: Daily drug chart.................................................................................19
Table 3: daily drug chart....................................................................................19
Table 4: daily drug chart...............................................................................19-20
Table No_5: Nursing care plan 1-19/12/17.......................................................23
Table No_6: Nursing care plan 1-20/12/217.....................................................23
Table No_7: Nursing care plan 1-21/12/17..................................................23-24
Table No_8: Nursing care plan 1-22/12/17.......................................................24
Table No_9: Nursing care plan 1-23/12/17.......................................................24
Table No_10: Nursing care plan 1-25/12/17.....................................................25
Table No_11: Nursing care plan 1-26/12/17.....................................................25
Table Number- 12: Vital Signs..........................................................................26
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List of Abbreviations
CMO Chief Medical Offices
CRA Community Relay Agent
DOA Date of Admission
DOD Date of Discharge
G.S General Supervisor
Km Kilometer
MDH Mbengwi District Hospital
SRN State Registered Nurse
SRN/RH State Registered Nurse in Reproductive Health
TB Tuberculosis
IWC Infant Welfare Clinic
NA Nursing Assistant
HIV Human Immune Virus
ANC AntenatalClinic
IVD Intravenous Direct
SPPTB Sputum Positive Pulmonary Tuberculosis
SNPTB Sputum Negative Pulmonary Tuberculosis
EPTB Extra Pulmonary Tuberculosis
DOTs Directly Observed Treatment Short Course
RHEZ IsoniazidRifampicinPyrazinamideEthambuto
RHE Rifampicin Isoniazid Ethambuto
S Streptomycin
MD Medical Doctor
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Table of Content
CERTIFICATION………………………………………………………..........2
DEDICATION……………………………………………………………........3
ACKNOWLEDGEMNTS………………………………………………..........4
LIST OF TABLES……………………………………......................................5
LIST OF ABBREVIATIONS……………………………………………........6
TABLE OF CONTENTS…………………………….......................................7
CHAPTER ONE - INTRODUCTION…………………………….............8-11
CHAPTER TWO - REVIEW OF LITERATURE ON THE CASE…...12-16
CHAPTER THREE-PRESENTATION OF CASE……………….........17-26
CHAPTER FOUR - REVIEW OF MEDICATIONS ……………..........27-30
CHAPTER FIVE - TUBERCULOSIS IN AN HIV ADULT……….......31-32
CHAPTER SIX – CONCLUSION……………………………….............33-34
REFERENCE …………………………….................................................34
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CHAPTER ONE - INTRODUCTION
1.1 Definition of the case
The HIV virus itself doesn‟t kill. It weakens the immune system by destroying
CD4 cells, which usually defend against infection. Most people will remain
healthy for many years after contracting HIV. Only after around five to ten
years, when the virus has severely damaged the immune system, do people
progress to the next stage – AIDS.
AIDS is diagnosed when a defined set of clinical conditions are found in a
person infected with HIV. These conditions are mostly infections that occur
because the immune system is unable to fight them – so called „opportunistic
infections‟. TB is one of the most common „opportunistic infections‟ in people
with HIV.
Tuberculosis is an infectious and contagious disease caused by a microorganism
called mycobacterium tuberculosis or Kock‟s bacilli. It is one of the most killer
diseases because of the advent of HIV /AIDs. HIV infection increases the
prevalence rate of tuberculosis.
1.2 Motivation
I was motivated by the fact that the case was a roaming patient moving from
hospital to hospital without the diagnosis of tuberculosis in HIV. He came from specialised hospitals in Yaoundé to a district hospital in Mbengwi where he was diagnosed of pulmonary tuberculosis.
General objective (goal):
Successfully manage the case of Tuberculosis in an HIV adult as a member of
the medical and nursing team; and to submit the report of this case study in
partial fulfilment to obtain the HND in nursing.
.
