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TB ARHTRITIS
SECTION A4A1 SEPTEMBER 23, 2010

4
PATIENT‘S PROFILE
DEMOGRAPHIC HISTORY:
Patient’s Name: Boy XX

Age: 8 years old
Gender: Male
Address: San Miguel, Sto. Tomas Batangas
Date of Birth: October 20, 2001
Educational Grade 3
Attainment:
Religion: Born Again Christian
Nationality: Filipino
Dialect: Tagalog
Date of Admission: August 4, 2010
Chief Complaint: Painful and swollen left knee
Admitting T/c TB Arthritis on Left Knee ; R/o first degree
Diagnosis: bone tumor
Principal Diagnosis: TB Arthritis on Left Knee S/P Open Biopsy + RFS
+
Debridement + Arthrotomy
HEALTH HISTORY:
History of Present Illness
Four years prior to admission, patient was allegedly kicked by his uncle
on his left knee. Swelling and pain was noted on left knee. He has positive
history of manipulation. Two weeks after, due to persistence of pain, patient
was brought to a local hospital for x – ray and knee aspiration was done.
Prescriptions of medications were given but the parent was not able to give
the medication.
Two years prior to admission, they sought consult to Philippine
Orthopedic Center (POC) due to swollen and pain in the left knee.
Laboratory examination was done and was diagnose with TB arthritis. Knee
aspiration were performed, histopath only shows an inflammatory process
but negative for malignancy. Patient on that time was has no assistive device
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however as time pass by Boy XX suffers from difficulty on bending his left
knee.
Ten months prior to admission, patient was playing and accidentally
fell on the ground which resulted to breaking of the skin, pain felt by the
patient become worst. They seek consultation to POC, Incision and drainage
(I and D) was done due to an open and unhealing wound with pus.
Eight months prior to admission, patient was advice for hinged
Illizarov. Patient’s wound was treated with antibiotics and wound care.
Few weeks prior to admission, due to persistence of swelling, they
were advised for arthrotomy and debridement.
Past Medical and Surgical History

At the age of 2, Boy XX has been hospitalized due to pneumonia at the
Ospital ng Sampaloc. Fever, cough and colds are the common health
problems. He has no allergy to foods or drugs.
The patient was fully immunized child
Vaccine Minimum Age No. of doses Age received Interpretation
at 1st dose and analysis
BCG Birth or 1 After birth BCG was
anytime after given at
birth earliest
possible age
to protect the
possibility of
TB meningitis
and other TB
infectious in
which infants
are prone.
DPT 6 weeks 3 1 month and An early start
2 weeks of DPT
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reduces the
chance of
severe
pertussis
OPV 6 weeks 3 1 month and The extent of
2 weeks protection
against polio
is increase
the earlier
the OPV is
given
Hep B At birth 3 At birth An early start
of Hep B
reduces the
chance of the
child to be
infected and
become a
carrier. This
vaccine also
prevents liver
cirrhosis and
liver cancer.
Measles 9 months 1 9 months This vaccine
prevents
death,
malnutrition,
pneumonia
and diarrhea.
Family Health History
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Boy XX has no known family history of asthma, allergy to food and

medication, cancer and arthritis. On the other hand, there were history of
(+) Diabetes Mellitus (DM) and Hypertension– from maternal side and (+)
Pulmonary Tuberculosis – paternal side.
Social Health History

The patient is the eldest of the two siblings. His parents were
separated and the mother re-married. Boy XX is under the custody of his
mother and stepfather. In spite of this situation, Boy XX grows as a friendly
child and communicates well with others. Boy XX’s mother verbalizes, that
his child really loves to play and get along with his friends.
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GENOG
RAM Paternal Side
Virginia Efren Ilay unknown
Ilay
Bryan Vivian Junji 7
William Ilay Brenda “Andang

”
Herman
Benjamin Juno
Maternal side Ilay Ilay
Paternal side
Liver cirrhosis
Diabetes Mellitus type 2
Hypertension
Tuberculosis
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DEVELOPMENTAL MILESTONE
School- age Developmental milestones

Developmental Stage Focus Observation
Theory
A. SIGMUND LATENCY Task:

FREUD’S STAGE Sexuality • He was able to
PSYCHOSEXUAL (6 – 12 years repressed and have interest
(PSYCHOANALYTI old) focuses on in school work
CAL) relationship with such as
DEVELOPMENT peers of the writing,
same sex. reading, and
printing
• Sexual drive is numbers and
channeled into letters easily.
socially • Able to
appropriate articulate an
activities such understanding
as group of right and
activities, wrong.
sports, school
work and
socialization
with peers.
• Formation of
superego and
final stage of
psychosexual
development.
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B. ERIK ERIKSON’S Industry vs. I. Indicators of • Has eagerness

PSYCHOSOCIAL inferiority Positive to learn
THEORY Resolution socially
To achieve a productive
sense of self • Sense of skills and
confidence competence tools.
• He has a
• Completion of sense of
projects competence
even in his
• Pleasure in present
effort and condition
effectiveness • Demonstrate
concern for
• Ability to • Personal
cooperate and cleanliness
compromise and
appearance.
• Identification • Has ability to
with admired cooperate in
others limited
activities given
• Joy of to him
involvement in appropriate in
the world and his condition.
others • Able to enjoy

things that he
• Balance of is doing such
work and play as mingling

with other
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II. indicators of people and

Negative asking
Resolution questions
related to his
• feeling of curiosity.
unworthy and
inadequate
• poor work
history
• inadequate
problem-
solving skills
• manipulation
of others/
violation of
others’ rights
• lack of friends
of the same
sex
• overly high
achieving/
perfectionist
• reluctance to
try new things
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for fear of
failing
• feeling unable
to gain love or
attention
unless totally
successful.
C.PIAGET’S THEORY Concrete • Learning to • Cooperate
OF COGNITIVE Operation apply logical and share
DEVELOPMENT thinking information
about the acts
• Development that was
of previously
understanding performed.
of reversibility • Able to
and spatiality increased
socialization.
• Learning to • He can
differentiate classify
and classify objects.
(can solve • Can count
conservational numbers.
problems)
• Increased
socialization
and
application of
rules.
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• However,
thinking is still
concrete
(cannot solve
complex
verbal
problem).
D. KOHLBERG’S Conventional Stage 3
DEVELOPEMNT OF level Good- Boy- Nice • Strong desire
MORAL REASONING Girl orientation for acceptance
from other
• Seeks good people.
relation and • Showed good
approval of motives and
family group; concern for
Orientation to others.
interpersonal
relations of
mutuality
• Behavior
motivated by
expectations
of others;
strong desire
for approval
and
acceptance.
“I must follow
the rules so I
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will be
accepted”.
E. SULLIVAN’S Juvenile • Major task is • Able to formed

STAGES OF HEALTHY the circle of
INTERPERPSONAL formation of friends with
DEVELOPMENT satisfactory the same sex.
relationships • He was able to
within peer learn to
groups, negotiate to
which is his own needs.
achieved
with the use
of
competition,
cooperation
and
compromise.
• Learns to
accept
subordination
from authority
figures outside
the family.
• More concepts
of self- status
and role.
• Learns to
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negotiate own
needs.
• Severe anxiety
may result in a
need to
control in
restrictive,
prejudicial
attitude.
REVIEW OF SYSTEMS
System Findings Interpretation and

Analysis
General Patient is underweight, The patient general
Presentation with open wound, appearance varies with
swollen left knee lifestyle and present
condition of the client.
(Fundamentals of
Nursing by Kozier &
Erb’s 8th Editiion page
572.)
Hematologic Low hemoglobin level a decreased
hemoglobin increases
the risk of oxygen
deficit in the tissues
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(Fundamentals of
Nursing by Kozier and
Erb’s 8th Edition Volume
2 page 1414.)
Skin Boy XX has pale skin as Pallor is the result of
evident on his inadequate circulatory
laboratory of CBC dated blood and subsequent
August 4, 2010 showing reduction in tissue
that his hemoglobin oxygenation.
were 111 gm/L wherein (Fundamentals of
the normal is 127 – 183 Nursing by Kozier and
gm/L. Also he suffers Erb’s 8th Edition Volume
from non healing wound 1 page 576.)
on his left knee.
EENT EYES: The patient Pallor may reflect poor
conjunctiva is pale in arterial circulation due
color; Hbg: 111g/L( Aug to diminished
4, 2010) la result circulating blood
EARS: normal volume
NOSE: normal (Fundamentals of
THROAT: normal Nursing by Kozier 2004
edition page 554)
Cardiovascular No cardiovascular Normal

problem (Fundamentals of
Erb’s page 538 8th
edition volume 1.)
Respiratory No cough and sputum Breathing that is normal
in rate and depth is
called eupnea. Those
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that increase the rate

include stress (readies
the body for fight or
flight)
(Fundamentals of
Nursing by Kozier page
506 7th edition,page
1363 8th edition)
Gastro intestinal Normal Normally air and fluid
move through the
intestines creating soft
gurgling sounds.
(Fundamentals of
Nursing by Perry and
Potter page 743-745 6th
edition)
Genito Urinary Urine output of 6 to 8 Average daily urine
times a day output is to 800 – 1400
ml for 8-14 years of age
(Fundamentals of
edition volume 2)
Musculoskeletal Not able to perform Immobility of the
wide range of motion. patient with limited
range in motion in one
or more joints.
(Fundamentals of
edition volume 1)
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Endocrine Normal There are no

palpitations, intolerance
of heat or cold,
polyuria, polydipsia,
polyphagia, diaphoresis.
Neurological Patient is coherent in Assessment of mental
which he is aware of status reveals the
time, place and what is client’s general cerebral
happening around him function. Mental status
includes level of
consciousness
(Fundamentals of
edition volume 1)
Psychiatric Cooperative and does Normal
not manifest changes of
mood and tension
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PHYSICAL ASSESSMENT
DATE OF ASSESSMENT: August 27, 2010 1:00pm

General Survey:
Client is underweight, was conscious and coherent with Long Leg Cast
and mold on the left part of the leg and a muscle atrophy of the distal part of
the left leg was noted, sitting on the bed with IV line PNSS regulated to 22
gtts per min. His hair is well groomed and no body odor being noted during
assessment. Patient was not in distressed. He is cooperative and responds to
questions appropriately. He exhibits moderate lower tone of voice but
enough to understand during conversation assisted by his mother and he has
a proper thought association and has a sense of reality.
Vital Signs:
Vital Normal Actual Interpretation/Analysis
signs Findings
Blood 100/60 90/60 On the disease process any condition
pressure affects the cardiac output, blood
volume, blood viscosity has direct
effect on the bold pressure. The
patient was not in distress during the
assessment
(Kozier, B. (2004). Fundamentals of
Nursing p. 510).
Temperatu 36.5-37.5 36.0 Afebrile due to decrease of
re inflammation and infection and
because there is a maintenance or
compliance of medication.
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Inflammation is a local, nonspecific

defensive response of the tissues to an
injurious or infectious agent. It is an
adaptive mechanism that destroys or
dilutes the injurious agent, prevents
further spread of the injury, and
promotes the repair of damaged
tissue.
Nursing p. 634)
Pulse rate 55-90 78 Normal Range

Nursing p. 496).
Respiratory 12-25 18 Normal Range
rate (Kozier, B. (2004). Fundamentals of
Nursing p. 506).
4 ft
Height
Weight 23kg
BMI Normal 16 kg/m2 Clients height is not appropriate
18.5 – 24.9 with his weight which results to
kg/m2 the BMI of 16 kg/m2 which is below
the normal range.

