INTRODUCTION

GENERAL OBJECTIVE:

After the presentation and discussion of the case, the student’s knowledge of the specific
disease process of Pulmonary Tuberculosis New Case, Maintenance Phase will be enhanced and
further understood comprehensively, detailed, and accurate history taking, Typology of Nursing
Problems in Family Nursing Practice , explanation of the disease process, interpretation of
laboratory tests and results, explanation of pathophysiology, and the different treatment
modalities given to the patient.

SPECIFIC OBJECTIVES:

1. Present the patient’s biographical profile along with a comprehensive nursing health
history.
2. Utilize the Typology of Nursing Problems in Family Nursing Practice as basis for a more
comprehensive nursing assessment
3. Identify both normal and abnormal findings of the physical assessment done to the
patient
4. Relay to the class the different laboratory results and other special tests done to the
patient
5. Discuss the related anatomy and physiology of the case to be presented
6. Trace the pathophysiology of the disease process using a schematic diagram
7. Present the pharmacologic drugs given to the patient along with the corresponding
mechanism of action, side effects, adverse effects, drug-drug interaction, and nursing
responsibilities
8. Present pharmacological drugs given and to relate it to the disease condition.
9. Recognize the needs of the patient, prioritize and formulate appropriate nursing care
plan for the patient
10.Implement the nursing interventions along with the patient and family based on the
knowledge of the patient
11.Evaluate the patient’s response to treatment given
12.Formulate and suggest necessary recommendations for the improvement of the patient’s
health and the barangay

INTRODUCTION OF THE DISEASE

PULMONARY TUBERCULOSIS

DEFINITION

Pulmonary Tuberculosis is a highly communicable disease caused by Mycobacterium

tuberculosis, Mycobacterium Bovis, Mycobacterium Avium. M. tuberculosis is a
nonmotile, non sporulating, acid-fast rod that secretes niacin; when the bacillus reaches a
susceptible site, it multiplies freely. Because M. tuberculosis is an aerobic bacterium, it primarily
affects the pulmonary system, especially the upper lobes, where the oxygen content is highest,
but it also can affect other areas of the body, such as the brain, intestines, peritoneum, kidney,
joints, and liver.

The initial infection usually occurs 2 to 10 weeks after exposure. The patient may then develop
active disease because of a compromised or inadequate immune system response. The active
process may be prolonged and characterized by long remissions when the disease is arrested,
only to be followed by periods of renewed activity. Tuberculosis has an insidious onset, and
many clients are not aware of symptoms until the disease is well advanced. Improper or
noncompliant use of treatment programs may cause the development of mutations in the
tubercle bacilli, resulting in a multidrug- resistant strain of tuberculosis (MDR-TB). The goal of
treatment is to prevent transmission, control symptoms, and prevent progression of the
disease.

TB is a worldwide public health problem that is closely associated with poverty, malnutrition,
overcrowding, substandard housing, and inadequate health care. Mortality and morbidity rates
continue to rise. TB is transmitted when a person with active pulmonary disease expels the
organisms. A susceptible person inhales the droplets and becomes infected. Bacteria are
transmitted to the alveoli and multiply. An inflammatory reaction results in exudate in the
alveoli and bronchopneumonia, granulomas, and fibrous tissue. Onset is usually insidious.

MODE OF TRANSMISSION
● The route of transmission of M. tuberculosis is through inhalation of droplets from an
individual with active tuberculosis.
● Bacteria are transmitted to the alveoli and multiply. An inflammatory reaction results in
exudate in the alveoli and bronchopneumonia, granulomas, and fibrous tissue. Onset is
usually insidious.

RISK FACTORS
● Close contact with someone who has active TB
● Immunocompromised status (eg, elderly, cancer, corticosteroid therapy, and HIV)
● Injection drug use and alcoholism
● People lacking adequate health care (eg, homeless or impoverished, minorities,
children, and young adults)
● Pre Existing medical conditions, including diabetes, chronic renal failure, silicosis, and
malnourishment
● Immigrants from countries with a high incidence of TB (eg, Haiti, southeast Asia)
● Institutionalization (eg, long-term care facilities, prisons)
● Living in overcrowded, substandard housing
● Occupation (eg, health care workers, particularly those performing high-risk activities)
● History of cigarette smoking
● Exposure to secondhand smoking
● Race: Hispanic or Latino, Black or African American, and Asian persons
● Gender: Male

CLINICAL MANIFESTATIONS
● Four cardinal signs and symptoms (at least two weeks of cough, unexplained fever,
unexplained weight loss and night sweats)
● Nonproductive cough, which may progress to mucopurulent sputum with hemoptysis

DIAGNOSTIC METHODS
● TB skin test (Mantoux test) - also known as purified protein derivative (PPD) test or
Mantoux test, shall be used only as an adjuvant when there is doubt in making a clinical
diagnosis of TB in children
● TB Blood Tests or QuantiFERON-TB Gold (QFT-G) test - QFT is an interferon-
gamma (IFN-γ) release assay, commonly known as an IGRA, and is a modern
alternative to the tuberculin skin test (TST, PPD or Mantoux). Unlike the TST, QFT is a
controlled laboratory test that requires only one patient visit and is unaffected by
previous Bacille Calmette-Guerin (BCG) vaccination. QFT is highly specific and sensitive:
a positive result is strongly predictive of true infection with M. tuberculosis. However,
like the TST and other IGRAs, QFT cannot distinguish between active tuberculosis
 disease and latent tuberculosis infection, and is intended for use with risk assessment,
radiography, and other medical and diagnostic evaluations.
● Chest x-ray - Primary screening tool that is used initially to detect presumptive TB in
the systematic screening of TB.
● Acid-fast bacillus smear - Detection of acid-fast bacilli (AFB) in stained and acid-
washed smears examined microscopically may provide the initial bacteriologic evidence
of the presence of mycobacteria in a clinical specimen. However, smear examination
permits only the presumptive diagnosis of TB because the AFB in a smear may be acid-
fast organisms other than M. tuberculosis.
● Sputum culture - A sputum culture is a test to find germs (such as TB bacteria) that
can cause an infection. A sample of sputum is added to a substance that promotes the
growth of bacteria. If no bacteria grow, the culture is negative. If bacteria grow, the
culture is positive. If TB bacteria grow, then the person has tuberculosis. A rapid sputum
test can tell if a person has TB within 24 hours. AFB stain test positive result: the acid-
fast bacilli, such as Mycobacterium tuberculosis, retain the red or pink color. AFB stain
test negative result: no red or pink bacteria are found in the stained slide.
● Sputum Xpert MTB/Rif - contributes to the rapid diagnosis of TB disease and drug
resistance. The test simultaneously detects Mycobacterium tuberculosis complex (MTBC)
and resistance to rifampin (RIF) in less than 2 hours. In comparison, standard cultures
can take 2 to 6 weeks for MTBC to grow and conventional drug resistance tests can add
3 more weeks. The information provided by the Xpert MTB/RIF assay aids in selecting
treatment regimens and reaching infection control decisions quickly.

CLASSIFICATIONS OF TB
1. Active TB disease – a presumptive TB case that is either bacteriologically confirmed or
clinically diagnosed by the attending physician.
2. Pulmonary TB (PTB) – refers to a case of tuberculosis involving the lung parenchyma.
A patient with both pulmonary and extrapulmonary tuberculosis should be classified as a
case of pulmonary TB.
3. Extrapulmonary TB (EPTB) – refers to a case of tuberculosis involving organs other
than the lungs (e.g. larynx, pleura, lymph nodes, abdomen, genito-urinary tract, skin,
joints and bones, meninges).
4. Bacteriologically confirmed TB (BCTB) – refers to a patient from whom a biological
specimen, either sputum or non-sputum sample, is positive for TB by smear microscopy,
culture or rapid diagnostic tests (such as Xpert MTB/RIF, line probe assay for TB, TB
LAMP).
5. Clinically diagnosed TB (CDTB) – refers to a patient for which the criterion for
bacteriological confirmation is not fulfilled but diagnosis is made by the attending
physicians on the basis of clinical findings, X-ray abnormalities, suggestive histology
and/or other biochemistry or imaging tests.
6. New – refers to a patient who has never had treatment for TB or who has taken anti-TB
drugs for less than one month. Preventive treatment is not considered as previous TB
treatment.
7. Previously treated for TB – refers to a patient who had received one month or more
of antiTB drugs in the past. Also referred to as Retreatment.
8. High risk for multidrug-resistant tuberculosis (MDR-TB) – previously treated for
TB, new TB cases that are contacts of confirmed DR-TB cases or non-converter among
patients on DS-TB regimens.
9. Rifampicin-resistant TB (RR-TB) – resistance to rifampicin detected using
phenotypic or genotypic methods, with or without resistance to other anti-TB drugs. It
includes any resistance to rifampicin, whether monoresistance, multidrug resistance,
polydrug resistance or extensive drug resistance.
TREATMENT
● First-line TB drugs (FLD) – refer to the agents used to treat drug-susceptible TB –
ethambutol, isoniazid, pyrazinamide and rifampicin. Streptomycin is now considered a
second-line TB medicine.
● Second-line TB drug (SLD) – refers to an agent reserved for the treatment of drug-
resistant

TREATMENT OF DRUG SUSCEPTIBLE TUBERCULOSIS

Treatment Regimens for DS-TB

Standard regimens for DS-TB: dosing for adults

Matrix for number of tablets required (adults)

Management of adverse drug reactions (first-line TB drugs)

TREATMENT OF DRUG RESISTANT TUBERCULOSIS

1. Education, counseling and support to patients and family members prior to treatment
2. Pretreatment evaluation (Determine other comorbidities (HIV, Diabetes, renal disease)
and other health issues (tobacco, alcohol, illicit drug use and abuse) and manage them
accordingly)
3. Assigning the appropriate DR-TB treatment regimen

Type of MDR-TB and RR-TB treatment regimens

 PATIENT PROFILE

Name of Interviewee : ROMEO BURANDAY

Diagnosis : Pulmonary Tuberculosis

Age when diagnosed : 47 years old

Sex : Male

Age : 47 years old

Birthdate : October 9, 1976

Address : Purok 1 Brgy. 108 Tagpuro, Tacloban City

Civil Status : Widow

Occupation : None

Health Care Financing : None

HISTORY OF PRESENT ILLNESS

2nd week of January, patient experienced persistent coughs for more than a week. He self-
medicated with Solmux Robitussin 500mg/ 1 tablet daily and opted for herbal treatment which
is Lana and increased fluid intake but no improvement and cough still persisted. No other
associated symptoms such as difficulty of breathing, fever, and loss of appetite. No consultation
was done.