1.3 Specific objectives
a) Identify the patient
b) Describe the circumstances of arrival of the patient
c) Admit the patient
d) State the provisional diagnosis on admission, state source
e) Administer any emergency medications
f) Clerk/Assess the patient
g) Administer the medications prescribed by the medical officer, monitor
and record side effects on the patient
h) Establish daily drug chart
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i) State results of confirmatory diagnostic tests
j) Develop and implement nursing care plans
k) Describe the evolution of the patient and vital signs
l) Revue the medications administered
m) Write the discharge summary
n) Identify positive findings, weaknesses; make recommendations; make
conclusions
1.5. Presentation of the Mbengwi District
The MDH is a reference hospital of Mbengwi health district; it is located some
20km South of Bamenda town and belongs to the Mbengwi Urban Area. It is
made up of 6 buildings with 30personnel and 45beds. Its average daily
consultation at the outpatient is 20patients. The staffing of the hospital is
distributed as follows;
Table 1: Table showing the staffing of the MDH
Staff Number
CMO 01
Medical doctors 01
General supervisor 01
Laboratory staff 04
Ward nurses 05
Maternity 06
1.6. Description of the TB unit of MDH
The TB unit of MDH is a small building located at the old stoned
building. It is made up of three rooms. It has a capacity of 6beds.
These units function with 6personnel, 2 HND, 3NA and 1cleaner.
1.7. General Objective
The main objective is to treat and follow up HIV patients suffering
from tuberculosis.
1.8. Specific Objectives
To create good nurse patient relationship.
Ensure comfort and reassurance for rapid recovery.
Follow up of HIV/TB patient
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Follow up exposed infants.
Provide psychological preparation before treatment
Provide free TB medications
Provide care to the patients admitted for a disease condition.
Participate in the training of student nurses
Ensure the management of the waste
Ensure the cleanliness of the units.
1.9. Activities of the service
Activities were carried put in 3shifts. We have 2days shift and
2night shift. The day shift starts from 7:30-1:30pm and from
6:30pm-7:30am.
During each shift, a shift report was written which state the health
condition of patients, number of admissions, number of Discharges,
transfers, treatments administered number if death and material
handed over.
1.10. Activities of the day shift
Reading of the night shift report and handling over
General cleaning, dusting of equipment and objects in the service.
Welcome and admit patient
Making up patients bed
Monitor vital signs
Cleaning of instruments and sterilizing them
Assisting during Doctor‟s rounds
Administer patient medications
Give counselling to patients
Write shift duty report and handling over the day shift.
The day shift was done by a ward charge that is an N.A. and assisted
by ol SRN
1.11. Activities of the night shift
Reading of the day shift report and taking over
Monitory the patients
Welcome and admit patients
Clean materials
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Monitor vital signs and record it
Writing of shift duty report
Handing over to day nurses
1.12. Activities of the night shift
The duty rooster of the unit gives information about the various
nurses working in the service including their night, and day shifts and
also they are off.
These nurses alternate in three shift; 20days and 02nugth shift and
except the ward charge who work on Monday to Fridays with the
assistant who are usually off duty on Saturdays, Sundays and public
Holidays. The cleaner works every morning except weekends in the
morning. Nurses on duty do their rounds before the medical Doctor‟s.
This is done every day. Doctors are called on phone to intervene in
case of emergency during weekends. The ward charges can also
interne during weekend when there is a severe case.
The other nurse work in the morning, the following day in the
afternoon, the following day in the night and goes off for 2days before
resuming duty.
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CHAPTER TWO - REVIEW OF LITERATURE ON THE CASE
2.0 Causes
Tuberculosis is an infectious and contagious disease caused almost
exclusively by Mycobacterium tuberculosis or Koch‟s bacillus.
Mycobacterium africanum is a variant of M. tuberculosis and has
been found in 10% of tuberculosis patients in Yaounde and the West
Province according to surveys carried in 1995 in Yaounde and 1998
in the West Prorvince.
2.1 Clinical Features (Signs and Symptons)
Tuberculosis should be suspected in a patient who presents with
cough, with or without sputum production that has lasted for at least
3weeks. But with an HIV patient, current cough is a call for concern.
This cough may be accompanied by haemoptysis (blood stained
sputum), chest pain, difficulties in breathing and generalize
symptoms such as loss of weight and appetite, night sweats,
tiredness and fever.
Tuberculosis can also be suspected if the chest X-ray of the patient
shows images suggestive of disease, e.g. cavities in lungs.
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2.2. Pathophysiology The immunological effect of HIV is manifested
especially on immunity at the cellular level, the part of the immune
system responsible for the response against the tubercle bacillus. The
diminished immunity brought about as a result of the HIV infection
reduces the capacity of the individual to contain the TB infection and
to prevent a new infection or re-infection of micro bacterium.