Nursing p. 1236)
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• Skin
PART METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATIO
S N / ANALYSIS
Skin Inspectio Skin color varies Dark brown with The skin is dry and
n from light to deep dry skin in the flaky because
brown; from ruddy lower extremities. sebaceous and
pink to light pink, Pale in appearance. sweat glands are
from yellow Generally uniform less active. Dry
overtimes to olive. except in areas skin is more
Generally uniform exposed to sun; prominent over
except in areas areas of lighter the extremities.
exposed to sun; pigmentation ▪Pallor is the
areas of lighter (palms, lips nail result of
pigmentation (palms, beds) in dark skin inadequate
lips nail beds) in dark people. circulating blood.
skin people. Normal blood
Palpation circulation relies
on muscle activity.
No edema, With swelling and Immobility
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abrasions, lesion. lesion on the left impedes

Temperature is knee accompanied circulation and
uniform and w/in by purulent diminishes the
normal range discharge. supply of nutrients
Temperature is to specific area
uniform and within and the surgery as
normal range evidenced by the
drop in in
hematocrit from
the normal 0.37-
0.54 to 0.31 g/L
and hemoglobin
values from the
normal 127-183
g/L dropping to 97
g/L
• ( Fundament
als of Nursing
by Kozier,
pp.535,540,107
1)
Nails Inspectio Convex curvature; Convex, smooth in Patient’s nail beds
n angle of nail plat texture, pallor, are pale as
about 160o capillary refill on the evidenced by the
- with smooth hands. Nail bed drop in in
texture color is pale on the hematocrit from
- color is highly lower extremities. the normal 0.37-
vascular& pink in 0.54 to 0.31 g/L
light skinned clients; and hemoglobin
dark skinned clients values from the
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may have brown or normal 127-183

black pigmentation g/L dropping to 97
in longitudinal g/L
streaks
with intact epidermis Pallor may reflect
on tissue poor arterial
surroundings circulation due to
- blanch test- prompt diminished
return of pink or circulating blood
usual color 3-5 sec. volume.
Kozier, 2008 (Fundamentals of
Nursing by Kozier,
p542)
• Head
PARTS METHOD NORMAL ACTUAL INTERPRETATION /
FINDINGS FINDINGS ANALYSIS
Hair Inspection Evenly Hair is evenly The mother of the
Palpation distributed hair distributed to patients attend to his
over the scalp different parts of need during
with thickness, the body and it is hospitalization, it
variable thick. No infection results to good
amount of body or infestation hygiene, the condition
hair. No noted. of the patient limits his
infection or activities but despite
infestation. of that relatives are
there for him to assist
his needs.
Scalp Inspection White, clean, White, clean, free
Palpation free from from masses,
masses, lumps lumps scars, lice,
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scars, lice, nits, nits, dandruff, and

dandruff, and lesions no area of
lesions no area tenderness (Fundamental of
of tenderness Nursing by Kozier,
p541)
Skull Inspection Rounded( norm Round Normal findings
Palpation ocephalic & (normocephalic), according to
symmetrical, smooth skull Kozier page 544.
with frontal, contour.
parietal, Smooth, absence
occipital, of nodules or
prominences) masses.
smooth,
uniform,
absence of
modules or
masses
• Eyes
Eyebrow Inspection Symmetrically Hair evenly Normal findings.
s aligned. distributed skin With age, eyebrows
Equally intact and become bristly and
distributed, aligned. coarse.
curled slightly Symmetrically (Kozier, B. (2004).
outward aligned and Fundamentals of
equal Nursing p. 732).
movement.
Eyelash Inspection Equally Eyelashes are Normal findings.
es distributed, equally Eyelashes should be
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Curled slightly distributed. And curled outward to sweep

outward it is curled foreign particles away
outward. from the eyes.
(Kozier, B. (2004).
Fundamentals of
Nursing p. 1152
Eyelids Inspection The skin is Lids closes Normal findings
intact, no symmetrically, according to Kozier page
discharge and bilateral blinking 548.
no and no visible
discoloration. sclera above
The lids close corneas when
symmetrically lids are open
blinks
involuntary
and with
bilateral
blinking.
Sclera Inspection Shiny, smooth Pale conjunctiva Conjunctivae is pale in
and & pink or red as evidenced by the
Conjunct in color drop in in hematocrit
iva from the normal 0.37-
0.54 to 0.31 g/L and
hemoglobin values from
the normal 127-183 g/L
dropping to 97 g/L
Pallor may reflect poor

arterial circulation due
to diminished circulating
blood volume
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(Kozier, B. (2004).
Fundamentals of
Nursing p. 554).
Cornea Inspection transparent, Transparent Normal findings
shiny & shiny and (Kozier, B. (2004).
smooth, details smooth. Fundamentals of
of the iris are Nursing p. 554).
visible
Pupils Inspection Black in color, Iris brown in Normal findings.
and iris equal in size, color, equal in
normally 3-7 size and round Pupils equally reactive
mm in in shape. Iris is to light and
diameter, flat and round. accommodates
sound- smooth Pupil diameter is symmetrically.
border iris flat 4mm.
& sound. Pupils Patient’s pupils (Kozier, B. (2004).
constrict when constrict when Fundamentals of
looking at near looking at near Nursing p. 554).
object and objects and
dilate when dilate when
looking at far looking at far
objects. objects.
Extraocu Inspection Both eyes Within normal Normal findings.
lar coordinated, findings.
muscle move in unison (Kozier, B. (2004).
tests with parallel Fundamentals of
alignment. Nursing p. 554).
Visual Inspection Able to read The patient can Normal findings.
Acuity newsprint with read comics (Kozier, B. (2004).
20/20 vision on book as given to Fundamentals of
snellen chart. him for Nursing p. 554
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visualization
with 20/20
visual acuity on
both eyes.
• Ears
Auricles Inspection The color is The color is Normal Findings
same as facial same as facial
skin, skin,
symmetrical, symmetrical,
the auricles the auricles
aligned with aligned with
outer cantus of outer cantus of
Palpate the eye. the eye.
Mobile, firm Kozier, B (2004).
and not tender, Mobile, firm Fundamentals of Nursing
pinna recoils and not tender, pg. 596
after it is pinna recoils
folded. after it is
folded.
Ear Inspection Distal third Distal third Normal Findings
Canal contains hair contains hair
follicles and follicles and
glands. Dry glands. Dry
cerumen, cerumen,
grayish-tan grayish-tan
color or sticky, color or sticky, Kozier, B (2004).
wet cerumen in wet cerumen in Fundamentals of Nursing
various shades various shades pg. 596
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of brown. of brown.
Hearing Inspection Normal voice Normal voice Normal Findings
Acuity tones audible. tones audible.
Sound is heard Sound is heard
in both ears or in both ears or
localized at the localized at the
center of the center of the according to Kozier page
head (Weber head. 558
Negative).
Air conducted
hearing is
greater than
bone
conducted
hearing
(positive
Rinne)
• Nose
PARTS METHOD NORMAL ACTUAL ANALYSIS
FINDINGS FINDINGS
Nose Inspection Symmetric and Symmetric in Patient can breathe
straight shape. No normally through nose
No discharge discharge or and no discharges. He
in flaring flaring, uniform can also identify
Uniform in in color. (-) common odors like
color tenderness and alcohol and perfume.
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Not tender, no lesions.

lesion
Normal findings
according to Kozier
page 560-561
Facial Palpation No tenderness No tenderness Normal findings
Sinuses noted. according to Kozier
page 560-561
Septum Inspection Air moves Nasal septum Normal findings
freely as the intact and in according to Kozier
client breathes midline. page 560-561
through the
nares. Nasal
septum intact
& in midline
• Mouth
Lips Inspectio Uniform pink Pallor, dry in Patient’s lips is pale as
n color texture, evidenced by the drop in
Palpation Soft, moist, symmetry of in hematocrit from the
smooth contour and normal 0.37-0.54 to 0.31
texture ability to purse g/L and hemoglobin
Symmetry of lips. values from the normal
contour 127-183 g/L dropping to
Ability to 97 g/L
purse lips
arterial circulation due to
diminished circulating
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blood volume
(Fundamentals of
Nursing by Kozier, p542)
Buccal Inspectio Uniform pink Pallor, dry, Patient’s buccal mucosa
mucosa n color elastic texture. is pale as evidenced by
Soft, moist, the drop in in hematocrit
smooth from the normal 0.37-
texture 0.54 to 0.31 g/L and
hemoglobin values from
the normal 127-183 g/L
dropping to 97 g/L

arterial circulation due to
diminished circulating
blood volume
(Fundamentals of
Nursing by Kozier, p542)
Gums Inspectio Pink gums, Pinkish gums, no Gums are pinkish in
n moist, firm retraction, moist color.
texture to and firm. (Fundamentals of
gums. Nursing by Kozier, p542)
Tongue Inspectio Central Central position, Normal
n position pink in color, (Fundamentals of
Palpation Pink color, moist, moves Nursing by Kozier, p542)
moist, slightly freely, no
rough; then, lesions,
whitish tenderness and
coating nodules.
Smooth;
lateral
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margins; no
lesions
Raised
papillae
Moves freely,
no tenderness
Smooth
tongue base
with
prominent
veins.
Teeth Inspectio 24 pediatric Missing tooth, Normal Findings
n teeth with 22
smooth, smooth, yellow,
white, shiny shiny tooth
tooth enamel enamel (Fundamentals of
pink gums pink gums moist. Nursing by Kozier, p602)
moist.
Uvula Inspectio Soft, moist, Soft, moist, Normal Findings
n smooth smooth texture (Fundamentals of
texture Pink Pink and smooth. Nursing by Kozier, p602)
and smooth.
Tonsils Inspectio No discharge. No discharge. Normal Findings
n Tonsils of Tonsils of normal
normal size. size.
Pink and Pink and smooth (Fundamentals of
smooth posterior wall. Nursing by Kozier, p602)
posterior wall.
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• Neck
Neck Inspection Proportional Muscles equal in Patient has unlimited
to size of the size, head ROM.
head, centered, There are no palpable
symmetrical coordinated lymph nodes. Head can
and straight. smooth easily flex and rotates.
Freely movement, Trachea is in the central
movable head was placement and no
Palpation without flexed, indication of possible
difficulty. hyperextend, neck tumor nor thyroid
laterally flexes, enlargement
No palpable laterally rotates,
lumps or no noted Muscles in the neck like
tenderness palpable lymph sternocleidomastoid and
The trachea is nodes, trachea trapezius draw the head
in the Central in central to the side and elevate
placement in placement in the chin and elevate the
midline of midline of neck shoulders to shrug them.
neck, spaces spaces are
are equal on equal on both The trachea, thyroid
both sides. sides, thyroid gland, anterior cervical
gland moves nodes and carotid artery
with deglutition. lie within the anterior
triangle.
(Fundamentals of nursing
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by Kozier p566)
• Upper extremities
PARTS METHOD NORM AL ACTUAL INTERPRETATION /
Shoulder Inspection Able to Able to do ROM. Normal Findings
s Palpable tolerate wide
range of
motion. No
difficulty upon
bending and
stretching. .
No lesions, no
scars and no
deformity.
Arms and Inspection Able to Able to do ROM Both arms have equal
forearms Palpable tolerate wide exercises strength, patient can
range of without difficulty move arms against
motion. No in doing. gravity and against full
difficulty upon resistance.
bending and
stretching. No (Fundamentals of
lesions, no Nursing by Kozier p1068)
scars and no
deformity.
Elbows Inspection Able to Able to do ROM Normal findings
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Palpable tolerate wide exercises according to Kozier page

range of without difficulty 1061
motion. No in doing.
difficulty upon
bending and
stretching. .
No lesions, no
scars and no
deformity.
Wrist Inspection Able to Able to do ROM Normal findings
Palpable tolerate wide exercises according to Kozier page
range of without difficulty 1061
motion. No in doing.
difficulty upon
bending and
stretching. .
No lesions, no
scars and no
deformity.
Hands Inspection Able to Able to do ROM Normal findings
and Palpable tolerate wide exercises according to Kozier page
Fingers range of without difficulty 1061
motion. No in doing in the
difficulty upon left hand.
bending and
stretching. . With the
No lesions, no presence of IV
scars and no line in the right
deformity. hand it makes
difficult to
move.
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• Thorax
Chest Inspection Anteroposteri Anteroposterior Normal
size and or to to transverse
shape transverse chest (Fundamentals of
chest is symmetrical. nursing by Kozier p573)
symmetrical.
Breath Auscultatio Bronchovesicu Patient has a Normal.

sounds n lar breathe clear,
sound. bronchovesicula (Fundamentals of
r breath sound. nursing by Kozier p573)
Posterior Palpation Full and vocal nor tactile Normal findings

symmetric fremitus, according to Kozier page
chest Bronchovesicula 578-579
expansion. r breath sound.
Fremitus
tactile most
clearly at the
apex of the
lungs
Quiet,
rhythmic and
effortless
respiration.
Vesicular and
Percussion bronchovesicu Notes resonate,
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lar breath except over

sound. scapula, the
lowest point of
Notes resonance is at
resonate, the diaphragm
except over
scapula, the
lowest point of
resonance is
at the
diaphragm.
Anterior Inspection Quiet, Quiet rhythmic Normal findings
rhythmic and and effortless. according to Kozier page
effortless 578-579
Palpation respiration.
Full and
symmetric
chest
expansion.
Same as
posterior
vocal
fremitus,
fremitus is
Percussion normally
decreased
over heart and
breast tissue.
Notes
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resonate
down to the
6th rib at the
level of the
diaphragm but
are flat over
areas of
heavy muscle
and bone, dull
on areas the
heart and the
liver, and
tympanic over
the underlying
stomach.
• Breast
PARTS METHOD NORNAL ACTUAL ANALYSIS
FINDINGS FINDINGS
Breast Inspection No masses No masses and Normal findings
Palpation and lumps lumps (Kozier, 2008)
Areola Inspection Dark in color Dark in color in Normal Findings
Palpation in contrast to contrast to
surrounding surrounding skin.
skin. No No masses, lumps
masses, and lesions.
lumps and (Kozier, 2008)
lesions.
Nipples Inspection Size is Size is Normal findings.
Palpation proportional. proportional.
No
34
TB ARHTRITIS
4
discharged or (Kozier, 2008)

secretions.
• Abdomen
PARTS METHOD NORMAL FINDINGS ACTUAL INTERPRETATION
FINDINGS / ANALYSIS
Skin Inspection Unblemished skin, Unblemished Normal findings
integrity uniform in color. skin, uniform Kozier page 592-
in color 598
Contour Inspection Flat, rounded. Flat, Normal findings
and Symmetric contour. symmetric Kozier page 592-
symmetr contour. 598
y
Moveme Inspection Symmetric Symmetric Normal findings

nt movements caused movement Kozier page 592-
by respiration. caused by 598
respiration, no
visible
vascular
pattern.
Bowel Auscultati Audible bowel sounds Audible bowel Normal findings
sounds on sounds Kozier page 592-
598
Umbilicu Inspection Clean Clean Normal findings
s Kozier page 592-
598
Bladder Palpation Not palpable Not palpable Normal findings
Kozier page 592-
598
Liver Palpation May not be palpable. No Normal findings
Border feels smooth enlargement. Kozier page 592-
35
TB ARHTRITIS
4
Not palpable 598
• Genitalia
Patient refuses to be assessed but according to the patient he
was not circumcise yet.
• Lower Extremities
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATIO
FINDINGS N / ANALYSIS
Hip Inspection Able to Able to perform minimal
perform range of motion exercise (Fundamentals of
wide range no masses and Nursing by Kozier
of motion. deformities. p1068)
No masses,
scars and
deformity.
Leg Inspection Able to Dry Skin, Left leg was As a result of
Palpation perform swelling; a presence of invation of the
wide range lesion and purulent bacteria on the left
of motion. discharge joint, inflammation
No masses, Unable to perform wide occur resulting to
scars and range of motion such swelling in the left
deformity. flexion and extension. area, and
Muscle atrophy on the left immobility.
distal leg part. Client experience a
No masses, scars and significant
36
TB ARHTRITIS
4
deformity on the right leg. decrease in

muscular strength
and agility
whenever they do
not maintain a
moderate amount
of physical activity.
(Fundamentals of
Nursing by Kozier
pg. 495)
Knee Inspection Able to Unable to perform wide As a result of

