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Instructions for Obtaining Continuing Education Credit. In order to receive continuing education CE for SS4042 Case Studies in Tuberculosis Training in. Nurse Case Managment please visit TCEO and follow these 9 Simple Steps before July 20 2020. 9 Simple Steps to Get Your Continuing Education CE. 1 After completing a course login or create a new account on TCEO www cdc gov GetCE. 2 Visit Search Courses and enter SS4042 to find the course. 3 Scroll down and click on the title of the course. 4 Review the information on the Course Summary page and click Continue. 5 If promped enter in the Course Code TBNCS62018 in the Course Access Code box Hint these. codes are provided by the course intructor or may be found in the course materials. 6 Choose the type of continuing education you d like to earn You can select more than one. 7 Under Pending CE on the My Activities page click on the course Evaluation and complete it You. will be returned to the My Activities page, 8 Under Pending CE click on the post test and complete it If you don t pass the post test you will. have one opportunity to retake it, 9 Visit the Completed CE section of the My Activities page to download your certificate. Accreditation, CNE The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing. Education by the American Nurses Credentialing Center s Commission on Accreditation. This activity provides 2 4 contact hours,Disclosure. CDC our planners presenters and their spouses partners wish to disclose they have no financial interests or. other relationships with the manufacturers of commercial products suppliers of commercial services or. commercial supporters Planners have reviewed content to ensure there is no bias. Content will not include any discussion of the unlabeled use of a product or a product under investigational use. The Centers for Disease Control and Prevention and Heartland National TB Center are jointly providing the CNE for. this activity, CDC did not accept commercial support for this continuing education activity.
Dear Healthcare Professional, Prior to reveiwing the content of this book it is highly recommended to complete the Centers. for Disease Control and Prevention CDC Self Study Modules on Tuberculosis TB The. modules contain basic information regarding transmission pathogenesis epidemiology. testing infection control managing adherance patient rights contact investigations and. outbreak detections You can access the modules at www cdc gov tb education ssmodules. default htm, Seldom does patient care follow the relatively straight forward path outlined in the CDC Self. Study Modules on TB Due to this the case studies in this book are designed to provide. guidance and relevant reference material to gain insight into challenges faced in TB case. management Patients have multiple barriers to accurate diagnosis and completion of therapy. and public health nurses must develop skills in problem solving to successfully treat and care. for a patient with TB infection or TB disease, The studies in this book are based on real life experiences of TB nurses in the Heartland region. and beyond They are designed to illustrate key concepts in TB prevention and care and can. be used to train new nurses and other healthcare providers who are inexperienced in TB case. management, All materials in this document are in the public domain and may be used or printed without special. permission citation of source is appreciated, Suggested citation Heartland National Tuberculosis Center Case Studies in Tuberculosis Training in.
Nurse Case Management, This publication was supported by the Grant or Cooperative Agreement Number U52PS10161 01. funded by the Centers for Disease Control and Prevention Its contents are solely the responsibility of. the authors and do not necessarily represent the official views of the Centers for Disease Control and. Prevention or the Department of Health and Human Services. Heartland National Tuberculosis Center is funded by the Centers for Disease Control and Prevention. This document is available through Heartland National Tuberculosis Center. 2303 Southeast Military Drive,San Antonio Texas 78223. Phone 800 839 5864 1 800 TEX LUNG,Fax 210 531 4590. Website http www HeartlandNTBC org,How to Use This Book. This collection of nursing case studies and their accompanying tools are intended to complement a. TB program s education and training of its nursing staff It can be incorporated into new employee. introduction and training on TB case management used as a continuing education tool for current. employees or as an individual learning tool,Individual Continuing Education.
This book has been accredited by the Training and Continuing Education Online TCEO office and can. provide 2 4 continuing nursing education hours For more information and to obtain credit please see. the opposite page,Suggested Group Training, The individual nursing cases should be copied and distributed to the group Cases do not need to be. taught in the order presented in the manual Specific cases may be pulled out to instruct on a particular. programmatic issue, The group leader or instructor should have a copy of the answers and if possible a copy of each. corresponding reference for each lesson The case study should be read aloud the instructor should stop. to ask the group the questions and facilitate the answers using the references to underscore the learning. point Answers to the questions should be made available to the group after the discussion. It is recommended that a copy of the references be readily available to the TB program staff both as a. supplemental learning tool and as a future resource. Suggested Individual Training Part of a Structured Program of Employee. This product can be used for individually structured training It can be used to orient new employees. as part of a continuing education system or a re teaching tool when specific issues arise A schedule of. completion can be devised by the training coordinator and mutually agreed upon by the trainee s. The individual nursing cases should be copied and distributed as arranged by the trainer A copy of the. corresponding references should be available at the same time. As an individual works through a case study it is preferable that the case questions first be answered by. the trainee and then shared with the trainer discussing the learning points and clarifying any incorrect. answers using the corresponding references, A less reinforcing method in the interest of time is to have the trainer supply the answers to the trainee. AFTER they have completed the case study and have the trainee follow up errors by reviewing the. corresponding references,Table of Contents,Case Study 1. Directly Observed Therapy 11, Participants will learn the importance of assessing patients for barriers to completing TB.
