Question

TUBERCULOSIS Case study A 48-year-old physician-scientist, who had emigrated from China, worked in a microbiology laboratory with TB specimens for several years. Her skin test was negative for TB when she came to the United States, but a blood test was positive after she developed fever, weakness, weight loss, lower chest, and abdominal pain, and shortness of breath. She was found to have fluid around her lung (pleurisy). She underwent a pleural biopsy, which grew Mycobacterium tuberculosis. She started taking four medications - isoniazid, rifampin, pyrazinamide and ethambutol for 6 months. After two months she returned to the hospital, concerned that she had been "coughing up blood" over the previous 3 days. In addition to hemoptysis, he revealed that, since her previous visit, she had continued to feel malaise, was continuing to lose weight, and had been experiencing night sweats. The emergency room physician immediately transferred the patient for isolation in a local hospital. A repeat chest radiograph revealed progressive bilateral fibronodular disease with a "miliary pattern. The patient was given a 20- month regimen of levofloxacin, kanamycin, cycloserine, pyrazinamide and prothionamide. Following completion of therapy, closure of the destruction cavity was found with local pneumofibrosis. At the end of the 20-month regimen she had regained her strength and weight. She continued the medicine for even longer than the recommended because drug resistance was found. During therapy, she developed joint aches from one of the drugs but finished the course. Despite the drug resistance, the patient recovered and is apparently cured, although she occasionally experiences chest pain when she takes a deep breath. Instructions Instructions . Read the Case • Prepare the SBAR to use to give report on this patient to the nurse taking his care • Include What 3 health promotion topics you discussed with to decrease the risk of contracting TB • Submit to Dropbox the completed SBAR by TUE 9/24 @ 10 PM

prepare SBAR

Answer 1

Answer) Situation: The patient is experiencing occasional chest pains while taking long breaths. She was suffering from the progressive bilateral fibronodular disease but now she is cured. She has also developed joint aches from one of the drugs. We need to monitor the frequency of chest pains and also order chest radiograph to detect the recurrence of the disease.

Background: The patient was experiencing some chest pains when she was admitted. She had a history of the progressive bilateral fibronodular disease which has been cured by a 20-month regimen of levofloxacin, kanamycin, cycloserine, pyrazinamide, and prothionaamide. The disease was cured but she has developed joint aches and experiencing chest pains while deep breaths.

Assessment: Patient is experiencing chest pains and joint ache.

Recommendation: We need to monitor the frequency of chest pains and also order chest radiograph to detect the recurrence of the disease. For joint ache, some medications must be given.