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Nursing assignment 1232

  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

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