TB is transmitted by air through an infected person. The interaction
between HIV/TB is bi-directional because mycobacterium
Tuberculosis increases the replication of HIV in vitro and active TB
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Accelerates the evolution of the HIV infection is HIV positive TB
patients. The presence of active pulmonary TB or extra pulmonary
TB in an HIIV positive patient is indicative of an imminent Aids
phase (National tuberculosis control programme-Cameroon)
2.3. Diagnosis
Sputum microscopic examination is the basic test to be carried out. It
consists in the examination of the patient‟s sputum under the
microscope after it has been stained by the ZienhlNeelsen technique.
The laboratory examinations that are performed are;
Acid flaccid bacilli (ZienhlNeelsen test)
Gene expert
Chest X-ray
Biospsy
2.4. Treatment
The internationally accepted strategy for TB control is known as
DOTS (Directly Observed Treatment, Short Course) and involves
five components:
1. Sustained political and financial commitment
2. Case‐detection through quality‐assured bacteriology
3. Standardized treatment with supervision and patient support
4. An effective drug supply and management system
5. Monitoring and evaluation system and impact measurement5
(Interagency coalition on AIDS and Development-Canada TB/HIV
CO-INFECTION, www.icad-cisd.com)
New cases of tuberculosis are treated with a standardize 6 months
therapeutic regimen. Relapses, treatment failures and retreatment are
managed with a standardize 8 months retreatment regimen. Drugs
are available in district hospitals and approved centres. The health
centre under the supervision of the district health team ensures the
follow - up of the treatment initiated at the district hospital.
The treatment of choice includes the following;
RHEZ dose 20 -25mg/kg body weight in adults used in the
intensive phase for 2 months.
RH dose 20 -25mg/kg body weight in adults used in the
continuation phase 6 months
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After which a series of sputum control has to be done at 2nd
month of
treatment, 5th
of treatment and 6th
month of treatment.
For cases of relapses, re-treatment cases are managed with the following
choices of drugs.
RHEZ dose 20 -25mg/kg body weight in adults used in the
intensive phase for 3 months.
RHE dose 20 -25mg/kg body weight in adults used in the
continuation phase from 4 to 8months
After which a series of sputum control has to be done at 3nd
month of treatment,
8th
of treatment.
2.5. Complication
HIV/TB is a deadly duo since the disease suppresses the immune
system and give rise to other opportunistic infection.
2.6. Prognosis
It is fatal
2.7. Prevention
TB should be suspected to all HIV cases with current cough
Encourage health centres to identify and refer suspected cases
All TB suspects be identified and screen for TB.
All sputum positive cases be put on treatment
The standardize treatment regimen make sure they are applied
The patient for intensive phase should be isolated
Increase the level of sensitization of the disease in the general
population
Early diagnosis and treatment
2.8. Defining Nursing Care Plan
A nursing care plan is described as all the activities that involve in the
patients from the arrival, management and the evolution of the
patient. These include;
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The physical presentation of the patient
The past medical history
The present medical history
Laboratory investigation
Treatment
2.9 Nurses’ responsibilities in the administration of drug
The nurse must respect the seven rights of drug administration also
known as the seven rules.
- The right patient
- The right drug
- The right dose
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CHAPTER THREE-PRESENTATION OF CASE
3.1. Presentation of the patient
The patient is an adult man suffering from HIV/ TB
3.1.1. Demograhic Identity of the case on Admission
Name of the patient: N J
Age: 56 years
Sex:male
Address: mile 19 Mbengwi
Occupation: Engineer
Nationality: Cameroonian
Religion: Christain
Ward: Private 3
Bed Number: bed1
Blood Group: “O+”
DOA: 9/12/2017
3.1.2. Describe the conditions of arrival of the patient at the
hospital/ward and all of what was done to him/her before
admission
The patient was supported into the ward and vital signs monitored.
Physical examination was done by the doctor, lab investigation was
requeted. The doctor requested about how he feels, he then
complained of cough, severe weight loss, night sweat and fever for
two months.