treatment DOT and the consequences of non adherence to an adequate drug regimen. Case Study 2,Respiratory Isolation 17, Participants will learn to assess laboratory results for level of infectiousness in a TB case and how. to implement TB isolation guidelines,Case Study 3, Evaluation of a Contact to a Patient with Pulmonary TB 23. Participants will be guided through the process of identifying extrapulmonary TB disease during a. contact investigation,Case Study 4, Supporting Private Providers Who Manage TB Infection in the Community 29. Participants will learn about the diagnosis of clinical TB and the challenges that sometimes. happen when working with private providers unfamiliar with TB. Case Study 5,Multi Drug Resistant TB 35, Participants will learn about the diagnosis of multi drug resistant TB and the challenges that. sometimes happen when working with private providers unfamiliar with TB. Case Study 6,Pediatric Tuberculosis 41, Participants will learn about the diagnosis and treatment of TB in an pediatric patient and how.
to handle exposure to siblings in the home,Case Study 7. Hepatotoxicity in TB Treatment 49, Participants will learn about risk factors and signs and symptoms of drug induced hepatotoxicity. Case Study 8,TB and Biologics 55, Participants will learn about the risks associated with TNF antagonist e g Remicaid Humira. and Enbrel treatment in latent TB infected patients and procedures for managing a patient who. moves during treatment,Table of Contents,Case Study 9. Positive TST and Pregnancy 61, Participants will learn the about the diagnosis classification and treatment regimen in a pregnant.
patient with a positive TST,Case Study 10,TB Infection and INH Resistant Contact 67. Participants with learn about appropriate interventions in managing a patient with TB infection who. is a contact to a person with Isoniazid resistant TB disease. Case Study 11,TB Infection in a Homeless Man 73, Participants will learn about the case management of a homeless patient with TB infection and. treatment with 3HP,Case Study 12,TB Infection and HIV 81. Participants will learn about TB test interpretation and follow up in immunocompromised. individuals as well as managing concurrent alcohol intake with TB infection treatment. Appendices,Appendix A Smear Classification Results 87. Appendix B Criteria for Patients to be Considered Noninfectious 89. Appendix C Guidance on Release from Hospital Tuberculosis Isolation 91. Appendix D Interpreting the TST Reaction 93, Appendix E Expert Resources for Tuberculosis Consultation and Training 95.
Appendix F Building a Treatment Regimen for MDR TB 97. Appendix G Administration of Amikacin Injection 99. Appendix H Interjurisdictional TB Notification IJN Form 101. Appendix I TB Screening Algorithm for Biologics or Tofacitinib 105. Appendix J References 107,Acronyms and Abbreviations. AFB Acid fast Bacilli IGRA Interferon Gamma Release Assay. AII Airborne Infection Isolation INH Isoniazid, ALT Alanine Aminotransferase LFT Liver Function Test. ART Antiretroviral Therapy LTBI Latent Tuberculosis Infection. AST Aspartate Aminotransferase M bovis Mycobacterium bovis. ATS American Thoracic Society MDR TB Multidrug resistant Tuberculosis. BCG Bacille Calmette Gu rin MTBC Mycobacterium tuberculosis complex. BPH Benign Prostatic Hypertrophy M tb Mycobacterium tuberculosis. CBC Complete Blood Count NAAT Nucleic Acid Amplification Test. CDC Centers for Disease Control and Prevention PA Posteroanterior. CNE Continuing Nursing Education PSA Prostate Specific Antigen. CT Computed tomography PZA Pyrazinamide,CXR Chest X ray QFT G QuantiFERON TB Gold. DOT Directly Observed Therapy QFT GIT QuantiFERON TB Gold In Tube. DST Drug Susceptibility Testing RFB Rifabutin,ED Emergency Department RIF Rifampin. EKG Electrocardiogram TNF Tumer Necrosis Factor,EMB Ethambutol TB Tuberculosis.
ESR Erythrocyte Sedimentation Rate TBI Tuberculosis Infection. GI Gastrointestinal TID Three times a day, HepBsAg Hepatitis B Surface Antigen TST Tuberculin Skin Test. HIV Human Immunodeficiency Virus U S United States. HNTC Heartland National Tuberculosis Center,Case Study 1. Directly Observed Therapy,Case Study 1,Directly Observed Therapy. A 67 year old Hispanic male presented to a hospital emergency department with a three week history of. night sweats weight loss nausea shortness of breath and a productive cough A chest x ray CXR was. done and revealed extensive bilateral cavitary disease Per hospital protocol sputum specimens were. collected and resulted in positive Acid Fast Bacilli AFB with 10 organisms per high power field see. Appendix A He was diagnosed with active pulmonary TB. Further evaluation revealed a medical history of hepatitis C and a social history that included previous. intravenous drug use heroin cigarette and alcohol use incarceration and a hospitalization 30 years ago. with a gunshot wound that resulted in a nephrectomy and colostomy which was later re anastomosed. 1 What are some potential barriers to completion of treatment for this patient. A Cigarette and alcohol use,B Previous history of heroin addiction. C Hepatitis C positivity,D All of the above, Six weeks into treatment his isolate was reported to be susceptible to all first line drugs and EMB was.
