P.O BOX: 875, BAMENDA. MOTTO: HOPE IS THE KEY SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARDS OF HIGHER NATIONAL DIPLOMA (HND) IN NURSING April 2018 A CASE STUDY REPORT ON TUBERCULOSIS IN AN HIV POSITIVE CARRIED OUT DURING AN INTERNSHIP AT THE MBENGWI DISTRICT HOSPITAL FROM 8 DECEMBER 2017 TO 8 JANUARY 2018 SUPERVISED BY: Dr Mfonfu Daniel PRESENTED BY: TUNGA HILDA ANNE REPUBLIQUE DU CAMEROUN --------------------------- PAIX-TRAVAIL-PATTIE ---------------------------------- MINISTERE DE L’ENSEIGNEMENT SUPERIEUR ---------------------------- DIRECTION DE L’ENSEIGNEMENT SUPERIEUR PRIVE --------------------------------------- REPUBLIC OF CAMEROON ----------------------------- PEACE-WORK-FATHERLAND ------------------------------------- MINISTRY OF HIGHER EDUCATION --------------------------------- DEPARTMENT OF PRIVATE EDUCATION -----------------------------------
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P.O BOX: 875, BAMENDA.
MOTTO: HOPE IS THE KEY
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE AWARDS OF HIGHER NATIONAL DIPLOMA (HND) IN
NURSING
April 2018
A CASE STUDY REPORT ON TUBERCULOSIS IN AN HIV POSITIVE CARRIED OUT DURING AN INTERNSHIP AT THE MBENGWI DISTRICT HOSPITAL FROM 8 DECEMBER 2017
TO 8 JANUARY 2018
SUPERVISED BY:
Dr Mfonfu Daniel
PRESENTED BY:
TUNGA HILDA ANNE
REPUBLIQUE DU CAMEROUN --------------------------- PAIX-TRAVAIL-PATTIE ---------------------------------- MINISTERE DE L’ENSEIGNEMENT SUPERIEUR ---------------------------- DIRECTION DE L’ENSEIGNEMENT SUPERIEUR PRIVE ---------------------------------------
REPUBLIC OF CAMEROON ----------------------------- PEACE-WORK-FATHERLAND ------------------------------------- MINISTRY OF HIGHER EDUCATION --------------------------------- DEPARTMENT OF PRIVATE EDUCATION -----------------------------------
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CERTIFICATION
This is to certify that, this report was written and presented by Tunga Hilda
Anne of the department of Nursing at Capitol Higher Institute of Health
Sciences and Beauty Therapies Bamenda as a partial fulfillment of the
requirement for the award of a Higher National Diploma (HND).
The HIV virus itself doesn‟t kill. It weakens the immune system by destroying
CD4 cells, which usually defend against infection. Most people will remain
healthy for many years after contracting HIV. Only after around five to ten
years, when the virus has severely damaged the immune system, do people
progress to the next stage – AIDS.
AIDS is diagnosed when a defined set of clinical conditions are found in a
person infected with HIV. These conditions are mostly infections that occur
because the immune system is unable to fight them – so called „opportunistic
infections‟. TB is one of the most common „opportunistic infections‟ in people
with HIV.
Tuberculosis is an infectious and contagious disease caused by a microorganism
called mycobacterium tuberculosis or Kock‟s bacilli. It is one of the most killer
diseases because of the advent of HIV /AIDs. HIV infection increases the
prevalence rate of tuberculosis.
1.2 Motivation
I was motivated by the fact that the case was a roaming patient moving from
hospital to hospital without the diagnosis of tuberculosis in HIV. He came from specialised hospitals in Yaoundé to a district hospital in Mbengwi where he was diagnosed of pulmonary tuberculosis.
General objective (goal):
Successfully manage the case of Tuberculosis in an HIV adult as a member of
the medical and nursing team; and to submit the report of this case study in
partial fulfilment to obtain the HND in nursing.
.
1.3 Specific objectives
a) Identify the patient
b) Describe the circumstances of arrival of the patient
c) Admit the patient
d) State the provisional diagnosis on admission, state source
e) Administer any emergency medications
f) Clerk/Assess the patient
g) Administer the medications prescribed by the medical officer, monitor
and record side effects on the patient
h) Establish daily drug chart
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i) State results of confirmatory diagnostic tests
j) Develop and implement nursing care plans
k) Describe the evolution of the patient and vital signs
l) Revue the medications administered
m) Write the discharge summary
n) Identify positive findings, weaknesses; make recommendations; make
conclusions
1.5. Presentation of the Mbengwi District
The MDH is a reference hospital of Mbengwi health district; it is located some
20km South of Bamenda town and belongs to the Mbengwi Urban Area. It is
made up of 6 buildings with 30personnel and 45beds. Its average daily
consultation at the outpatient is 20patients. The staffing of the hospital is
distributed as follows;
Table 1: Table showing the staffing of the MDH
Staff Number
CMO 01
Medical doctors 01
General supervisor 01
Laboratory staff 04
Ward nurses 05
Maternity 06
1.6. Description of the TB unit of MDH
The TB unit of MDH is a small building located at the old stoned
building. It is made up of three rooms. It has a capacity of 6beds.
