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.

5

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.

6

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
7

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

8

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
9

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?

16

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?

17
Client 3: Pranav

PPD: 12mm

Is the client positive or negative? Does he/she need a referral for x-ray?
18
Client 4: Miguel

PPD: 15mm

HIV positive

Is the client positive or negative? Does he/she need a referral for x-ray?
19
Client 5: Jason

PPD: 10mm

HIV Negative

Is the client positive or negative? Does he/she need a referral for x-ray?
20

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

Simulation

Tuberculosis Screening

Tuberculosis Pre-Clinical Work-up
Research three EBP articles related to target population
Describe and discuss the target population
Create a concept map of their risks, needs and/or common comorbidities  
Describe and discuss culturally competent care or developmental competence within the target population
Apply results to target population and research six community resources related to target population
Compare and contrast family, community, national, and/or global implications 
Assignment: Create a TB screening questionnaire based on your research

Simulation Scenario
You are a public health nurse who does PPD TB screenings every Tuesdays, Thursdays and Saturdays.
Here are your clients today:
Client 1: Miriah: Local nursing student who needs testing prior to entering the program
Client 2: African-American. Angelique: Someone trying to get a job in an adolescent group home who has previously worked in a nursing home. Needs testing for her new job. This client is also currently 20 weeks pregnant.
Client 3: International student from India just enrolled at a local university. Needs testing to live in the dorms.
Client 4: Hispanic Migrant worker lived in a crowded house with extended family members all winter long. One of them was sick and coughing all winter long. Saw a poster about TB in a public bathroom and thought he should be tested.
Client 5: Native American. Former IV drug user who lived in an inner city drug house in Chicago from the age of 18 to 20. He is a police officer and has moved back to F/M is trying to get a job as a correctional officer in the Juvenile Detention Center.

Visit Agenda
Health History
Screening Form
Additional Health History
Physical Assessment
What Physical Assessments would you do?
Testing
Administer TB test
Any other testing needed?
Referrals and Resources

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.

5

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.

6

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

7

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

8

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
9

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?

16

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?

17

Client 3: Pranav
PPD: 12mm
Is the client positive or negative?
Does he/she need a referral for x-ray?

18

Client 4: Miguel
PPD: 15mm
HIV positive
Is the client positive or negative?
Does he/she need a referral for x-ray?

19

Client 5: Jason
PPD: 10mm
HIV Negative
Is the client positive or negative?
Does he/she need a referral for x-ray?

20

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