A computerised tomography scan (CT) of the abdomenshowed a non-enhancing oval shaped left suprarenalmass with calcification and an ipsilateral hypoplastic butfunctional left kidney. There was neither ascites norsignificant abdominal lymph nodes. The conclusion was asuprarenal tumour-adenoma or adrenocortical carcinomato exclude tuberculous adrenalitis. A CT brain scan wasnormal. In view of the CT abdominal findings suggestive ofadrenal tuberculosis, and ESRcommenced on anti-tuberculous drugs. Ten days afteradmission, she had nausea, vomiting, fever with chills andextreme lethargy. Cardiovascular examination showed atachycardia, low volume pulse, BP 70/40 mmHg and bloodfilm showed trophozoites of plasmodium falciparum. Bloodcultures done thrice revealed no growth. She wasmanaged with intravenous fluids (dextrose in saline),antimalarials, antibiotics and hydrocortisone. She maderemarkable recovery and was maintained on oralprednisolone and fludrocortisone.58mm/hr, she wasCreate a Nursing Care Plan focusing on the possibleadverse effect of administering specific medication basedon the case of the patient. You have review and read firstthe medication intended for this patient before you canproceed to the Nursing Care Plan. A 63-year-ol woman presented with increasing darkeningof the skin, dizziness, and easy fatigability, nausea withoccasional vomiting and progressive weight loss overeight months prior to presentation. There were noheadaches, blurredconsciousness nor change in her bowel habit. The medicalhistory and systemic review revealed no abnormality andwere not significant as to the likely cause of her diseasestate. Physical examination revealed an elderly lady, pale,asthenic with generalized hyperpigmentation especially onthe face, oral mucosa, palmar creases and knuckles. Nofeatures of malnutrition or hypovitaminosis.vision,andneitherlossofThere was no significant peripheral lymphadenopathy.Main findings in the systemic examination were a pulse of106 bpm, regular and small; blood pressure 100/60 mmHgsupine and 70/40mmHg sitting. She could not stand onaccount of severe postural dizziness. The apex beat wasnormal. Fundoscopy revealed a normal fundus. All othersystems were essentially normal. A clinical assessment ofAddison's disease to exclude paraneoplastic syndromewas made. Laboratory investigations and results areshowninTable1.Of notearetheanaemia(haemoglobin10gm/dl), with normal red cell morphology;ESR 58mm/hr (Westergreen method); fasting blood sugarwas 76mg% and total serum protein of 7.8g/L (albumin-3.4g/L and globulin 4.4g/L). Plasma cortisolundetectable at 0wasand 30 minutes of cosyntropinadministration (0.25 mg). Plasma rennin and aldosteroneactivity could not be estimated. HIV screening wasnegative (HIV 1 & II) Radiological diagnostic tests includedan abdominal ultrasound, which was reported as showingnormal liver, spleen, pancreas and pelvic organs.However, the left kidney was not outlined.A computerised tomography scan (CT) of the abdomenshowed a non-enhancing oval shaped left suprarenalmass with calcification and an ipsilateral hypoplastic butfunctional left kidney. There was neither ascites norsignificant abdominal lymph nodes. The conclusion was asuprarenal tumour-adenoma or adrenocortical carcinomato exclude tuberculous adrenalitis. A CT brain scan wasnormal. In view of the CT abdominal findings suggestive ofadrenal tuberculosis, and ESR 58mm/hr, shecommenced on anti-tuberculous drugs. Ten days afteradmission, she had nausea, vomiting, fever with chills andextreme lethargy. Cardiovascular examination showed atachycardia, low volume pulse, BP 70/40 mmHg and bloodfilm showed trophozoites of plasmodium falciparum. Bloodcultures done thrice revealed no growth. She wasmanaged with intravenous fluids (dextrose. in saline).was

Question

Accepted Answer

Anti - tubercular drugs are used  with different combination as in different circumstances.…