Criteria
FAMILY NURSING CARE PLAN
Cues 10
____________________ Health problem 15
Family nursing problem 20
In Partial Fulfillment of Goal of care 10
Objectives of care 15
Interventions 30
The Requirements in NCM-209
IMCI ROTATION
____________________
Submitted To:
Mrs. Bevan Balbuena, RN, MN
Submitted By:
Hinlog, Aila Kye B.
BSN – 2B, Group 3
April 24, 2020
Topic: Tuberculosis
Dat Cues Health Family Goal of Care Objectives of Care Interventions
e Problem Nursing
Problem
A Vital Signs Inadequate Inability to After nursing After nursing 1. Assess patient’s
P - Temperature of knowledge recognize interventions, interventions, the ability to learn.
R 37.8 degrees about the the presence the family will family will be able to: Note level of
I Celsius, Febrile. nature of of the have the a. know the fear, concern,
L tuberculosis condition adequate clinical fatigue,
(+) Cough of more as Health due to knowledge to manifestations participation
19, than 2 weeks Deficit. inadequate recognize of tuberculosis; level; best
(+) Hemoptysis knowledge and b. participate on environment in
2 (+) Yellowish sputum comprehend the necessary which patient
0 the nature of tests as part can learn; how
2 - Chest or back tuberculosis. for treatment of much content;
0 pains not tuberculosis best media and
referable to any and; language; who
Musculo- c. modify current should be
skeletal lifestyle to included.
disorders prevent R: Learning
- significant complications depends on
weight loss from emotional and
- sweating tuberculosis. physical readiness
- fatigue and is achieved at
- body malaise an individual pace.
- shortness of
breath 2. Explain to
patient the early
(+) Cigarette Smoking signs and
symptoms of
Imaging tuberculosis
- X-ray which includes:
impression: Cough of two
Cavitary TB weeks or more,
Fever, Chest or
back pains not
Laboratories referable to any
- Increased Musculo-
White Blood skeletal
Cells and disorders,
Platelet hemoptysis,
- Decreased significant
Hemoglobin, weight loss and
Hematocrit, other symptoms
Red Blood Cells such as
sweating,
Direct Sputum Smear fatigue, body
Microscopy (DSSM) malaise, and
Result shortness of
breath.
Positive R: Early detection
- On the spot of signs and
specimen on symptoms would
Day 1 of testing mean early
- Early morning treatment and less
specimen on complication.
Day 2 of testing
- On the spot 3. Discuss to
specimen on patient the
Day 3 of testing infectious agent
and its mode of
transmission
which is
airborne droplet
method through
coughing,
singing or
sneezing.
R: Knowledge
about its mode of
lowers the risk of
getting the disease
as well as
transmitting to other
family members.
4. Encourage
patient to
undergo Direct
Sputum Smear
Microscopy
(DSSM).
R: This shall be the
primary diagnostic
tool in
Tuberculosis.
5. Emphasize to
patient that no
diagnosis shall
be made based
on the X-ray
examination
alone.
R: Diagnosis
should be first
started with DSSM.
6. Educate client
on how to
collect a sputum
sample for the
diagnostic test
which will be
performed for
straight 3 days.
R: Sputum that
does not include
saliva is the
appropriate sample
will yield the
accurate result.
7. Provide
instruction and
specific written
information for
patient to refer
to schedule for
medications and
follow-up
sputum testing
for documenting
response to
therapy.
R: Written
information relieves
patient of the
burden of having to
remember large
amounts of
information.
Repetition
strengthens
learning.
8. Emphasize the
importance of
maintaining
high-protein and
carbohydrate
diet and
adequate fluid
intake.
R: Meeting
metabolic needs
helps minimize
fatigue and
promote recovery.
Fluids aid in
liquefying or
expectorating
secretions.
9. Encourage to
increase clear
oral fluid intake.
R: To aid the
expulsion of
sputum.
10. Encourage
abstaining from
smoking.
R: Although
smoking does not
stimulate
recurrence of TB, it
does increase the
likelihood of
respiratory
dysfunction or
bronchitis.
Reference:
Cuevas, F. (2017). Public Health Nursing in the Philippines.