These units function with 6personnel, 2 HND, 3NA and 1cleaner.
1.7. General Objective
The main objective is to treat and follow up HIV patients suffering
from tuberculosis.
1.8. Specific Objectives
To create good nurse patient relationship.
Ensure comfort and reassurance for rapid recovery.
Follow up of HIV/TB patient
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Follow up exposed infants.
Provide psychological preparation before treatment
Provide free TB medications
Provide care to the patients admitted for a disease condition.
Participate in the training of student nurses
Ensure the management of the waste
Ensure the cleanliness of the units.
1.9. Activities of the service
Activities were carried put in 3shifts. We have 2days shift and
2night shift. The day shift starts from 7:30-1:30pm and from
6:30pm-7:30am.
During each shift, a shift report was written which state the health
condition of patients, number of admissions, number of Discharges,
transfers, treatments administered number if death and material
handed over.
1.10. Activities of the day shift
Reading of the night shift report and handling over
General cleaning, dusting of equipment and objects in the service.
Welcome and admit patient
Making up patients bed
Monitor vital signs
Cleaning of instruments and sterilizing them
Assisting during Doctor‟s rounds
Administer patient medications
Give counselling to patients
Write shift duty report and handling over the day shift.
The day shift was done by a ward charge that is an N.A. and assisted
by ol SRN
1.11. Activities of the night shift
Reading of the day shift report and taking over
Monitory the patients
Welcome and admit patients
Clean materials
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Monitor vital signs and record it
Writing of shift duty report
Handing over to day nurses
1.12. Activities of the night shift
The duty rooster of the unit gives information about the various
nurses working in the service including their night, and day shifts and
also they are off.
These nurses alternate in three shift; 20days and 02nugth shift and
except the ward charge who work on Monday to Fridays with the
assistant who are usually off duty on Saturdays, Sundays and public
Holidays. The cleaner works every morning except weekends in the
morning. Nurses on duty do their rounds before the medical Doctor‟s.
This is done every day. Doctors are called on phone to intervene in
case of emergency during weekends. The ward charges can also
interne during weekend when there is a severe case.
The other nurse work in the morning, the following day in the
afternoon, the following day in the night and goes off for 2days before
resuming duty.
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CHAPTER TWO - REVIEW OF LITERATURE ON THE CASE
2.0 Causes
Tuberculosis is an infectious and contagious disease caused almost
exclusively by Mycobacterium tuberculosis or Koch‟s bacillus.
Mycobacterium africanum is a variant of M. tuberculosis and has
been found in 10% of tuberculosis patients in Yaounde and the West
Province according to surveys carried in 1995 in Yaounde and 1998
in the West Prorvince.
2.1 Clinical Features (Signs and Symptons)
Tuberculosis should be suspected in a patient who presents with
cough, with or without sputum production that has lasted for at least
3weeks. But with an HIV patient, current cough is a call for concern.
This cough may be accompanied by haemoptysis (blood stained
sputum), chest pain, difficulties in breathing and generalize
symptoms such as loss of weight and appetite, night sweats,
tiredness and fever.
Tuberculosis can also be suspected if the chest X-ray of the patient
shows images suggestive of disease, e.g. cavities in lungs.
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2.2. Pathophysiology The immunological effect of HIV is manifested
especially on immunity at the cellular level, the part of the immune
system responsible for the response against the tubercle bacillus. The
diminished immunity brought about as a result of the HIV infection
reduces the capacity of the individual to contain the TB infection and
to prevent a new infection or re-infection of micro bacterium.
TB is transmitted by air through an infected person. The interaction
between HIV/TB is bi-directional because mycobacterium
Tuberculosis increases the replication of HIV in vitro and active TB
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Accelerates the evolution of the HIV infection is HIV positive TB
patients. The presence of active pulmonary TB or extra pulmonary
TB in an HIIV positive patient is indicative of an imminent Aids
phase (National tuberculosis control programme-Cameroon)
2.3. Diagnosis
Sputum microscopic examination is the basic test to be carried out. It
consists in the examination of the patient‟s sputum under the
microscope after it has been stained by the ZienhlNeelsen technique.
The laboratory examinations that are performed are;
Acid flaccid bacilli (ZienhlNeelsen test)
Gene expert
Chest X-ray
Biospsy
2.4. Treatment
The internationally accepted strategy for TB control is known as
DOTS (Directly Observed Treatment, Short Course) and involves
five components:
1. Sustained political and financial commitment
2. Case‐detection through quality‐assured bacteriology
3. Standardized treatment with supervision and patient support
4. An effective drug supply and management system
5. Monitoring and evaluation system and impact measurement5
(Interagency coalition on AIDS and Development-Canada TB/HIV
CO-INFECTION, www.icad-cisd.com)
New cases of tuberculosis are treated with a standardize 6 months
therapeutic regimen. Relapses, treatment failures and retreatment are
managed with a standardize 8 months retreatment regimen. Drugs
are available in district hospitals and approved centres. The health
centre under the supervision of the district health team ensures the
follow - up of the treatment initiated at the district hospital.
The treatment of choice includes the following;
RHEZ dose 20 -25mg/kg body weight in adults used in the
intensive phase for 2 months.
RH dose 20 -25mg/kg body weight in adults used in the