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case study on Tuberculosis
- 1. CASE PRESENTATIONCASE PRESENTATION BYBY S.SANDHOSHINIMEENAS.SANDHOSHINI MEENA
- 2. A 22 yearsold male patient was admitted in hospital withA 22 years old male patient was admitted in hospital with CHIEF COMPLAINTS :CHIEF COMPLAINTS : IntermittentIntermittent fever since one monthfever since one month Night sweatsNight sweats Weight lossWeight loss A productive cough since 1 weekA productive cough since 1 week Chest painChest pain HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS: Dyspnea, sputum production ,fatigue and weaknessDyspnea, sputum production ,fatigue and weakness
- 3. PAST MEDICAL HISTORY:PASTMEDICAL HISTORY: -Not a k/c/o asthma , COPD , HTN , DM-Not a k/c/o asthma , COPD , HTN , DM PAST MEDICATION HISTORY:PAST MEDICATION HISTORY: -NIL--NIL- PERSONAL HISTORY/SOCIAL HABITS:PERSONAL HISTORY/SOCIAL HABITS: -- smokersmoker - Takes mixed diet- Takes mixed diet - MarriedMarried - Not alcoholicNot alcoholic
- 4. PHYSICAL EXAMINATION:PHYSICAL EXAMINATION: -Patientis conscious and oriented-Patient is conscious and oriented -No pallor/icterus-No pallor/icterus -febrile-febrile ON EXAMINATION:ON EXAMINATION: PR:PR: 72 beats/min72 beats/min CVSCVS: S1&S2 sounds audible: S1&S2 sounds audible RR:RR: 20 breaths/min20 breaths/min RS:RS: Dullness to chest percussionDullness to chest percussion ,, Rales,Rales, Increased vocal fremitus .Increased vocal fremitus . TEMP:TEMP: 100°F100°F CNS:CNS: normalnormal BPBP : 120/80mmHg: 120/80mmHg PP/A:/A: soft, normal bowel soundssoft, normal bowel sounds areare audible.audible.
- 5. LAB INVESTIGATIONS:LAB INVESTIGATIONS: PARAMETERSPARAMETERSOBSERVED VALUESOBSERVED VALUES NORAML VALUESNORAML VALUES CBCCBC HbHb 16g/dl16g/dl 14-18 g/dl14-18 g/dl PlateletPlatelet 1,53,000 per1,53,000 per µ/lµ/l 1,50,000-4,00,000 per1,50,000-4,00,000 per µ/lµ/l ESRESR 12 mm/hr12 mm/hr 0-20mm/hr0-20mm/hr RBCRBC 5.5 million cells/mcL5.5 million cells/mcL 4.32-5.72million4.32-5.72million cells/mcLcells/mcL BLOOD SUGARBLOOD SUGAR FBSFBS 85 mg/dl85 mg/dl 70-115 mg/dl70-115 mg/dl
- 6. DIFFERENTIALDIFFERENTIAL COUNT (DC)COUNT (DC) NeutrophilNeutrophil76% ↑76% ↑ 57-67%57-67% lymphocyteslymphocytes 45% ↑45% ↑ 23-33%23-33% esinophilsesinophils 9% ↑9% ↑ 1-6%1-6% monocytesmonocytes 10% ↑10% ↑ 3-7%3-7% basophilbasophil 11% ↑11% ↑ 0-7%0-7% TOTALTOTAL LEUKOCYTELEUKOCYTE COUNT (TLC)COUNT (TLC) 11,200cells/mcL ↑11,200cells/mcL ↑ 3,500-3,500- 10,500cells/mcL10,500cells/mcL
- 7. OTHER TESTS:-OTHER TESTS:- -Chest radiographChest radiograph - Tuberculin skin testTuberculin skin test - Sputum smearSputum smear IMPERSSION:-IMPERSSION:- -- chest radiograph – patchy or nodular infiltrates in the apicalchest radiograph – patchy or nodular infiltrates in the apical area of the upper lobe of left lungarea of the upper lobe of left lung - Tuberculin skin test- positiveTuberculin skin test- positive - Sputum smear –positive (Mycobacteruim tuberculosis is seen)Sputum smear –positive (Mycobacteruim tuberculosis is seen) DIAGNOSIS:-DIAGNOSIS:- PulmonaryPulmonary TuberculosisTuberculosis
- 8. SlSl DRUGDRUG DOSEDOSERORO AA FREFRE QQ DURATIONDURATION 1.1. T. IsoniazidT. Isoniazid 300mg300mg oraloral odod 2.2. C. RifampinC. Rifampin 450mg450mg oraloral odod 3.3. T. PyrazinamideT. Pyrazinamide 750mg750mg oraloral odod 4.4. T. PyridoxineT. Pyridoxine 25mg25mg oraloral odod 5.5. T. EthambutolT. Ethambutol 800mg800mg oraloral odod
- 9. DISCHARGE ADVICE :-DISCHARGEADVICE :- SISI NN OO BRANDBRAND NAMENAME GENERICGENERIC NAMENAME DOSEDOSE RORO AA FREFRE QQ DURATIONDURATION 1.1. AKT-4AKT-4 C.RifampinC.Rifampin T. PyrazinamideT. Pyrazinamide T. EthambutolT. Ethambutol T. IsoniazidT. Isoniazid 450mg450mg 750mg750mg 800mg800mg 300mg300mg P/OP/O OdOd OdOd OdOd First 3First 3 monthsmonths 2.2. AKT-3AKT-3 C.RifampinC.Rifampin T. EthambutolT. Ethambutol T. IsoniazidT. Isoniazid 450mg450mg 800mg800mg 300mg300mg P/OP/O OdOd OdOd OdOd OdOd Next 3Next 3 monthsmonths
- 10. SOAP NOTES:-SOAP NOTES:- SUBJECTIVE:SUBJECTIVE:A 22 year old male patient was admitted inA 22 year old male patient was admitted in hospital with c/ohospital with c/o Difficulty in breathing , night sweats, ChestDifficulty in breathing , night sweats, Chest pain, fever, weight loss, productive cough.pain, fever, weight loss, productive cough. OBJECTIVE:OBJECTIVE: upon examinations ,it was noted that patient hasupon examinations ,it was noted that patient has increased white blood cell count with a lymphocyteincreased white blood cell count with a lymphocyte predominance.predominance. ASSESSMENT:ASSESSMENT: chest radiograph, tuberculin skin test, sputumchest radiograph, tuberculin skin test, sputum smear are taken for further investigations and it shows that thesmear are taken for further investigations and it shows that the patient has pulmonary tuberculosis.patient has pulmonary tuberculosis. PLAN OF TREATMENT:PLAN OF TREATMENT: C. rifampinC. rifampin ,, T. isoniazid,T. isoniazid, T. ethambutol, T.pyrazinamide are given for 6 months dosageT. ethambutol, T.pyrazinamide are given for 6 months dosage regimen to treat pulmonary tuberculosisregimen to treat pulmonary tuberculosis
- 11. PATIENT COUNSELLINGPATIENT COUNSELLING •To take anti-tuberculosis drug regularly.To take anti-tuberculosis drug regularly. • Advice to cover the mouth while coughing or sneezing.Advice to cover the mouth while coughing or sneezing. • Patients on rifampin is adviced to contact doctor if theyPatients on rifampin is adviced to contact doctor if they notice unusual bleeding or bruising.notice unusual bleeding or bruising. • Information is told that their urine, saliva, sweat, tears, andInformation is told that their urine, saliva, sweat, tears, and faeces may turn a red-orange colour due to rifampin.faeces may turn a red-orange colour due to rifampin.
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