CASE STUDIES IN TUBERCULOSIS Nurse Case Management Training Tools for Patient Success E X C ELLEN C E | EXPERTI S E | INN O VATI ON [...]... previously abnormal findings References: • 3 - ATS 2000 pages 137 8-1 379 • 6 - CDC 2009 3.5 CASE STUDY #3 REFERENCES These references are designed to assist in case management and advocacy for promoting the optimal management of care for TB patients who present with extrapulmonary findings 1 Centers for Disease Control and Prevention (CDC 2005) Guidelines for the Investigation of Persons with Infectious TB... Document the patient information and inform the physician that the patient does not meet the standard for discharge because of the high-risk home setting (children < 4 years old and patient AFB-smear positive) 4) Document the patient information and inform the physician that it is inappropriate to discharge a tuberculosis patient with only 3 hours notice After one week of hospitalization, the patient is... Reference: • 7 - MDHSS 2006 2.12 CASE STUDY #2 REFERENCES These references are designed to assist in case management and advocacy for promoting the optimal management of care for TB patients who require isolation or confinement 1 Francis J Curry National Tuberculosis Center (CNTC 2007) Tuberculosis Infection Control: A Practical Manual for Preventing TB, Appendix J – Respiratory Isolation of Pulmonary Tuberculosis. .. and advocacy for promoting the optimal management of care for TB patients using directly observed therapy (DOT) 1 New Jersey Medical School Global Tuberculosis Institute (UMDNJ 2006) Designing a Drug- o -Gram: A Program for Initiating Appropriate Tuberculosis Therapy, 2006 Accessed at http://www.umdnj.edu/ ntbcweb/downloads/products/Drug%20Gram%20Users%20Guide.pdf on 3/14/2009 - Also contains a download... discharge the patient by noon He provided the prescriptions for isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), ethambutol (EMB), and vitamin B6 B What is the appropriate response for the request to discharge? 1) Document the patient information, fill the prescriptions as ordered and proceed with discharge plans 2) Document the patient information and inform the physician that the patient cannot... Keep all appointments given to you by clinical staff Several appointments will be necessary to be sure your treatment is working The treatment for tuberculosis is usually for six or more months It is very important for you to keep all of the appointments made for you _ (client's initials) 2 Be sure you take your medicine for the treatment of your tuberculosis as your doctor or other clinic staff... Document the patient information and inform the physician that the patient does not meet the standard for discharge because of the high-risk home setting (children < 4 years old and patient AFB-smear positive) a This patient does not meet the criteria for discharge from hospitalization to home with high-risk contacts: he has not had 3 consecutive negative smears and no documentation of clinical improvement... strategy in locating a missing patient Reference: • 6 - CDC 2008 F What recommendation should be made to the administrator of the health department clinic managing the patient? 3) Seek a court order based on non-adherence to isolation, non-adherence with instructions to avoid alcohol, and non-adherence with DOT a This is a tough judgment call, but balancing the needs of the patient vs protecting the health... Calculating the number of doses may be possible by reviewing a detailed directly observed therapy log A drug-o-gram tool facilitates calculation of doses for more complicated cases Both automated and hard-copy forms are referenced here References: • 1 - UMDNJ 2006 • 2 - CDC 2003 Pages 3, 40 and Table 2 • 3 - CDHS/CTCA 2003 1.9 CASE STUDY #1 REFERENCES These references are designed to assist in case management. .. list of “Priority situations for the use of DOT” - Figure 1 on page 41 provides a decision algorithm for the Management of treatment interruptions” - Figure 3 on page 17 provides a “Range and median of treatment completion rates by treatment strategy for pulmonary tuberculosis reported in 27 studies - Figure 4 on page 18 is an “Example of a flow chart for patient monitoring” - Page 8 “Completion of Treatment” . National Tuberculosis Center, Case Studies in Tuberculosis: Nurse Case Management Training Tools for Patient Success. This project was made possible by a grant through the Centers for Disease. CASE STUDIES IN TUBERCULOSIS Nurse Case Management Training Tools for Patient Success E X C ELLEN C E | EXPERTI S E | INN O VATI ON