4th week of January, the above symptoms persisted, now with evident weight loss, fatigability,
lethargy, fever, chills, night sweats, and chest tightness with a pain rating scale of 6 out of 10.
On February 3rd of 2023, persistence of symptoms prompted to seek consultation. He was
prescribed to undergo tuberculosis treatment.

After taking anti-tuberculosis medications for a month, the client experienced swelling. He
claimed that severe pain worsens at night when it is cold and the patient can no longer get a
good night's sleep. Mefenamic acid was taken to alleviate the pain. After a few weeks,
symptoms persisted accompanied with ringing of the ears and changes in vision were noticed, a
consultation was done. Celecoxib was prescribed for pain in his lower extremities. Although an
X-ray of his lower extremities was advised, the patient refused.

During the 1st home visit, the client verbalized that he is currently on tuberculosis treatment
and is compliant with his medications. He is taking Celecoxib for the relief of pain. Still with
cough, pain and swelling in his knees and foot.

Currently, he is on his 3rd month of tuberculosis regimen. He is experiencing fatigue, lethargy,

low grade fever (38C), chills, night sweats, chronic cough with blood streaked sputum, chest
tightness accompanied by cough, vision changes (optic neuropathy), ringing in the ears,
swelling and pain of right and left knee, and pain upon mobilization.

PAST MEDICAL HISTORY

Patient is unable to recall any immunizations given to him during his childhood. However, in
2003 he was given an anti-tetanus shot when he accidentally stepped on a nail. And in 2021,
he had his COVID-19 vaccine (AstraZeneca), he completed the 2 doses but did not have
booster doses. No history of any hospitalization nor surgeries.

FAMILY HISTORY OF ILLNESS

Patient’s father and mother are both separated, and he has had no contact with them for
several years. He cannot recall his parents' birthdates. He verbalized “dire ak maaram kun pira
talaga tak bugto pero kun ha anak hit akon la nanay ngan tatay, uusa la ako”.

Patient has one healthy child but is not living with him. His wife died on January 1, 2023, due to
kidney disease.

Noted history of hypertension on the maternal side and history of rheumatism on the paternal
side. No known other heredofamilial diseases such as diabetes mellitus, cancer, thyroid, kidney,
nor heart diseases.

CURRENT MEDICATIONS AND ALLERGIES

Patient is currently on medications such as Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol

for tuberculosis. Celecoxib for pain relief on his foot. And he is taking Multivitamins. No known
allergies noted.

PSYCHOSOCIAL HISTORY

Patient was born on October 9, 1997, and was raised in Tacloban City. He is living in Brgy 108,
Tagpuro for 4 years. His 1-storey house is made up of wood and light materials. The house is
well ventilated and is composed of one bedroom, kitchen, and comfort room. Currently, the
water source is from a well near his house, and for drinking water, he buys them at a nearby
water refilling station. Garbage is collected once a week by the local garbage collector. He
smokes 1 pack of cigarettes a day for 33 years. He drank alcohol before but after he was
diagnosed with tuberculosis he stopped. He is then exposed to secondhand smoking through
his neighbor who is also his cousin.

Due to illness, he has not worked for almost 3 months already. He used to work as a
construction worker at Manila but after experiencing symptoms he quit his job and went back to
tagpuro.

ACTIVITIES OF DAILY LIVING

Patient usually sleep for 10 hours. He sleeps at around 7 PM and wakes up at 9 AM. He does
experience difficulty sleeping when pain on his lower extremities is noted. Due to illness, he was
not able to work so he spends most of his time in his home. He eats 2-3 times a day and
usually gets his food from his nearby relatives. It mainly consists of rice, vegetables, and a
protein such as fish, chicken, or pork. However, he limits his intake of chicken or fried foods
because it aggravates the pain on his knee but since he is dependent on what his relatives
provide, he has no choice but to eat what is being provided. Client voids 3-5 times a day with
yellow-colored urine. He defecates once daily with brown and formed stools. No complaints
about urinating and defecating. As for exercise, he walks a little around their area.
A. FAMILY STRUCTURE, CHARACTERISTICS, AND DYNAMICS
Members of the Relation to Sex Age Civil Residence
Household the Head Status

Romeo Buranday Head Male 47 Widow Purok 1, Brgy. 108

Tagpuro, Tacloban City

Patient lives alone in a house that he builds on his own in their family’s compound.

DECISION MAKING
Mr. Buranday makes his own decisions regarding everything but he sometimes consults his
daughter with the options he has.

FAMILY RELATIONSHIP
Since he lives on his own there are no conflicts noted within the household but he is in a good
relationship with his daughter. His daughter seldomly checks up on him from time to time.

B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

Members of Educational Last Year of Occupation Place Incom

the Attainment School of e
Household Attendance Work

Romeo 2nd years high 1991 Unemployed - P0

Buranday school

RELIGION
He is a Roman Catholic. He doesn’t attend Sunday mass or any events at their church but he
prays every night before going to sleep.

SIGNIFICANT OTHERS
No other relatives or significant others live within the family.

RELATIONSHIPS OF THE FAMILY TO THE COMMUNITY

Mr. Buranday has been part of the community for 47 years. He is not active when it comes to
community events because he claims that he has no time and is not interested in attending
community activities.

C. HOME AND ENVIRONMENT

1. Housing
a. Adequacy of Living Space
The structure of the house is small but just enough to accommodate him since he lives
alone. Client has a one-storey house that is 3x4 meter and made up of wood and light
materials. The house is well ventilated but there is no adequate lighting. House is
composed of one bedroom, kitchen, and comfort room.

1. Sleeping Arrangement
Mr. Buranday sleeps in his bedroom on the floor with a mat. He has 1 portable electric
fan and uses a mosquito net to protect himself from mosquito bites.

1. Presence of Breeding Site of Vectors of Diseases

There is a presence of breeding sites noted. Around his house there are plants planted
in a can, when it rains these cans collect lots of water from rain becoming stagnant and
uncovered. Uncovered water container is seen in the comfort room of the client.

1. Presence of Accident Hazards

Fire hazard was observed since the house was made up of wood and light materials and
he uses firewood for cooking located in front of the house. The compound where he
lives is an inclined area. When it rains, the pathway becomes muddy and slippery and
with that there is a presence of fall hazard noted.

1. Food Storage and Cooking Facilities

Firewood is used for cooking food. He cooks his food in the kitchen area located in the
house. Leftover food is kept in a plastic container or is placed at the table with a plastic
cover.

1. Water Supply
For drinking water, he buys them at a nearby water refilling station. Their water source
is from a deep well that is located 5 meters away from their house. This is used for
bathing, cleaning the dishes and washing the clothes.

1. Toilet Facility
Mr. Buranday has his own toilet facility with a septic tank. It is well maintained.
Uncovered water containers can be seen inside the comfort room.

1. Garbage Disposal
Client does not use any method of segregation and recycling of garbage. He places his
garbage on a sack that is hung at the back of the house which is tightly closed. He
collects them and brings it to the garbage collector once a week.
 1. Drainage System
Their drainage system is an open type.

2. KIND OF NEIGHBOURHOOD
The area is not congested. The compound where he lives is composed of his relatives.
The compound where he lives is an inclined area. When it rains, the pathway becomes
muddy and slippery.

3. SOCIAL AND HEALTH FACILITIES

There are designated Barangay Health Workers in their neighborhood. The multipurpose
room or the basketball court are used for social or health events. The distance between
Kawayan and their Barangay is five to ten minutes, where their district health center is
located.

4. COMMUNICATION AND TRANSPORTATION FACILITIES

Mr. Buranday doesn’t have any mobile technology to use for communication. The
community has a "Bandilyo" that they use to disseminate information. They use tricycles
and motorcycles as their mode of transportation. Within the barangay, they have a
consistent and reliable form of transportation.

D. HEALTH STATUS OF EACH FAMILY MEMBER

1. Medical and Nursing History
Mr. Buranday, is a 47 year old male. He is unemployed due to his illness. He claimed to have
childhood illnesses such as fever, cough, and colds. He claimed to have a tetanus shot and was
vaccinated for COVID-19 (AtraZeneca). He is currently diagnosed with pulmonary tuberculosis
and claims that he has good compliance with his medications. No known allergies noted.

1. Nutritional Assessment
Mr. Buranday weighs 41 kg. He drinks alcohol and smokes cigarettes before but after he
was diagnosed with tuberculosis he stopped. However, he is exposed to secondhand
smoke. According to him, evident weight loss was seen when he had tuberculosis. From
58kg to 41kg. He eats 2-3 times a day and usually gets his food from his nearby
relatives.

