CASE STUDIES IN TUBERCULOSIS

1 EXCELLENCE | EXPERTISE | INNOVATIONCase STUDIES in TuberculosisTraining in Nurse case ManagementDisclosureCDC, 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 will not include any discussion of the unlabeled use of a product or a product under investigational Centers for Disease Control and Prevention and Heartland National TB Center are jointly providing the CNE for this did not accept commercial support for this continuing education : 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 activity provides contact 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.

2 9 Simple Steps to Get Your Continuing Education (CE)1. After completing a course, login or create a new account on TCEO ( ).2. Visit Search Courses and enter SS4042 to find the Scroll down and click on the title of the Review the information on the Course Summary page and click 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 Under Pending CE on the My Activities page, click on the course Evaluation and complete it. You will be returned to the My Activities 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 Visit the Completed CE section of the My Activities page to download your for Obtaining Continuing Education CreditDear 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).

3 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 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.

4 All materials in this document are in the public domain and may be used or printed without special permission; citation of source is citation: Heartland National TUBERCULOSIS Center, case STUDIES in TUBERCULOSIS : Training in Nurse case 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 National TUBERCULOSIS Center is funded by the Centers for Disease Control and 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: to Use This BookThis collection of nursing case STUDIES and their accompanying tools are intended to complement a TB program s education and training of its nursing staff.

5 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 EducationThis book has been accredited by the Training and Continuing Education Online (TCEO) office and can provide continuing nursing education hours. For more information and to obtain credit, please see the opposite Group TrainingThe 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 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.

6 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 LearningThis 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.

7 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 ContentsCase 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 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 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 Study 4 Supporting Private Providers Who Manage TB Infection in the Community.

8 29 Participants will learn about the diagnosis of clinical TB and the challenges that sometimes happen when working with private providers unfamiliar with 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 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 Study 7 Hepatotoxicity in TB Treatment ..49 Participants will learn about risk factors and signs and symptoms of drug-induced Study 8TB and Biologics ..55 Participants will learn about the risks associated with TNF- antagonist ( Remicaid, Humira, and Enbrel) treatment in latent TB-infected patients and procedures for managing a patient who moves during of ContentsCase Study 9 Positive TST and Pregnancy.

9 61 Participants will learn the about the diagnosis, classification and treatment regimen in a pregnant patient with a positive Study 10TB 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 Study 11TB Infection in a Homeless Man ..73 Participants will learn about the case management of a homeless patient with TB infection and treatment with Study 12TB 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 A. Smear Classification Results ..87 Appendix B . Criteria for Patients to be Considered Noninfectious ..89 Appendix C . Guidance on Release from Hospital TUBERCULOSIS Isolation.

10 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 AbbreviationsAFBAcid-fast BacilliIGRAI nterferon Gamma Release AssayAIIA irborne Infection IsolationINHI soniazidA LTAlanine Aminotransferase LFTL iver Function TestARTA ntiretroviral TherapyLTBIL atent TUBERCULOSIS InfectionASTA spartate AminotransferaseM. bovisMycobacterium bovisAT SAmerican Thoracic SocietyMDR-TBMultidrug-resistant TuberculosisBCGB acille Calmette-Gu rinMTBCM ycobacterium TUBERCULOSIS complexBPHB enign Prostatic HypertrophyM.