Palpation perform range of motion, with dry invation of the
wide range skin, swelling, lesions and bacteria on the left
of motion. purulent discharge in the joint, inflammation
No masses, left knee and deformity occur resulting to
scars and related to his present swelling in the left
deformity. condition. area, and
immobility.
(Fundamentals of
Nursing by Kozier
pg. 497)
Foot Inspection Able to Comfortable to perform Normal
and Palpation perform wide range of motion. (Fundamentals of
toes wide range Nursing by Kozier,
of motion. No masses, scars and p496)
37
TB ARHTRITIS
4
No masses, deformity
scars and
deformity.
Periphe Palpation Symmetric Weak pulse on right and A weak pulse on
ral full left dorsalis pedis pulse left foot indicates
pulse pulsation reduced capillary
perfusion.
(by Kozier, p496)
Functional Level Classification:

0 – Completely Independent
1 – Requires use of equipment or device
2 – Requires help from another person or assistance, supervision or teaching.
3 – Requires help from another person and assistive device.
4 – Dependent does not activity in activity.
38
TB ARHTRITIS
4
ANATOMY AND PHYSIOLOGY
Anatomy and Physiology of the Knee

Bones and Joints
The knee is the meeting place of two
important bones in the leg, the femur (the
thighbone) and the tibia (the shinbone).
The patella (or kneecap, as it is commonly
called) is made of bone and sits in front of
the knee.
The knee joint is a synovial joint.
Synovial joints are enclosed by a ligament capsule and contain a fluid, called
synovial fluid, that lubricates the joint.
The end of the femur joins the top of
the tibia to create the knee joint. Two
round knobs called femoral condyles are
found on the end of the femur. These
condyles rest on the top surface of the
tibia. This surface is called the tibial
plateau. The outside half (farthest away
from the other knee) is called the lateral
tibial plateau, and the inside half (closest to
the other knee) is called the medial tibial
plateau. The patella glides through a
special groove formed by the two femoral condyles called the patellofemoral
groove.
39
TB ARHTRITIS
4
The smaller bone of the lower

leg, the fibula, never really enters the
knee joint. It does have a small joint
that connects it to the side of the
tibia. This joint normally
moves very little.
Articular cartilage is the

material that covers the ends of the
bones of any joint. This material is about one-quarter of an inch thick in most
large joints. It is white and shiny with a rubbery consistency. Articular
cartilage is a slippery substance that allows the surfaces to slide against one
another without damage to either surface. The function of articular cartilage
is to absorb shock and provide an extremely smooth surface to facilitate
motion. We have articular cartilage essentially everywhere that two bony
surfaces move against one another, or articulate. In the knee, articular
cartilage covers the ends of the femur, the top of the tibia, and the back of
the patella.
LIGAMENTS and TENDONS

Ligaments are tough bands of tissue that
connect the ends of bones together. Two
important ligaments are found on either side
of the knee joint. They are the medial
collateral ligament (MCL) and the lateral
collateral ligament (LCL). Inside the knee
joint, two other important ligaments stretch
between the femur and the tibia: the
anterior cruciate ligament (ACL) in front, and the posterior cruciate ligament
(PCL) in back. The MCL and LCL prevent the knee from moving too far in the
40
TB ARHTRITIS
4
side-to-side direction. The ACL and PCL control the front-to-back motion of
the knee joint.
The ACL keeps the tibia from sliding

too far forward in relation to the femur. The
PCL keeps the tibia from sliding too far
backward in relation to the femur. Working
together, the two cruciate ligaments control
the back-and-forth motion of the knee. The
ligaments, all
taken together, are the most important structures
controlling stability of the knee.
Two special types of ligaments called

menisci sit between the femur and the tibia. These
structures are sometimes referred to as the
cartilage of the knee, but the menisci differ from
the articular cartilage that covers the surface of the joint.
The two menisci of the knee are important for two reasons: (1) they
work like a gasket to spread the force from the weight of the body over a
larger area, and (2) they help the ligaments with stability of the knee.
Imagine the knee as a ball resting on a flat plate. The ball is the end of
the thighbone as it enters the joint, and the plate is the top of the shinbone.
The menisci actually wrap around the round end of the upper bone to fill the
space between it and the flat shinbone. The menisci act like a gasket,
helping to distribute the weight from the femur to the tibia.
41
TB ARHTRITIS
4
Without the menisci, any weight on

the femur will be concentrated to one
point on the tibia. But with the menisci,
weight is spread out across the tibial
surface. Weight distribution by the
menisci is important because it protects
the articular cartilage on the ends of the
bones from excessive forces. Without the
menisci, the concentration of force into a small area on the articular cartilage
can damage the surface, leading to degeneration over time.
In addition to protecting the

articular cartilage, the menisci help the
ligaments with stability of the knee. The
menisci make the knee joint more stable
by acting like a wedge set against the
bottom of a car tire. The menisci are
thicker around the outside, and this
thickness helps keep the round femur
from rolling on the flat tibia. The menisci
convert the tibial surface into a shallow
socket. A socket is more stable and more efficient at transmitting the weight
from the upper body than a round ball on a flat plate. The menisci enhance
the stability of the knee and protect the articular cartilage from excessive
concentration of force.
Taken all together, the ligaments of

the knee are the most important
structures that stabilize the joint.
42
TB ARHTRITIS
4
Remember, ligaments connect bones to bones. Without strong, tight

ligaments to connect the femur to the tibia, the knee joint would be too
loose. Unlike other joints in the body, the knee joint lacks a stable bony
configuration. The hip joint, for example, is a ball that sits inside a deep
socket. The ankle joint has a shape similar to a mortise and tenon, a way of
joining wood used by craftsmen for centuries.
Tendons are similar to ligaments,

except that tendons attach muscles to
bones. The largest tendon around the
knee is the patellar tendon. This tendon
connects the patella (kneecap) to the
tibia. This tendon covers the patella and
continues up the thigh.
There it is called the quadriceps tendon since it attaches to the

quadriceps muscles in the front of the thigh. The hamstring muscles on the
back of the leg also have tendons that attach in different places around the
knee joint. These tendons are sometimes used as tendon grafts to replace
torn ligaments in the knee.
Muscles
The extensor mechanism is the motor
that drives the knee joint and allows us to
walk. It sits in front of the knee joint and is
made up of the patella, the patellar tendon,
the quadriceps tendon, and the quadriceps
muscles. The four quadriceps muscles in front
43
TB ARHTRITIS
4
of the thigh are the muscles that attach to the quadriceps tendon. When
these muscles contract, they straighten the knee joint, such as when you get
up from a squatting position.
The way in which the kneecap fits into the patellofemoral groove on
the front of the femur and slides as the knee bends can affect the overall
function of the knee. The patella works like a fulcrum, increasing the force
exerted by the quadriceps muscles as the knee straightens. When the
quadriceps muscles contract, the knee straightens.
The hamstring muscles are the muscles in the back of the knee and
thigh. When these muscles contract, the knee bends.
Nerves
The most important nerve around the
knee is the popliteal nerve in the back of
the knee. This large nerve travels to the
lower leg and foot, supplying sensation and
muscle control. The nerve splits just above
the knee to form the tibial nerve and the
peroneal nerve. The tibial nerve continues
down the back of the leg while the peroneal
nerve travels around the outside of the
knee and down the front of the leg to the
foot. Both of these nerves can be damaged by injuries around the knee.
Blood Vessels
The major blood vessels around the knee travel with the popliteal
nerve down the back of the leg. The popliteal artery and popliteal vein are
the largest blood supply to the leg and foot. If the popliteal artery is
44
TB ARHTRITIS
4
damaged beyond repair, it is very likely the leg will not be able to survive.
The popliteal artery carries blood to the leg and foot. The popliteal vein
carries blood back to the heart.
BOOK BASED PATHOPHYSIOLOGY:

Exposure to Environmental factors:
High risk factors:
Mycobacterium
Tuberculosis High risk communities
• Old age
• Infants Low income

communities
• Children
Health care facilities
• Low socio-
economic status
• Drug addict
Mode of entry:
Droplet nuclei
Inhalation
Primary immune defense:
Vibrissae, Cilia and mucus
Bacteria enters the lung (alveoli)
(Usually on the upper lobes)
Secondary immune response:

Multiplication
Macrophages and Neutrophils
of bacteria
45
TB ARHTRITIS
4
Escape of
Non-specific Pneumonitis bacilli to the
(Lung Inflammation) bloodstream
and
lymphatic
Bacilli may become dormant for life
(After isolation and immune develops)

JOINTS
(Dorma
nt)
Areas are ankles,

hips, knees, spine
and wrist
Dormant bacilli becomes

active
Tuberculosis Arthritis
Symptoms:
Decreased movement in the

joints affected
Excessive sweating,
especially at night
Joint swelling w/ warm tender

joint
46
Low grade fever
Muscle atrophy and spasms
Loss of appetite
TB ARHTRITIS
4
Untreated Treatment
Complication:
Collapse of the vertebrae
Joint destruction
Treatment:
Spinal decompression
Pharmacologic
Inability to move the affected treatment
part.
Immobilization of
the affected part
surgical
intervention
Systemic complications
DEAT
H RECOVER
Y
47
TB ARHTRITIS
4
CLIENT BASED PATHOPHYSIOLOGY

:
High risk factors: Exposure to
Environmental factors:
• Low socio- MYCOBACTERIUM
economic status High risk community
TUBERCULOSIS
• Poor nutrition Low income community
• Exposure to M.
Mode of entry:
Inhalation of droplet
nuclei
(M. TB)
Primary immune defense:
Vibrissae, cilia and mucus
Immunosupresse
d
Bacteria enters lungs (Alveoli)
48
Multiplication
of bacteria
TB ARHTRITIS
4
Escape of
bacilli to the
bloodstream
and
lymphatic
LEFT
KNEE
(Dorma
nt)
Bacilli activated
(Bacilli activated by
INFLAMMATORY inflammation sustained from NEEDLE
RESPONES trauma and poor nutritional
status) BIOPSY
(Synovial fluid aspiration)
+ M. TB.
TUBERCULOSIS
ARTHRITIS
LOCAL AND SYSTEMIC Symptoms:
Decreased movement in the joints

affected
Joint swelling with warm tender

joint
Intermittent fever, pain and pus
Muscle atrophy (left calf)
Weight loss
49
Loss of appetite
TB ARHTRITIS
4
Pharmacologic treatment
(RIPES, Ranitidine, Nalbupine & paracetamol)
Immobilization of the part (long leg cast)
Incision and drainage
Debridement w/ NGT asepto drain
Recov
LABORATORY REPORTS ery
Diagnostic Procedures
HEMATOLOGY
Hematology is the branch of internal medicine, physiology, pathology,
clinical laboratory work, and pediatrics that is concerned with the study of
blood, the blood-forming organs, and blood diseases.
Laboratory Results:
Compone Norm Results Analysis Nursing
nts al Intervention
Rang
e
Augus Augus Augus Augus
t 4, t 14, t 22, t 27,
2010 2010 2010 2010
Hemoglo 127- 111 93 102 97 A Pretest:

bin mass 183 hemoglobi Explain the
g/L n test is purpose and
performed procedure and
to assess the
50
TB ARHTRITIS
4
determine medical history

