Pleural Effusion

~A Case Presentation~
As a partial requirement for
Medical-Surgical Nursing I

Presented By:
Aguado, John Prose
Almarra, Edrianne Paul
Antonino, Jelaine
Bacena, Dianne Jamaica
Marpa, Ian Rafael
Marquez, Charmaine
Ong, Julie Ann
Taguba, Neilson John
Villanueva, Irish
Saligumba, Emyl Cyril
Soliven, Kathlene Chelo
Zacarias, Andrea
III-CN

Presented To:
Dr. Concordia Eva Garcia RMT, RN, MD
 Why Pleural Effusion?

• 1st time to encounter

• Secondary illness
• Secondary to
Tuberculosis
 What is Pleural Effusion?
• It is the abnormal
accumulation of fluid
in the pleural space
resulting from
excess fluid
production or
decreased
absorption .
• Normally, the pleural
space approximately
contains 1mL of fluid
Classifications of Pleural Effusion:

1. Transudative Effusion
2. Exudative Effusion
 Transudative effusions

• Clear, pale yellow, watery substance

• Influenced by systemic factors that alter
the formation or absorption of fluid
• Contains few protein cells
• Common causes: CHF and liver or
kidney disease
 Exudative effusions

• Pale yellow and cloudy substance

• Influenced by local factors where fluid absorption is
altered (inflammation, infection, cancer)
• Rich in protein (serum protein greater than 0.5)
• Ratio of pleural fluid LDH and serum LDH is >0.6
• Pleural fluid LDH is more the two-thirds normal upper
limit for serum
• Rich in white blood cells and immune cells
• Always has a low pH
• Common causes: tuberculosis, pneumonia, cancer,
and trauma
 Light’s criteria
 Pleural fluid protein divided by serum protein is greater than 0.5.
 Pleural fluid LDH divided by serum LDH is greater than 0.6.
 Pleural fluid LDH is greater than two-thirds the upper limit of
normal for the serum LDH.
 If none of these criteria is met, the patient has a transudative
pleural effusion
 Statistics
 According to WHO:

The estimated prevalence of

pleural effusion is 320 cases per
100,000 people in third world
countries.
In developed countries the
common causes of pleural
effusions in adults are cardiac
failure, malignancy and
pneumonia, whereas in
developing countries are
tuberculosis and parapneumonic
effusions are more prevalent.
 Statistics
 According to DOH:
The Philippines currently has
250,000 cases of Tuberculosis, as of
the year 2009. Pleural Effusion
accounts to approximately 38% of
patients with Tuberculosis.
www.doh.gov.ph
www.doh.gov.ph
 BIOGRAPHICAL DATA
NAME: Mrs. M
ADDRESS: Brgy Cembo
AGE: 42 y/o
GENDER: Female
BIRTHDATE: May 30, 1969
RELIGION: Roman Catholic
DATE OF ADMISSION: July 17, 2011
MODE OF ADMISSION: Medicine Ward
 CHIEF COMPLAINT

“Nahihirapan akong huminga”,

as verbalized by the client
 History of Present Illness

• Four months prior to admission,

the client experienced
productive cough with greenish
phlegm, and night sweats. She
failed to seek for consultation
because she believed that it
was just an ordinary cough that
is self-limiting.
 History of Present Illness

• Three months prior to admission, the

client still experienced productive cough
(greenish phlegm) and night sweats.
She also experienced fever (39C), chest
tightness, and paroxysmal nocturnal
dyspnea. She consulted a private doctor
and was given Lagundi TID x 7days and
Clarithromycin 500 mg BID x 7days. She
had taken these drugs as prescribed by
the physician. After a week, the patient
still complains of the same symptoms.
She failed to have a follow up check up
due to lack of time
 History of Present Illness

• Two months prior to admission, the client still

manifested symptoms such as productive cough
(greenish phlegm), persistent fever (39C) in the
afternoon, and night sweats. The client now had
anorexia and lost a total of 3 kg from her previous
weight of 47 kg. She began to experience orthopnea
of 2 pillows, easy fatigability and paroxysmal nocturnal
dyspnea.
 History of Present Illness