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE,

AND DISEASE PREVENTION
Before consulting the doctor, patient went to the tambalan for his persistent cough and he was
given lana which he applied to his chest. Short relief was felt. After his wife died, he became
more conscious of his health, he complied with the medications that were prescribed to him.
 ANATOMY OF THE RESPIRATORY SYSTEM
The Respiratory System is composed of the upper and lower respiratory tracts. The two
tracts are responsible for ventilation (movement of air in and out of the airways). The upper
respiratory tract known as the upper airway, warms and filters inspired air consists of the
nose, paranasal sinuses, pharynx, tonsils, adenoids, larynx and trachea. The lower
respiratory tract (the lungs) can accomplish gas exchange or diffusion.

LOWER RESPIRATORY TRACT

The lower respiratory tract consists of the lungs, which contain the bronchial and alveolar
structures needed for gas exchange.

● LUNGS
- Are paired elastic structures enclosed in the thoracic cage, which is an airtight chamber
with distensible walls. Each lung is divided into lobes. The right lung has upper, middle,
and lower lobes whereas the left lung consists of upper and lower lobes. Each lobes is
further subdivided into two to five segments separated by fissures, which are extensions
of the pleura.
● PLEURA
- The lungs and wall of the thoracic cavity are lined with a serous membrane called the
pleura. The visceral pleura covers the lungs, parietal pleura lines the thoracic cavity,
lateral wall of the mediastinum, diaphragm and inner aspects of the ribs.

● MEDIASTINUM
- Middle of the thorax, between the pleural sacs that contain the two lungs; contains all of
the thoracic tissue outside the lungs (heart,thymus, the aorta and vena cava, and
esophagus).
● BRONCHI AND BRONCHIOLES
- The right mainstem bronchus is shorter, wider, and straighter than the left mainstem
bronchus. The mainstem bronchi subdivided several times to form the lobar, segmental,
and subsegmental bronchi. Further divisions form the bronchioles. The most distant
bronchioles are called the respiratory bronchioles. Beyond these lie the alveolar ducts
and alveolar sacs.
● ALVEOLI
- There are three types of alveolar cells.
- Type I cells account for 95% of the alveolar surface area and serve as a barrier
between the air and the alveolar surface
- Type II cells account for only 5% of this area but are responsible for producing type I
cells and surfactant
- Surfactant reduces surface tension, thereby improving overall lung function. Alveolar
macrophages, the third type of alveolar cells are phagocytic cells that ingest foreign
matter and as a result provide an important defense mechanism.
FUNCTION OF RESPIRATORY SYSTEM
1. Oxygen Transport
- Oxygen is supplied to and carbon dioxide is removed from cells by way of the
circulating blood through the thin walls of the capillaries. Oxygen diffuses from
the capillary through the capillary walls to the interstitial fluid
2. Respiration
- The oxygen concentration in blood within the capillaries of the lungs is lower
than that in the lungs is lower than in the lungs alveoli. This whole process of
gas exchange between the atmospheric air and the blood and between the blood
and cells of the body is called respiration.
3. Ventilation
- Ventilations require movement of the walls of the thoracic cage and of its floor,
the diaphragm. The effect of these movements is alternately to increase and
decrease the capacity of the chest. Physiologic factors that govern airflow in the
lungs are collectively referred to as the mechanics of ventilation and include air
pressure variances, resistance to airflow and lung compliance.
4. Air Pressure Variances
- Air flows from a region of higher pressure to a region of lower pressure. During
inspiration, movements of the diaphragm and intercostal muscles enlarge the
thoracic cavity and thereby lower the pressure inside the thorax to a level below
that of atmospheric pressure.
5. Airway Resistance
- Resistance is determined by the radius, or size of the airway through which the
air is flowing, as well as by lung volumes and airflow velocity.
Once the TB bacteria gets into your body, it enters the lungs first, but once it’s active, it can
spread to the lymph nodes (glands that protect your body from disease) and other areas of the
body. Tuberculosis most commonly affects the lungs, a condition called pulmonary tuberculosis.
When it affects parts of the body besides the lungs, it’s called extrapulmonary tuberculosis.
With each inhalation, air is pulled through the windpipe (trachea) and the branching
passageways of the lungs (the bronchi), filling thousands of tiny air sacs (alveoli) at the ends of
the bronchi. These sacs, which resemble bunches of grapes, are surrounded by small blood
vessels (capillaries). Oxygen passes through the thin membranes of the alveoli and into the
bloodstream. The red blood cells pick up the oxygen and carry it to the body's organs and
tissues. As the blood cells release the oxygen they pick up carbon dioxide, a waste product of
metabolism. The carbon dioxide is then carried back to the lungs and released into the alveoli.
With each exhalation, carbon dioxide is expelled from the bronchi out through the trachea.)
 PHYSICAL EXAMINATION
Patient was examined sitting on a chair, conscious,
coherent, conversant with no changes in level of
consciousness, oriented to time, place, and to people
around him. Speech is not slurred. Fairly groomed.
Easy fatigability, lethargic. Chest tightness
accompanied by cough noted PRS 8/10.
General Survey

Vital Signs:
• Blood Pressure: 100/70 mmHg
• Respiratory Rate: 20 cpm
• Heart Rate: 83 bpm
• Temperature: 38.0 C
• O2 Sat: 97% at room air
• Weight: 41kg

Skin, Hair, and Nails

Skin: Evenly colored skin tones. Warm to touch. Dry Skin.
Skin is intact and no reddened areas. Tattoo was
observed on the chest. No edema noted. No cyanosis
noted. No rashes noted. Good skin turgor noted.

No scalp lesions or flaking noted. Hair is smooth and

firm, evenly distributed. Scalp is clean and dry. No
Hair: dandruff noted.

Nails plates are soft. Nails are short and clean with
capillary refill at 3 seconds and no clubbing noted.
 Nails:
Head and Neck
Head Head is symmetric, round, erect, and in midline and
appropriately related to body size (Normocephalic), no
lesions, or bumps noted. The head is normally hard
and smooth without lesions.

Neck is symmetric with no bulging masses or

engorgement. The thyroid cartilage and cricoid
Neck cartilage moves upward symmetrically as the client
swallows. No anterior neck mass, no inflamed lymph
nodes and jugular vein distention.

Eyebrows sparse with equal distribution. Anicteric

sclera noted. Pinkish conjunctiva noted. The upper
and lower lids close easily and meet completely when
closed, without redness or swelling. Both pupils
Eyes constrict when assessing each pupil’s direct and
consensual reaction to light. Visual changes
(prominent color yellow and green)
Auricle is equal in size and aligned with the corner of
each eye. Mastoid process non-tender. No discharge
Ears
present.
Mouth, Throat, Nose, Sinuses, Moist lips and oral mucosa with no lesions and
Mouth ulcerations. Nasal structure is smooth and symmetric.
Nares are patent. Nasal septum in midline without
deviation.
Thorax and Lungs Symmetrical chest expansion. Accessory muscles are
not used when breathing. No tenderness, pain, or
unusual sensations. No wheezing. Sternum is
positioned at midline and straight. Retractions were
not observed. Minimal fine crackles heard upon
auscultation.
Heart and Neck Vessels Jugular vein not distended, bulging, or protruding. No
blowing or swishing or other sounds were heard upon
auscultation. No decrease in heart rate noted.
Abdomen Abdomen is soft, round and symmetric, without
masses, lesions, pulsations, or peristaltic waves. Pain
was not noted. Abdomen is free of hair or increased
vasculature. Bruises were not noted. Umbilicus in the
midline, without herniation, swelling or discoloration.
Negative for Turner’s sign and Cullen’s sign
Musculoskeletal Extremities Swelling in both knees noted. With prs of 9/10 upon
mobilization. Able to ambulate with assistance. No
body paralysis noted.

REVIEW OF SYSTEMS
Integumentary System:
Skin: Skin has evenly colored skin tones, dryness noted, jaundice not noted, no cyanosis, good
skin turgor noted. Warm to touch. Skin is intact and no reddened areas. Tattoo was observed
on the chest. Skin is smooth and no lesions, rashes, lumps, sores, and bruises noted.
Scalp and Hair: Has black hair color. Hair is smooth and firm. Fine vellus hair covers the entire
body except for the soles, palms, and lips. No signs of hair loss. Scalp is clean and dry. No
lesions noted.
Nails: Nails plates are soft. Nails are short and clean with capillary refill at 3 seconds and no
clubbing noted.
Head: Head is symmetric, round, erect, and in midline and appropriately related to body size
(Normocephalic), no lesions, or bumps noted. The head is normally hard and smooth without
lesions. The temporomandibular joint has no swelling, tenderness or crepitation with
movement.
Face: The face is symmetric with a round appearance. No abnormal movements noted. Mouth
opens and closes fully, and the lower jaw moves laterally.
Neck: Neck is symmetric, with head centered and no bulging masses. The thyroid cartilage and
cricoid cartilage moves upward symmetrically as the client swallows. Trachea is midline. No
swelling, enlargement and tenderness. No anterior neck mass, no inflamed lymph nodes and
jugular vein distention.
Eyes: No redness, swelling, or lesions noted. Pinkish conjunctiva and anicteric sclera are noted.
No drainage noted. Cornea is transparent with no opacities. No diplopia, itching, excessive
tearing, or trauma to eyes noted. Both pupils constrict when assessing each pupil’s direct and
consensual reaction to light. Visual changes (prominent to color yellow and green).
Ears: Ears are equal in size bilaterally. Auricle aligns with the corner of each eye. Skin is
smooth with no lesions, lumps or nodules. Color is consistent with facial color. No discharge
noted. No tinnitus, and trauma to ears. Vibrations are equally heard well in both ears.
Nose: Color of nose matches face. Nose is smooth and symmetric, with no tenderness upon
palpation. Nares patent. Nasal septum intact and free of ulcerations or perforations. No
difficulty with smell, pain, postnasal drip, sneezing, or frequent nosebleeds.
Throat: Uvula midline, no swelling or enlargement and no tenderness. Uvula has no exudate
and redness.Uvula rises with phonation. No sore throats noted.
Mouth: Moist lips and oral mucosa, no lesions or ulcerations. Hard and soft palate have no
lesions. Soft palate is not pale. Tongue is midline without lesions or masses.
Sinuses: Frontal and maxillary sinuses are nontender and no crepitus is palpable. No sinus
tenderness noted.