the of the patient.
amount of Post test:
hemoglobi Interpret the
n in a test result and
person's monitor
red blood appropriately
cells for anemia or
(RBCs). polycythemia.
This is
important
because
the
amount of
oxygen
available
to tissues
depends
upon how
much
oxygen is
in the
RBCs, and
local
perfusion
of the
tissues. A
low
hemoglobi
n
51
TB ARHTRITIS
4
measurem
ent usually
means the
person has
anemia.
Anemia
results
from a
decrease
in the
number,
size, or
function of
RBCs.
Hematoc 0.37- 0.33 0.28 0.33 0.31 A decrease Pretest:Explain
rit 0.54 in the test procedure
number or and purposes.
size of red Post test:
cells also Interpret the
decreases test result and
the monitor
amount of appropriately
space they for anemia.
occupy,
resulting in
a lower
hematocrit
.
Decreased
hematocrit
52
TB ARHTRITIS
4
indicates
anemia,
such as
that
caused by
iron
deficiency
or other
deficiencie
s. Further
testing
may be
necessary
to
determine
the exact
cause of
the
anemia.
Leukocyt 4.5- 10.40 11.20 7.50 0.10 An Pretest:
e count 10 x elevated Explain test
109/L number of procedure and
white purposes.
blood cells Post test:
is called Interpret test
leukocytosi outcome and
s. This can monitor
result from appropriately.
bacterial
infections,
53
TB ARHTRITIS
4
inflammati
on,
leukemia,
trauma,
intense
exercise,
or stress. A
decreased
WBC count
is called
leukopenia
. It can
result from
many
different
situations,
such as
chemother
apy,
radiation
therapy, or
diseases of
the
immune
system.
Segment 0.50- 0.66 0.68 0.63 0.49 A decrease Pretest:
ers 0.70 in Explain test
neutrophils procedure and
is known purposes.
as Post test:
54
TB ARHTRITIS
4
neutropeni Interpret test

a. outcome and
Although monitor
most appropriately
bacterial for neurophilia
infections or neutropenia.
stimulate
an
increase in
neutrophils
, some
bacterial
infections
such as
typhoid
fever and
brucelosis
and many
viral
diseases,
including
hepatitis,
influenza,
rubella,
rubeola,
and
mumps,
decrease
the
neutrophil
55
TB ARHTRITIS
4
count.
Lymphoc 0.20- 0.30 0.19 0.26 0.40 Lymphope Pretest:
ytes 0.40 nia is also Explain test
seen in procedure and
acute purposes.
infections. Post test:
Of all Interpret test
hematopoi outcome and
etic cells monitor
lymphocyt appropriately
es are the for
most lymphocytosis
sensitive and
to whole- lymphopenia.
body
irradiation,
and their
count is
the first to
fall in
radiation
sickness.
Monocyt 0.00- 0.04 0.08 0.07 0.07 Increased Pretest:
monocyte
es 0.07 Explain test
counts are
procedure and
associated with
recovery from purposes.
an acute Post test:
infection, viral Interpret test
illness, outcome and
parasitic
monitor
infections,
appropriately
56
TB ARHTRITIS
4
collagen for leukemia

disease and
and infection.
some cancers
Eosinoph 0.00- 0.05 0.04 0.04 Normal Pretest:

ils 0.05 Explain test
procedure and
purposes.
Post test: Use
special
precautions if
patient is
receiving
steroid
therapy,
epinephrine,
thyroxine or
prostaglandins.
Platelet 150- 661 621 475 A high Pretest: 1.

count 400 x platelet Explain test
10^9/ count can procedure and
L be caused purposes.
by cancer, 2. Avoid
infections, strenuous
anemia, exercise
and before blood is
inflammato drawn.
ry diseases 3. Note
including what
57
TB ARHTRITIS
4
rheumatoi medications
d arthritis and what
and treatment the
inflammato patient is
ry bowel receiving.
disease. Post test:
Interpret test
outcome and
monitor
appropriately.
Observe for
signs and
symptoms of
GI bleeding,
hemolysis,
hematuria,
petechiae,
epistaxis and
bleeding of the
gums.
Prothrom 11-15 15.9 Prothrombi Pretest: 1.

bin time secon n time (PT) Explain test
ds is a blood procedure and
test that need for
measures frequent
how long it testing.
takes Emphasized
blood to the need for
58
TB ARHTRITIS
4
clot. An regular
abnormal monitoring
prothrombi through
n time is frequent blood
often testing if long
caused by term therapy is
liver prescribed.
disease or 2.
injury or by Caution
treatment against self
with blood medication.
thinners. Ascertain what
drugs the
patient has
been taking.
3.
Instruct the
patient never
to start or
discontinue
any drug
without the
doctor’s
permission.
4. Cousel
regarding diet.
Excessive
amounts of
green leafy
vegetables will
59
TB ARHTRITIS
4
increase
vitamin K
levels and
could intefere
with
anticoagulant
metabolism.
Post test:
1. Interpret
test outcome
and monitor
appropriately
with follow-up
testing and
observation.
2. Avoid
intramuscular
injections
during
anticoagulant
therapy
because
hematomas
may form at
the injection
site.
Activated 22-45 32.7 Normal Pretest:

PTT secon Explain test
60
TB ARHTRITIS
4
ds purpose,
procedure,
benefits and
risks.
Post test:
1. Interpret
test outcome
and monitor
appropriately.
2. Watch for
signs of
spontaneous
bleeding.
3. Alert the
patient to
watch for
bleeding gums,
hematuria and
excessive
bruising.
4. Avoid use of
aspirin.
Blood “B”
Type
RH Positive
typing (+)
CRP Reacti Reacti React React reactive Pretest:
ve ve ive ive CRP Explain test
showed procedure and
61
TB ARHTRITIS
4
leukocytosi purposes. A
s fasting sample
is preferred.
Water may be
taken.
Post test:
Interpret test
results,
counsel and
monitor
appropriately.
Semi- <6 6 48 24 12 Increased Pretest:

quantitat mg/L CRP is a Explain test
ive CRP very early procedure and
and purposes. A
sensitive fasting sample
response is preferred.
to most Water may be
microbial taken.
infections. Post test:
Its Interpret test
value was results,
evidently counsel and
shown in monitor
the rapid appropriately.
screening
or
detection
62
TB ARHTRITIS
4
of
concurrent
infection in
patients
at risk as a
marker for
post-
surgical
infection
and in
assessing
response
to
antibiotic
therapy.
MCV 82- 79 77 78 79 Mean Pretest:
92/L corpuscula Explain the
r volume purpose and
(MCV) is a procedure for
measurem testing and
ent of the assess of
average possible cause
size of of anemia. No
your RBCs. fasting is
When the required
MCV is Post test:
decreased, Interpret the
your RBCs test result and
are smaller monitor
than appropriately
63
TB ARHTRITIS
4
normal for anemia.

(microcytic Counsel
) as is seen appropriately
in iron for proper diet,
deficiency medications,
anemia or related
thalassemi hormone and
as. enzyme
problems and
genetically
linked
disorders.
MCH 28-32 25 25 24 25 Mean Pretest:

pg corpuscula Explain the
r purpose and
hemoglobi procedure for
n (MCH) is testing and
a assess of
calculation possible cause
of the of anemia. No
average fasting is
amount of required
oxygen- Post test:
carrying Interpret the
hemoglobi test result and
n inside a monitor
red blood appropriately
cell. for anemia.
Macrocytic Counsel
64
TB ARHTRITIS
4
RBCs are appropriately

large so for proper diet,
tend to medications,
have a related
higher hormone and
MCH, while enzyme
microcytic problems and
red cells genetically
would linked
have a disorders.
lower
value.
MCHC 32- 31 33 31 31 Mean Pretest:
38% corpuscula Explain the
r purpose and
hemoglobi procedure for
n testing and
concentrati assess of
on (MCHC) possible cause
is a of anemia. No
calculation fasting is
of the required
average Post test:
concentrati Interpret the
on of test result and
hemoglobi monitor
n inside a appropriately
red cell. for anemia.
Increased Counsel
MCHC appropriately
65
TB ARHTRITIS
4
values for proper diet,

(hyperchro medications,
mia) are related
seen in hormone and
conditions enzyme
where the problems and
hemoglobi genetically
n is linked
abnormally disorders.
concentrat
ed inside
the red
cells, such
as in burn
patients
and
hereditary
spherocyto
sis, a
relatively
rare
congenital
disorder.
Decreased
MCHC
values
(hypochro
mia) are
seen in
conditions
66
TB ARHTRITIS
4
where the
hemoglobi
n is
abnormally
diluted
inside the
red cells,
such as in
iron
deficiency
anemia
and in
thalassemi
a.
Clotting 5-15 8’00” Normal Pretest: 1.
time mins Explain test
procedure and
need for
frequent
testing.
Emphasized
the need for
regular
monitoring
through
frequent blood
testing if long
term therapy is
prescribed.
2.
67
TB ARHTRITIS
4
Caution
against self
medication.
Ascertain what
drugs the
patient has
been taking.
3.
Instruct the
patient never
to start or
discontinue
any drug
without the
doctor’s
permission.
4. Cousel
regarding diet.
Excessive
amounts of
green leafy
vegetables will
increase
vitamin K
levels and
could intefere
with
anticoagulant
metabolism.
Post test:
68
TB ARHTRITIS
4
1. Interpret
test outcome
and monitor
appropriately
with follow-up
testing and
observation.
2. Avoid
intramuscular
injections
during
anticoagulant
therapy
because
hematomas
may form at
the injection
site.
Bleeding 1-7 2’15” Normal Pretest:

time mins 1. Explain test
purpose and
procedure.
2. Instruct
patient to
abstain from
aspirin and
aspirin-like
drugs for at
least 7 days
69
TB ARHTRITIS
4
before the
test.
3. Inform the
patient that
scar tissue
may form at
the puncture
site.
Post test:
Interpret the
test result and
monitor
appropriately
for prolonged
bleeding.
CLINICAL CHEMISTRY
A procedure in which a sample of blood is examined to measure the

amounts of certain substances made in the body. An abnormal amount of a
substance can be a sign of disease in the organ or tissue that produces it.
Laboratory Normal Results Analysis Nursing

test Value Intervention
August August
9,2010 16,2010
SGOT <31.00 132.40 50.0 U/L Increase of Pretest:
U/L aspartate Explain the
aminotransf test purpose
70
TB ARHTRITIS
4
erase (AST, and blood

formerly drawing
called procedures.
"SGOT") is Post test:
seen in any Interpret the
condition test result
involving and monitor
necrosis of appropriatel
hepatocytes y for heart
, myocardial and liver
cells, or disease.
skeletal
muscle
cells.
SGPT <32.00 112.95 207.5 Increase of Pretest:
U/L U/L serum Explain the
alanine test purpose
aminotransf and blood
erase (ALT, drawing
formerly procedures.
called Post test: 1.
"SGPT") is Have patient
seen in any resume
condition normal
involving activities.
necrosis of 2.
hepatocytes Interpret test
, myocardial results and
cells, monitor as
erythrocyte appropriate
71
TB ARHTRITIS
4
s, or for liver
skeletal disease.
muscle cells
FECAL ANALYSIS
Examination of fecal matter for diagnostic purposes by chemical,
physical, or microscopic means; includes performing chemical screening
tests and screening for microorganisms or parasites.
08-12-2010 08-16-2010
PHYSICAL CHARACTERISTICS: PHYSICAL CHARACTERISTICS:
Color: Brown Color: Light Brown
Consistency: Well formed Consistency: Soft
MICROSCOPIC FINDINGS: CHEMICAL TEST:
Vegetable Cells: few Red Blood Cells: 0-1
RESULT: No ova nor parasite seen Pus Cells: 0-2
RESULT: No ova nor parasite seen
Nursing Intervention:
Pretest:
1. Explain purpose and procedure. Obtain history of diarrhea including
time and length of time. Instruct the patient to defecate into a clean,
dry bedpan or large-mouthed container.
72
TB ARHTRITIS
4
2. Do not allow patient to defecate into the toilet bowl or urinate into the
bedpan.
Post test: Interpret test outcomes, monitor for intestinal infection and
counsel appropriately about treatment and possible further testing.
BACTERIOLOGY SECTION
08-09-2010
Examination Desired:
 Culture and Sensitivity
 Gram’s Stain
 AFB
PRELIMINARY REPORT: RBC-++++ WBC-few. No microorganism seen. No
spore forming bacilli seen.
FINAL REPORT: No acid fast bacilli seen. No growth after 72 hours of
incubation.
HISTOPATHOLOGICAL REPORT
 kinds of Specimen: left knee joint aspirated
GROSS EXAMINATION: DATE: 05-14-
08
The specimen consists of four smears and few light brown friable tissue
fragments with an aggregate measurement of 0.4 x 0.2 x 0.1 cm. Block all. 1
block
MICROSCOPIC EXAMINATIONS: DATE: 05-15-08
Smear and cellblock show many neutrophils, few lymphocytes and
occasional macrophages against a background of red blood cells and pink
morphous material. There are no malignant cells nor granulomatous
formation seen in the specimen submitted.
HISTOPATHOLOGICAL DIAGNOSIS:
73
TB ARHTRITIS
4
Synovial fluid, Left Knee Arthrocentesis: Negative for malignant

cells
 Kind of specimen submitted: Left knee, patella and femoral condyles

GROSS EXAMINATION: DATE: 08-05-10
Submitted for rush frozen section are soft, doughty to firm irregular tan
tissue fragments with white cartilaginous flecks aggregately measuring
3x2x1 cm, four slides prepared, remnants processed routinely.
RUSH FROZEN SECTION DIAGNOSIS:
• Negative for malignancy
• Chronic casceating granulomatous inflammation
suggestive of tuberculosis
Subsequently submitted are multiple irregular pink to cream tan soft
tissue fragments with an aggregate measurement of 5x4x1.5 cm.
Representative sections taken.
MICROSCOPIC EXAMINATIONS: DATE: 08-