3.1.3. Provisional diagnosis by MD
Pulmonary tuberculosis
3.1.4. Patient past medical history
Age: 56
No of children: 0
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Serology statue: positive
Diagnosed of HIV in 2014
Patient was a roaming patient as he move from one hospital to other
he was not being diagnose for TB
Treatment type: on tenolamnevir at l‟hopitaljamot Yaoundé before
coming to Mbengwi
Hb: 3.2 G/D
MP: Negative
VDRL: non reactive
Urine: protein and glucose not seen
TPHA: negative
CD4: 61cells
AFB: 3+++
3.1. Past Surgical history
He has never had TB before
Past surgical history
He has never been operated upon
Social history
He does not drink nor smoke
3.2. Family History
No TB found in any of the family members
3.3. Social History
The patient does not drink alcohol or smoke
Physical assessment (vital signs) - TOC, BP, Body weight, pulse,
Respiration, Bowel, Urine, Vomitus, Intake
Temperature:40.2oc
BP:110\70mmhg
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Body weight:51kg
Pulse:116b\min
Respiration:26c\m
Bowel:normal stool
Urine:urinates 3 times daily(normal)
Vomitus:nil
Intake:fruits only
Table 2: Daily drug chart
Time drug dose route frequency remarks Identity
of nurse
Name of medication
Morning ceftriazone 1g IVD 12hrly served Hilda
Noon Paracetamol 900mg IVD 8hrly served Hilda
Evening gentamycine 80mg IM 12hrly served Hilda
Table 3: Daily drug chat
Time drugs dose route frequency remarks Identity
of nurse
Name of Medication
Morning RHEZ
Ceftriazone
inj
Pyridoxine
gentamycine
3tabs
1g
5mg
80mg
Oral
IVD
Oral
IM
Daily
12hrly
Daily
12hrly
Served
Served
Served
served
Hilda
Hilda
Hilda
Hilda
Noon Ampicilline
paracetamol
1g
900mg
IVD
IVD
8hrly
8hrly
Served
served
Hilda
Hilda
Evening Ceftriazone
Gentamycine
Tenolamefir
1g
80mg
600mg
IVD
IM
oral
12hrly
12hrly
daily
Served
Served
served
Hilda
Hilda
Hilda
Table 4: daily drug chart
Time Drugs dose route frequency remarks Identity
of nurse
Name of medication
Morning RHEZ
Ceftriazone
inj
3tabs
1g
Oral
IVD
Daily
12hrly
Served
Served
Hilda
Hilda
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3.4. Patients on Admission
Consulted by doctor an adult male age of 56years with cough
(productive), weight loss, night sweat and fever
3.5. Vital sign on admission
Temperature: 40.2oC
Weight: 51kg.
Respiratory rate: 90 cycles/min.
Pulse: 140 beat/min.
3.6. Physical examination
Colored conjunctions
Abdominal pains
Numbness of the lower limbs
3.7. Diagnosis
Pulmonary tuberculosis
3.8. Laboratory examination
Mp –negative
Full blood count
HB 32g/d
WBC 9.6*10^3/mm
CRP:+++
Neutrophils 58%
Eosinophils 00%
Basophils 00%
Lymphactytes 62%
Pyridoxine
Gentamycine
5mg
80mg
Oral
IM
Daily
12hrly
Served
served
Hilda
Hilda
Noon Ampicilline
Paracetamol
1g
900mg
IVD
IVD
8hrly
8hrly
Served
served
Hilda
Hilda
evening Ceftriazone
Gentamycine
Tenolamefir
1g
80mg
600mg
IVD
IM
oral
12hrly
12hrly
daily
Served
Served
served
Hilda
Hilda
Hilda
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3.9. Specific management of patient with drugs
09/12/17
Transfuse 2pints of whole blood
Ceffriazone injection 1g*2*7/7
Ampiccilline injection 1g 1vail*3*7/7
Gentamycine injection 80mg
Paracetamol injection 300mg
900mg tiding 3/7
10/12/1
1. RHEZ 3 tablets daily at 5am
2. Ceflriczone injection1g bd*7/7
3. Ampicilline injection(1vial tid *7/7)
4. Gentamycine injection song 1amp bd*5/7
5. Paracytamolinjection300mg(900mg tid*3/7)
6. Pyridoxine 1tab daily x 30 days
11/12/17
1. RHEZ 3tabs daily at 5am
2. Cefriazone injection 80mg 1g bd*5/7
3. Centa injection 80mg(1amp bd*5/7)
4. Paracetamol injection 300mg(900mg tid *3/7)
5. Ampicelline1g(1tid*7/7)
6. TB control
12/12/17
1. RHEZ 3 tabs daily at 5am
2. Cefriazone injection 1g(1g bd*7/7)
3. Gestamycine injection 80m(80mg bd*5/7)
4. Ampicelline injection 1g(1g tid*7/7)
13/12/17
Continues antibiotics(RHEZ 3 tabs daily at 5am