Respiratory System:
Thorax: Nasal flaring not observed. The client has evenly colored skin tone, with no jaundice
noted.

➢ Posterior Thorax: Scapulae are symmetric and non protruding, shoulders and scapula are
at equal horizontal positions. Accessory muscles are not observed while breathing. No
tenderness, pain. No palpable crepitus, skin is free of lesions and masses. Fremitus is symmetric
and easily identified in the upper regions of the lungs. Patient has a respiratory rate of 20 cpm
with no dyspnea. Percussion elicits flat tones over the scapula.Diaphragmatic excursion is equal
bilaterally. Minimal fine crackles heard upon auscultation.
Anterior Thorax: Sternum is positioned at midline and straight, retractions were not observed,
no retractions or bulging of intercostal spaces were noted. Chest tightness accompanied by
coughing was noted. Use of accessory muscles are not used when breathing. No lesions,
tenderness or pain, no crepitus was palpated over the lung area. Fremitus was symmetric and
easily identified in the upper regions of the lungs. Percussion elicited dullness over breast
tissue, the heart, and the liver.
Cardiovascular System:
Neck Vessels: No palpitations, with no exertional dyspnea, and no orthopnea noted. With
normal blood pressure.

➢ Jugular Venous Pulse and Pressure: Jugular venous pulse is not visible, jugular vein not
distended, bulging, or protruding at 45 degrees or more. No blowing or swishing or other
sounds were heard upon auscultation. Pulses are equally strong, no pulsations or vibrations
palpated in the areas of the apex, left sternal border, or base.

➢ Carotid Arteries: arteries are elastic and no thrills were noted. Heart: 83 bpm, with regular
rhythm, with identical radial and apical pulse. No murmurs were heard. S1 and S2 heart sounds
are normally present. No extra heart sounds noted .
Gastrointestinal System:
Abdomen: Soft, round and symmetric, without masses, pulsations, or peristaltic waves. No
tenderness noted.
Umbilicus: Midline, without herniation, swelling or discoloration.
Bowel: No mucoid stools, melena, or hematochezia. No rectal bleeding.
Genitourinary System: No polyuria, nocturia, dysuria urgency, hematuria, or incontinence.
Endocrine System: No polyuria, polydipsia, and polyphagia. No excessive sweating, no hot &
cold intolerance.
Breast and Lymphatic System:
Breast: Texture dry, with no edema. Nipples nearly equal bilaterally. No signs of dimpling or
retraction. No tenderness and thickening of tissues. No masses palpated.
Axillae: No rash or signs of infection noted. No palpable nodes.
Musculoskeletal System:
Swelling on both knees noted. Muscle strength at both right upper and lower extremities of 5/5
and both left upper and lower extremities of 2/5. With joint pain and muscle pain. No history of
trauma. Muscles symmetric in size and shape. No deformities noted.
Neurologic System:
He is able to communicate and follow verbal commands. No tremors and unusual tenderness.
Frequent remote memory loss.

Cranial Nerves

➢ CN I- able to smell and identify presented material (alcohol)

➢ CN II- has difficulty in reading a text

➢ CN III, IV, VI- eyes able to move smoothly at various directions (6 field of vision).
Bilateral illuminated pupils constrict simultaneously

➢ CN V- able to clench, no tenderness on the face. Able to identify sharp and dull
stimuli to forehead, cheeks, and chin

➢ CN VII-able to smile, frown, purse lips, raise eyebrows, and puff cheeks
out.Movements are symmetric

➢ CN VIII- able to hear sound of ticking watch

 ➢ CN IX- gag reflex present, no dysphagia

➢ CN X- uvula up straight at mildline

➢ CN XI-able to put resistance upon application of force on right shoulder

➢ CN XII- able to stick out tongue from mouth

Reflexes

➢ Deep tendon reflex: reflex score 2+

➢ Biceps reflex: elbow reflex and biceps contraction is seen. Forearm flexes and
supinates

➢ Brachioradialex reflex: elbow able to extend, triceps contracts

➢ Triceps reflex: knee extends, quadriceps muscle contracts

➢ Patellar reflex: plantarflexion of the foot observed

➢ Achilles reflex: response to tap of reflex hammer

➢ Ankle clonus: no rapid contractions or oscillations of ankles Level of Consciousness

➢ Verbal response: oriented to place, time, and person. Able to respond to verbal
command

➢ Motor response of both sides of the body: able to stick out tongue, squeeze fingers,
but has limited movement due to weakness
Mental Status

➢ State of consciousness: was conscious and coherent

➢ Memory: able to recall some short and long term memory

➢ Affect: able to express emotions

➢ Orientation: oriented to time, place and person

SIGNS AND SYMPTOMS

This may result from pleural effusion (a buildup of fluid
between the thin membranes, the pleura, that cover
CHEST TIGHTNESS the lungs and line the inside of the chest wall. The
ACCOMPANIED BY COUGH inflamed parenchyma may cause pleuritic chest pain.
Blood streaked sputum can be due to destruction of a
patent vessel located in the wall of the cavity, the
CHRONIC COUGH WITH rupture of a dilated vessel in a cavity, or the formation
BLOOD STREAKED SPUTUM of an aspergilloma in an old cavity. The inflamed
parenchyma may cause pleuritic chest pain.
A persistent low-grade fever with sweats especially at
night is linked with TB. The TB causing bacteria
remains dormant in the body for years without showing
any symptoms. Gradually as the immune system is
weakened, TB becomes active. Night sweats associated
LOW GRADE FEVER with active tuberculosis are responses in part to
ACCOMPANIED BY CHILLS signaling molecules that are released by cells of the
AND NIGHT SWEATS immune system as they react to the infectious
organism. The bacteria themselves may also be
 releasing fever-causing signals.
Nutritional status, sleep quality, and depression are the
variables found to be capable in predicting fatigue of
pulmonary tuberculosis. The body needs energy from
FATIGUE the oxygen metabolism process and reduced pulmonary
functions from chronic inflammation due to the body’s
immune response to tuberculosis caused fatigue

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST LEVEL ASSESSMENT

I. Presence of Wellness Condition

A. Potential for Enhanced Capacity for Health Maintenance/ Health Management
CUES: He eats 2-3 times a day, usually given to him by his nearby relatives. It mainly
consists of rice, vegetables, and a protein such as fish and pork. He takes his TB
medication regularly.

CUES: "Gindadamo ko na iton akon pagkaon para ako tumambok pero di pa ako
sigurado kun ano it mga bawal nga pagkaon ha akon." as verbalized by the patient.

II. Presence of Health Threats

A. Accident Hazards: Fire Hazard
CUE: Fire hazard was observed since the house was made up of wood and light
materials and he uses firewood for cooking located in front of the house.

B. Accident Hazard: Fall Hazard

CUE: The compound where he lives is an inclined area. When it rains, the pathway
becomes muddy and slippery.

C. Presence of breeding sites or resting sites of vectors of diseases (e.g., mosquitos, flies)
CUE: Presence of flower pots filled with water was observed outside his house which
may host vectors of diseases such as mosquitoes

III. Presence of Health Deficits

 A. Illness States, regardless of w bvbhether it is diagnosed or undiagnosed by medical
practitioner: Pulmonary Tuberculosis
CUE: Mr. Buranday noted chronic dry cough, night sweats, fatigue and weight loss
which prompted consultation. He then was diagnosed with pulmonary tuberculosis and
given anti-tuberculosis drugs such as Rifampin, Isoniazid, Pyrazinamide, and
Ethambutol.

B. Illness States, regardless of whether it is diagnosed or undiagnosed by medical

practitioner: Reactive Arthritis
CUE: Mr. Buranday has swelling on both knees and cannot straighten his leg due to
untolerated pain especially when walking. He was advised by a physician to have an x-
ray but due to financial constraints, he did not comply with it.

SECOND LEVEL ASSESSMENT

A. Potential for Enhanced Capacity for Health Maintenance/ Health Management

● Inability to make decisions with respect to taking appropriate health action due
to feeling of confusion, helplessness and/or resignation brought about by
perceived magnitude/severity of the situation or problem, i.e., failure to break
down problems into manageable units of attack

B. Accident Hazards: Fire Hazard

● Inability to provide a home environment conducive to health maintenance and
personal development due to inadequate family resources, specifically, financial
constraints

C. Accident Hazard: Fall Hazard

● Inability to provide a home environment conducive to health maintenance and
personal development due to lack of physical resources

D. Presence of breeding sites or resting sites of vectors of diseases (e.g., mosquitos, flies)
● Inability to provide a home environment conducive to health maintenance and
personal development due to lack of or inadequate knowledge of preventive
measures

E. Illness States, regardless of whether it is diagnosed or undiagnosed by medical

practitioner: Pulmonary Tuberculosis
 ● Inability to make decisions with respect to taking appropriate health action due
to inaccessibility of appropriate resources for care specifically physical
inaccessibility.

