Jill M. is the nurse epidemiologist for the Warren County Health Department. Par

Question

Jill M. is the nurse epidemiologist for the Warren County Health Department. Part of Jill’s role at the health department is to administer tuberculosis (TB) screening to at-risk populations and to track TB cases seen in the county. Nurse Jill has identified the homeless population in Warren County as a high-risk population for TB.

Nurse Jill has already implemented a TB education program at the homeless shelter. Every other month, she goes to the shelter and teaches a class about TB: what it is, who is at risk, and why individuals should undergo TB screening. Furthermore, every person who wishes to stay at the shelter must submit to a TB screening test.

Yesterday, the homeless shelter contacted Nurse Jill and reported that one of the men staying at the shelter tested positive for active TB, but shelter staff now cannot find him. The shelter director suspects that the man has left to work at one of the rural farms that offer temporary work, but he does not know which farm.

Nurse Jill talks to the men at the shelter who spoke with the client. She learns that the client, Jose, is in his thirties and speaks only Spanish. The friends give Jill some leads about farms the client may have gone to. Nurse Jill calls the farms and speaks to the farm managers. Luckily, Jill discovers that one of the farm managers had recently gone to the shelter to recruit workers. Nurse Jill visits the farm and, by interviewing the newly hired men, finds the missing active TB case. Because of his transient lifestyle, Nurse Jill decides to enroll the man in directly observed therapy (DOT) for TB treatment. DOT will provide a hotel room and meals for the man while he receives TB treatment.

Questions

1. Identify each individual/group at risk of contracting TB from this client?

2.What primary, secondary, and tertiary prevention interventions did Nurse Jill use to prevent the spread of TB?

a. Nurse Jill used primary interventions to prevent spread of TB including

b. Nurse Jill used secondary interventions to prevent spread of TB including

c. Nurse Jill used tertiary interventions to prevent spread of TB including

3. What barriers to controlling TB did Nurse Jill encounter?

How did she overcome these barriers?

Explanation / Answer

Risk Fctrs fr Tubrculsis

Th risk f prgrssin frm xpsur t th tubrculsis bcilli t th dvlpmnt f ctiv diss is tw-stg prcss gvrnd by bth xgnus nd ndgnus risk fctrs. xgnus fctrs ply ky rl in ccntuting th prgrssin frm xpsur t infctin mng which th bcillry ld in th sputum nd th prximity f n individul t n infctius TB cs r ky fctrs. Similrly ndgnus fctrs ld in prgrssin frm infctin t ctiv TB diss. lng with wll-stblishd risk fctrs (such s humn immundficincy virus (HIV), mlnutritin, nd yung g), mrging vribls such s dibts, indr ir pllutin, lchl, us f immunsupprssiv drugs, nd tbcc smk ply significnt rl t bth th individul nd ppultin lvl. Scicnmic nd bhvirl fctrs r ls shwn t incrs th suscptibility t infctin. Spcific grups such s hlth cr wrkrs nd indignus ppultin r ls t n incrsd risk f TB infctin nd diss. This ppr summrizs ths fctrs lng with hlth systm issus such s th ffcts f dly in dignsis f TB in th trnsmissin f th bcilli.

Prvntin f Tubrculsis

s with ll hlth cnditins, prvntin f TB is lwys bttr thn cur. lthugh thr is n sur-fir wy t cmpltly prvnt th sprd f TB t this pint in tim, thr r numbr f msurs tht cn b put in plc t rduc th sprd f th illnss.

In cmmunity r grup with high burdn f diss, it is th rspnsibility f public hlth fficils, knwing its cus nd bilgic implictins, t put in plc prvntiv msurs t llvit th burdn. Thr r thr prvntin pprchs tht r crucil in dcrsing mrtlity nd mrbidity f diss: primry, scndry, nd trtiry prvntin. Ths lvls f prvntin wr first dscribd by Lvll nd Clrk nd cntinu t prvid usful frmwrk t dscrib th spctrum f prvntin ctivitis.