14/12/17
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Continues antibiotics 1g(RHEZ 3 tabs daily
5am)
15/12/17
Continues ceffriazone 1g (RHEZ 3 tads daily at
5am
16/12/17
Amoxicalline tabs 1 tid *1g
Relay with orals antibiotics
17/12/17
1. Amoxicalline tabs 500mg (1tib 7/7)
2. Ranferon capsule (1 bd * 30/7)
3. RHEZ tab 3 tabs daily at 5am
18/12/17
1. Continue RHEZ
2. Continue Ranferon
3. Amoxicilline tabs
4. Pyridoxine
19/12/17
Continue RHEZ
Continue Ranferon
Continue Amoxicilline
Pyridoxine 25mg daily
20/12/17
1. Continue RHEZ
2. Continue Amoxiciline
3. Continue Pyridoxine
4. Continue Ranferone
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Table No_5: Nursing care plan 1-19/12/17: Need: Need to eat soft and easily
digested food
Nursing diagnosis: Activity intolerance related to lack of energy and inability to
eat
Objectives Nursing
intervention.
Rationale Evaluation.
Patient will eat
soft and easily
digested food
Educate the carrier
of the type of food
Adequate
information on how
to prepare the food
will improve
nutrition
Goal was met.
The patient
was able to eat
Table No_6: Nursing care plan 1-20/12/217: Need: need to have normal
temperature
Nursing diagnosis: Hyperthermia (38.6c/ related to disease condition
Hyperthermia (38.6c/ related to disease condition
Objectives Nursing
intervention.
Rationale Evaluation.
Client temperature
will be within
normal range of
36.2c-37.2c in
2hours after
nursing
intervention
Reduce
patients
clothing
Improve
ventilation in
the room
Administer
paracetamol
as prescribed
Monitor temperature
Reduce
clothing,
allow free air
to pass
through the
and heat loss
by convection
Paracetamol has
anti-pyretic property
which reduces
patient temperature
Temperature
dropped from
40.2c to normal
value 36.8c
Table No_7: Nursing care plan 1-21/12/17: Need: need to sleep
Nursing diagnosis: Altered sleep pattern related to exhaustion and manifested
by agitation
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Objectives Nursing
intervention.
Rationale Evaluation.
Patient will sleep
8hours daily
within the time
stay in the hospital
Advise patient to
sleep on demand
Sleeping on demand
will improve pattern
of sleeping and
calming the patient
Patient slept
for more than
12hours
Table No_8: Nursing care plan 1-22/12/17: Need: need to breathe normaly
Nursing diagnosis: Altered breathing (90cycle/min/related to infection as
manifested by nasal abdominal muscle in breathing
Objectives Nursing
intervention.
Rationale Evaluation.
Patient will
have a
breathing rate
of 40-6
cycles/min/in
12hours
-Assess patient
respiratory track
to keep it open
-Give Ampicillin
Gentamycin as
prescribed
-Place the patient
in a lateral
position
-To know if there is any
variation of respiration rate
-Ampicilli, Cerfriazone,
Gentamycin reduces
infection and decreases
respiration track infection
Putting patient in the lateral
position will give room to
expand freely give room to
expand freely
Goal was met
as in 24hours,
the respiratory
rate was
without the use
of accessory
muscles
Table No_9: Nursing care plan 1-23/12/17: Need: need to breathe normaly
Nursing diagnosis: Altered nutrition less than body requirement related to the
ability to feed
Objectives Nursing
intervention.
Rationale Evaluation.
Patient will eat
4squamitts
meals for
6hours for
6days
-Educate the patient
on nutrition
Give drugs as
prescribed
-To know if there is any
variation of respiration rate
-Ampicilli, Cerfriazone,
Gentamycin reduces
infection and decreases
Monitor urine
output 12hourly
25
respiration track infection
Putting patient in the lateral
position will give room to
expand freely give room to
expand freely
Table No_10: Nursing care plan 1-25/12/17: Need: need to be calm
Nursing diagnosis: Knowledge deficit on the prognosis and management of the
disease
Objectives Nursing intervention. Rationale Evaluation.