F. Illness States, regardless of whether it is diagnosed or undiagnosed by medical

practitioner: Reactive Arthritis
● Inability to provide adequate nursing care to the sick, disabled, dependent or
vulnerable/at-risk member of the family due to inadequate family resources for
care, specifically: financial constraints

PRIORITIZATION OF IDENTIFIED NURSING PROBLEMS

NURSING PROBLEMS SCORE RANK

Potential for Enhanced Capacity for Health 5 1

Maintenance/ Health Management as a wellness
condition

Illness States, regardless of whether it is diagnosed or 4.33 2

undiagnosed by medical practitioner: Pulmonary
Tuberculosis

Presence of breeding sites or resting sites of vectors of 4.17 3

diseases (e.g., mosquitos, flies)

Illness States, regardless of whether it is diagnosed or 3.33 4

undiagnosed by medical practitioner: Reactive
Arthritis

Accident Hazards: Fire Hazard as a health threat 2.84 5

Accident Hazard: Fall Hazard as a health threat 2.32 6

 POTENTIAL FOR ENHANCED CAPACITY FOR HEALTH MAINTENANCE/ HEALTH
MANAGEMENT AS A WELLNESS STATE

ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 3/3 x 1 1 The problem is a wellness state it
problem requires attention to improve the patient’s
ability to improve his health
Modifiability 2/2 x 2 2 This is considered as easily modifiable
of the since patient is already aware of the need
problem for change and is active in learning proper
nutrition and medication regimen

Preventive 3/3 x 1 1 This is easily preventable because

potential services and medications are available and
patient is actively participating in his health
management
Salience of 2/2 x 1 1 The patient considers this as a problem
the problem needing immediate attention and
believes by improving his knowledge and
practice in providing health intervention,
he will be able to regain normal health
Total: 5

ILLNESS STATES, REGARDLESS OF WHETHER IT IS DIAGNOSED OR UNDIAGNOSED

BY MEDICAL PRACTITIONER: PULMONARY TUBERCULOSIS AS A HEALTH DEFICIT

ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 3/3 x 1 1 The problem is a health deficit since PTB
problem is already present and it requires
immediate attention to prevent untoward
effects
Modifiability 2/2 x 2 2 This is considered as easily modifiable
of the since the information and services on PTB
problem are already readily available.

Preventive 1/3 x 1 0.33 This is moderately preventable because

potential though the information and services on
PTB are already available, the patient is
hindered by his knee pain on acquiring the
appropriate services and medications on
time
Salience of 2/2 x 1 1 The patient considers this as a problem
the problem needing immediate attention since he
is already experiencing multiple signs and
symptoms of PTB
Total: 4.33

PRESENCE OF BREEDING SITES OR RESTING SITES OF VECTORS OF DISEASES (E.G.,

MOSQUITOS, FLIES) AS A HEALTH THREAT
 ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 2/3 x 1 0.67 The problem is a health threat that
problem demands immediate attention to
eliminate untoward consequence from
vector borne diseases
Modifiability 2/2 x 2 2 This is considered as easily modifiable
of the since information about vector of diseases,
problem and its prevention control and are readily
available and can easily be given to the
patient through proper health education
Preventive 3/3 x 1 1 The possible problems associated with the
potential condition has high preventive potential
when adequate interventions are done

Salience of 1/2 x 1 0.5 The patient is aware of the presence of risk

the problem but still considers this as a problem not
needing immediate attention since
patient’s focus is still on his present health
condition
Total: 4.17

ILLNESS STATES, REGARDLESS OF WHETHER IT IS DIAGNOSED OR UNDIAGNOSED

BY MEDICAL PRACTITIONER: REACTIVE ARTHRITIS AS A HEALTH DEFICIT

ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 3/3 x 1 1 The problem is a health deficit since
problem Reactive arthritis is already present and it
requires immediate attention to lessen the
pain that the patient is suffering.
Modifiability 1/2 x 2 1 The problem is partially modifiable since
of the health teaching can be imparted and
problem medications can be given to the patient.

Preventive 1/3 x 1 0.33 The preventive potential of the problem is

potential low since the problem is already existing
and there is financial constraints.

Salience of 2/2 x 1 1 It is considered as a problem needing

the problem immediate attention since this can affect
his daily activities
Total: 3.33

ACCIDENT HAZARDS: FIRE HAZARD AS A HEALTH THREAT

ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 2/3 x 1 0.67 The problem is a health threat that
 problem requires immediate attention to avoid Fire
and health problems associated with it
Modifiability 1/2 x 2 1 This is considered as partially
of the modifiable since patient is already aware
problem of the need for change but it will require
significant financial and material resources
for structural planning and renovation. The
family’s resources are currently insufficient.
Preventive 2/3 x 1 0.67 This is moderately preventable because
potential knowledge of Fire prevention is already
available but due to insufficient resources
it is difficult to provide appropriate
intervention
Salience of 1/2 x 1 0.5 The patient is aware of the presence of risk
the problem but still considers this as a problem not
needing immediate attention since he
does not have extra funds for renovation.
And he chose to focus his extra money on
his current health problem.
Total: 2.84

ACCIDENT HAZARD: FALL HAZARD AS A HEALTH THREAT

ACTUAL
CRITERIA COMPUTATION JUSTIFICATION
SCORE
Nature of the 2/3 x 1 0.66 The problem is a health threat that
problem requires immediate attention to avoid fall
especially because the patient is
experiencing pain on his knees that affects
his ambulation.
Modifiability 1/2 x 2 1 This is partially modifiable since
of the finances and materials are not yet available
problem to fix the problem.

Preventive 2/3 x 1 0.66 This preventive potenial for this problem is

potential moderate since knowledge can be
imparted but still lacks the finance to
purchase needed marerials such as
assistive device.
Salience of 0/2 x 1 0 The patient does not recognize the
the problem existence of the problem or condition
needing change.
Total: 2.32
 LABORATORY AND DIAGNOSTICS

COMPLETE BLOOD COUNT

TEST RESULT REFERENCE CLINICAL SIGNIFICANCE

(5/4/23) RANGE

WBC Count 14.8 x10^ g/L 5.0-10.0 ELEVATED

WBC count increases during

infection, due to increased
polymorphonuclear leukocytes and
macrophages as a part of the body’s
immune defense to combat invading
bacterial populations. If an infection
develops, the body releases a large
number of white blood cells,
including macrophage, to attack and
destroy the bacteria causing it.

Hemoglobin 92 g/L 130-180 DECREASED

Hematocrit 0.26 g/L 0.40 - 0.50

A potential implication for the
increased inflammation in TB
patients with anemia could be that
as the infection progresses, chronic
inflammation results in dampened
hemoglobin synthesis as reported in
anemia of chronic disease. The
proinflammatory milieu could have
reduced production of
erythropoietin, suppressed response
of bone marrow erythropoietin, and
an altered iron metabolism, which in
turn could have impaired
erythropoiesis leading anemia. In
addition, hemoglobin (Hb) levels
tend to decrease as acid-fast bacilli
(AFB) smear positivity increases
(Saathoff, et. al. 2015).
Furthermore, treatment from anti-
TB drugs can cause hematologic
changes including anemia.

DIFFERENTIAL COUNT

Neutrophils 61% 50-70 NORMAL

Lymphocytes 20% 20-40 NORMAL

Monocytes 1 0-7 NORMAL

Eosinophils 18% 1-6 ELEVATED

Eosinophilia may be an implication
of allergic reaction from anti-TB
 drug treatment or due to an
occuring infection. Mycobacterial
infection induced blood eosinophilia
and infiltration of alpha-defensin
producing eosinophils at the
infection site. (Khatun, et. al. 2019).
Furthermore, due to the
inflammation occurring from the
disease, cytokines are activated and
released by the macrophage. Some
cytokines such as IL-6, IL-5 are
responsible for maturation,
proliferation, activation and
migration of eosinophils in the
bloodstream.

BLOOD CHEMISTRY

TEST RESULT REFERENCE CLINICAL SIGNIFICANCE

(5/4/23) RANGE

CREATININE 162 umol/L 65-105 umol/L ELEVATED

Increase in serum creatinine may be

due to adverse effects caused by TB
drug therapy. Some anti-TB drugs
are known to be nephrotoxic such as
Rifampicin. Damaged kidneys can
cause reduction in glomerular
filtration, affecting filtration of
metabolic wastes which in turn
causes high amounts of creatinine to
stay in the bloodstream.

BLOOD URIC ACID 771 umol/L 180-400 umol/L ELEVATED

Antituberculosis medications such as

pyrazinamide and ethambutol have
been associated with increasing uric
acid levels. Pyrazinamide inhibits the
renal excretion of uric acid by
pyrazinoic acid ethambutol reduces
its renal clearance. Severe
hyperuricemia, as manifested by the
patient, can lead to renal
impairment.

SGPT/ALT 22.7 U/L 0-41 U/L NORMAL

 IMAGING STUDIES

X-RAY CHEST PA (5/4/2013)

● Hazy densities are seen in the upper lung CLINICAL SIGNIFICANCE

fields
● The heart is not enlarged
CXR showing haziness in the upper lung fields
● The rest of the visualized structure are
suggests consolidation or infiltration. Infiltration or
unremarkable
lung consolidation indicates increased density which
may reflect an inflammatory response in the lung
(Karimi, et. al. 2014). Potential consolidation or
infiltration occurs in the upper lobe due to relatively
higher oxygen tension and delayed lymphatic
drainage in these areas.

