Mrs. Bull is a 39 year old female who presents to the Emergency Department (ED) complaining of a persistent cough for the last 3 months. In the last 3 days, she’s been experiencing chills and night sweats and today she noticed she was coughing up blood.
Critical Thinking Check
Bloom's Taxonomy: Analysis
You suspect Mrs. Bull may have tuberculosis. What other personal and/or medical history questions do you need to ask to be sure?
Observe and document any sputum from productive cough
You assessment findings include rhonchi in the right upper lobe of Mrs. Bull’s lungs, normal S1 and S2 heart sounds heard, active bowel sounds, and 2+ peripheral pulses x 4 extremities. Her skin appears clammy and somewhat pale. Upon further questioning, Mrs. Bull reports recent travel to South America. She denies knowingly having a fever, but acknowledges she has been more fatigued lately and reports a recent unintentional weight loss of 20 lbs in the last 2 months. Vital signs are as follows: BP146/78 mmHgHR92 bpm
RR24 bpmTemp101.2°F
SpO290% on room air
Critical Thinking Check
Bloom's Taxonomy: Application
What nursing action(s) should be taken at this time?
Proper protocol for airborne isolation – each family member is also required to wear a particulate respirator when in the room with the patient – patient should not leave the room – keep the door closed at all times
Educate Mrs. Bull on s/s to report that may indicate worsening – further hemoptysis, difficulty breathing, worsening cough
Inform them that this medication course could be 6-12 months long
Mrs. Bull’s sputum cultures reveal she is, indeed, positive for Mycobacterium tuberculosis. Her PPD skin test reveals a 17 mm induration on her left arm after 48 hours. She is admitted to a general medical-surgical floor into a negative pressure room. She has now completed 3 weeks of RIPE therapy, which she tolerated well, and she no longer has a cough or other symptoms. Since she is no longer considered contagious, the doctor has ordered for her to be discharged home to continue the rest of her medication course.
Critical Thinking Check
Bloom's Taxonomy: Application
What discharge teaching will be required for Mrs. Bull?
Medication regimen should be taken every day for as long as the provider ordered (6-12 months). She should continue taking them even if she feels better and even though she is no longer contagious.
S/S to report to healthcare provider – new cough, fever, chills, night sweats, hemoptysis
Avoid any travel to high-risk countries for the next 6 months
Critical Thinking Check
Bloom's Taxonomy: Analysis
Explain why medication compliance is so important for Mrs. Bull.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.