Client 1: Miriah

Mission trip a year ago to work in a orphanage in Mexico. They stayed in the orphanage with the kids. Some kids had a bad cough.

No signs or symptoms of TB.

20 year old 3/25/1999

Lives at home with parents

Recently enrolled in a nursing program at a local university

Has worked in a nursing home and as a lifeguard in the summers at the Northside pool since she was a sophomore in high school.

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Client 2: Angelique (accompanied by Mirlande, age 5)

Didn’t know she was pregnant when she went on the trip.

5th child.

Uncle was sick and coughing when they were visiting

Doesn’t know if had BCG vaccine

PPD positive; chest x-ray positive for latent TB.

On Medical assistance.

Her 4th Child, Mirlande, just recently turned 5 years, accompanied her mom to Haiti.

Mother, Mary, lives in the home with Angelique and her family. Mary, Angelique and Mirlande recently returned from a three month long trip to see Angelique’s maternal grandmother in Haiti.

35Y Haitian-American.

She is 20 weeks pregnant.

She is trying to get a job in an adolescent group home and previously worked in a nursing home. Needs testing for her new job.

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Client 3: Pranav

Pranav is a 24Y male from India.

He is a new graduate student at a local university and needs a PPD to live in the dormitory.

Married with one child. She is in India with family.

Risk Factors

Born outside of the US

Was given the BCG vaccine as a child.

Lived in a multi-generational home.

Visited relatives in the countryside annually

Physical Exam Question Answers

No signs or symptoms of TB

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Client 4: Miguel

65Y Mexican-American Single Male

Works as a migrant farm worker.

Goes back and forth across the border

Lives in McAllen, TX

Recently widowed from the love of his life

Risk Factors

Lives in a multi-generational home with his brother and his family

Got a temporary job

Born in Mexico

Is very embarrassed to tell you that he was with a prostitute after the death of his wife

Physical Exam

Cough over 3 months

Night sweats

c/o chest pain

Recent weight loss of ten pounds

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Client 5: Jason

Grew up in a multi-generational home

Recently went home to visit grandmother who lives with his aunt and uncle and several cousins and nieces and nephews.

33Y Native American male born on the White Earth Reservation

He is a former police officer who is applying for a supervisory position in the local Juvenile Detention Center.

Lived in a drug house for 6 months out of high school

Was in the military from age 20-25; served in Afghanistan

Worked in the state penitentiary for a year before moving to Chicago for 5 years.

No Signs or Symptoms of TB

No positive TB tests

Grew up in a multi-generational home

Recently went home to visit grandmother who lives with his aunt and uncle and several cousins and nieces and nephews.

33Y Native American male born on the White Earth Reservation

He is a former police officer who is applying for a supervisory position in the local Juvenile Detention Center.

Lived in a drug house for 6 months out of high school

Was in the military from age 20-25; served in Afghanistan

Worked in the state penitentiary for a year before moving to Chicago for 5 years.

No Signs or Symptoms of TB

No positive TB tests

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Group Activity

Create a Health History Screening tool

Discussion

What risk factors are there in each client?

What are the signs and symptoms of TB infection?

Any special considerations should you take for the clients?

Health History

TB Screening questionnaire

What risk factors are there in each client?

Additional Health History information

Any additional screenings?

Physical Assessment

What signs/symptoms of TB would you look for?

Lab Tests and Potential Referrals

What are lab test? How are the lab test administered? What potential referrals are you going to give to your patients?

Follow Up appointment

When should your clients come back for follow up?

Client 1: Miriah

PPD: 10 mm

Is the client positive or negative? Does he/she need a referral for x-ray?

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Client 2: Angelique & Mirlande

Angelique: PPD 4 mm

Mirlande: PPD 5mm

Are the clients positive or negative? Do either or both of them need a referral for x-ray?

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Client 3: Pranav

PPD: 12mm

Is the client positive or negative? Does he/she need a referral for x-ray?

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Client 4: Miguel

PPD: 15mm

HIV positive

Is the client positive or negative? Does he/she need a referral for x-ray?

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Client 5: Jason

PPD: 10mm

HIV Negative

Is the client positive or negative? Does he/she need a referral for x-ray?

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Follow-up

What happens at each client’s next appointment if applicable?

Medications/Nursing Interventions

Research TB on the CDC website. Come up with plan of action for each client (including latent vs active care plans and medication regimens) Public Health Facilities have standing orders to treat and monitor TB. Research Illinois state protocol.

What medications and nursing interventions can a public health nurse provide?

How to properly read and interpret a PPD

What are the parameters for properly measuring and interpreting a PPD?

Are there any special considerations?

How can we identify at risk clients who might need special considerations?

Dietary Considerations

Foods

Vitamins

Minerals

Supplements

Medication Regimens

Latent

Child

Adult

Active

Non-HIV positive

HIV positive

What are the major side effects of TB medications and how can they be prevented?

Recommendations

How can a Doctor’s office help each client?

How can you as the Public Health Nurse help each client?

What would you recommend if you were to write an SBAR for a doctor/nurses note for the client file?

What labs would you recommend be drawn?

What are you going to teach the patient?

What community resources can you give to the patient?

Discussion

How do you contain the disease with limited resources?

How to educate the public on the outbreak or potential exposure?

Client and Community Education

Create a plan of action together and educate the clients on dietary recommendations and medications and preventing the spreading of the disease.

References