• She also began to

complain of chest
pain
P: right thorax
Q: Sharp pain
R: non-radiating
S: 4/10
T: upon deep
inspiration, relieved
after shallow
breathing).
 History of Present Illness

• She now consulted a

private doctor and
was subjected for
chest x-ray revealing
pleural effusion of the
right lung. The client
had undergone
thoracentesis and
450cc of fluids was
collected from her
right lung.
Normal CXR Right Pleural Effusion
Thoracentesis
 History of Present Illness

• The patient was relieved from pain after

the procedure and was sent home with
stable vital signs. The patient was
prescribed to take Acetylcystein 600
mg/tab TID, Paracetamol 500 mg/tab TID.
She was advised to have a follow up chest
x-ray after two weeks. The patient failed to
have a follow up chest x-ray due to
financial problem
 History of Present Illness

• One month prior to admission, the patient

still experienced productive cough, chest
pain on deep inspiration (P: right thorax, Q:
Sharp pain R: non-radiating, S: 7/10, T:
upon deep inspiration, relieved after
shallow breathing). The client still had
anorexia and lost 4 kg from her previous
weight of 44 kg.
 History of Present Illness

• The patient consulted again a

private MD. She was subjected
again for chest x-ray and pleural
effusion on the right lung was
detected. Second thoracentesis
was done and 1,000 mL of fluids
was collected. She was relieved
from pain after the procedure and
was sent home with stable vital
signs. The patient was advised to
have a follow up chest x-ray after
two weeks.
 History of Present Illness

• Two weeks prior to admission, the

patient again experienced
productive cough and dyspnea,
and easy fatigability. She was
subjected to chest x-ray. Third
thoracentesis was done and 800ml
of fluid from the right lung was
collected.
• The patient finally decided to
be subsequently admitted to
Ospital ng Makati.
 REVIEW OF SYSTEMS

Neurological System none

Cardiovascular System none
Respiratory System (+) dyspnea
(+) paroxysmal nocturnal dyspnea
(+)chest pain (P-pain in right thorax
during deep inspiration and
movements Q- Sharp pain R-Non-
radiating
S-7/10 T- relieved by shallow breathing
(+) orthopnea of 2 pillows

Integumentary System (+)night sweats

Endocrine System none
Urinary System none
Reproductive System none
 PAST MEDICAL HISTORY

• The client only had

hospitalization in the past
due to child delivery. The
client has no known
allergies to certain kind of
foods and medication. She
had no history of injury or
falls. She had also
completed her
immunizations.
 FAMILY HISTORY
The client has history of cancer,
specifically; her mother has been diagnosed
to have breast cancer while his father has
been diagnosed to have prostate cancer.
GENOGRAM of Mrs. M’s Family:

Joe
Therese

Mark Mr. Husband

Mary Maricar Mrs. M Mercy
38
49 45 42 36

LEGEND:

Male prostate Ca

Female breast Ca
Jeff
Marj
Deceased healthy 20
16
Personal and
Social History
Health Perception
and Health Management Pattern:

Mrs. M described a healthy person as someone without

an illness and still manages to do his/her daily
activities.
Mrs. M rated her general health status as 6/10, She
added that she still has a positive outlook in life even
though she has a disease.
With regards to self breast examination, the client is
familiar with it but doesn’t have enough knowledge on
how to perform it.
 Health Perception
and Health Management Pattern:

Mrs. M takes care of her body

through bathing, trimming of
fingernails, wearing of slippers at
home, brushing teeth, and using
deodorant.
The patient doesn’t smoke and
doesn’t drink any alcoholic beverage.
Health Perception
and Health Management Pattern:

Mrs. M lives in Brgy. Cembo with her

husband and two siblings. Her family is
renting a half of a bungalow house
situated along a road. The house has two
rooms with a wall that divides it. The wall
is not touching the roof, leaving an open
space between the two rooms. Mrs M.
suspected that one of the family
members living in the other side of the
house has tuberculosis. She admitted
that the air is polluted around their area
because she can even inhale the smoke
around their compound. Their house is
poorly-ventilated and poorly-lighted.
Nutritional and Metabolic Pattern
3-Day Diet Recall

August 30, 2011 August 29, 2011 August 28, 2011

½ bowl of goto
1 bowl of Arozcaldo
Breakfast 1 bowl of soup 2pcs. Medium-sized
1 glass of milk
(7:30AM) 1 glass of milk pandesal
1 glass of water
1 glass of milk

½ bowl of ginataan
½ cup of steamed rice
Lunch 1 bowl champorado 2 slices of tasty bread
½ serving of menudo
(12:30NN) 1 glass of water 1 glass of orange juice
1 glass of orange juice
2 glasses of water

Snack 1 stick of bananaQ

- -
(3:00PM) 1 glass of water

½ cup of steamed rice ½ cup of steamed rice

½ cup of steamed rice
Dinner 1 serving of pakbet 1 pc. Lumpiang sariwa
½ serving of monggo
(7:00PM) 2 glasses of water 1 glass of milk
2 glasses of water
1 glass of milk 1-2 glass of water
 Nutritional and Metabolic Pattern
3-Day Diet Recall

 Mrs. M is the one who prepares the food for her family
before. Most of the time, she cooks Filipino dishes
such as pork adobo & pork sinigang. Mrs. M does not
forget to wash her hands everytime before she
prepares the food.
 Mrs. M stated that she is not taking any vitamins
since before.
 The patient lost a total of 7 kg in her weight before
hospital admission.
Elimination Pattern:
 Regarding her defecation, she usually
defecates once a day and the stool is dark
brown in color and the consistency is solid.
The patient doesn’t have any discomforts
upon defecation. She seldom experiences
constipation or diarrhea.
 Regarding her urinary elimination pattern,
Mrs. M frequently urinates (4-5x/day) because
she is taking Furosemide every night. She
stated that she doesn’t feel any discomfort or
pain during micturition.
 Activity-Exercise Pattern:
• Mrs. M is a high school
teacher. She goes to school in
the morning and goes home at
1:00 pm. She said that before
she felt the symptoms of easy
fatigability, she exercises during
weekend morning for 30 minutes
using a waist twisting disc. She
also considers walking to her
school for work as an exercise.
Sleep and Rest Pattern:

• Mrs. M had difficulty of sleeping in the

hospital because she is not comfortable sleeping
with the hospital environment and also, because
of the pain she has been experiencing on the
thoracostomy site upon trunk movements. She
described the pain as sharp, and rated it as
7/10. During the interview, facial grimace is
evident. She sometimes nods her head just to
agree. She also speaks at a low-volume voice.
 Sleep Diary
August 30, 2011 August 29, 2011 August 28, 2011

Hours of Sleep (12AM-5AM) (11AM-4:30AM) (12AM-4:30AM)

during Night 5 hours 5 1/2 hours 4 1/2 hours

Hours of Nap (1:30PM-3:00PM) (4:30PM – (1:00-3:00 PM)

During Afternoon 1 ½ hours 6:00PM) 2 hours
1 ½ hours
Quality of Sleep Continuous Continuous Not Continuous.
Awakened at 3am
due to pain on the
thoracostomy site.
Fell asleep after
pain subsided.

Feeling upon Refreshed Refreshed Not Refreshed

waking up
PHYSICAL EXAMINATION
General Appearance: During the interview, the client is
conscious and coherent. The client has evident facial grimace.