Primry Prvntin

Primry prvntin dnts ctin tkn t prvnt th dvlpmnt f diss in prsn wh is wll nd ds nt hv th diss in qustin” Ths ctivitis includ hlth prmtin s wll s diss prvntin ctivitis. Hlth prmtin ctivitis cn b s simpl s using pprprit hnd wshing tchniqus r cn b mr sphistictd such s vccintin t prvnt diss ccurrnc.

Vccins

Th nly vccintin fr TB n th mrkt is th bcill Clmtt-Guérin (BCG) vccin; hwvr, its us is rrly indictd in th Unitd Stts. Bfr putting vccin n th mrkt in th Unitd Stts, th Cntrs fr Diss Cntrl nd Prvntin (CDC) lng with th US Fd nd Drug dministrtin nd thr gvrnmnt gncis, must vlut th vccins fficcy, sfty, cntrindictins, utility, nd cst ffctivnss.

Envirnmntl cntrls

nthr frm f primry prvntin fr TB is nvirnmntl cntrl, such s ultrvilt lights nd vntiltin; hwvr, ths msurs r tkn mstly t hspitls nd cnnt b prcticlly implmntd t plcs whr mst TB trnsmissin xists (.g., nursing hms, prisns, in th cmmunity, tc.). Hwvr, prgrms imd t dcrsing vrcrwding cn ls b cnsidrd primry prvntin msurs fr TB.

Scndry Prvntin

Scndry prvntin dnts th idntifictin f ppl wh hv lrdy dvlpd diss, t n rly stg in th diss’s nturl histry, thrugh scrning nd rly intrvntin.” “Th rtinl fr scndry prvntin is tht if w cn idntify diss rlir in its nturl histry, intrvntin msurs will b mr ffctiv. Prhps w cn prvnt mrtlity r cmplictins f th diss nd us lss invsiv r lss cstly trtmnt t d s

Scndry prvntin f TB invlvs th idntifictin nd tsting f trgts grups f ppl nd cmmunitis with grtr liklihd f bing infctd. "Trgtd tubrculin tsting fr LTBI is strtgic cmpnnt f tubrculsis (TB) cntrl tht idntifis prsns t high risk fr dvlping TB wh wuld bnfit by trtmnt f LTBI, if dtctd”.

Sm f ths high risk grups r:

nthr typ f scndry prvntin msur is clld cntct invstigtin. During cntct invstigtin public hlth wrkr intrviws ptints with ctiv TB diss in rdr t idntify “cntcts” r ppl wh my hv bn xpsd t tht prsn. nc idntifid th cntcts will b vlutd fr LTBI nd TB diss nd prvidd with pprprit trtmnt, whn ncssry.

Trtiry Prvntin

Th trtmnt f ppl wh hv lrdy dvlpd diss is ftn dscribd s trtiry prvntin. Th finl strtgy usd fr prvnting nd cntrlling TB in th Unitd Stts is idntifying nd trting ptints with ctiv TB. ch prsn with infctius TB hs th ptntil t infct mny thrs; hwvr, th sit f th infctin is imprtnt in dtrmining its cpbility t sprd. Fr xmpl, th lungs nd lrynx r tw cmmn rgns whr TB my b highly infctius. If instd, th TB infctin is lclizd t rs such s lymph nds r utsid th lung, trtmnt is ncssry, yt it is nt trnsmissibl nd, thrfr, is nt mjr public hlth cncrn.

Th trtmnts usd fr ppl with ctiv TB will vry dpnding n whthr th TB is rsistnt t sm f th stndrd TB mdictins. Trtmnt cn tk 6 mnths r lngr. Sm f th mst cmmn drugs usd t trt TB r:

DOT is usd t b sur tht ptints wh hv ctiv diss t rmmbr t tk thir TB mdictins.

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