09-10
Microscopy done.
HISTOPATHOLOGICAL DIAGNOSIS:
OPEN BIOPSY WITH RUSH FROZEN SECTION, LEFT KNEE:
• Chronic casceating granulomatous inflammation
suggestive of tuberculosis.
74
TB ARHTRITIS
4
DRUG STUDY:
Pre – op Drug
Medicatio Classificat Action Indication Adverse Contra- Nursing
n ion Effects Indications: Consideration
s
Tetracain • Anest local  Spinal CV:  ContraIndicat Use with
e hetic, anesthetic anesthesi  Cardiac ed in patients caution in
Local , blocks a; arrest, Hypersensitivi  acutely ill
both the  local  hypotensio ty to patients;
initiation anesthesi n tetracaine,  debilitate
and a in the CNS: ester-type d
conductio eye for  Chills, anesthetics, patients;
n of nerve various  convulsion aminobenzoic  Elderly
impulses diagnosti s, acid, or any  patients
by c and component of with
 dizziness,
decreasin examinati the increased
 nervousnes
g the on formulation. intra-
s,
neuronal purposes abdomina
 unconsciou
membran  topically l
sness
e's applied to pressure;
GI:
permeabili nose and dose
 Nausea,
75
TB ARHTRITIS
4
ty to throat for  vomiting reduction

sodium diagnosti Ocular: may be
ions c  Blurred required.
procedur vision,
es  pupil
constrictio
n
Otic:
 Tinnitus
Respiratory:
 Respiratory
arrest
Medicatio Classificat Action Indication Adverse Effects Contra- Nursing

n ion Indications: Consideration
s
Bupivacai local block the For the CNS: contraindicated in • Motor
ne anaestheti generation production of  Mild patients with a activity,
c and the local or regional dizziness known usually in
conductio anesthesia or or hypersensitivity to it the lower
n of nerve analgesia for drowsiness or to any local half of the
76
TB ARHTRITIS
4
impulses, surgery RESPIRATORY anesthetic agent of body

presumabl  difficulty the amide-type or to following
y by breathing other components proper
increasing  tightness of Bupivacaine administratio
the in the n of caudal
threshold chest or lumbar
for SKIN epidural
electrical  Rash, anesthesia.
excitation  hives
in the
nerve
Post-op Drugs:
Antibiotic
Medicatio Classifica Action Indication Contraindica Adverse Effects Nursing

n tion tion Consideratio
n
Ceftazidin Third • Serio • Contraindic CNS: • Monitor
e generation us UTI ated in  Seizure patients for
cephalo and patients  Dizziness super
Dosage: sporin that lower hypersensi  Headache. infection
77
TB ARHTRITIS
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1 gm IV inhibits it cell respirato tive to this CV: • Ask patient

q12 wall ry tract drug.  phlebitis is he is
synthesis, infection • Use allergic to
promoting • Comp cautiously penicillin
osmotic licated in patients before
instability UTI hypersensi administrati
• Unco tive to on
mplicate penicillin
d UTI
Cefuroxim Antibiotic Inhibit cell • lower • Contraindic CV: • Before
e wall respirato ated in  phlebitis giving drug,
synthesis by ry tract patients  thrombophlebi ask patient
Dosage: promoting infection hypersensi tis. if he is
750 mg q8 osmotic • UTI, tive to GI: allergic to
IV instability; • Septicae drug or  pseudomembr penicillins or
usually mia other anous colitis cephalospor
bactericidal cephalospo  nausea and ins.
rins. vomiting, • Obtain
• Use  diarrhea. specimen
cautiously Hematologic: for culture
in patients  Transient and
hypersensi sensitivity
78
TB ARHTRITIS
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tive to neutropenia, tests before

penicillin  Eosinophilia giving first
because of  hemolytic dose.
possibility anemia, • Therapy
of cross-  thrombocytop may begin
sensitivity enia. while
with other awaiting
beta- results.
lactam • Absorption
antibiotics. of oral drug
Ranitidine H2- Competitivel • Activ • Contraindic CNS: • Assess
receptor y inhibits e ated in  Vertigo patient for
antagonist action of duodena patients  Malaise abdominal
Dosage: histamine on l and hypersensi  headache. pain.
25mg IV the H2 at gastric tive to EENT: • Note
q8 receptor ulcer drug. presence of
 blurred
sites of • Use blood in
vision.
parietal cells, cautiously emesis,
• Maint Hepatic:
decreasing in patients stool, or
enance  Jaundice.
gastric acid with gastric
therapy Other:
secretion. hepatic aspirate.
for  burning
dysfunctio • Drug may
79
TB ARHTRITIS
4
duodena n. and itching be added to

l or • Adjust at injection total
gastric dosage in site, parenteral
ulcer patients  anaphylaxi nutrition
with s, solutions.
impaired angioedema.
renal
function.
Anti - Koch’s
Rifampicin Anti- Inhibits DNA- Pulmonary • Contraindic CNS: • For best

tuberculosi dependent tuberculosi ated in  Headache. absorption,
Dosage: s RNA s, with patients  Drowsiness give
200mg polymerase, other hypersensi . capsules 1
once a day. which antitubercul tive to  Behavioura hour before
impairs RNA otics rifampin or l changes. or 2 hours
synthesis; related CV: after meals.
bactericidal. drugs.  Shock. • Monitor
• Use EENT: hepatic
cautiously  Visual function,
in patients disturbanc hematopoie
80
TB ARHTRITIS
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with liver es. tic studies,

disease. GI: and uric
 Anorexia. acid levels.
 Nausea • Watch for

and and report
vomiting. to
GU: prescriber
 Acute renal signs and
failure. symptoms
 Hematuria. of hepatic
Skin: impairment.
 Pruritus
 Urticaria
 Rash
Isoniazid Anti- May inhibit Pulmonary
Contra CNS: • Should be
Tubercular cell wall and extra indicated
 SEIZURE taken on an
in patients
Dosage: biosynthesis pulmonary  Toxic empty
with drug
7.5ml by TB induced encephalop stomach 1
once a interfering live hr before or
athy
disease
day with lipid EENT: 2 hr after
and DNA  Optic meals.
81
TB ARHTRITIS
4
synthesis neuritis • Assess CNS

bactercidal and often,
atrophy hepatic
GI: status, and
 Anorexia. visual
 Nausea disturbance
and s
vomiting • Have
HEMATOLOGY: pyridoxine
 Agranulocy on bedside
tosis to
 Aplastic compensate
anemia loss.
HEPATIC:
 Jaundice
 Hepatice
SKIN:
Irritation to
injection site.
Pyrazinam Anti- Has Pulmonary • Contraindic CNS: • Should be
ide Tuberculos bactericidal tuberculosi
ated in • Headache taken with
is s.
82
TB ARHTRITIS
4
action patients • Dizziness food

Dosage: against hypersensi CV: • Monitor liver
250mg/ tuberculosis tive to this • Shock function
5ml once in acid drug. EENT: tests
a day environment • Use • Visual • Monitor
present in cautiously disturbance serumuric
macrophage in patients GI: acid
s and with liver • Anorexia. concentratio
inflammed disease. ns during
• Nausea and
tissue. therapy
vomiting
GU:
• Acute renal
failure.
• Hematuria.
Skin:
• Pruritus
• Urticaria
Ethambut Anti- Suppresses Pulmonary • Contraindic CNS: • Drug should
ol tubercular the growth tuberculosi ated in  Headache be taken
s
of tubercule patients  Dizziness with food.
Dosage: bacili. younger RESPIRATORY: • Monitor
83
TB ARHTRITIS
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Tab than 13  Bloody renal and

200mg year. hepatic
sputum
once a
• Patients EENT: function,
day
hypersensi  Visual CBC and
tive to this disturbanc urinalysis
drug es. during the
GI: therapy
 Anorexia.
 Nausea
and
vomiting.
SKIN:
Toxic epidermal
necrosis
Analgesic and Antipyretic
Ibuprofen Nonopioid May inhibit • Rheumat • Contraindic CNS: • Check renal

analgesic; prostaglandi oid ated in  Headache and hepatic
Dosage: antipyretic; n synthesis, arthritis, patients  Dizziness function
250/5 7.5ml anti- to produce • Osteo- hypersensi  Nervousne periodically
q8 inflammato anti- arthritis tive to ss in patients
84
TB ARHTRITIS
4
ry inflammatory • Arthritis drug and in  aseptic on long-

, analgesic, • Fever those with meningitis. term therap
and • Juvenile angioedem CV: • Stop drug if
antipyretic arthritis a,  peripheral abnormalitie
effects. syndrome edema s occur and
of nasal  fluid notify
polyps, or retention prescriber.
bronchosp  edema. • It may mask
astic EENT: signs and
reaction to symptoms
 tinnitus.
aspirin or of infection.
GI:
other • It may take
 epigastric
NSAIDs. 1 or 2
distress
• Use weeks
 nausea
cautiously before full
 diarrhea
in patients anti-
 Constipatio
with GI inflammator
n
disorders, y effects
 abdominal
history of occur.
pain
peptic
GU:
ulcer
 acute renal
85
TB ARHTRITIS
4
disease. failure
 hematuria.
Hematologic:
 prolonged
bleeding
time
 aplastic
anemia,.
Metabolic:
 hypoglyce
mia,
 hyperkale
mia.
Respiratory:
 bronchospa
sm.
Skin:
 rash,
 Stevens-
Johnson
syndrome.
86
TB ARHTRITIS
4
Nalbuphin Narcotic Agonist of • Pain Contra CNS: • Assess

e Analgesic kappa opiate indicated
syndrom  drowsiness effectivenes
receptors in patient
causing e, hypersensi  headache, s and
Dosage: inhibition of • preparat tive to euphoria or interactions
5mg IV q6 ascending ion for nalbuphine of other
depression,
pain or any
the GI: medications
pathways. component
operatio of the  dry mouth patient may
n formulatio be taking
 nausea,
n
(preventi  vomiting, • Monitor
on), and therapeutic
RESPIRATORY:
aftercare effectivenes
 bronhospas
period; s and
m,
As a adverse
SKIN:
further reactions at
 sweating
means beginning of
 Pain at site
of therapy and
of
analgesi periodically
injection.
cs in throughout
general therapy.
anesthes • Monitor
ia. blood
87
TB ARHTRITIS
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pressure,
CNS and
respiratory
status, and
degree of
sedation at
beginning of
therapy and
at regular
intervals
during use.
Paracetam Anti- Thought

to Relief of  Contrai Hematologic: • Use liquid
ol pyretic ; produce mild to
ndicated in  Hemolytic form for
moderat
analgesic analgesia by patients anemia, children and
ely
Dosage: blocking pain severe hypersensi  neutropenia, patients
250 mg impulses by pain of tive to  leucopenia, who have
musculo-
orally inhibiting drug pancytopenia. difficulty
skeletal
every 6 synthesis origin, Hepatic: swallowing.
hours for prostaglandi e.g. • Advise
 Use  Jaundice
rheumati
temp of ns in the patient or
sm, cautiously Metabolic:
38C above CNS arthritis, caregiver
in patients  Hypoglyce
88
TB ARHTRITIS
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tendoniti with long mia that many

s. term Skin: over the
alcohol use  Rash counter
because  urticaria products
therapeuti contain
c doses acetaminop
cause hen; be
hepatotoxi aware of
city in this when
these calculating
patients. total daily
dose.
• Warn
patient that
high doses
or
unsupervise
d long term
use can
cause liver
damage
89
TB ARHTRITIS
4
Ketorolac Analgesics Inhibit • Short • contraindic CNS: • Assess

Anti prostaglandi term ated in  Dizziness patient’s
inflammato n synthesis manage- patients  drowsiness pain before
Dosage: ry ment of with a  headache and after
15mg q6 pain previously CV: drug
• Post- demonstra therapy
 edema
operativ ted • Be alert for
 HPN,
e hypersensi adverse
 palpitation
inflamm tivity to reactions
EENT:
a-tion ketorolac and drug
 corneal
• ketorolac interactions
edema
should be
 keratitis
avoided in
GI:
patients
 diarrhea,
with renal
GI:
dysfunctio
n  pain
 nausea
Supplemental
90
TB ARHTRITIS
4
Ferrous Hematinic Provide Iron Contraindicat GI: • GI upset

sulfate elementary deficienc ed in
 Constipatio may be
y patients
syrup iron, an n relatd to
with
essential hemosider  Epigastric dose
Dosage: component osis, pain • Drug may
primary to
5ml once in the  Diarrhea be give in
hemocrom
a day formation of atosis, and  Anorexia between
hemoglobin haemolytic meal.
 Nausea
anemia
 Black stool • Monitor
haemoglobi
Others;
n level
temporarily
stained teeth • Inform
from liquid form patient/guar

dian black
stool is
normal as
result of the
effect of
drug.
91
TB ARHTRITIS
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Lactulose Hyperosmo Produces • Constipa • Contra Gi : • Monitor

tic laxative osmtic effect tion indicated abdomennal frequency/c
Dosage: in colon , • To in patients cramp onsistency
3.35gm / resulting prevent on low Belching of stools
5ml give distention , and galactose , diarrhea, • diarrhea
15ml TID promotes treat diet flatulence. may
peristalsis hepatic Nausea and indicate
encephlo • Use vominting overdose
pathy courteousl • Monitor
y in closely for
patients fluid and
with electrolyte
diabetic loss with
mellitus chronic use.
92
TB ARHTRITIS
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STATEMENT OF NURSING DIAGNOSIS:
1.Chronic pain related to destruction of the

left knee articular joint cartilage secondary
to surgical interventions.
2. Ineffective tissue perfusion related to
decrease hemoglobin in the blood.
3. Impaired physical mobility r/t loss of
integrity of bone structures.
4.Impaired skin integrity related to
inflammatory response secondary to
infection.
5.Risk for falls r/t use of mobility devices
93
TB ARHTRITIS
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94
TB ARHTRITIS
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NURSING CARE PLAN

