45 year old Caucasian woman who is presented in the ER at 22:00. Her chief complaint is hemoptysis but is also complaining of fever, chest pains and night sweats. She notes that she hasn’t felt well for a few days but today she has had been having large amount of hemoptysis. Also says her husband has been tested for TB and tested positive but has never shown signs or symptoms. Both husband and wife are HIV positive confirmed 10 years ago, leading to the patient to be consided immunocompromised. She has no smoking history and drinks on occasion socially. She was told that he is a carrier. Upon admission patient is put on 2lpm via nasal cannula to maintain sats above 92% as ordered.
PHYSICAL EXAM
Patient appears to be in respiratory distress and complaining of chest pain. During percussion, patient had impaired resonance posteriorly in upper lobes, course crackles are also present in both upper lobes and in hilar regions during auscultation. Upon physical examination the trachea appears to be slightly deviated to the right, inspection of chest movement also revealed unequal chest movement. Patients temperature is 40 C, respiratory rate of 24, blood pressure 150/120, heart rate of 105. Skin appeared slightly cyanotic centrally around gums and lips. Pulse ox on 2L nasal canula was 85%. Patient continually produced a productive cough with blood throughout.
SOAP S: Patient is complaining of of shortness of breath, fever, chest pain, night sweats, and hemoptysis. Patient is also HIV positive.
O: Patient's breath sounds have course crackles in upper lobes with decreased resonance to percussion. Vitals on 2L nasal canula are: Temp 40 C, RR 24, BP 150/120, HR 80. Sputum test positive for M. tuberculosis. Mantoux skin test is positive. Chest X ray revealed infiltrates in apical posterior upper lobes with hilar lymph node enlargement. ABG results are pH 7.59, CO2 60, HCO3 24, PaO2 45. CBC results: WBC-14.2, RBC-4.7, Hb-15, Hct-38, MCV-80, MCH-30, MCHC %-33.
A: Tuberculosis with moderate hypoxemia. Pneumonia throughout right lung fields.
P: First 2 months daily: Isonizid, rifampin, pyrazinmide, ethambutol, then isoniazid and rifampicin alone for another 4 months. Patient must be monitored for compliance or DOT (directly observed treatment). Isolation is required and appropriate droplet procedures need to be taken to prevent the spread of M. tuberculosis.
Questions:
What is the name of the organism that causes Tuberculosis?
What are two places in the body where this organism grows best? Why does it grow well in these places?
What would an ABG result in a patient with end-stage Tuberculosis look like?
What are a few of the basic principles of Tuberculosis therapy?
Tuberculosis
Group Members:
- Chelsi Fielder - use red text
- Nichole Griffith- use blue text
- Brenna Emmons - use green text
TuberculosisAdmitting History:
45 year old Caucasian woman who is presented in the ER at 22:00. Her chief complaint is hemoptysis but is also complaining of fever, chest pains and night sweats. She notes that she hasn’t felt well for a few days but today she has had been having large amount of hemoptysis. Also says her husband has been tested for TB and tested positive but has never shown signs or symptoms. Both husband and wife are HIV positive confirmed 10 years ago, leading to the patient to be consided immunocompromised. She has no smoking history and drinks on occasion socially. She was told that he is a carrier. Upon admission patient is put on 2lpm via nasal cannula to maintain sats above 92% as ordered.
PHYSICAL EXAM
Patient appears to be in respiratory distress and complaining of chest pain. During percussion, patient had impaired resonance posteriorly in upper lobes, course crackles are also present in both upper lobes and in hilar regions during auscultation. Upon physical examination the trachea appears to be slightly deviated to the right, inspection of chest movement also revealed unequal chest movement. Patients temperature is 40 C, respiratory rate of 24, blood pressure 150/120, heart rate of 105. Skin appeared slightly cyanotic centrally around gums and lips. Pulse ox on 2L nasal canula was 85%. Patient continually produced a productive cough with blood throughout.SOAP
S: Patient is complaining of of shortness of breath, fever, chest pain, night sweats, and hemoptysis. Patient is also HIV positive.
O: Patient's breath sounds have course crackles in upper lobes with decreased resonance to percussion. Vitals on 2L nasal canula are: Temp 40 C, RR 24, BP 150/120, HR 80. Sputum test positive for M. tuberculosis. Mantoux skin test is positive. Chest X ray revealed infiltrates in apical posterior upper lobes with hilar lymph node enlargement. ABG results are pH 7.59, CO2 60, HCO3 24, PaO2 45. CBC results: WBC-14.2, RBC-4.7, Hb-15, Hct-38, MCV-80, MCH-30, MCHC %-33.
A: Tuberculosis with moderate hypoxemia. Pneumonia throughout right lung fields.
P: First 2 months daily: Isonizid, rifampin, pyrazinmide, ethambutol, then isoniazid and rifampicin alone for another 4 months. Patient must be monitored for compliance or DOT (directly observed treatment). Isolation is required and appropriate droplet procedures need to be taken to prevent the spread of M. tuberculosis.
Questions:
What is the name of the organism that causes Tuberculosis?
What are two places in the body where this organism grows best? Why does it grow well in these places?
What would an ABG result in a patient with end-stage Tuberculosis look like?
What are a few of the basic principles of Tuberculosis therapy?