Case Study 11 Activity

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University of North Carolina, Charlotte *

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Nursing

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Apr 29, 2024

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Part I - Symptoms Calista was 26 years old when she opened a bakery called “Calista’s Cupcakes” in downtown San Francisco with her fiancé, Jerry. Despite the competitive market, her business was booming; everyone loved the clever recipes and the trendy atmosphere. Between running their fast-growing business and planning for their wedding, Calista hadn’t been able to keep to her usual eight hours of sleep a night. Although she had always lived a very healthy lifestyle, exercising daily, and eating healthy, she just hadn’t been feeling herself lately. She was tired all the time, had difficulty breathing, felt stressed, coughed up sputum, consistently ran a low-grade fever, and had lost weight as her appetite decreased. None of these symptoms alone had been particularly alarming so she had put off seeing her physician for a few weeks. Questions 1. What are Calista’s symptoms? List all that were mentioned. Difficulty breathing, stress, coughing up sputum, low grade fever, weight loss, decreased appetite, and frequently tired. 2. Based on the symptoms presented, what are three possible respiratory infectious diseases Calista could be suffering from? Explain why. Pneumonia, Tuberculosis, and Bronchitis. Tuberculosis causes affects the lungs resulting in a bad cough, fever, and fatigue. Pneumonia is a lung infection that presents as a cough with phlegm, fever, difficulty breathing, and loss of appetite. Bronchitis is caused by viral infections, and presents as coughing up mucus, chest pain, tiredness, low fever, shortness of breath, etc. They are all infectious diseases. They are caused by pathogenic microbes and can be spread from one person to another. 3. Based on Calista’s symptoms and your answers so far, it seems Calista is having trouble with her respiratory system. Several respiratory conditions can impact gas exchange. Describe the process of gas exchange in the lung (alveoli). Gas exchange between alveoli and capillaries starts from the pulmonary artery which passed through the capillary, alveolar membrane, and respiratory membrane. Oxygen diffuses into red blood cells, and carbon dioxide diffuses into alveolus and travels to the pulmonary vein. Part II – The Diagnosis As each day passed Calista’s symptoms grew worse and worse. After standing for long periods of time she could barely breathe; in fact, she couldn’t even work a full day in the bakery without feeling like she was going to pass out. When it got to the point that extreme exhaustion and high fever prevented her from getting out of bed, Jerry was alarmed.

“Calista, I’m taking you to see your doctor,” he said, and got her an appointment for the next morning. Once there, Calista explained to her physician, Dr. Nair, that she had been tired, fatigued, stressed, and that she hadn’t been sleeping well. She also mentioned that she had lost some weight and just didn’t have an appetite. The worst part was the shortness of breath and the cough. Her breathing troubles and coughing had lasted for about three weeks and seemed to be getting worse. As a precaution, Dr. Nair decided to provide Calista a surgical mask in case she had an infectious respiratory disease. She then proceeded to do a basic physical exam as well as a chest x-ray and a sputum analysis. Dr. Nair then asked Calista if she had traveled out of the country within the past three months. Calista looked confused and said “no.” The doctor followed this up by asking whether Calista had come into contact with anyone who had been out of the country. Thinking about it for a moment she replied, “Well, one of the employees in our bakery is from South Africa and she frequently visits her family back at home; she’s in South Africa visiting right now. I work with her weekly. Could that really be a factor?” “Yes, it could,” Dr. Nair said. “Did your employee have any symptoms that you can recall?” Calista reflected a moment and said, “Yes, she does seem to always have a cough. She told me it was just allergies and that she might be bothered by all the flour in the air.” The chest x-ray came back and showed nodular formations in both of Calista’s lungs near the clavicles. Based on the x-ray and symptoms, Dr. Nair suspected Calista had tuberculosis, more specifically active tuberculosis, also known as tuberculosis disease. South Africa has one of the highest incidences of active TB in the world and knowing that Calista had an employee who frequently visited that location made Dr. Nair suspect TB, but they would need to run some tests to be sure. Dr. Nair’s local laboratory lacked the most rapid testing mechanisms, so it would take a few days to receive results from the sputum stain and the sputum nucleic amplification test. Dr. Nair also took a blood sample for additional testing. Due to her suspicion for TB, Dr. Nair advised Calista to stay home and not work until they could confirm her diagnosis. She provided Calista with some surgical masks in the event she needed to go out. After Calista left, Dr. Nair contacted the local health department and reported that she suspected her patient had TB. Questions 4. What is the causative agent for tuberculosis (TB)? How does one get tuberculosis? Mycobacterium tuberculosis and is passed through droplets from a cough or sneeze by an infected person.

5. Explain the tests used to diagnose someone with active TB (make sure to include x-ray, sputum analysis, skin tests, and blood tests). Use the following website for help: http://www.merckmanuals.com/home/infections/ tuberculosis-and-leprosy/tuberculosis-tb. Blood tests: Interferon-gamma release assay is the blood test that can detect tuberculosis. A blood sample is sent to a lab and is mixed with synthetic proteins, and based off the secretions of the blood cells, one can determine if someone has tuberculosis. Skin tests: Also known as tuberculin skin test and is done by injecting protein derived from tuberculosis, and then applied to the skin. Based off their skins reaction, they can be diagnosed with tuberculosis. X-ray: People who have tuberculosis typically have abnormal x-ray images, but it also presents as other disorders. To ensure an accurate diagnosis, doctors will also utilize a tuberculin skin test and sputum test. Sputum test: sputum sample is examined under a microscope to determine if tuberculosis bacteria is present. A bacterial culture will also be done to ensure accurate results as microscopic examination is less accurate. 6. Using information from the Centers for Disease Control and Prevention (CDC) and the link in the previous question, compare and contrast latent TB with active TB (also called TB disease). Fill out the table below, then add in the information we know so far about Calista. See: https://www.cdc.gov/tb/publications/factsheets/general/ ltbiandactivetb.pdf. Latent TB Active TB (TB Disease) Calista Causative agent Mycobacterium tuberculosis Mycobacterium tuberculosis Unknown Signs/ symptoms Does not feel sick Unexplained weight loss; loss of appetite; fatigue; fever; chills; persistent coughing; coughing up sputum Fatigue; fever; stress; shortness of breath; persistent coughing; loss of appetite; weight loss; loss of appetite; less sleep

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