Nursing care for pulmonary tuberculosis patients with acute respiratory failure : Two case studies

Abstract

     Pulmonary tuberculosis is a public health problem and the leading cause of death in the country. Most tuberculosis infections occur in the lungs (80%). People infected with tuberculosis may or may not have symptoms of tuberculosis. Lung infection results in abnormal lung function, unable to function in gas exchange or ventilation to a normal level. This leads to acute respiratory failure, which is a life-threatening crisis and results in an increased mortality rate.   

     Objectives: To study and compare two case studies in order to provide nursing care guidelines for pulmonary tuberculosis patients with acute respiratory failure

     Methodology:  This was the study of two cases. Two pulmonary tuberculosis patients with acute respiratory failure were selected. Data were collected from medical records. Gordon’s 11 functional health patterns were employed.  Relevant literature was reviewed from documents, textbooks, academic works, articles and related research to investigate the problems and formulate nursing diagnosis to plan nursing practice. Nursing outcomes were also summarized and evaluated.    

     Results: The two cases were diagnosed with pulmonary tuberculosis and acute respiratory failure.

     Case Study 1 was a 24-year-old Thai woman with no history of underlying disease. Before coming to the hospital, she had high fever, drowsiness, and shortness of breath for 3 hours. She also had tuberculosis infection in the lungs and acute respiratory failure. She was intubated and mechanically ventilated, resulting in abnormal functioning of the organs in the body, namely the nervous system, the cardiovascular system, the respiratory system and the renal system. She was admitted to the Medical Ward, Khon Kaen Hospital for 26 days. She was safe and referred back to the community hospital.

     Case Study 2 was a 70-year-old Thai man  with a history of pulmonary tuberculosis. In 2019, he took the medicine for 6 months and had no history of underlying disease. One day before coming to the hospital, he had the following important symptoms, fever, cough with phlegm and shortness of breath. While admitted at the community hospital, he received Mask C bag 10 LPM oxygen and was sent to Khon Kaen Hospital. He had pulmonary tuberculosis infection and acute respiratory failure. He was intubated and mechanically ventilated. Empyema thoracis was detected. Intercostal drainage was administered in the left lung, resulting in abnormal functioning of the organs in the body, including the cardiovascular system, the respiratory system and the renal system. He was admitted to the Medical Ward, Khon Kaen Hospital for 37 days. He was safe and discharged from the hospital. 

      Discussion: Both patients were diagnosed after admission and found to have pulmonary tuberculosis. When infected with pulmonary tuberculosis, there was injury tissue lung can chance of having respiratory failure. Although there were differences in gender, age and health conduction, the patients still had a high chance of survival. Nurses can screen use early warning signs along with signs and symptoms of respiratory failure to assess and screen patients and surveil for their symptoms that may get worse quickly and in time. Therefore, nurses must have the competency and provide effective nursing care with the goal of keeping patients safe and reduce the mortality rate. After discharge back to normal life and prevent spread of disease