Patient will
state the
cause, signs
and symptoms
-Educate the patient on nutrition
-Give drugs as prescribe
Reassuring the patient carrer
-Education concerning the
treatment and outcome of the
disease
Answering and questioning the
patient to clarify doubts.
Reassurance
will make the
patient gain
information on
the disease.
Anxiety was
relieved as the
career was calm
Table No_11: Nursing care plan 1-26/12/17: Need: need to have knowledge
Nursing diagnosis: Anxiety of the patient carer related to unknown outcome of
the patient‟s disease
Objectives Nursing
intervention.
Rationale Evaluation.
Patient will
state the cause,
signs and
symptoms and
prognosis in
two days
-Educate the
patient on the
cause, prognosis,
treatment and
outcome
Reassurance will make the
patient gain information on
the disease.
Patient could
give the cause,
signs, treatment
and outcome of
the disease
26
Table Number- 12: Vital Signs
Date Period TOC BP Body
Weigh
t
Pulse
b/c
Respiration Bowel Urine Vomitus Intake
9/12/
17
Morning 40.2 116/76 61kg 116 26c/m Nil 500cc Nil Fruits
Evening 38.5 120/80 61kg 120 24c/m Nil 350cc Nil Fruits
10/12
/17
Morning 39.1 125/85 60kg 122 22cm Nil 250cc Nil Fruits
Evening 38.2 115/70 60kg 120 24cm Twice 300cc Nil Fruits
11/12
/17
Morning 36.5 120/70 58kg 122 22cm Once 250cc Nil Fruits
Evening 36.9 118/70 58kg 120 22cm Nil 150cc Nil Nil
12/12
/17
Morning 37.5 120/60 57kg 118 20cm Nil 250cc Nil Pap
Evening 37 115/70 57kg 116 20cm Nil 150cc Nil Pap/fr
uits
13/12
/17
Morning 36.5 120/70 56kg 113 18cm Nil 200cc Nil Fruits
Evening 36 120/80 56kg 112 18cm Nil 200cc Nil Pap
27
CHAPTER FOUR - REVIEW OF MEDICATIONS
4.1. MEDICATION 1
1. (RHEZ) / 4(RH)
Composition
The regimen comprises a combination of Rifampicin- Isoniazid-
Pyrazinamide (RHEZ) taken daily for 2 months followed by a
combination of Rifampicin- Isoniazid taken daily for 4 months
that is a total duration of 6months of continuous treatment.
Indication
Initial Intensive Phase
The drugs: a fixed dose combination (4-FDC) of Rifampicin-
Isoniazid –Ethambutol- Phyrazinamid is least one (once a day on
an empty stomach in the morning at least one hour before eating)
under the strict supervision of the health personnel.
Contra – Indications
Patient with hypertitis (jaundice)
Respiratory Distress
Purpura, acute haemolytic anaemia
Kidney failure, shock.
Abdominal pain and nausea.
An erythematous skin and / or itches and / or rash.
Dosage
Adults dose: 20 – 25 mg/ kg body weight
Children dose: 5 – 10 mg –kg body weight
Side Effects
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The side effects of anti – tuberculosis drugs can be classified into
two categories: Minor and major side effects.
Minor side effects only cause sight discomfort. They however,
have to be taken into consideration as they can lead to the
abandonment of treatment by a patient who painfully supports the
side effects and who on feeling better, may no longer see the need
to follow up such treatment for so long a time. It is therefore
important to watch out for these symptoms, modify the treatment to
diminish or clear them away; but above all convince the patient to
continue treatment.
Major side effects can constitute a serious threat on the patient‟s
life. It is therefore necessary to be vigilant so as to anticipate
prodromal signs of the major side effects on time and so refer the
patient with such symptoms to a competent health care institution.
4.2. MEDICATION 2
2. CEFTRAXONE
Composition
Each vial contained ceftriaxone Sodium equivalent to 250mg, 500mg
or 1g
Indication
It is indicated for the treatment of lower respiratory tract infection,
urinary and billiary tracts infection, abdominal infection, pelvis
infection, skin infection, soft tissues, bone and joint infections,
,meningitis and pre-operative prophylaxis of infections.