1. Chronic pain
Assessment NURSING INFERENCE GOALS NURSING RATIONALE EVALUATIO
DIAGNOSIS INTERVENTI N
ON
Cues: Chronic pain tissue Short Term: INDEPENDEN Short Term:
related to damage on T: • Provides
Subjective: destruction the articular After 2 hours • Assess necessary After 2 hours
“masakit po! of the left left knee of pain patient’s data for of pain
Umpisa sa knee articular management pain; optimal management
tuhod joint cartilage ,pain felt by intensity, pain the patient
hanggang secondary to release of the patient pattern, control verbalizes a
paa” as surgical biochemical has lessen and managem decrease in
verbalized by interventions mediators from level of duration ent the intensity
the patient. 7 (severe) to of pain from
3- severe (7) to
Pain Scale: travels to PN 4(moderate). • Establishe moderate
7/10 to SC (dorsal • Listen s rapport pain (4)
(0 – no pain horn) attentively and trust Long Term:
10 – worst Long Term: to patients for
pain) perception therapeuti After 2 weeks
95
TB ARHTRITIS
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spinothalami After 2 weeks of pain c of pain

c tract of pain and treatment management
Objective: management reaction to interventions
the pain verbalizes
• Immobiliz brain stem alleviation of that his pain
ation of and thalamus pain has • Assess • for has gone
the L knee gone down to patient baseline down to level
joint by a a level of wound data 0-1 (of no
long leg somatic comfort that appearanc necessary pain to just
mold sensory is acceptable e and long for pain an awareness
cortex to the patient leg mold control of pain).
• swollen which is 1. managem
and ent
unhealing • Instruct Patient
knee send signal patient to understand
down to SC elevate • Promote the rationale
• pallor head 30- lung for activity
45 expansion restrictions
• masking releases degrees and and
pain by substances affected verbalizes
facial part will effective

coping
96
TB ARHTRITIS
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grimace PAIN – sum be techniques

total of all • Neurov properly to pain
the complex ascular supplied
activities of checks by O2
the CNS distal to • if 5 ‘P’
the present
affected indicates
site S/Sx of
compartm
ent
syndrome
; cast is
• Active too tight
ROM on
the • increases
unaffected and
site. maintains
muscle
tone and
strength
• Instruct on the
97
TB ARHTRITIS
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to do toes upper
exercises extremitie
s
• Elevate
the left • to
lower stimulate
extremitie circulation
s no
higher • and
than heart promote
level venous
circulation
• Teach
patient for
alternate
pain • to release
managem anxiety
ent like and
guided participati
imagery, on to
distraction alleviate
98
TB ARHTRITIS
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strategy pain
• Use
diversiona
l
technique
s like • divert pain
playing and
psp, alleviates
coloring boredom
books and
drawing, anxiety
watching
television
• Teach
client to
do self • to relieve
care boredom ;
activities increasing
self worth,
and
99
TB ARHTRITIS
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maintainin
g control
• Educat
e the • participati
patient on of the
not to play patient in
with his self care
cast or activities
mold, be helps
vigilant alleviate
with the boredom
odor and and self
swelling worth
• Advise • to avoid
d mother complicati
to lessen ons and
strenuous further
activities reinjury
of the
patient ;
100
TB ARHTRITIS
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have rest
periods
longer
• help
• Educat diminish
e and give fear and
accurate helplessne
informatio ss to the
n to the family and
mother misconcep
about the tions
disease, about pain
medicatio
ns and
non-drug
pain
relieving • additional
technique knowledge
s relieves
mother of
• Instruct anxiety ;
101
TB ARHTRITIS
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the reduces
mother to pain and
good promotes
proper optimum
home recovery
care: give to the
medicatio patient
ns as
prescribed • maintain
, wound skin
and cast integrity
care, and helps
proper rebuild
hygiene. muscles
• Give and bones
nutritional
food
intake
(high in
protein)
and
102
TB ARHTRITIS
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vitamin
suppleme
nts
• antipyretic
Dependent: Analgesic
• 1.Admi Blocking
nister pain pain
medicatio impulses
ns as • prevent
prescribed infection,
: promotes
good
PARACETAMO hygiene
L and
250mg/ml comfort
7.5ml q6
• maintain
• 2.Assist skin
in integrity
cleaning and
103
TB ARHTRITIS
4
and relieve
changing discomfort
dressing
of the
affected
left knee
• 3.Assisted
in
applying
adhesive
tapes at
the edges
of the cast
2. Ineffective Tissue Perfusion
Assessment NURSING INFERENCE GOALS NURSING RATIONALE EVALUATIO
DIAGNOSIS INTERVENTI N
ON
Cues Ineffective Underlying Short term: Independen Short term:
tissue Disease t
Objectives: perfusion process After 6-8 1.changes in After 6 hours
related to ↓ hours of 1.Monitor vital signs of nursing
• With pale decrease Underweight nursing vital signs may indicate interventions
104
TB ARHTRITIS
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lips and hemoglobin ↓ interventions and record complication the client was
conjunctiv in the blood ↓ Hgb level the client will able to
a in the body be able to 2.These understand
↓ understand 2. Assess the characteristic ways on how
• Hgb level Ineffective ways on how circulation of s of pulses, he can
of 97g/L tissue he can the foot. skin color, improved his
perfusion improve his Check for the capillary refill present
• BP: 90/60 present peripheral time and condition
condition pulses, color temperature
• Disruption capillary refill indicates
of skin and impairment Long term
surface at Long term temperature in blood
the Left of fingers or circulation After 2 weeks
knee After 2 weeks toes of nursing
• BMI of nursing 3.iron is a intervention,
16kg/m2 intervention, carrier of the client’s

the client’s 3.Advise to oxygen tissue
tissue eat foods rich needed for perfusion was
• Delayed
perfusion will in iron such cellular partially
Wound
begin to as organ respiration normalized
Healing
normalize meats
legumes and
105
TB ARHTRITIS
4
green leafy
vegetables
4. feSO4 is
Dependent use to fortify
4.administer foods and to
feSO4 as treat iron
ordered deficiency
anemia.
106
TB ARHTRITIS
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3. Impaired Physical Mobility

ASSESSMEN NURSING INFERENCE GOALS NURSING RATIONALE EVALUATIO
T DIAGNOSIS INTERVENTI N
ON
Subjective: Impaired Disease After 30mins • Instruct • For The goals
“Nahihirapan physical process of nursing in use of position was met as
po akong mobility r/t interventions side rails, changes/ evidenced
kumilos” loss of Destruction the client overhead transfers by:
integrity of of left knee will: trapeze,
Objective: bone articular joint roller pads Client
With long leg structures cartilage perform performed
posterior active ROM • Suppor • To active ROM
mold Impaired such as t affected maintain such as
physical flexion and body position of flexion and
Cannot mobility extension of part/joints function extension of
perform ADLs the using and the
unaffected pillows/roll reduce unaffected
Functional extremities s, foot risk of extremities
level: 3 10x supports pressure 10x
(requires ulcers
help from demonstrate • Provide Client
another 2 techniques demonstrate
107
TB ARHTRITIS
4
person and that will regular • To d 2

equipment enable safe skin care promote techniques
device) repositioning to include skin that will
to prevent pressure integrity enable safe
pressure area repositioning
ulcers managem to prevent
ent pressure
ulcers
• Assist • To
or have prevent
the pressure
significant ulcers
other
reposition
client on a
regular
schedule
(every 2
hours)
• To
• Consult develop
108
TB ARHTRITIS
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with individual
physical/ exercise/
occupatio mobility
nal program
therapist, and
as identify
indicated appropriat
e mobility
devices
4. Impaired Skin Integrity

Assessme NURSING INFERENC GOALS and NURSING RATIONALE EVALUATION
nt DIAGNOSIS E Objectives INTERVENTION
109
TB ARHTRITIS
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CUES Impaired Underlying Short term Independent Short term

skin Disease
Subjective: integrity process After 6-8 1. Assess skin. 1.Established After 6 hours
related to ↓ hours of Noted color, comparative of nursing
“Malaki inflammator Affection of nursing turgor, and baseline intervention
ang sugat y response joints intervention sensation. providing the
ko sa secondary ↓ the Described and opportunity
tuhod” as to infection Swelling of measured for timely 1.Client’s
verbalized affected 1.Client’s wounds and intervention mother was
by the area mother will observed changes able to
patient ↓ be able to 2. Maintaining Performed
Disruption Perform 2.Demonstrate clean, dry proper wound
Objectives: of skin proper wound good skin skin provides care
surface at care hygiene, e.g., a barrier of
• With the left wash thoroughly infection. 2.Client was be
purulent knee 2.Client will and pat dry Patting skin able to
discharg ↓ be able to carefully dry instead of verbalized
e on the Underweig verbalize rubbing understanding
wound ht understandin reduces risk about his
site ↓ g about his of dermal current
Delayed current trauma to condition
wound condition fragile skin
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• Disrupti healing Long term

on of ↓ Long term 3.Emphasize 3.improved
skin Impaired importance of nutrition and After 2 weeks
surface skin After 2 weeks adequate hydration will of nursing
at the integrity of nursing nutrition and fluid improve skin intervention,
left intervention, intake condition the client was
knee the client will be able to
be able to 4.skin friction display timely
• Localize display timely caused cause wound healing
d wound 4.Instruct family by stiff or
erythem healing and the client to rough clothes
a maintain clean leads to
dry clothes, irritation of
• Joint preferably cotton fragile skin
swelling fabric and increases
• BMI risk for
16kg/m2 infection
5.Long and
5.Instructe family rough nails
to clip and file increase risk
nails regularly of damage
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6. performing
6. Emphasize the hand washing
importance of reduces the
hand washing risk for
techniques infection
Dependent
7. wound
7.Provide and dressings
applied wound protect the
dressings wound and
carefully the
surrounding
tissue
8. Demonstrate
and allow return 8.to know if
demonstration of the patient
wound care really
understand
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the principle
of proper
wound care
5. Risk for Falls

ASSESSMEN NURSING INFERENC GOALS NURSING RATIONALE EVALUATION
T DIAGNOSI E INTERVENTION
S
Objective: Risk for Disease After 1 hour • Review • To The goal was
falls r/t use process of nursing history of predict met as
Use of of mobility interventions prior falls current risk evidenced by
crutches and devices Destruction the client associated for falls
wheelchair of left knee will: with Patient
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articular immobility demonstrated

