Nursing  Tuberculosis screening

Client 1: MiriahMission 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 3/25/1999Lives at home with parentsRecently enrolled in a nursing program at a local universityHas worked in a nursing home and as a lifeguard in the summers at the Northside pool since she was a sophomore in high school.5Client 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 visitingDoesn’t know if had BCG vaccinePPD 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.6Client 3: PranavPranav 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 FactorsBorn outside of the USWas given the BCG vaccine as a child.Lived in a multi-generational home.Visited relatives in the countryside annuallyPhysical Exam Question AnswersNo signs or symptoms of TB7Client 4: Miguel65Y Mexican-American Single MaleWorks as a migrant farm worker.Goes back and forth across the borderLives in McAllen, TXRecently widowed from the love of his lifeRisk FactorsLives in a multi-generational home with his brother and his familyGot a temporary jobBorn in MexicoIs very embarrassed to tell you that he was with a prostitute after the death of his wifePhysical ExamCough over 3 monthsNight sweatsc/o chest painRecent weight loss of ten pounds8Client 5: JasonGrew up in a multi-generational homeRecently 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 ReservationHe 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 schoolWas in the military from age 20-25; served in AfghanistanWorked in the state penitentiary for a year before moving to Chicago for 5 years.No Signs or Symptoms of TBNo positive TB testsGrew up in a multi-generational homeRecently 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 ReservationHe 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 schoolWas in the military from age 20-25; served in AfghanistanWorked in the state penitentiary for a year before moving to Chicago for 5 years.No Signs or Symptoms of TBNo positive TB tests9Group ActivityCreate a Health History Screening toolDiscussionWhat 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 HistoryTB Screening questionnaireWhat risk factors are there in each client?Additional Health History informationAny additional screenings?Physical AssessmentWhat signs/symptoms of TB would you look for?Lab Tests and Potential ReferralsWhat are lab test? How are the lab test administered? What potential referrals are you going to give to your patients?Follow Up appointmentWhen should your clients come back for follow up?Client 1: MiriahPPD: 10 mmIs the client positive or negative? Does he/she need a referral for x-ray?16Client 2: Angelique & MirlandeAngelique: PPD 4 mmMirlande: PPD 5mmAre the clients positive or negative? Do either or both of them need a referral for x-ray?17Client 3: PranavPPD: 12mmIs the client positive or negative? Does he/she need a referral for x-ray?18Client 4: MiguelPPD: 15mmHIV positiveIs the client positive or negative? Does he/she need a referral for x-ray?19Client 5: JasonPPD: 10mmHIV NegativeIs the client positive or negative? Does he/she need a referral for x-ray?20Follow-upWhat happens at each client’s next appointment if applicable?Medications/Nursing InterventionsResearch 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 PPDWhat 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 ConsiderationsFoodsVitaminsMineralsSupplementsMedication RegimensLatentChildAdultActiveNon-HIV positiveHIV positiveWhat are the major side effects of TB medications and how can they be prevented?RecommendationsHow 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?DiscussionHow do you contain the disease with limited resources?How to educate the public on the outbreak or potential exposure?Client and Community EducationCreate a plan of action together and educate the clients on dietary recommendations and medications and preventing the spreading of the disease.References

 
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