Anthropometric Measurement:

Weight: 40 kg
Height: 1.49 cm
BMI: 18 Abnormal
Vital Sign:

Temperature : 39°C Abnormal

Cardiac Rate: 109bpm Abnormal
Respiratory Rate: 26cpm Abnormal
Blood Pressure: 100/70 Normal
PHYSICAL EXAMINATION
ORGAN/ BODY METHODS FINDINGS SIGNIFICANCE
PART(S) USED
Head: Inspection normocephalic Normal
Skin: Inspection Intact Normal
Palpation (+) dry skin Abnormal
Warm to touch Abnormal
elastic skin turgor Normal
Eyes: Inspection White sclera Normal
(-) sunken eyeball Normal
(-) pale conjunctiva Normal
(-) discharge Normal
Ears: Inspection Bilaterally equal in size Normal
Palpation (-) lesions Normal
(-) discharge Normal
No tenderness Norma
Nose: Inspection symmetric and straight Normal
(+) pink mucosal membrane Normal
(-) deviated septum Normal
(-) discharge Normal
(-) nasal flaring Normal
PHYSICAL EXAMINATION
ORGAN/ BODY METHODS FINDINGS SIGNIFICANCE
PART(S) USED

Mouth Inspection (+) dry lips Abnormal

pinkish tongue Normal
(-) lesions Normal
pink tonsils and buccal Normal
mucosa
Nails Inspection (-) cyanotic nailbeds Normal
Palpation capillary refill more than Abnormal
3secs.

Neck Inspection Symmetric and head Normal

Palpation centered Normal.
Thyroid gland moves Normal
upward upon swallowing Abnormal
Trachea is midline
(+) tender lymphnodes
PHYSICAL EXAMINATION
ORGAN/ BODY METHODS FINDINGS SIGNIFICANCE
PART(S) USED
Thorax and Lungs Inspection (-) Chest wall retractions Normal
Palpation asymmetric Tactile fremitus Abnormal
Auscultation (absent on the right Abnormal
Percussion thorax) Abnormal
asymmetric respiratory Normal
excursion (movement only Abnormal
on the left thorax)
asymmetric breathsounds
(absent breathsounds on
the right)
(-) adventitious breath sound
dull, flat sound over the right
thorax
Heart Auscultation (-) heart murmur Normal
Abdomen Inspection Flat abdomen Normal
Auscultation (+) ascites Abnormal
Normal bowel sounds Normal
No bruit heard normal
Extremities Inspection Arms bilaterally symmetric Normal
Palpation (-) edema Normal
(-) lesions or ulcerations Normal
(+) palpable distal pulse Normal
Contraptions:
• IV on Right Hand (PNSS 1L x 8hrs)
• CTT on Right Thorax at 8th ICS
connected to a one-bottle water seal
system
• With Foley Catheter
MEDICAL AND NURSING DIAGNOSES
Medical Diagnosis: Pleural Effusion secondary to PTB

Nursing Diagnoses:
• Ineffective Breathing Pattern r/t decreased lung volume capacity
• Acute Pain r/t accumulation of fluid in the pleural space and rubbing of
thoracostomy tube to the lungs
• Imbalanced Nutrition: less than body requirement r/t inability to ingest
adequate nutrients
• Hyperthermia r/t disease process
• Sleep Deprivation r/t Paroxysmal nocturnal dyspnea
• Risk for fluid volume deficit related to administration of diuretic drugs
• Risk for Injury related to thoracentesis
• Risk for infection r/t presence of ctt
Pathophysiology
Exposure to Air Living in Poorly-
Exposure to TB
Pollutants lighted and
overcrowded
house

Inhalation of TB
Bacilli

Tubercle Formation
(Primary Infection)

Productive cough,
Fever 39C, Anorexia,
Formation of weight loss, easy
Granuloma fatigability

PTB
AFB (+)
 PTB

Not early detected

subpleural caseous focus in the lung ruptures into the pleural space

Mycobacterial antigens enter the pleural space

Vigorous inflammatory response associated with

an exudation of white blood cells and proteins.

Increase WBC count

(16.6 x 10^9 mm/ L)
Increase Monocyte count
(0.13 g/L)
 Vigorous inflammatory response
associated with an exudation of
white blood cells and proteins.

