MDR-TB

A Case study on

Mult

i-d

rug

-resi

stant

TB

• Definition• Prevalence• The subject• Subjective• Objective• Assessment• Plan• Intervention• Evaluation

• Multi-drug-resistant tuberculosis (MDR-TB), resistant to: - Isoniazid (INH) - Rifampicin (RMP)

• Mycobacterium tuberculosis• spread from person to person as

readily as drug-sensitive TB

Definition

PrevalenceMORTALITY: TEN LEADING CAUSES

PHILIPPINES, 2009

1. Diseases of the Heart2. Diseases of Vascular System3. Malignant Neoplasms4. Pneumonia5. Accidents6. Tuberculosis, all forms7. Chronic lower respiratory diseases8. Diabetes Mellitus9. Nephritis, nephritic syndrome and nephrosis10. Certain conditions originating in the perinatal period

Prevalence

The SubjectName: Ramon JoveroAge: 52 years oldOccupation: former tricycle driver

Height: 5’1”Weight: 48 kgDBW: 52.7 kg BMI: 20TER: 1920 kcal

Interpretation:BMI is considered normal, but needs to gain

4.7 kg to achieve his DBW.

• Underlying disease: MDR-TB • Secondary condition: Gout disease• Civil Status: Married but is separated

• Chief complaints:Prior to admission, the patient experiences fever, severe cough, night sweats and difficulty in breathing. He also experiences to be easily felt being tired even if he’s not doing his usual work and physical activities.

Subjective

Objective

Objective

Nutrient Adequacy Actual Nutrient Intake/Recommended

Nutrient Intake *100

• CHON = 175 % (excessive)• Energy = 86 % (inadequate)• CHO = 80 % (inadequate)• Fats = 36 % (inadequate)

Objective

• Pt’s BMI is considered normal but needed to gain 4.7 kg to achieve his DBW.

• Prior to admission, to pt. showed evidences featuring s&s of his underlying and secondary medical condition.

• The pt’s attitude towards food intake shows a lack nor excess acquisition of nutrients which made him susceptible in acquiring other complications.

Assessment

Short term goals:

• To lower uric acid level, to reduce patient’s susceptibility to Gout’s disease.

• To gain 4.7 kg weight to meet his desirable body weight.

• To introduce aerobic exercises (walking, jogging, biking,) lasting 20 to 30 minutes, at least three to four times a week as applicable on patient’s condition.

• DOT (directly observed therapy)

Plan

Long term goals:

• Proper education and awareness.• To encourage the patient follow the

prescribed diet for lowering of uric acid level until the normal value will be achieve.

• To encourage the patient follow the prescribed medication to eliminate MDR-TB.

Plan

• Nutrition counseling to the patient and his family, allowing them to learn and be independent in applying and maintaining the nutritional guidelines given to their affected family member/s.

• Making of follow up schedules to check the patient’s compliance to the prescribed diet and medications.

Intervention

• Facilitation of normal weight maintenance by encouraging structured programs that emphasize therapeutic lifestyle changes including nutrition and physical education, management of fat and calorie intake, appropriate physical activities and regular checkups.

Intervention

• Reassessment on patient’s nutritional status.

• Checking food intake/dietary history through his food records/diary to confirm if the recommended diet for the patient was been prepared and implemented by the patient and his family.

• Monitor patient’s physical activities on weekly basis.

Evaluation

FIN

ISH