discontinued The remaining three drugs were changed to twice weekly dosing by DOT After 2 months of. therapy the PZA was discontinued and sputa collected were AFB smear and culture positive The patient. was adherent to his medication tolerated the drug regimen and had resolution of symptoms He was. cooperative with the public health worker and requested to self administer his medications. 2 Should the patient be taken off DOT and allowed to self administer. A Yes allowing him to self administer will help build trust and rapport with the patient. B Yes it is general practice to allow most patients to self administer during the continuation phase. of treatment, C No explain to him that all patients stay on DOT because no one trusts TB patients. D No explain that DOT is the standard of care for all TB patients. DOT is the standard of care for all patients diagnosed with TB disease regardless of circumstances. however the nurse case manager provided this patient with a one month supply of medications to. self administer and instructed him to return to the clinic every month to refill his prescription After 2. months of self administered treatment sputa were obtained and smears and cultures were reported. as positive The culture grew Mycobacterium tuberculosis M tuberculosis and susceptibility studies. continued to show that the isolate was sensitive to all first line medications. 3 What is the most likely cause for the persistently positive cultures. A It is probably a laboratory error, B He is probably not absorbing his medication due to a previous colon resection. C He is probably not taking his medication, D He has treatment failure due to his Hepatitis C co infection. Nurse Case Studies 11, Due to the persistently positive culture the nurse case manager contacted the prescribing physician A. repeat CXR was ordered and revealed continuing cavitary changes in the right upper lobe In speaking. with the patient he identified that he was given medications to self administer but did not take them. because he developed intolerable side effects A pill count was conducted and confirmed the patient had. not receiveded treatment for two months, 4 What should be included in the evaluation process.
A Collection of three sputum specimens,B Evaluate hearing. C Repeat a TST,D All of the above, A thorough evaluation that included three sputum specimens and repeat drug susceptibility testing was. done TB medications were restarted and given by DOT Repeat drug susceptibility testing indicated no. drug resistance and after 2 months of anti TB therapy sputum smears and cultures converted to AFB. negative and symptoms improved The patient completed adequate TB treatment successfully. Reflection, In this scenario the patient had an extensive medical history which included multiple biological and. social factors that pose as potential barriers to treatment completion Though he was cooperative with. the public health worker it is important to remember that DOT is the standard of care for all patients. diagnosed with TB disease DOT allows the health care provider to identify and address challenges with. treatment and is associated with improved treatment success. DOT allows the health department to identify and manage intolerable side effects The patient was. classified as a treatment failure because he was four months into treatment and had not converted his. culture to negative The patient was forthcoming with the physician about not taking his medication. therefore a pill count was conducted to verify how much medication was taken It is essential to. determine if the patient took monotherapy as this could potentially lead to drug resistance to the TB. medications,12 Nurse Case Studies, 1 What are some potential barriers to completion of treatment for this patient. Answer D All of the above, Rationale One role of the nurse case manager is to identify potential social and biological.
barriers to treatment which can include current or previous substance use and Hepatitis C. positivity 17, 2 Should the patient be taken off DOT and allowed to self administer. Answer D No explain that DOT is the standard of care for all TB patients. Rationale DOT is the standard of care recognized by experts in the field and has been. associated with improved treatment success 17, 3 What is the most likely cause for the persistently positive cultures. Answer C He is probably not taking his medication, Rationale Although there are many reasons why a culture will remain positive treatment not. received by DOT is an indicator that the medications are being taken improperly 17. 4 What should be included in the evaluation process. Answer A Collection of three sputum specimens, Rationale Patients who are being reconsidered for treatment should have 3 additional sputa. collected and repeat culture and drug susceptibility testing 17. 17 Nahid P Dorman S E Alipanah N Barry P M Brozek J L Cattamanchi A Chaisson L H Chaisson R E Daley C L Grzemska M. Higashi J M Ho C S Hopewell P C Keshavjee S A Lienhardt C Menzies R Merrifield C Narita M O Brien R Peloquin C A Raf. tery A Saukkonen J Schaaf H S Sotgiu G Starke J R Migliori G B Vernon A Executive Summary Official American Thoracic Society. Centers for Disease Control and Prevention Infectious Diseases Society of America Clinical Practice Guidelines Treatment of Drug Susceptible. Tuberculosis Clin Infect Dis 2016 63 7 853 867 doi 10 1093 cid ciw566. Nurse Case Studies 13,Case Study 2,Respiratory Isolation.

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