Increase pulmonary Intense inflammation obstructs

interstitial fluid the lymphatic pores in the
parietal pleura
Low serum
albumin level:
25 g/L
Changes in Decrease in lymphatic
permeability of drainage
capillaries

PLEURAL EFFUSION
(Accumulation of fluid in
the pleural cavity)
Decrease breath sounds, Irritation of sensory
stony dull sound when nerves in the parietal
percussed pleura during deep
PLEURAL EFFUSION
inspiration
(Accumulation of fluid in the
pleural cavity)
CXR: Opaque
densities on the right
Dyspnea, Pleuritic
lower lobe
chest pain,
& blunting of
Increase in intra-alveolar Orthopnea,
costophrenic angle
& intra-pleural pressure Paroxysmal
nocturnal dyspnea
Dyspnea, Increase
RR Decrease lung
Decrease respiratory expansion Prolonged pleural
excursion effusion

Lung collapse
Risk for infection of pleural
fluid

Empyema
LABORATORY &
DIAGNOSTIC TESTS
Complete Blood Count
Procedure/Item Abnormal flags Result Units Reference
Range
Hemoglobin 16 g/DL ( 13.0 – 18.0 )

Hematocrit 45 % ( 40.0 – 52.0 )

RBC 5 Mil/mm^3 ( 4.70 – 5.40 )

WBC *High 16.6 /mm^3 (4-11 x 10^9)

Neutrophils 0.77 g/L (0.50-0.70)

Lymphocytes 0.39 g/L (0.20-0.40)

Monocytes *High 0.13 g/L ( 0.02 – 0.05 )

Eosinophils 0.03 g/L ( 0.02-0.04 )

Basophils -- /mm^3 ( 10 – 100 )

Arterial Blood Gases
Result Normal Range

pH 7.48 7.35-7.45

PCO2 47 35-45mmHg

HCO3 23 22-26mmHg

PaO2 88 80-100%

Significance: The patient has respiratory alkalosis.

This may be due to rapid & shallow breathing.
Procedure/Ite Abnormal Result Units Reference
m flags Range

Albumin *Low 25 g/L ( 34 - 50 )

AST (SGOT) 35 u/L ( 15 - 37 )

ALT (SGPT) 33 u/L ( 30 - 65 )

Alkaline 143 u/L (50-165)

Phosphat
ase
Acid-fast Bacillus (AFB)
 (July 20, 2011)
 Specimen: Sputum
 Result: AFB (+)
Gram Stain
 (August 20, 2011)
 Specimen: Pleural Fluid
 Result: Smear shows no presence of
gram (-) bacilli.
CYTOPATHOLOGY
 (August 20, 2011)
 Specimen: Pleural Fluid
 Pathologic Diagnosis: Negative for
malignant cells
Chest X-ray
 (July 14, 2011)
 Impression: Consider
moderate pleural
effusion; right
 Right Lateral
Decubitus: Evidence
of minimal pleural
fluid
Chest X-ray
Right Lateral Decubitus
CT-SCAN of Chest
 Result: PTB with
organizing Pneumonia,
Superior and postero-
medial right lower lobe
with right hilar
lymphadenopathies
and right pleural
effusion.
CT – MRI
 (August 11, 2011)
 Findings:
 Mediastinal lymphadenopathies
 Right pleural effusion with thick
pleural density
 Heart not enlarged
 Pulmonary Fibrosis in Left Lower
Lobes
 COURSE IN THE WARD
AUGUST 31,2011  Patient received lying on bed, awake, calm and coherent
Wednesday  Patient was febrile
(6:00AM – 2:00  Patient was ambulatory
PM)  Has an IVF of 1L PNSS at 31-32 gtts/min for 8 hours infusing well
 Patient’s vital signs were taken and recorded
Temperature: 39°C
Cardiac Rate: 109bpm
Respiratory Rate: 22cpm
Blood Pressure: 100/70