IMPRESSION:
● PTB, both upper lobe

KNEE (5/4/23)

● Osteoarthritic changes are seen in both knees CLINICAL SIGNIFICANCE

with mild narrowing of the joint spaces
Anti-TB drugs, commonly pyrazinamide can cause
breakdown of tissues in the joints leading to
osteoarthritic changes. Pyrazinamide is a strong
urate retention agent, causing a greater than 80%
reduction in renal clearance of uric acid which causes
high concentration of uric acid in the bloodstream. It
can build up and cause tiny sharp crystals to form in
and around joints. These crystals can cause the joint
to become inflamed (red and swollen) and painful.
 DRUG STUDY

DRUG NAME MECHANISM OF ACTION INDICATION CAUTION/ SIDE EFFECTS/ NURSING RESPONSIBILITY
CONTRAINDICATION ADVERSE EFFECTS

Rifampicin + Isoniazid Rifampicin and isoniazid are Treatment of Tuberculosis Hypersensitivity. Patient w/ GI symptoms (e.g. anorexia, nausea, Before: Monitor hepatic enzymes and function,
active bactericidal anti-TB jaundice. Concomitant use vomiting, constipation, diarrhea), bilirubin, serum creatinine, CBC and platelet
drugs which are particularly w/ saquinavir/ritonavir alterations in liver function, peripheral count.
Dosage: 150mg active against the rapidly Drug to drug interaction: combination. neuritis, optic neuritis, headache,
growing extracellular Alcohol, hepatotoxic History of DM, psychosis, drowsiness, convulsions, vertigo,
organisms and also have medications, ritonavir, peripheral blood disorders (e.g. leucopenia, During: Advise patient to take on empty
bactericidal activity neuropathy. haemolytic anemia, aplastic anemia,
Frequency: saquinavir may increase risk Patient w/ HIV infection, stomach with 8 oz of water 1 hr before or 2 hrs
intracellularly. Rifampicin of hepatotoxicity. May porphyria, eosinophilia), dry mouth, itching w/ or after meal (with food if GI upset).
inhibits DNA-dependent malnutrition, w/o rash, flushing, urticaria, rash,
OD decrease effects of digoxin, slow acetylator status,
RNA polymerase activity in disopyramide, fluconazole, epilepsy purpura, pancreatitis, oedema, Avoid alcohol during treatment.
susceptible cells. and alcohol interstitial pneumonitis, hyperreflexia,
methadone, mexiletine, oral dependence. Hepatic and Do not take any other medications without
Route: Oral Specifically, it interacts w/ anticoagulants, oral severe renal impairment. hyperglycaemia, adrenal
consulting a physician, including antacids; must
bacterial RNA polymerase antidiabetics, oral Elderly. Pregnancy and insufficiency, gynaecomastia,
take at least 1 hr before antacid.
but does not inhibit the contraceptives, tacrolimus, lactation. menstrual disturbances, difficulty in
mammalian enzyme. Cross- tricyclic antidepressants, micturition, muscular weakness,
Pharmacotherapeutic: resistance to rifampicin has myopathy, SLE-like syndrome,
Semisynthetic agent. phenytoin, quinidine,
only been shown w/ other pellagra, exfoliative dermatitis, After: Urine, feces, sputum, sweat, tears may
tocainide, verapamil.
rifamycins. It has activity pemphigus, toxic epidermal become red-orange; soft contact lenses may be
against slow- and necrolysis, pemphigoid reactions, permanently stained. • Notify the physician of
Clinical: Antibiotic, intermittently-growing M. orange-red discolouration of urine, any new symptom, immediately for yellow
antitubercular, Herbal: St. John’s wort may eyes/skin, fatigue, weakness, nausea/vomiting,
tuberculosis. Isoniazid acts saliva and other body secretions;
miscellaneous. decrease concentration. sore throat, fever, flu, unusual
against actively growing hearing loss and tinnitus, influenza-
tubercle bacilli. like symptoms, resp symptoms, bruising/bleeding. • If taking oral contraceptives,
collapse and shock, check with physician (reliability may be affected)
thrombocytopenic purpura,
disseminated intravascular
coagulation, acute renal failure.
Rarely, psychoses, pemphigoid
reaction, erythema multiforme, Lyells
syndrome and vasculitis.
Potentially Fatal: Severe/fatal
hepatitis (e.g. jaundice).
 DRUG NAME MECHANISM OF ACTION INDICATION CAUTION/ SIDE EFFECTS/ NURSING RESPONSIBILITY
CONTRAINDICATION ADVERSE EFFECTS

Rifampicin Tablet inhibits bacterial RNA ● Tuberculosis People with hypersensitivity to ● diarrhea Before: Monitor hepatic enzymes
polymerase which is the ● Leprosy Ripe Tablet and jaundice are not ● skin rash and function, bilirubin, serum
Isoniazid enzyme responsible for the ● Legionnaires Disease recommended for this medicine. ● nausea creatinine, CBC and platelet count.
Pyrazinamide transcription of DNA. It should be used with caution in ● vomiting
Rifampicin binds and people with a history of ● loss of appetite
Ethambutol prevents RNA synthesis by Drug to Drug Interaction: alcoholism and hepatic and renal ● drowsiness Inform the patient that it will discolor
blocking elongation and impairment. Elderly, ● often turns the urine, stool, saliva, tears, sweat, and
synthesis of bacterial malnourished patients, children color of sweat, other body fluids red-brown.
Dosage: proteins. It blocks the bond Interaction with Lab Test below 2 years of age, pregnant urine and tears red
between nucleotides in the or breastfeeding women need to or orange.
150mg/ 75mg/ 400mg/ RNA backbone. ● Positive Coombs' reaction [direct],
take this medicine in lower ● liver problems or
275mg rifampin inhibits standard assay's
doses. allergic reactions
ability to measure serum folate and
B12; transient increase in LFTs and During: Advise the patient to take the
decreased biliary excretion of medicine on an empty stomach 1
Frequency: hour before or 2 hours after a meal.
contrast media.
OD
Interaction with Medicine Maintain adequate hydration (2-3
● CYP3A3/4 enzyme substrate; L/day of fluids unless instructed to
Route:
CYP1A2, 2C9, 2C18, 2C19, 2D6, restrict fluid intake).
Oral 3A3/4, and 3A5-7 enzyme inducer.

After: Encourage to report or

Clinical: Antitubercular ● Coadministration with INH or observe persistent vomiting; fever,
halothane may result in additive chill, or flu-like symptoms; unusual
hepatotoxicity; probenecid and co- bruising or bleeding; or other
trimoxazole may increase rifampin persistent adverse effects such as
levels while antacids may decrease neurotoxicity, hepatotoxicity,
its absorption. hyperuricemia, and optic
neuropathy.
Interaction with Disease
● Use with caution and modify dosage
in patients with liver impairment;
 observe for hyperbilirubinemia;
discontinue therapy if this in
conjunction with clinical symptoms or
any signs of significant
hepatocellular damage develop;
since rifampin has enzyme-inducing
properties, porphyria exacerbation is
possible; use with caution in patients
with porphyria; do not use for
meningococcal disease, only for
short-term treatment of
asymptomatic carrier states.

Interaction with Food

● Rifampin is best taken on an empty
stomach since food decreases the
extent of absorption.
 DRUG NAME MECHANISM OF ACTION INDICATION CAUTION/ SIDE EFFECTS/ NURSING RESPONSIBILITY
CONTRAINDICATION ADVERSE EFFECTS

Celecoxib Relief of signs/symptoms of Hypersensitivity to aspirin, NSAIDs, Side Effects: Frequent Before: Assess onset, type,
osteoarthritis, rheumatoid sulfonamides. Treatment of (16%–5%): Diarrhea, location, duration of
Action Inhibits cyclooxygenase-2, the enzyme arthritis (RA) in adults. perioperative pain in coronary artery dyspepsia, headache, upper pain/inflammation. Inspect
responsible for prostaglandin synthesis. Treatment of acute pain, bypass graft (CABG) surgery. respiratory tract infection. appearance of affected joints
Dosage: 200mg Tab Therapeutic Effect: Reduces inflammation, primary dysmenorrhea. Relief Occasional (less than 5%): for immobility, deformity, skin
relieves pain. of signs/symptoms associated Abdominal pain, flatulence, condition. Assess for allergy to
with ankylosing spondylitis. Cautions: History of GI disease nausea, back pain, sulfa, aspirin, or NSAIDs
Route: Oral
Treatment of juvenile (bleeding/ulcers); concurrent use peripheral edema, dizziness, (contraindicated).
Pharmacokinetics: Rapidly absorbed from GI rheumatoid arthritis (JRA).j with aspirin, anticoagulants; insomnia, rash
tract. Widely distributed. Protein binding: 97%. smoking; alcohol; elderly; debilitated
Frequency: OD Metabolized in the liver . Primarily eliminated pts; asthma; renal/hepatic During:
in feces. Half-life: 11.2 hrs impairment; heart failure. Pts with Adverse Effects: Increased
edema, cerebrovascular disease, risk of cardiovascular Monitor for signs and
Pharmacotherapeutic: ischemic heart disease, known or events, (MI, CVA), serious, symptoms of DRESS (fever,
NSAID. suspected deficiency of cytochrome potentially life-threatening GI rash, lymphadenopathy, facial
P450 isoenzyme 2C9 bleeding. swelling) periodically during
Drug to Drug Interaction: therapy. Discontinue therapy if
Clinical: Anti- May decrease antihypertensive effect of ACE symptoms occur.
inflammatory inhibitors and angiotensin II antagonists.
Fluconazole may significantly increase
concentration. May increase lithium After: Assess for therapeutic
concentration. Warfarin may increase risk of response: pain relief;
bleeding. Aspirin may increase risk of celecoxib- decreased stiffness, swelling;
induced GI ulceration, other GI complications. increased joint mobility;
reduced joint tenderness;
improved grip strength.
Observe bleeding, bruising,
Herbal: Avoid herbs with anticoagulant or
weight gain. If GI upset occurs,
antiplatelet activity (e.g., evening primrose,
take with food. • Avoid aspirin,
garlic, ginger, ginseng).
alcohol (increases risk of GI
bleeding)
 DRUG NAME MECHANISM OF ACTION INDICATION CAUTION/ SIDE EFFECTS/ NURSING RESPONSIBILITY
CONTRAINDICATION ADVERSE EFFECTS

