Nursing care for tuberculosis patients with co-existing diabetes mellitus: A case study.

Abstract

          This case study aimed to investigate the nursing care of a tuberculosis patient with co-existing diabetes mellitus. The patient, a 48-year-old Thai woman, presented with a 10 kg weight loss in 5 months. She was there for her scheduled sputum AFB result checkup. She had a history of inconsistent diabetes mellitus, with medication she purchased from a private clinic.

          The study results showed that upon admission, the patient was conscious, had a mild cough, and no shortness of breath. Vital signs were measured: temperature 37°C, heart rate 116 beats/minute, respiratory rate 20 breaths/minute, blood pressure 121/73 mmHg. Lung crepitation was observed in both lungs. Blood oxygen saturation (SpO2) was 98%. Sputum AFB was negative. Electrocardiogram (EKG) showed sinus tachycardia. Chest X-ray (CXR) revealed reticular infiltration in the left lung. The physician diagnosed Pulmonary Tuberculosis (TB) and Diabetes Mellitus (DM) under consideration. Admission to the female inpatient isolation ward at Khonsan Hospital was recommended. During treatment, the patient presented with coughing, shortness of breath (but not wheezing), and lung crepitation in both lungs. They received Paracetamol 500 mg (1 tablet orally prn) for fever every 6 hours, Glyceryl guaiacolate 100 mg (2 tablets orally tid pc+hs), Dextromethophan 15 mg (2 tablets orally tid pc), and Berodualforte NB (Inhalex forte) 0.5+1.25 mg/4ml (1 ampoule every 12 hours). After treatment, there was no shortness of breath and the lungs were clear. Other medications administered included Isoniazid 100 mg (3 tablets orally hs), Pyrazinamide 500 mg (2 tablets orally hs), Ethambutal 400 mg (2 tablets orally hs), Rifampicin 450 mg (1 tablet orally hs), and Vitamin B6 50 mg (1 tablet orally hs). The patient also experienced nausea and vomiting. After receiving medication for TB treatment, administer Metoclopramide 10 mg IV prn every 8 hours, Domperidone 1 tablet orally twice daily in ORS mixed with water, sipped frequently. Symptoms improved, with no vomiting and occasional nausea. The patient had a history of diabetes mellitus (DM) and was not receiving continuous treatment. Monitoring included checking DTX premeal OD and administering Metformin 500 mg 1 tablet orally bid pc. There was no hypo-hyperglycemia. The patient was admitted for 12 days for hospitalization. A 6-month follow-up was conducted. There was no transmission of tuberculosis to family members or the community.