Pulmonary Tuberculosis Case Study

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Transcript of Pulmonary Tuberculosis Case Study

I. INTRODUCTION A. Overview of the study

Colon cancer ranks 6th overall leading cause of cancer-related deaths in the Phillipines , 5th among males and 7th among females. An estimated 2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths will be seen in 1998. Colon cancer increases markedly after age 50. A malignancy in the colon or rectum can be referred to as colorectal cancer. Strictly speaking, a malignancy in the colon is colon cancer and a malignancy in the rectum is rectal cancer. Most colon cancers occur on the left side in the sigmoid region. The colon is a muscular tube approximately 6 feet long connecting the small intestine to the rectum. The right side of your body has the ascending colon which receives waste from the small intestine. This ascends upward to the transverse colon which crosses over the small intestines and descends on the left side of the body as the descending colon. At the bottom the colon again crosses the belly toward the rectum as the sigmoid colon. Finally, the sigmoid colon empties into the 8-inch rectum. When the cells that line the colon or rectum start to proliferate in an uncontrolled manner it is called a tumor. It is common to find a benign type of growth called polyps. These are small and produce few, if any, symptoms. However, over time these polyps can grow and develop into cancer.


B. Objectives and Purpose of the Study As a student nurse, it is indeed my vocation to adjoined hands with the health care team for the promotion of wellness of our clients. My main goals for this study are the following: To establish rapport To identify chief complaints of clients to give its specific interventions To determine the family and personal history of the client that many affect clients present condition To identify the cause and effect the main problem through the correct analysis of the pathophysiology of the case To determine the medical management given through identifying doctors order and its rationale To make nursing care plans for the different health problems encountered by the client To evaluate the effectiveness of the actual nursing care plan that was established C. Scope and Limitation of the Study Specifically this study is more concerned with the care of one patient in Polymedic General Hospital, Medical Ward. I performed physical assessment to the patient to properly identify the nursing problems, which requires necessary and direct interventions and medical regimen. I had 2 days duty or 16 hours care for the patient and some limited informants.. Thus this care study focuses on the particular case of the patient. The study of the medications and doctors order are limited to our chosen patient, a case of Colon Cancer.


II. HEALTH HISTORY A. Patients Profile Name of Patient: RF Sex: Male Age: 73 Birthday: May 31, 1938 Birthplace: Misamis Oriental Religion: PIC Civil Status: Married Educational Attainment: CollegeLevel Occupation: OFW Number of Siblings: 5 Nationality: Filipino Date Admitted: July 5, 2011 Time Admitted: 5:15 pm Informant: Daughter Blood Pressure: 110/60 mmHg Temperature: 36.7O C Pulse Rate: 82 bpm Respiration: 21 cpm Allergy: No known allergy Attending Physician: Dr. O Admitting Diagnosis: T/C Colon Cancer

B. Past Health History Mr. RF verbalized he has been confined due to gastritis but he already forgot about the date he was admitted. He has no allergy to any foods or other stuffs.


C. Chief Complains and History of Present Illness Patient RF, &3 years old, from Lapasan, CDOC, few days prior to admission he already experienced poor appetite and severe generalized body weakness and due to this instance,he was brought to PGH by his daughter last July 5, 2011 with the admitting diagnosis of T/C Colonic cancer. the initial vital signs of: temperature- 36.7 C, respiratory rate- 44 cpm, and a pulse rate of 138 bpm.

III. DEVELOPMENT DATA A. Erik Eriksons Stages of Psychosocial Development Theory Erikson describes eight developmental stages through which a healthily developing human should pass from infancy to late adulthood. In each stage the person confronts, and hopefully masters, new challenges. Each stage builds on the successful completion of earlier stages. The challenges of stages not successfully completed may be expected to reappear as problems in the future. Each of Erikson's stages of psychosocial development are marked by a conflict, for which successful resolution will result in a favourable outcome and by an important event that this conflict resolves itself around. In the Eriksons 8th stage of psychosocial Development theory which is Senior: Integrity vs. Despair (65 years onwards). Integrity means moral soundness, whole or completeness of a person, Despair means being hopeless. When it comes to my patient he was loosing hope that his illness will be cure, it is because he feels that he was really old and he dont have the capabilities of living the way it should be. But still, because of the support of the family little by little he was trying to understand his situation tried to think on positive side and for himr to live longer for his family that still need him as a father, as a grandfather and as a husband. B. Sigmund Freuds Psychosexual Development Theory According to Freud, people enter the world as unbridled pleasure seekers. Specifically, people seek pleasure through from a series of


