Myrna Leiper, RN, BSN Public Health Nurse Advisor MA Dept of ...
Myrna Leiper, RN, BSN Public Health Nurse Advisor MA Dept of ...
Myrna Leiper, RN, BSN Public Health Nurse Advisor MA Dept of ...
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Double Trouble<br />
Managing the patient with TB & HIV Co-Infection<br />
May 4, 2012<br />
<strong>Myrna</strong> L. <strong>Leiper</strong>, <strong>BSN</strong>, <strong>RN</strong><br />
Massachusetts Department <strong>of</strong> <strong>Public</strong> <strong>Health</strong>
Objectives<br />
• Identify activities TB Prevention and Control<br />
• Describe TB Case Management through Case<br />
Study<br />
Describe challenges for case management<br />
Identify TB treatment & Interactions with Antiretroviral<br />
medications<br />
Indentify Barriers to treatment<br />
Discuss Inpatient care<br />
Integrate Local public health case management<br />
Identify Community Resources
TB Case Management<br />
• Immediate case reporting<br />
to ISIS<br />
• Case management<br />
assignment through<br />
<strong>MA</strong>VEN<br />
• Formulate discharge plan<br />
• Collaborate with local<br />
health<br />
• Home Visit within 3<br />
working days<br />
• Home assessment<br />
• DOT<br />
• Assess side effects<br />
• Contact Investigation<br />
within 7 working days<br />
• Concentric circle<br />
• Identify potential barriers<br />
– Language<br />
– Cultural<br />
– Educational level<br />
– Misconceptions<br />
• Ongoing care until<br />
completion <strong>of</strong> therapy
Case Study<br />
• 45 year old female<br />
• Haiti<br />
• Date <strong>of</strong> arrival: 11/2009<br />
• Hospitalized for chest and arm burns October 2010<br />
• Things are never as they seem – Diagnosis <strong>of</strong> TB and HIV<br />
• Primary Sites <strong>of</strong> Disease: Pulmonary & Lymphatic<br />
• TST: 0mm<br />
• CXR: abnormal non-cavitary, B-infiltrates<br />
• Respiratory Specimen’s:<br />
– sputum smear positive<br />
– Culture MTB Complex<br />
• Standard 4 drug treatment: INH, RIF, EMB, PZA, MOXI<br />
• Family contact investigation: husband, 2 children, brother<br />
• Discharged plan: home with local public health case management
Complications for a complicated<br />
case<br />
• Medical history included<br />
HIV, Mental illness,<br />
• Misunderstanding about<br />
TB diagnosis complicated<br />
by HIV<br />
• Continued need for<br />
inpatient admission<br />
• 94 B Hospital to Hospital<br />
transfer<br />
• Admitted to Lemuel<br />
Shattuck Hospital<br />
• Inpatient complications<br />
– Elevated LFT’S<br />
– H. Pylori<br />
– Pleural effusion<br />
– Pulmonary emboli
Dr Marie Turner
Ready for discharge – Challenges<br />
and Barriers<br />
• Small community<br />
• No public transportation<br />
• Nearest TB clinic was 22 miles away<br />
• Cultural needs<br />
• Language barriers<br />
• Medical insurance – did not qualify for many<br />
benefits<br />
• Family dynamics
Success through Teamwork<br />
• Several family meetings<br />
• Discharge to the<br />
community<br />
• Local public health<br />
involvement<br />
• DOT<br />
• Supported visits to TB<br />
Clinic<br />
• Patient completed therapy<br />
Teamwork
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