With long leg joint Demonstrate techniques to
posterior cartilage techniques • Instruct in • For protect self
mold to protect use of side position from falls
Impaired self from rails, changes/
Cannot physical falls overhead transfers Verbalized
perform ADLs mobility trapeze, and follow 2
Verbalize roller pads safety
Functional Risk for and follow 2 • To measures to
level: 3 falls safety • Stress the ensure that prevent falls
(requires measures to importance the client
help from prevent falls of monitoring understands Verbalized
another conditions/ris the purpose understandin
person and Verbalize ks that may for doing g of
equipment understandin contribute to these safety individual’s
device) g of occurrence of precautions. risk factors
individual’s falls. that
risk factors contribute to
that • Review • To possibility of
contribute to safety prevent falls fall and take
possibility of measures: steps to
fall and take correct
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steps to situations
correct 1.Locking
situations wheelchair
. before transfers
2. Clearing away
small rugs,
cords, or
anything else
that could cause
you to trip, slip,
or fall.
3.Ensuring that
the rubber tips
on your walking
aid are clean
and in good
condition to help
prevent slipping
4. Avoiding slick
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conditions, such
as wet floors
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MEDICAL AND SURGICAL MANAGEMENT
Synovial Biopsy
Synovium is an important target
of arthritis research. The synovium is
the primary site of inflammation and a
major effector organ in a variety of
joint diseases.
A synovial biopsy is the removal
of a piece of tissue lining a joint. The
tissue is called the synovial
membrane. With the local anesthetic, you will feel a prick and a burning
sensation. As the trocar is inserted, there will be some discomfort. Synovial
biopsy and analysis of synovial tissue can provide valuable insights into the
pathophysiological mechanism, disease status, treatment effect, and
prognosis of inflammatory joint diseases.It helps diagnose gout, bacterial
infections, or other infections, and may suggest the presence of
inflammatory conditions such as autoimmune disorders.
• Procedure:
Synovial tissue samples were obtained blindly under local
anaesthesia. Briefly, after sterile precautions, the suprapatellar pouch
was approached laterally and inflated with approximately 30 ml of
lidocaine 1% using a 21-gauge needle. Subsequently, when
withdrawing the needle from the joint cavity, the subcutaneous tissue
and skin overlying the suprapatellar pouch were thoroughly infiltrated
with lidocaine 1%. Next, a small incision was made into the skin and a
portal (diameter 4.5 mm; 28146 OT; Stöpler, Utrecht, The Netherlands)
was inserted into the suprapatellar pouch. Through this portal between
15 and 25 biopsies were taken from different parts of the suprapatellar
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pouch using a grasping forceps with scoop-tipped ends (Arthroforce III

take-apart 3.5 mm needle and 1.5 mm grasping forceps; Stöpler). After
this procedure the biopsy specimen was placed in paraformaldehyde
4% and processed for routine histology.
• Indications:
Synovial biopsy is performed in order to identify the ff:
 Coccidioidomycosis (a fungal infection)
 Fungal arthritis
 Gout (urate crystals that form in the joints)
 Hemochromatosis (abnormal accumulation of iron deposits)
 Tuberculosis
 Synovial cancer
• Contraindications:
Contraindications were unhealthy skin, non-cooperative patient,
and anticoagulant treatment.
• Risks:
There is a very slight chance of infection and bleeding. Rarely, there
is a chance of the needle striking a nerve or blood vessel.
• Nursing responsibilities prior to procedure:
 Explain the procedure to the patient and answer any questions
 Have the patient sign a consent
Joint X-RAY
This test is an x-ray of a knee, shoulder, hip, wrist, ankle, or other joint.
The x-ray is used to detect fractures, tumors, or degenerative conditions of
the joint. There is low radiation exposure. X-rays are monitored and
regulated to provide the smallest amount of radiation exposure needed to
produce the image. Most experts feel that the risk is low compared with the
benefits. Pregnant women and children are more sensitive to the risks of the
x-ray.
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• Indication
 Blunt trauma or fall type of injury
 Isolated patella tenderness
• Contraindication
 Not recommended for pregnant women
 Very little chance of developing cancer in the long term from the
radiation
• Benefits of x-ray
 It is painless, fast and easy
 No radiation is left in the body after X-ray is finished
Rush Frozen Section

The frozen section is a pathological laboratory procedure to perform
rapid microscopic analysis of a specimen. It is used most often in oncological
surgery. The technical name for this procedure is cryosection.The quality of
the slides produced by frozen section is of lower quality than formalin fixed,
wax embedded tissue processing. While diagnosis can be rendered in many
cases, fixed tissue processing is preferred in many conditions for more
accurate diagnosis.
Frozen sections are intraoperative consultations used to establish a
rapid histopathologic diagnosis of a pathologic process. Other indications for
this special consultation include assessment of surgical resection margins,
apportioning tissue for special studies, and harvesting fresh or snap-frozen
tissue for researchstudies.
• Procedures
Fresh, unfixed tissue is frozen to make it hard enough to cut thin
sections. A cryostat, a special microtome refrigerated to -20oC is
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then used to cut a frozen section, which is placed onto a glass slide,
stained, and cover-slipped for examination under the microscope.
• Indications
 Differentiate between benign and malignant
 Determine type of malignancy–eg, lymphoma v. carcinoma
 Evaluate tissue margins for involvement by malignancy, eg basal
cell carcinomas
 Determine adequacy of tissue for further studies after the Pt is
closed
 Determine type of tissue
• Benefits
 Immediate diagnosis while patient is undergoing surgery
 Immediate treatment
• Nursing responsibilities after the debridement
 Keep the wound and dressings clean and dry.
 Assist in giving the medications as prescribed be the physician.
 Assess for: any signs of infections, including fever and chills,
 Redness, swelling, increasing pain, excessive bleeding, or
discharge at the wound site
 Chalky white, blue, or black appearance to tissue around wound
Arthrotomy
The medical term “arthrotomy” means “cutting into a joint.” Also
known as a synosteotomy, an arthrotomy can be performed for a variety of
reasons, usually as part of a larger surgery which is intended to address a
problem inside the joint or an issue with one or more of the bones which
articulates at the joint. Procedures of this nature are usually performed by an
orthopedic surgeon, a surgeon who specializes in surgeries involving the
bones and joints.
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One reason to perform an arthrotomy is to gain access to the joint for

the purpose of a joint repair or replacement surgery. Cutting into the joint
may be necessary to access the surgical field and to make the interior of the
joint visible to the physician. However, it also increases healing time.
Historically, surgeons had to weigh the damage caused by an arthrotomy
with the need for the surgery when making treatment recommendations to
patients.
When arthrotomy is required as part of a medical procedure, the
surgeon uses specialized tools which have been designed for cutting quickly
and efficiently into the joints while minimizing damage. The surgeon plans
out the cuts ahead of time so that when the patient is on the table, the
surgeon already has a plan in mind for performing the surgery. Patients
should be aware that even “routine” surgeries can be accompanied with
complications, and a good surgeon will discuss the potential risks of a
procedure before it begins so that the patient will be prepared ahead of time.
• Procedures
 A cuff-like device that inflates may be used around your thigh to
help control bleeding during knee arthroscopy.
 The surgeon will make 2 or 3 small incisions (cuts) around your
knee. Saltwater (saline) will be pumped into your knee to open up
the space.
 A narrow tube with a tiny camera on the end will be inserted
through one of the incisions. The camera is attached to a video
monitor in the operating room. The surgeon looks at the monitor to
see the inside of your knee. In some operating rooms, the patient
can also watch the surgery on the monitor, if they want to.
 The surgeon will look around your knee for problems. The surgeon
may put other medical instruments inside your knee through the
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other small incisions. The surgeons will then repair or remove the
problem in your knee.
 At the end of your surgery, the saline will be drained from your
knee. The surgeon will close your incisions with stitches and cover
them with a dressing. Many surgeons take pictures of the procedure
from the video monitor so that afterward you can see what was
found and what was done.
• Indications
 A torn meniscus. Meniscus is cartilage that cushions the space
between the bones in the knee. Surgery is done to repair or
remove it.
 A torn or damaged anterior cruciate ligament (ACL) or posterior
cruciate ligament (PCL)
 Inflamed or damaged lining of the joint. This lining is called the
synovium.
 Misalignment of the kneecap (patella). Misalignment puts the
kneecap out of position.
 Small pieces of broken cartilage in the knee joint
 Removal of Baker's cyst -- a swelling behind the knee that is
filled with fluid. Sometimes this occurs when there is
inflammation (soreness and pain) from other causes, like
arthritis.
 Some fractures of the bones of the knee
Risks
 Bleeding
 Infection
 Injury to a blood vessel or nerve
 Infection in the knee joint
 Knee stiffness
• Benefits of Arthrotomy
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The advantage of arthroscopy over traditional open surgery is

that the joint does not have to be opened up fully. Instead, only two
small incisions are made - one for the arthroscope and one for the
surgical instruments. This reduces recovery time and may increase
the rate of surgical success due to less trauma to the connective
tissue. It is especially useful for professional athletes, who
frequently injure knee joints and require fast healing time. There is
also less scarring, because of the smaller incisions. Irrigation fluid is
used to distend the joint and make a surgical space. Sometimes this
fluid leaks into the surrounding soft tissue causing
extravasation and edema
• Nursing Responsibilities prior to procedure:
 NPO for 6-12 hours before the procedure
Debridement with NGT Asepto Drain

Debridement is the process of removing necrotic tissue or foreign
material from and around a wound to expose healthy tissDebridement is
used to clean dead and contaminated material from your wound to aid in
healing.
The procedure is most often done for the following reasons:
• To remove tissue contaminated by bacteria, foreign tissue, dead cells,
or crusting
• To create a neat wound edge to decrease scarring
• To aid in the healing of very severe burns or pressure sores
(decubitus ulcers)
• To get a sample of tissue for testing and diagnosis
• Procedures in performing diff. types of debridement:

 Surgical Debridement
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Surgical debridement is done using scalpels, forceps, scissors,

and other instruments. It is used if your wound is large, has deep
tissue damage, or if your wound is especially painful. It may also be
done if debriding your wound is urgent. The skin surrounding the
wound will be cleaned and disinfected. The wound will be probed with
a metal instrument to determine its depth and locate any foreign
matter. The doctor will cut away dead tissue. The wound will be
washed out to remove any free tissue. In some cases, transplanted
skin may be grafted into place. Sometimes, cutting away the entire
contaminated wound may be the most effective treatment.
 Chemical Debridement
A debriding medicine will be applied to your wound. The wound
will be covered with a dressing. The enzymes in the medicine will
dissolve the dead tissue in the wound.
 Mechanical Debridement
Mechanical debridement can involve a variety of methods to
remove dead or infected tissue. It may include using a whirlpool bath,
a syringe and catheter, or wet to dry dressings. Wet to dry dressing
starts by applying a wet dressing to your wound. As this dressing dries,
it absorbs wound material. The dressing is then remoistened and
removed. Some of the tissue comes with it.
 Autolytic Debridement
This form of debridement uses dressings that retain wound fluids
that assist your body's natural abilities to clean the wound. This type of
dressing is often used to treat pressure sores. This process takes more
time than other methods. It will not be used for wounds that are
infected or if quick treatment is needed. It is a good treatment if your
body cannot tolerate more forceful treatments.
• Possible Complications
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 Complications are rare, but no procedure is completely free of

risk. If you are having a debridement, your doctor will review a
list of possible complications which may include:
 Pain
 Bleeding
 Infection
 Delayed healing
 Removal of healthy tissue with mechanical debridement
 Factors that may increase the risk of complications include:
 Infection
 Pre-existing medical conditions
 Smoking
 Diabetes
 Use of steroid or other immunosuppressive medicines
 Poor nutrition
 Poor circulation
 Immune disorders
Incision and Drainage

Incision and drainage and clinical lancing are minor surgical procedures
to release pus or pressure built up under the skin, such as from an abscess,
boil, or infected paranasal sinus. It is performed by treating the area with an
antiseptic, such as iodine based solution, and then making a small incision to
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puncture the skin using a sterile instrument such as a sharp needle, a

pointed scalpel or a lancet. This allows the pus fluid to escape by draining
out through the incision.
• Procedure
a. Use universal precautions
b. Cleanse site over abscess with skin prep
c. Drape to create a sterile field
d. Infiltrate local anesthetic, allow 2-3 minutes for anesthetic to
take effect
e. Incise widely over abscess with the #11 blade, cutting through
the skin
f. Allow the pus to drain, using the gauzes to soak up drainage and
blood. Use culture swab to take culture of abscess contents,
swabbing inside the abscess cavity
g. Use the hemostat to gently explore the abscess cavity to break
up any loculations within the abscess
h. Using the packing strip, pack the abscess cavity
i. Place gauze dressing over wound, and tape in place
• Indications
 Abscess on the skin which is palpable
• Contraindications
 Extremely large abscesses which require extensive incision,
debridement, or irrigation (best done in OR)
 Deep abscesses in very sensitive areas (supralevator,
ischiorectal, perirectal) which require a general anesthetic to
obtain proper exposure
 Palmar space abscesses, or abscesses in the deep plantar spaces
 Abscesses in the nasolabial folds (may drain to sphenoid sinus,
causing a septic phlebitis)
• Complications
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 Insufficient anesthesia
 No drainage
 Drainage is sebaceous material
• Nursing responsibilities prior to Procedure:
 Obtain informed consent
 Inform the patient of potential severe complications and their
treatment
 Explain the steps of the procedure, including the not insignificant
pain associated with anesthetic infiltration
 Explain necessity for follow-up, including packing change or
removal
LIST OF MEDICATIONS:
August 5-10
Nalbupine 5mg IV q6 x 5days due at 10pm
Ketorolac 15mg q6 ANST (-) x 6 hrs
Ranitidine 25mg IV q8
Cefuroxime 750 mg q8 IV ANST (-) due at 10pm
Ibuprofen 250/5 7.5ml q8 x 7days
Paracetamol 250/5 7.5ml q6 for T> 38 C
Ethambutol 200/ paper; paper tab OD x 2 mos
INH 200/5mg syrup 7.5ml OD x 12 mos
PZA 200/5mg syrup 13.5 ml OD x 2mos
Rifampicin 200/5mg syrup 11.5 ml OD x 12 mos
Lactulose 3.35gm / 5ml give 15ml TID x 3days
August 11-22
Cefuroxime 750 mg / IV q8 ANST (-)
Ibuprofen 250/5 7.5 ml q8 x 7days
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Paracetamol 250/5 7.5 ml q8 T > 38 C

Ethambutol 200/ paper tab; paper tab OD x 2 mos
INH 200/ 5mg syrup 7.5 ml OD x 12 mos
Rifampicin 200/ 5mg syrup 11.5 ml OD x 12 mos
Ceftazidine 500 mg IV q5 ANST (-)
August 23 -29
Paracetamol 250mg/ml; 7.5ml q6 x T > 38 C
Ethambutol 200/paper tab; paper tab OD x 2 mos
Rifampicin 200 mg / 5ml syrup; 11.5 ml OD x 12mos
PZA 250 mg x 5ml; 13.5ml OD x 2 mos
Ceftazidine 1 gm IV q12 ANST (-)
FeSo4 syrup 5ml OD
August – September 2010