erogenous zones. These erogenous zones are only part of the story, as the social relations learned when focused on each of the zones are also important. Freud's theory of development has 2 primary ideas: One, everything you become is determined by your first few years - indeed, the adult is exclusively determined by the child's experiences, because whatever actions occur in adulthood are based on a blueprint laid down in the earliest years of life (childhood solutions to problems are perpetuated) Two, the story of development is the story of how to handle anti-social impulses in socially acceptable ways. My patient belongs to the genital stage which begins at puberty involves the development of the genitals, and libido begins to be used in its sexual role. However, those feelings for the opposite sex are a source of anxiety, because they are reminders of the feelings for the parents and the trauma that resulted from all that. C.Robert J. Havighursts Developmental Task Theory Havighurst categorized the tasks, in first category are the tasks, which has to be completed in certain period, and the second are the tasks that continue for a long, sometimes for a lifetime.So what happens if the task is not completed in that stage or completed in a later date? Havighurst reply to that it is critical that the tasks should be completed during the appropriate stage, otherwise result will be the failure to achieve success in future tasks. D. Jean Piagets Theory of Development According to Piaget, development is driven by the process of equilibration. Equilibration encompasses assimilation (i.e., people transform incoming information so that it fits within their existing schemes or thought patterns) and accommodation (i.e., people adapt their schemes to include incoming information). My patient belongs to the formal operational stage. In this stage, individuals move beyond concrete experiences and begin to think abstractly, reason logically and draw conclusions from the information available, as well as apply all these processes to hypothetical situations. The abstract quality of the adolescent's thought at the formal operational level is evident in the adolescent's verbal problem solving ability. The logical quality of


the adolescent's thought is when children are more likely to solve problems in a trial-and-error fashion. Adolescents begin to think more as a scientist thinks, devising plans to solve problems and systematically testing solutions. They use hypothetical-deductive reasoning, which means that they develop hypotheses or best guesses, and systematically deduce, or conclude, which is the best path to follow in solving the problem.

IV. MEDICAL MANAGEMENT A. DOCTORS ORDER Order 7/5/11 Please admit under the service of Dr. O

Secure Consent to care

Monitor or V/S q 4

Start venodysis w/ D5NSS IL @ 15 gtts/min LABS: -CBC -Urinalysis -Chest x-ray PA -Serum Na+, K+ creatinine MEDS - Vamin 500 cc for 12 hours I & O q shift Refer accordingly


7/6/11 NaCl 1 tab TID Iterax tramal 7/7/11 hold iterax Morphine 10g 1 tab q 8o D/C tramal once Morphine is started 7/8/11 continue meds 7/9/11 Paracetamol 500g 1 tab q 4 PRN for fever D/C vamin when consumed Flanax 275 g 1 tab BID IVF to ff D5NSS1L @ 15 gtts/min 7/10/11 d/c flanax refer to Dr. RY for colonoscopy & Biopsy - if for colonoscopy pls. do 1. CXR 2. ECG 12 leads 7/11/11 may change FBC in AM per request 7/12/11 follow up CXR result for possible colo this am depending on response of bowel prep give morphine 10 mg 1 tab now increase IVF rate to 25 gtts/min 7/13/11 give flanax 1 tab sched for colo @ 9 am tomorrow - do the routine bowel prep - refer to Dr. G 7/14/11 suggest surgical consult colostomy schedule noted resume previous diet resume vamin 500 cc to run for 12 hours refer to Cr. RY for evaluation if ok w/ family plan : Diverting loop colostomy ?& debarment of perineal abcess 7/15/11 request CBC, serum Nat, Kt, Crea, SGPT secure unit of PRBC for possible transfusion pls. facilitate hot sitz bath for 15 min 3 x a day for 2 -3 days provide bedside commode pls. transfuse 2 units of PRBCof blod type @ 20 gtts/min please close main IVF line once BT is ongoing 7

7/16/11 secure another units of FWB for possible BT repeat CC result 7/17/11 absolute NPO once vamin glucose is consumed; start kabiverl 2,000 kcal to run for 24 hours decrease IVF rate to 10 gtts/ min