 Tepid sponge bath was done to lower hyperthermic state

 Endorsed elevated temperature to the nurse-in-charge
 Bed rails were raise to promote patient’s safety
 Instruct the significant other how to do the tepid sponge bath if fever is present
 Intake and output strictly monitored
Intake Output
Oral- 400 mL Urine- 500 mL
IV- 500 mL Chest tube – 60mL
Total - 900mL Total - 560mL
No. of stool – 0
• Checked thoracostomy tube for leak, kinks, patency and output.
 Noted fluctuations in every inspiration on the drainage bottlez
 Secured bottle lower than the client (under the bed).
Drug Study
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation

Generic: Mucolytics Breaksdown the 600 mg PO q4 Evaluates client’s Evaluate the

Acetylcystein link that binds respiratory status effectiveness of
e mucus together (respiratory rate, depth, Acetylcysteine through
rhythm) assessing the
Check sputum for respiratory status of
color, consistency and the client and amount
amount. of sputum
Liquifies mucus If bronchospasm expectorated.
occurs, stop the
treatment and notify
the physician.
Makes cough Instruct patient to notify
more productive prescriber immediately
about nausea, rash, or
vomiting.

Warn patient about

acetylcysteine’s
unpleasant smell;
reassure him that it
subsides
as treatment
progresses.

To decrease mucus
viscosity, urge patient
to consume 2 to 3 L of
fluid daily unless
contraindicated by
another condition.
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation
Evaluate effectiveness
Generic Anti-TB Agents Inhibits cell 400mg + 275mg Take it continously and of medication through
Name: action of PO never skip doses to observing the clients
Pyrazinamide Mycobacterium avoid multi-drug coughing and coping
+ Ethambutol tuberculosis resistance. mechanism with the
drug
Monitor Vision of
patient. Ethambutol
Bacteriostatic causes optic neuritis.

Examine patients at
regular intervals and
question about
possible signs of
toxicity: Liver
enlargement or
tenderness, jaundice,
fever, anorexia,
malaise, impaired
vascular integrity

Report to physician
onset of difficulty in
voiding. Keep fluid
intake at 2000 mL/d if
possible.
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation

Generic Antituberculosi Inhibits DNA 300 mg PO OD Administer on an Evaluate effectiveness

Name: s agent and RNA empty stomach, 1 hr of medication through
Rifampicin polymerase before or 2 hr after monitoring hemoptysis
activity meals. production, liver fxn
Administer in a single test and CXR
daily dose.
Give with meals
because it causes
Cell death gastric irritation.
Prepare patient for the
reddish-orange
coloring of body fluids
(urine, sweat, sputum,
tears, feces, saliva);
soft contact lenses
may be permanently
stained; advise
patients not to wear
them during therapy.
arrange for follow-up
visits for liver and renal
function tests, CBC,
and ophthalmic 
examinations.
Advise client to avoid
omission of dose to
prevent drug
resistance
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation
Generic: Antibiotic 4.5 g/ml TIV q6 Perform skin test
Piperacillin + Binds to before giving the initial
Tazobactam bacterial cell dose.
membrane and Assess client for
inhibits beta- allergy to penicillin.
lactamase Check C&S result.

Monitor client for 30

mins when given
Cell lysis parenterally; administer
epinephrine if
anaphylaxis occurs.

Do not mix
aminoglycosides with
penicillin in the same
IV infusion –
deactivates
aminoglycoside

Check for CBC result

and Monitor for
hemorrhagic
manifestations
because high doses
may induce
coagulation
abnormalities.
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation

Generic: Loop diuretic Acts in loop of 10 mg/mL TIV q8 Monitor for adequate Evaluate effectiveness
Furosemide Henle, proximal intake and output and of Furosemide through
and distal tubule potassium loss. frequently monitoring
urinary output.
Monitor client’s weight
and vital signs esp BP
Inhibits Na and Monitor for signs and
Cl reabsorption symptoms of hearing
loss, which may last
from 1 to 24 hrs.

Teach client to take

Furosemide early in
the day to decrease
nocturia.

