Nursing Care for Pulmonary Tuberculosis Patients with Type 2 Diabetes: A Case Study from Family and Community Health Practice at Samut Sakhon Hospital, Samut Sakhon Province

Abstract

Tuberculosis (TB) is a significant infectious disease and a global public health concern. The World Health Organization (WHO) reported that in 2022, there were approximately 10.6 million TB patients worldwide, with more than 1.3 million deaths from the disease. This is particularly prevalent among populations with comorbidities such as Type 2 Diabetes Mellitus (T2DM), a chronic disease affecting the body’s metabolic system and compromising immune function, thereby increasing vulnerability to TB infection. This represents a condition closely associated with tuberculosis. In Thailand, the average TB incidence is approximately 150 cases per 100,000 population, with a continuous increase in TB patients with diabetes comorbidity, exceeding the average in the Southeast Asian region. Thailand remains classified as a high TB burden country. This increased TB burden results from immune system abnormalities that occur with elevated blood glucose levels, impairing the body’s ability to effectively control Mycobacterium tuberculosis. Additionally, TB patients with diabetes typically experience higher mortality rates during treatment and have a greater chance of relapse compared to general TB patients. This study aims to examine nursing approaches for a case study of pulmonary tuberculosis with Type 2 diabetes comorbidity and to utilize the findings as a guideline for appropriate nursing care planning. The methodology included studying outpatient medical records, patient and family history-taking, observation, and comparative data analysis. The focus was on examining the patient’s health patterns, the pathophysiology of both diseases, signs and symptoms, nursing diagnoses, and appropriate care guidelines for the patient. The expected results of this study will help demonstrate the relationship between tuberculosis and diabetes, highlighting the impact of diabetes on the progression of tuberculosis, such as delayed recovery rates, risk of complications, and potential problems arising from using TB medications concurrently with blood glucose control medications. Furthermore, this study aims to present nursing approaches that can reduce the risk of complications, improve patients’ health rehabilitation processes, and help patients effectively manage their conditions.
Case Study: A 67-year-old Thai female presented with cough, easy fatigue, and chest tightness for 7 days, decreased appetite, weakness, and weight loss. Chest X-ray revealed Left Upper Lobe (LUL) Capacity, and sputum examination for Acid-Fast Bacillus (AFB) was positive (3+). The patient had a history of diabetes and was diagnosed with Pulmonary Tuberculosis with Type 2 Diabetes Mellitus. She was treated with standard first-line TB medications. The patient understood and acknowledged that high blood glucose levels from diabetes increase susceptibility to infection. She cooperated well with treatment, controlled her diet, and took medications regularly. After treatment, her condition gradually improved. Close contacts were screened for TB, and no infections were found. After completing 6 months of TB treatment, sputum examination showed no TB bacteria. The patient recovered well with no abnormal symptoms. The physician terminated TB treatment and discharged her from the TB clinic, scheduling follow-up appointments at the diabetes clinic along with foot examination and retinal examination (DR) on the same day. Sputum AFB follow-up and chest X-rays were scheduled every 6 months for four times to monitor for TB recurrence. The researcher applied Gordon’s Functional Health Patterns as a framework for nursing care planning for this patient, focusing on collecting and analyzing the patient’s health data across multiple dimensions such as health perception and health management patterns, nutrition and metabolism patterns, rest and sleep patterns, and perception and adaptation patterns. Data was gathered from medical records, history-taking, observation, and interviews with the patient and relatives to systematically assess the patient’s self-care abilities. The study results reflect the relationship between tuberculosis and diabetes, including the importance of holistic nursing planning to prevent complications, control blood glucose levels, reduce TB transmission, and maintain normal blood glucose levels, ultimately leading to good quality of life and the ability to live normally in society.