Ceftazidine 1 gm IV q12 ANST (-)
Ethambutol 200mg /paper tab; 1 paper tab OD x 12 mos
Rifampicin 200 mg / 5ml syrup; 11.5 ml OD x 12mos
PZA 250 mg x 5ml; 13.5ml OD x 2 mos
Paracetamol 250mg/ml; 7.5ml q6 x T > 38 C
FeSo4 syrup 5ml OD
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COURSE IN THE WARD
129
Doctor’s Order Rationale
08/04/10
 Pre Anesthetic Order TB ARHTRITIS Indicated for surgeries
4
For surgery
SECTION A4A1
tomorrow under SAB
SEPTEMBER 23, 2010 below the umbilicus, like
the lower extremities.
• Secure consent for anesthesia Protects clients from
having any surgical
procedure they do not
want or do not
understand. It also
protects the hospital and
the health personnel
from a claim by the client
or family that permission
was not granted.
• NPO post midnight Anesthetics depress
gastrointestinal
functioning and there
was a danger the client
would vomit and aspirate
during the procedure.
• Hook to D5 .3 NSS 500 cc via q18 IV D5.3NSS contains 5
cath x KVO due on NPO grams of Dextrose, 56
mEq of Sodium and 56
mEq of Chloride. Its
shorthand name would
be "D51/3NS". And it also
promotes a line for
intravenous medications.
• Secure Blood for possible Replacement in
anticipation of blood loss
during the surgery.
• Pre Meds: to OR
Prepare:
o Tetracaine A potent local
anesthesia.
o Bonivacaine Indicated for local
anesthesia including
130
nerve block anesthesia.
o Nalbuphine Used as a supplement to
balanced anesthesia, for
TB ARHTRITIS
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NURSING CARE MANAGEMENT

Nursing Interventions for Symptoms
Symptoms Interventions
Fever  Promote surface cooling by means of tepid
sponge bath.
 Increase fluid intake if the patient has no
restriction. Fluid can be in the form of water,
iced drinks, ice-blocks, jelly or juices.
 Take temperature readings every 4 to 6 hours.
Pulse, respirations and blood pressure should
also be monitored in high fever as these vital
signs may indicate complications.
 Administer or teach use of antibiotic as ordered
Loss of appetite  Offer frequent, small meals high in protein.
 Offer nutritional supplements to increase calorie
consumption and make up for deficient vitamins
and nutrients.
Swollen joint with  advise patient to take a complete rest
warm and  apply ice to the area
tenderness  keep the affected leg elevated
 Give anti-inflammatory medicine as ordered to
help relieve pain
Excessive sweating  advise fluid intake if not contraindicated
at night  Have patient take a cold bath or shower before
going to bed at night
 Keep well ventilated room and provide fan if
needed.
Decreased  Keep side rails up and bed in low position to
movement of the promote a safe environment.
joint  Turn and position the patient every 2 hours or as
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needed
 Clean, dry, and moisturize skin as needed.
 Apply splint to the affected limb and keep the
patient in a comfortable position
Nursing Intervention for Surgical Procedures

Prior to:
Open Biopsy, RFS, Arthrotomy And Debridement
 Explain all the treatment test, and procedure to the patient or a
member of his family.
 Ask the patient or mother if the patient has allergies to any
medications.
 Keep patient on NPO for at least eight hours before the procedure.
 Assess the vital signs of the patient prior to the procedure: this
includes taking your temperature, blood pressure, pulse, and
respirations rate.
 Instruct or assist patient to remove all clothing and jewelleries and don
a hospital gown.
 Provide the patient and his family with emotional support.
After the procedure

 Keep side rails up and bed in low position to promote a safe
environment.
 Monitor the affected area for swelling, pain and excessive bleeding and
take steps to control it.
 elevate affected limb
 apply ice or cold packs
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 Remove and change bandage as instructed or immediately it becomes

wet or bloody.
 wound should not come in contact with water, advise patient to always
keep the wound and bandage clean and dry
 Apply splint to the affected limb for immobilization and support of
knee.
 Emphasize on rehabilitation program for early ambulation, and
strengthening exercises, since this is important to maintain knee range
of motion, reduce scar tissue and strengthen weakened muscles.
 Administer antibiotic as ordered to help prevent infection.
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DISCHARGE PLANNING
MEDICATIONS
Compliance to anti-tuberculosis drugs helps to control the spread of
infection throughout the body.
 RIFAMPICIN(RIF)
 200/cap susp. 11.5 OD ml x 12 months PO
 Taken with food to prevent GI upset
 Cause hepatotoxicity(reddish orange urine)
 ISONIAZID(INH)
 200/cap susp. 11.5 OD ml x 12 months PO
 Causes peripheral neuropathy (characterized by numbness and
tingling sensation of hands and feet)
 Given with Pyridoxine (Vit. B6)
 PYRAZINAMIDE(PZA)
 250/5 13.5 ml OD x 2 months PO
 Causes hepatotoxicity and hyperuricemia
 Protect drug from light
 ETHAMBUTOL(EMB)
 200 mg/paper tab 1 paper tab OD x 2 months
 Causes optic neuritis characterized by blurring of vision.
 FERROUS SULFATE SYRUP

 5ml OD x 30 days PO
 Take with empty stomach for better absorption
 Use straw when taking medicine to prevent staining of teeth
 Can cause black stool
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EXERCISE
Maintaining joint mobility improve the overall functional status. An
appropriate program of exercise helps to decrease pain and improve
function.
o Active range of motion
 It is to encouraged because they prevent joint stiffness. If the
patient cannot actively exercise the joint, passive range of motion
should be performing.
o Assistive devices
 This is necessary for mobility. It should be properly fitted and the
patient should be instructed in their correct and safe use.
TREATMENT
The major goals for the treatment of patient include increased
knowledge about the disease and treatment regimen, adherence to the
medication, increased activity and absence of complications.
 Adherence to therapeutic Regimen

 Practicing proper hygiene
 Consuming a nutritious and adequate rest
 Participating in an appropriate level of activity
 Taking medications as prescribe
 Teach patient and family about infection control behavior (hand
washing)
 Emphasizes importance of completing the antibiotic regimen.
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HEALTH TEACHINGS
1. Maintain body hygiene
2. Advice the client to avoid extraneous activities like running, jumping
and high impact exercises. Choose the right activities-those that can
build your muscles around the joints and don’t damage them.
3. Remind the patient to take the medications as exactly as doctors
prescribe. Discuss with him the action, indication, dosage, frequency,
and the contraindications of the take home drugs.
4. If pain persists, tell the patient to have some rest the painful joints and
apply cold compress to relieve pain and hot compress to ease stiff and
achy joints and muscles.
5. Tell patient to avoid consuming all preserved meat, cheese, meat
stock, salad dressing, chocolate and candy because this kind of foods
aggravate the condition of the joints.
OUT PATIENT
Referral for home care is warranted for the patient who returns home
after TB arthritis. The family should be informing to watch out for subtle sign
of recurrent TB arthritis. Medical follow up should be discussed to the client
and the family to monitor patient’s condition.
DIET
The diet control is aimed at checking the build-up of bacteria and
toxins in the body of a patient with TB arthritis. Ideally, the diet of the patient
with such disease will not exceed 2000 calories. The best would be to
consume a fair amount of fruits, vegetables and proteins, minimizing the
intake of carbohydrates to the maximum extent possible. With a little care a
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4
right diet, the affected patient would be able to keep a tight check on his
condition.
1. Drinking juice extracted from green leafy vegetables like root beer or
carrot juice can eliminate deposits around joints.
2. Fruit juice is highly recommended food input especially pineapple
because it has a unique ingredient name bromelain, which directly
impacts the inflammation caused by arthritis. Fruits like melons,
bananas, citrus fruits, apricots and apples can also control arthritis.
3. Garlic, is a very effective anti-inflammatory agent, may incorporated
into the day-to-day diet either in raw or capsules. This can control the
inflammation and infection and it is also has some great analgesic
properties.
4. Intake of Vitamin C can decrease the inflammatory cell infiltration into
synovial fluid. Examples of Vitamin C food are citrus fruits,
strawberries, tomatoes, broccoli, sweet and white potatoes.
5. Vitamin D also helps in the prevention of bone loss and building bone
mass. Sources include fortified milk and fortified cereals.
PROGNOSIS
Prior to admission, the patient was carried by the mother and then
assisted to OPD through wheelchair. He was suffering from pain, swelling in
anterolateral left knee with open wound and presence of pus. The admitting
diagnosis was to consider TB Arthritis on the left knee. According to the
mother, the patient was weak and irritable. The following day after the
admission, open biopsy plus rush frozen section was performed and TB
Arthritis was then confirmed as the principal diagnosis. Surgical intervention
such as Arthrotomy and debridement was performed on the same day. Pain
relievers, anti-inflammatory and antibiotics were given for post operative
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medications. Cast and mold was put in his left knee. The patient was still
suffering from pain on the site of injury after the operation. The patient was
for close monitoring. After several days, the patient was merely active and
responds immediately. He can move his body from one side to another in
slow motion in a guarding behavior. There is a continuous contraption and
giving of medications for his faster recovery. After several days, the
prognosis was good. The lesion was starting to heal and pain was also
lessened.
EVALUATION
We met the objective we post at the beginning of this case
study. We gained knowledge about the related factor hinged in TB Arthritis,
through our clients we are able to apply the nursing intervention needed for
their situation. With this as our fundamental foundation, we can provide the
expected care management and health teaching for our clients with this kind
of condition. In addition to this the case study, it also identify and determine
the general problems and needs of the patient with TB Arthritis. The proper
evaluation concerning the nursing management of client has also been aptly
accomplished. This presentation was able to help the patient promote health
and medical understanding of such condition through the application of
nursing skills.
RECOMMENDATION
139
TB ARHTRITIS
4
Referral for physical therapy or to an exercise program may be

very helpful. A plan for daily exercise must be appropriate to the desired
activity of the patient; and for a time when pain is least severe, analgesic
must be given as prescribed. Adequate pain management is important for
the success of an exercise program. Also the family need to empathize with
the patient’s emotional reactions to the disease, and encourages
commitment to the treatment program, which is a key to positive outcomes.
Advice the family members to have X-ray since they are exposed to TB, as
advised by the doctor. Emphasize importance of taking the right diet (high
protein, high caloric).
For the Nursing student who will be assigned to Orthopedic Ward can
gain knowledge by reading this case study we prepared. This case
presentation is an appropriate tool that will meet the current information
needs of individuals, and guide to promote health. They must be first
equipped with the proper basic knowledge about the Anatomy and
Physiology of the system involved in this case TB Arthritis to be able to
determine the pathology of the case presented. This case presentation also
recommended to nursing students who have patients with TB Arthritis to use
this presentation as an instrument or a source of background knowledge
about the said problem. This case study will help them in achieving the said
basic knowledge.
140

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TB ARHTRITIS

SECTION A4A1 SEPTEMBER 23, 2010

Patient’s Name: Boy XX

Past Medical and Surgical History

Family Health History

Boy XX has no known family history of asthma, allergy to food and

Social Health History

Bryan Vivian Junji 7

William Ilay Brenda “Andang

Diabetes Mellitus type 2

School- age Developmental milestones

A. SIGMUND LATENCY Task:

B. ERIK ERIKSON’S Industry vs. I. Indicators of • Has eagerness

the world and his condition.

others • Able to enjoy

• Balance of is doing such

work and play as mingling

II. indicators of people and

E. SULLIVAN’S Juvenile • Major task is • Able to formed

System Findings Interpretation and

Cardiovascular No cardiovascular Normal

that increase the rate

Endocrine Normal There are no

DATE OF ASSESSMENT: August 27, 2010 1:00pm

Inflammation is a local, nonspecific

Pulse rate 55-90 78 Normal Range

(Kozier, B. (2004). Fundamentals of

abrasions, lesion. lesion on the left impedes

may have brown or normal 127-183

scars, lice, nits, nits, dandruff, and

Curled slightly distributed. And curled outward to sweep

Pallor may reflect poor

Not tender, no lesions.

Pallor may reflect poor

Palpable tolerate wide exercises according to Kozier page

Breath Auscultatio Bronchovesicu Patient has a Normal.

Posterior Palpation Full and vocal nor tactile Normal findings

lar breath except over

discharged or (Kozier, 2008)

Moveme Inspection Symmetric Symmetric Normal findings

Not palpable 598

deformity on the right leg. decrease in

Knee Inspection Able to Unable to perform wide As a result of

Functional Level Classification:

ANATOMY AND PHYSIOLOGY

Anatomy and Physiology of the Knee

The smaller bone of the lower

Articular cartilage is the

LIGAMENTS and TENDONS

The ACL keeps the tibia from sliding

Two special types of ligaments called

Without the menisci, any weight on

In addition to protecting the

Taken all together, the ligaments of

Remember, ligaments connect bones to bones. Without strong, tight

Tendons are similar to ligaments,

There it is called the quadriceps tendon since it attaches to the

BOOK BASED PATHOPHYSIOLOGY:

• Infants Low income

Primary immune defense:

Vibrissae, Cilia and mucus

Bacteria enters the lung (alveoli)