It was indicated to treat the opportunistic infection in the client
Contra- indication
It is indicated in patients with known allergy to Cephalosporrin class
of antibiotics.
Client did not present any contraindication
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Dosage
Adults and children over 12 years: 1-2g once daily. It may be raised
to 4g
Infants and children below 12years: 20-80mg/kg once daily.
For the client, the dose was 1g twice daily
4.3. MEDICATION 3
3. Gentamicin
Each ampoule contains a solution of Gentamicin Sulphate equivalent
to 10mg, 20mg and 40mg per ml
Indication
It is used in case of bacteriaemia, septicemia, urinaru tract infection,
severe chest infection
It was used to treat severe chest infection in the client
Dosage
In children up to 12 years 6mg/kg in 24hours
In infant up to 2weeks: 30mg/kg 12hourly
Adult: 160mg daily may be used.
The dosage for the client was 80mg 12 hourly
Precautions
In case of impairment of renal function
Side Effects
Nephrotoxicity, ototoxicity, nausea, vomiting and headache
No side effect was observed on the client
4.4. MEDICATION 4
4. Paracetamol
Each ampoule contains a solution of paracetamol 300mg and 600mg
per 2meals
15
30
Indication
It is used in case of hyperpyrexia
It was used on the client
Dosage
In children up to 12years: 300mg in 8hourly
In adult above 12years: 900mg 8hourly
The dosage for the client was 900mg 8hourly
4.5. MEDICATION 5
5. Pyridoxine
It is indicated for allergy reaction of anti tuberculosis drug
This patient was on pyridoxine 1tablet daily
4.6. Side effects observe on the case and management of them of the
above medications
No side effect was identified.
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CHAPTER FIVE – DISCHARGE SUMMARY
TUBERCULOSIS IN AN HIV ADULT
5.1. Diagnosis on Admission
TB in An HIV client
5.2. Diagnosis on Discharge
-pulmonary TB and added to his previous HIV condition.
5.3. Treatment received
RHEZ, Ceftriazone, Gentamycine, Paracetamol and Pyridoxine
5.4. Response to Treatment
Treatment was favourable
5.5. Home Treatment
They include;
RHEZ: 3 tablets daily at 5:00am
Pyridoxine: 1 tablet daily at 9:00am
Tenofovir, Lamivodine, Efavirence: 1 tablet at 7:00pm
5.6. Appointment Date
Client was advised to return to the hospital on the 5th of January
2018.
5.7. Follow Up (Appointment by telephone if appointment is not
respected)
The follow up of this patient is done by the use of a telephone if
appointment is not respected but this client respected his
appointment.
5.8. Advice on Discharge
Patients were discharge and advised on the following;
Advised to take medications on time
Patient encouraged to eat a balance diet
To respect subsequent appointments
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To come back to the hospital quickly if signs of complications
before the day of follow up
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CHAPTER SIX- CONCLUSION
6.1 Positive Findings
The client adhered to treatment
No major side effect was identified in the client during the
treatment
Client was satisfied because treatment was free of charge
Client was satisfied because hospitalization was free of charge
Client was satisfied because laboratory follow up was free of
charge
Adequate psychosocial workers who spent most of their time
counselling their patients
His medication was being serve by the health staff on duty
6.2. Difficulties Encountered
There include;
Difficulty of the patient career to master the nursing intervention
Difficult financial constrain
Difficulties to tolerate the side effects of drugs
Poor nutrition
Difficulties to accept his/her condition
6.3. Solutions
There include;
The same information is given to the client several times,
assurance was done by asking questions to ensure that he /she has
mastered.
The manager of the hospital should provide financial mines and
also train Tuberculosis staff on how to use it.
Pre/post treatment counselling has always been enforced
6.4. Recommendations
Family members should be well sensitize on the condition of the
client
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A proper fund be instituted for TB/HIV clients
6.5. Conclusion
TB/HIV patients should be treated according to guide line described
by World Health Organization (WHO). Reinforcement of counseling
during treatment is always very necessary.
6.6 References
There include;
National Tuberculosis Control Programme (Manual for Health
Personnel) 2006 Edition.
Past Reports of Madam Fozing Helen on Neonatal Sepsis 2015
session.
Past Report of Nji NuelaAnyenon Graphic Designs 2016 session.