Multivitamins The neurotropic B vitamins B1 (thiamine), B6 Multivitamins are generally safe for Taking too much of the Before: Assess patients for
(pyridoxine), and B12 (cobalamin) are essential most people to use. The vitamins product may cause side signs of vitamin deficiency
B1 + B6 + B12 Isoniazid can interfere with the
for proper functioning of the nervous system. dissolve in water and do not build up effects, such as: before and periodically during
Activity of B6. Vitamin B6
Deficiencies may induce neuro-logical disorders in the tissues very well. This means therapy.
supplementation is
like peripheral neuropathy (PN) and mainly that the body can easily remove any ● excessive urination
Therapeutic: vitamins recommended for Individuals
occur in vulnerable populations (eg, elderly, excess vitamins in the urine.
diabetics, alcoholics).
who take Isoniazid to prevent
Because of this, B vitamins are
● nausea
development of Isoniazid- During: Instruct to swallow
generally nontoxic, with very little risk ● vomiting whole with water
induced peripheral neuritis.
Dosage: 100mg/ 5mg/ of causing harm. However, taking a ● diarrhea
50mcg very high dose can be dangerous ● nerve damage
and cause side effects.
After: Asses for HF, pulmonary
Allergic reactions are also a edema, hypokalemia (in heart
Frequency: rare side effect of B vitamin pts), monitor serum potassium,
supplements. serum B12, rise in
OD
reticulocytes, reversal of
deficiency symptoms.

Route:Oral
 FAMILY NURSING CARE PLANS

INTERVENTION PLAN EVALUATION TOOL

FAMILY
HEALTH GOALS OF OBJECTIVE OF
CUES NURSING METHOD OF
PROBLEM CARE CARE NURSING RESOURCES
PROBLEM NURSE-FAMILY CRITERIA STANDARD METHOD/TOOL
INTERVENTION REQUIRED
CONTACT

Subjective Cues: Presence of Inability to make After a week of After a week of 1. Introduce oneself. Home Visit Material Complianc ● Demonstrate Direct
Wellness decisions with nursing nursing 2. Establish rapport. Resources: e to on how to Observation and
"Gindadamo ko Condition: respect to taking intervention, the intervention, the 3. State the purpose of agreed promote Interview
na iton akon Potential for appropriate client will be able client will be able the visit. Visual Aids interventio airway
pagkaon para Enhanced health action to: to: 4. Assess the n clearance.
ako tumambok Capacity for due to feelings environmental ● Verbalize the
pero di pa ako Health of confusion, condition and the Human importance of
sigurado kun Maintenance/ helplessness level of Resources: adhering to Verbal Feedback
ano it mga Promote health ● Demonstrate
Health and/or maintenance on how to understanding of the the treatment
bawal nga Management resignation client. regimen.
pagkaon ha and health promote
brought about by management. airway 5. Assess the ● Time and ● Plans an
akon." as perceived willingness to activity and
clearance. effort by both
verbalized by the magnitude/sever participate in food
● Verbalize the the nurse and
patient. ity of the activities and combination
importance of the family.
situation or adhering to identify feelings, for adequate
problem, i.e., the treatment concerns, and nutrition.
failure to break strength. Financial ● Verbalizes
regimen.
down problems 6. Instructs the patient Resources: activity in
Objective Cue: ● Plans an
into manageable activity and about correct preventing
He eats 2-3 units of attack. food positioning to spread of
times a day, combination facilitate drainage ● Money for tuberculosis
usually given to for adequate and to increase fluid transportation infection.
him by his nutrition. intake to promote and expense
nearby relatives. ● Verbalizes systemic hydration. for the visual
It mainly activity in 7. Teach the patient aid.
consists of rice, preventing that TB is a
vegetables, and spread of communicable
a protein such tuberculosis disease and taking
as fish and pork. infection. medications is the
He takes his TB most effective
medication means of preventing
regularly. transmission.
8. Promote activity and
adequate nutrition.
Plans a progressive
activity schedule
that focuses on
increasing activity
tolerance and
muscle strength and
a nutritional plan
that allows for small,
frequent meals.
9. Preventing
spreading of
tuberculosis
infection.Carefully
instructs the patient
about important
hygienic measures
including mouth
care, covering the
mouth and nose
when coughing and
sneezing, proper
disposal of tissues,
and handwashing.
 INTERVENTION PLAN EVALUATION TOOL
FAMILY
HEALTH GOALS OF OBJECTIVE OF
CUES NURSING METHOD OF
PROBLEM CARE CARE NURSING RESOURCES
PROBLEM NURSE-FAMILY CRITERIA STANDARD METHOD/TOOL
INTERVENTION REQUIRED
CONTACT

Subjective Cues: Presence of Inability to After 2 days of After 2 days of 1. Establish rapport. Home Visit Material Verbal 1.Enumerate Interview
“Waray ako Poor provide a home nursing nursing 2. Introduce Resources: Feedback some
kuryente ha Home/Environm environment intervention, the interventions, yourself and important
balay. Kandila la ental conducive to client will: the family explain the -Visual Aids things that
it ak gin gagamit Condition/Sanita health 1. Understan members will be purpose of the should be
na suga” as tion: Poor maintenance d the able to : visit.  Human remembered
verbalized Lighting and and personal importance 3. Assess the Resource: about having
ventilation development of 1. Enumerate client’s proper
due to lack of adequate some important comprehension -Time and effort lighting and
Objective Cue: skill in improving lighting things that of the condition. of the nursing ventilation
● Inside the home and should be 4. Discuss to the students, clinical and how it
house is environment. ventilation. remembered client important instructor, and will affect the
dark, hot 2. Develop about having things of having the family health of the
and and apply proper lighting proper/adequate members family
objects skills in and ventilation lighting and members.
are rarely providing and how it will ventilation and
seen adequate affect the health how it will give a 2. Perform
● The lighting of the family good effect on measures to
house is and members. his health. have
poorly ventilation 5. Explain the adequate
ventilated to his 2. Perform disadvantage of ventilation
and has home. measures to having only one and lighting
poor have adequate window and
lighting. ventilation and working in a dark
lighting. place.
6. Encourage the
family to modify
the structure of
the windows and
remove
 unnecessary
materials that
block passage of
air.

INTERVENTION PLAN EVALUATION TOOL

FAMILY
HEALTH GOALS OF OBJECTIVE METHOD OF
CUES NURSING RESOURC
PROBLEM CARE OF CARE NURSE-
PROBLEM NURSING INTERVENTION ES CRITERIA STANDARD METHOD/TOOL
FAMILY
REQUIRED
CONTACT

Subjective Cue: Accident Inability to After one After two 1. Introduce oneself to the Home Visit Material Verbal Feedback ● Enumerate Interview
“Waray ako Hazard: Fire provide a week of days of client. Resources: at least 4
kuryente ha Hazard as home nursing nursing 2. Establish rapport with the ways of
balay. Kandila la Health Threat environment interventions, intervention client. ● IEC preventing
it ak gin gagamit conducive to the client the family 3. State the purpose of the Material fire.
na suga” as health will be able will be able visit. s ● To identify
verbalized maintenance to take to: 4. Assess the at least 3 Interview
and personal precautionary environmental condition ● Emerge common
development measures ● Identify and the level of ncy kit causes of
Objective Cue: due to lack of and areas that understanding of the for fire.
Fire hazard was or inadequate appropriate may cause client. demons
observed since knowledge of actions to a fire 5. Assess the willingness to tration
the house was preventive prevent accident in participate in activities
made up of measures. occurrence of his home. and identify feelings, Human
wood and light fire concerns, and strength. Resources:
materials and he accidents. ● Enumerate 6. Demonstrate to the client
uses firewood at least 4 how to do wound care if ● Time
for cooking ways of there are minor burns and
located in front preventing from hazards specifically effort by
of the house. fire. fire: both the
nurse
● To identify a. Cover the burn with a and the
at least 3 sterile gauze bandage. family.
common b. Hold the burned area
causes of under cool (not cold)
fire. running water or apply Financial
 a cool, wet compress Resources:
until the pain eases.
c. Apply petroleum jelly ● Money
two to three times for
daily. transpo
d. Explain to the client the rtation
ways of preventing fire. and
expens
e for
the
visual
aid.
 INTERVENTION PLAN EVALUATION TOOL
FAMILY
HEALTH GOALS OF OBJECTIVE OF
CUES NURSING METHOD OF
PROBLEM CARE CARE NURSING RESOURCES
PROBLEM NURSE-FAMILY CRITERIA STANDARD METHOD
INTERVENTION REQUIRED
CONTACT

Subjective Cue: Accident Hazard: Inability to provide After a week Long Term: 1. Introduce Home Visit Material Resources: Verbal Long Term: Interview
“Nakukurian ak Risk for Fall as a a home of nursing ● The client oneself to the Feedback ● The client will
pag agi kay Health Threat environment interventions, will be able client. ● Equipment and be able to
masakit it ak conducive to the family will to recognize 2. Establish materials recognize the
tuhod, ngan nag health not be the rapport with the needed for hazardous
hihikatumba ako maintenance and susceptible to hazardous client. State the teaching and surrounding
kay it aragian personal a fall accident. surrounding purpose of the guidelines and his home that
diri patag” as development due his home visit. safety can injure
verbalize by the to lack of physical Clients will be that can 3. Assess the measures himself.
client resources. able to do injure environmental needed.
ways to himself. condition and ● The client will
prevent further the level of ● Materials and know safety
damage if an ● The client understanding resources from measures to
Objective Cue: accident will know of the client. the community avoid injury
The compound occurs. safety 4. Provide needed for the from a fall
where he lives is measures to assistive device repair. accident.
an inclined area. avoid injury 5. Identify
When it rains, from a fall alternative Short Term:
the pathway accident. options to be Human Resources: ● The client will
becomes muddy able to attain be able to
and slippery. Short Term: resources for ● Time and effort decide to
● The client the repairs by both the make the
will be able needed. nurse and the necessary
to decide to 6. Recognize family. measures like
make the available repairing the
necessary resources in the Financial pathway to
measures community Resources: their house to
 like agreed avoid the risk
repairing the interventions by ● Money for of a fall
pathway to conducting transportation accident.
their house random follow- and expense
to avoid the up visits. for the visual
risk of a fall aid.
accident.

