Tuberculosis screening

 
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