Teach client to report

any hearing loss or
signs of gout.
monitor for S/s of
hypokalemia; such as
muscle weakness and
cramps

Monitor for sideeffects

such as dizziness,
lightheadedness, or
fainting spells, Signs of
dehydration or low
electrolytes,
Drug Name Classificatio Action Dosage/Freque Nursing Evaluation
n ncy responsibilities
Generic third- 200 mg PO Assess for Evaluate the
Name: generation Binds to infection at effectiveness of
Cefixime cephalospor PBPs beginning of and medicine
in antibiotic throughout
therapy.
Inhibits
bacterial cell Ask patient for
wall allergies to
synthesis penicillin or
cephalosporins.
Death of
Bacteria Perform skin test
before the initial
administration.

Obtain specimens
for culture and
sensitivity before
initiating therapy.

Observe patient
for signs  and
symptoms of
anaphylaxis
( rash, pruritus,
laryngeal edema,
wheezing)
Drug Name Classification Action Dosage/Freque Nursing Evaluation
ncy responsibilities
Generic Opioids/anal 50mg/2mL TIV Assess onset, type, Evaluate
Name: gesic binds to µ- location, and effectiveness of
Tramadol opiate duration of pain. medication through
receptors and Effect of monitoring vital
inhibits medication is signs of client and
reuptake of reduced if full pain assessing pain
norepinephrin recurs before next recurrence.
e and dose.
serotonin  Assess drug
history especially
carbamazepine,
CNS depressant
reduces medication, MAOIs.
intensity of Review past
pain stimuli medical history,
sponse to especially epilepsy
pain. or seizures.
Assess renal or
hepatic function
laboratory values.
Give without
regards to meals
Monitor pulse and
blood pressure.
Assist with
ambulation if
dizziness or vertigo
Drug Name Classification Action Dosage/Freque Nursing Evaluation
ncy responsibilities
Generic Thrombolytic 250,000 units Continuous Evaluate
Name: enzyme Produces intrapleurally monitoring of HR effectiveness of
plasmin and rhythm Streptokinase
Streptokina throughout through checking
se Breaks thrombolytic for blood in the
down fibrin administration. chest tube
drainage.
Vital observations :
Dissolves record 15 minutely
blood clots for at least 1 hour
from onset of
infusion until stable.

Notify physician if
allergic reactions
may include fever
increased liver
enzymes, reduced
renal function,
polyarthralgia,
polyarthritis and
rash.
 Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation
Generic Anti-pyretic inhibiting the 300g TIV Check vital signs of the Evaluate effectiveness
Name: hypothalamic client esp temperature. of Paracetamol through
Paracetamol heat-regulating monitoring a decrease
centre. Inspect IM and in the temperature of
IVinjection the client.
sitesfrequently for
signs of phlebitis.
Inhibits fever
Report onset of loose
stools or diarrhea

Monitor I&O rates and

pattern:
DISCHARGE PLANNING
• Medication: After handling the patient for one day, we advice the client and
significant others that the client should continue the prescribed medications as
follows: Rifampicin 300 mg PO OD, Pyrazinamide + Ethambutol 400mg + 275mg PO as
ordered by the doctor.
• Exercise: We have encouraged the client to perform mild exercise such as jogging
for 30 minutes each day after the woundcompletely healed.
• Treatment:
• Health Teaching: Teach the client to avoid omission of doses of antituberculosis
drugs such as Rifampicin, Pyrazinamide and Ethambutol. We have advised the client to
expect reddish to orange color of urine, sweats, etc. We have advised the client to
seek for consultation if she experienced blurring of vision and jaundice.
• We also taught the client that Mycobacterium Tuberculosis is killed by heat and
sunshine that’s why appropriate lighting and ventilation of the house is important.

• Out-Patient Follow-up Care: Advised the client for a follow up check up and for
chest xray.
• Diet: We advised the client to increase intake of protein to increase healing of wound
brought about by chest tube thoracostomy. We also advised to take 8-10 glasses of
water everyday to avoid dehydration.