INTERVENTION PLAN EVALUATION TOOL

FAMILY GOALS
HEALTH OBJECTIVE OF
CUES NURSING OF METHOD OF RESOURCE
PROBLEM CARE
PROBLEM CARE NURSING INTERVENTION NURSE-FAMILY S CRITERIA STANDARD METHOD/TOOL
CONTACT REQUIRED

Objective cues: Health Threat: Inability to After 1 After 1 day of 1. Establish rapport with the Home Visit Material
Presence of make week of home visit and client. Resources:
● Uncove breeding sites or decisions of nursing 2. State the purpose of the visit. a. Understand Interview
red resting sites of with respect nursing interventions, the 3. Assess the client’s health Visual aids Verbal the negative
water vectors (e.g., to taking interventi client will be able condition for health feedback effects of
contain mosquitos, flies) appropriate on, the to: 4. Assess the client’s knowledge teaching that having an
er health action client will regarding vector-causing shows the open-type
● Stagna due to low be able a. Understand diseases. effects of drainage
nt water salience of to the negative 5. Assess client’s willingness to vector borne system that
in cans the problem. eradicate effects of cooperate diseases, can be a
the having 6. Explain the vector-causing management possible
presence stagnant diseases the possibility for and breeding site
of water at home acquiring one. preventing it. of vectors.
Inability to unwanted that can be a 7. Demonstrate how to reduce b. Enumerate
provide a sites of possible the possibility of breeding Human different
home and vectors breeding site sites and eradicate these Resources: ways of Interview
environment sites of of vectors. sites such as keeping a clean Verbal eradicating
conducive to vectors of b. Enumerate environment, removing Time and feedback breeding
health diseases different ways stagnant water and keeping it effort of both sites of
maintenance thereby of eradicating covered. the nurse and vectors.
and personal maintaini breeding sites 8. Emphasize the importance of the family c. Demonstrate
development ng a of vectors. covering water, especially the different
due to lack clean c. Demonstrate drinking water. Financial ways of
of environm the different 9. Familiarize the family with the Resources: eradicating
breeding
 ent free ways of available programs in the sites of
knowledge of eradicating community that promotes a Money for vectors.
of hygiene stagnant breeding sites cleaner and safe environment transportation Interview
and water of vectors. 10. Schedule a random visit to and for Demonstrati
sanitation. monitor and evaluate the material on and
application of the family of the resources compliance
agreed upon interventions. needed. with agreed
upon
interventio

INTERVENTION PLAN EVALUATION TOOL

FAMILY
HEALTH GOALS OF OBJECTIVE
CUES NURSING METHOD OF
PROBLEM CARE OF CARE RESOURCES
PROBLEM NURSING INTERVENTION NURSE-FAMILY CRITERIA STANDARD METHOD/TOOL
REQUIRED
CONTACT

Subjective Cues: Presence of Inability to After the After a day of 1. Introduce yourself to the client Home Visit Material
“Mayda ako tb health deficit: provide nursing nursing 2. State the purpose of the visit Verbal a. Recognize Interview
yakan han Illness states, nursing care intervention intervention 3. Establish rapport Resources: feedback the presence
doctor” as regardless of to the sick, the client the couple/ 4. Assess the client’s current of the
verbalized whether it is disabled, will be able family will be knowledge on Tuberculosis ● Pamphlet problem.
diagnosed or dependent, to have able to: 5. Assess the client’’s willingness to on
undiagnosed by vulnerable/at access to cooperate Pulmonary
medical risk member appropriate ● Determi 6. Obtain initial assessment Tuberculosi
practitioner: of the family resources ne the 7. Conduct health teaching about s
Objective cues: Pulmonary due to needed. nature, tuberculosis, specifically on its:
tuberculosis inadequate magnitu a. Nature and magnitude of the
● PRS of de and
family disease
chest pain: cause Human Verbal b.
resources for b. Risk Factors (Modifiable/
8/10 of Resources: feedback Understand Direct
care, Non- Modifiable)
● Weight tubercul and the situation observation and
specifically: c. Mode of transmission ● Time and compliance
loss osis and make interview
Financial d. Signs and Symptoms Effort of the with agreed
constraints ● Identify e. Prevention of tuberculosis appropriate
risks student upon decisions
8. Instruct the client to cough or nurse and intervention
and sneeze and expectorate into tissue regarding the
complic the family s family’s
and to refrain from spitting ● Clinical
ations manner of
of Instructor
 tubercul
osis treatment.
9. Review proper disposal of tissue
and good hand washing techniques
and encourage return
demonstration. c. Attend or
10. Stress the importance of avail free
Compliance medical Direct
uninterrupted drug therapy.
with agreed checkup at observation and
upon the city interview
intervention health center
s or the
nearest

INTERVENTION PLAN EVALUATION TOOL

FAMILY
HEALTH GOALS OF OBJECTIVE OF
CUES NURSING METHOD OF
PROBLEM CARE CARE NURSING RESOURCES
PROBLEM NURSE-FAMILY CRITERIA STANDARD METHOD/TOOL
INTERVENTION REQUIRED
CONTACT

Subjective Cues: Illness states, Inability to After the nursing After the nursing 1. Introduce yourself Home visit Material
regardless of provide nursing intervention the intervention the to the client Resources: Verbal a. Recognize Interview
“Tungod hine nga whether it is care to the sick, client will be able couple/ family 2. State the purpose feedback the presence
akon rayuma, diagnosed or disabled, to have access will be able to: of the visit ● Pamphlet of the
makuri pagbaktas undiagnosed by dependent, to appropriate 3. Establish rapport on problem.
labi it amon again medical vulnerable/at risk resources ● Know 4. Discuss the Rheumato
napa igbaw” practitioner: member of the needed. where consequences if id Arthritis
Reactive Arthritis family due to to get the problem is left
inadequate the untreated Human
Objective Cues: family resources necess 5. Check the Resources:
for care, ary patient’s vital
● Presence of service ● Time and
specifically: signs. Ask to rate
swelling on s and Effort of Verbal b.
Financial the pain from 0 to
both knees medicat the feedback and Understand Direct
constraints 10, and report the
● Facial ion student compliance the situation observation and
patient he/she is
grimace ● Provide nurse and with agreed and make interview
having.
noted when Mr. the family upon appropriate
6. Discuss the
he’s trying to Burand ● Clinical interventions decisions
 straighten his ay with importance of Instructor
leg and due medicin taking the regarding the
to untolerated e for medications on family’s
pain rheuma time manner of
● PRS of 9/10 toid 7. Encourage treatment.
arthritis progressive
activity through
self-care and Compliance
exercise as with agreed c. Attend or
tolerated. upon avail free
8. Explore with Mr. interventions medical
Buranday where checkup at Direct
he could get free the city observation and
medication which health center interview
is also accessible or the
for his condition. nearest
 RECOMMENDATIONS

FAMILY

Based on the assessment, we would like to recommend that the patient obtain AFB staining
result then present it together with other laboratory results in order to facilitate continuity of
care. Also, based on the laboratory results we recommend the patient to have further
diagnostic studies such as KUB Ultrasound, CT Stonogram, and BUN. Health teaching regrading
disease and therapeutic regimen is advised in order to communicate the importance of
compliance and follow-up check-ups. We would also advise the patient to drink medications at
the proper time and duration as prescribed. Furthermore, it is advised to reduce the risk of
cross-infection by ensuring proper ventilation of the house and proper hygiene. We also
recommend that relatives of Mr. B to visit him often to help him with his ADL’s and accompany
him to his medical appointments. To ensure the safety of everyone, they are advised to utilize
the community’s resources to prevent foreseeable accidents such falls and fires. Having a good
relationship with God is also important. This can be obtained through praying and asking for
God’s guidance and provision in daily life.

COMMUNITY

The goal of community health nursing includes promotion of health, disease prevention, and
restoration of health. During the home visit of the students at Purok 1, 2, and 3 Barangay 108,
Tagpuro, Tacloban City have shown willingness and readiness for an enhanced and holistic
health. However, it was observed that health services and community health programs was not
one of the most priority. The barangay have their own BHWs but they don’t have their own
Barangay Health Station. We highly recommend that they provide a place for their Barangay
Health Station where people can go in times of emergency for basic interventions ad if inquiries
are needed. Also, home visitation must be utilized to continuously monitor the health status of
the community. Furthermore, programs regarding health promotion would have a great impact
to the community to stand on their own. Lastly, the BHWs and Barangay Officials should
consistently implement these programs for it to be effective. The community of Barangay 108 in
Tagpuro Tacloban City hopes that services will be easily accessible for providing holistic
treatment.