Worksheet 1 A 63 years old male patient came at the Rural Health Unit for consultation.

His complaints of difficulty of breathing, dyspnea, persistent cough for 2 years, unexplained weight loss. He also complains of pains at the shoulder, chest and back. During the assessment he also verbalized to the RHU Nurse that occasionally when he cough out there is a blood streak in the sputum. He said that at present he can consume 3 packs of cigarette a day. The RHU Nurse auscultates the thoracic and back area of the patient. The RHU nurse found out upon auscultation he heard a wheezing sound over the lung field from an obstructed air flow. He also verbalized that hes father died having an untreated pulmonary tuberculosis because of having low socioeconomic status. 1. Identify what is the disease being manifested by the patient. (3 pts) Pulmonary tuberculosis. 2. What are the risk factors of developing such disease? (3 pts) According to Brunner and Suddarth Medical Surgical Nursing 8th edition, Page 534:

Risk factors of Pulmonary tuberculosis Close contact with someone who has active TB. Immunocompromised status (those with HIV infection, cancer, transplanted organs and prolonged high-dose corticosteroids therapy) Substance abuse (IV or injection drug users and alcoholics) Any person with adequate health care (the homeless; impoverished) Pre-existing medical conditions or special treatment Immigration from countries with a high prevalence of TB (Southeast Asia, Africa, Latin America, Caribbean) Institutionalization (long-term care facilities, psychiatric institutions, prisons) Living in overcrowded, substandard housing Being health care worker

Risk factors according to the situation +

3. Enumerate the clinical manifestations of the patient describe in the situation. (7 pts) Clinical manifestations of pulmonary tuberculosis as experienced by the patient: Difficulty of breathing Dyspnea

Persistent cough for 2 years Unexplained weight loss Pains at the shoulder, chest and back Coughed out with a blood streak in the sputum Wheezing sound over the lung field from an obstructed air flow upon auscultation

4. What are the possible diagnostic procedures that will be order to the patient? (4 pts) Tuberculin skin test (Mantoux test) Chest x-ray Acid-fast Bacillus smear Sputum culture

5. What are the possible surgical managements that will be performer to the patient? (2 pts) Thoracoscopy Thoracoplasty 6. What are the potential complications after thoracic surgery? (10 pts) Early Complications: Pneumonia Atelectasis Bronchopleural fistula Empyema Hemothorax Chylothorax Pulmonary edema Lobar torsion Cardiac hernia Gossypiboma Esophagopleural fistula Late Complications: Bronchopleural fistula Esophagopleural fistula Postpneumonectomy syndrome Chest wall arteriovenous fistula and Local tumor recurrence

7. What are the possible nursing diagnoses of the patient? (4 pts) Ineffective airway clearance related to copious tracheobronchial secretions Deficient knowledge about treatment regimen and preventive health measures and related individual management of the therapeutic regimen (noncompliance) 8. Draw a schematic presentation of the pathophysiology of the disease. (7 pts) Worksheet 2 (40 pts) Make a schematic diagram of the pathophysiology of DM type 2 and its treatment using the words and phrases below. Use arrow to connect each figures. Legend; use circles for clinical manifestations, rectangle for pathology, and diamond for treatment. Insulin injection, laser therapy, pancreatic transplantation, dialysis or kidney transplantation Diabetic neuropathy, small vessel disease, diabetic retinopathy, diabetic nephropathy, end stage renal failure, accelerated atherosclerosis, impaired immune function, increase osmolarity due to glucose, chronic elevations in blood glucose, failure to produce insulin, production of glucose from protein, and fat stores, wasting of lean body mass, production of excess glucagon, destruction of alpha and beta cells of the pancreas.