Pathophysiology Extended Case Study essay

Pathophysiology Extended Case Study essay

Tuberculosis

Tuberculosis is a bacterial infection of the lung caused by mycobacterium tuberculosis. It is a communicable disease that spreads from one person to the other by air droplets through sneezing or coughing. Pulmonary tuberculosis presents with coughing, fever, weight loss, night sweats, hemoptysis, fatigue, and chest pain. Mycobacteria tuberculosis may affect other parts of the body except for the nails and the hair. Extra-pulmonary tuberculosis presents with lower back pain, flank pain, dysuria, frequent urination, prostatitis, abdominal pain, mal-absorption, diarrhea, and difficulties in swallowing. The diagnostic tests are acid fast bacilli, chest xray, and complete blood count. Treatment involves the intensive phase which goes for two months and the continuation phase for four months. Pathophysiology Extended Case Study essay

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1. What is the transmission and pathophysiology of TB?

Tuberculosis is an airborne aerosol disease transmitted from a person with the infectious diseases through direct air droplets in sneezing, coughing, or spitting. After the inhalation of mycobacterium tuberculosis, four likely outcomes may happen depending on the body’s immunity, which are immediate clearance of the infection, latent infection, the onset of active disease, and active disease years after treatment (Melgar, et al, 2020). The bacilli establish an infection in the lungs to the alveoli, the body’s defense host may eliminate the infection by producing antibodies against it. When the body’s immune mechanism is weak, the bacteria proliferate in the alveoli and kill the cells. The infected macrophages produce the chemokines that attract phagocytic cells and other alveolar macrophages, forming a tubercle. If the body’s defense mechanism is still weak, the tubercle enlarges and enters into a draining lymph node. This causes the primary manifestations of tuberculosis. Continuous proliferation of the bacilli causes an effective cell-mediated immune response when the host immunity is high. Failure of the host to mount an effective cell-mediated immune response causes progressive destruction of the lung cells. In the absence of treatment, the patient becomes infected with the disease. The disease may become chronic leading to fibrotic changes around the lesions and tissue breakdown.

2. What are the clinical manifestations?

The classic features of tuberculosis are coughing, weight loss, fever, night sweats, hemoptysis, chest pain, and fatigue (Melgar, et al, 2020). On examination, the patient has fever, tachypnea, tachycardia, generalized lymphadenopathy, decreased breath sounds, and rales.

3. After considering this scenario, what are the primary identified medical concerns for this patient?

The patient is newly diagnosed with tuberculosis and she needs to start her treatment. The patient is a non-resident and fears seeking medical attention. Her medical concerns are the accurate diagnosis for accurate treatment. She should understand the causes of the illness, the mode of transmission, and the risks it poses to her children and the community. She should understand the need to take her medication to prevent drug resistance, and the need to attend the follow-up clinic for evaluation. The patient may also experience an emergence of drug resistance in the course of the treatment and continuous spread to other parts of the body.

4. What are the primary psychosocial concerns?

The patient is an illegal resident in her current state and worry’s lack of health access. She is a single parent with three children to look after.  Her primary psychosocial concerns are family problems because she is a single parent and has no one to look after her children when she is sick. She is likely to have anxiety and depression because tuberculosis is a progressive disease with a poor prognosis. Her worry could be if she will recover or progress to terminal illness. She has the fear of stigma because tuberculosis is contagious and other people may avoid close association. She lacks social support from her family and friends because she continues working when she is still sick (Walker, et al, 2018). Moreover, she is devastated when the physician tells her she developed multidrug resistance despite being compliant with treatment. She has a little perception of the illness because she continues to work and interact with other people despite the high risk for disease transmission. According to the world health organization guidelines on tuberculosis, a patient who develops multidrug resistance should be isolated.

5. What are the implications of the treatment regimen, as far as the likelihood of compliance and outcomes?

Treatment for tuberculosis entails a drug regimen with an intensive phase for two months and a continuation phase for four months. The drug regimen consists of ethambutol, isoniazid, rifampicin, and pyrazinamide. The potential side effects are skin itchiness, skin rash, easy bruising, jaundice, gastrointestinal symptoms like diarrhea, vomiting, loss of appetite and weight loss, numbness, and tingling sensation, and changes in eyesight especially the yellow and green vision, and dark colored urine (Bahuguna, A., & Rawat, D. S. 2020). These side effects are unpleasant to the patient and reduce compliance, hence treatment failure or drug resistance. The drugs may damage the liver mandating stopping the treatments till the liver enzymes come to normal. This period may cause the progression of tuberculosis or cause drug resistance. Daily intake of medicine becomes monotonous and boring, resulting in poor compliance and eventually treatment failure. The patient developed multi-drug resistance due to treatment failure. She will take more drugs for a longer duration of time. This increases the exposure to the side effects and increased the cost of treatment which may eventually cause treatment failure. Pathophysiology Extended Case Study essay

6. Identify the role of the community clinic in assisting patients, particularly undocumented patients, in covering the cost of TB treatment. What resources exist for TB treatment in community health centers around the United States? Compare the cost for treatment, subsidized as it would be for a community health center, and unsubsidized.

The community clinic provides a mutually enabling environment that works on the principles of quality, equity, and mutual respect for the patients and the caregivers. The community clinic should provide primary health care services to its members by the provision of promotive, curative, rehabilitative, preventive, and supportive care to all members. Patients with tuberculosis, should screen and test for other related comorbidities, initiate treatment, treatment support adherences, and social livelihood support. Tuberculosis is a complex illness with expensive treatment modalities. The majority of the patients in a community are unemployed and lack a livelihood that would support the cost of medication and transportation. The community clinics are incorporating NGOs and CSOs in tuberculosis activities according to the local norms. These organizations collaboratively work towards tuberculosis prevention, care, and control by financing medicine for all patients, providing basic needs like proper nutrition and follow-up fee, and creating communication linkages between the patient and the care provider.

The resources available for patients with tuberculosis at the health centers are program evaluation to improve treatment, control, and prevention. Evaluation tools include the testing tools and resources for modeling costs. National tuberculosis programs aim at promoting health and improving the quality of care. There are patient educational services that improve drug adherence and disease outcome. There are vaccination services for all patients who are yet to receive their BCG vaccine. There are committees for refugees and immigrants to become proactive in the consumption of health. In the united states of America, the average cost of treating tuberculosis is 34,000 dollars while the subsidized cost is 20,000 dollars.

7. What are the implications of TB for critical care and advanced practice nurses?

Patients with a poor prognosis for tuberculosis require critical care because they often develop respiratory failure or acute respiratory distress syndrome (Otu, et al, 2018). Nurses support the patients throughout treatment to prevent such complications. The critical care nurse dispenses treatment to the patient and observes the progress during the follow-up clinics. They communicate to the patients and educate them about their illness and the importance of drug compliance. The nurse considers the social aspects that hinder treatment adherence like; poverty and indiscipline. Poverty-stricken patients lack proper diet and transport fees during the follow-up clinic. The nurse ensures the patient has access to a proper diet by proving food and transport fees to access healthcare. Non-governmental organizations are funded by donors and well-wishers to help meet the basic needs of patients in need of critical care.

NURS_530_DE – Extended Case Study Rubric

(Please review the case below, and answer questions, on page 1, page 2, see attachment, and RUBRIC under attachment, I also will upload a sample paper from another student.)
Maria is a 42-year-old single mother living in New York City with her three sons. She immigrated to New York from Peru two years ago. About six months after she arrived, she began developing night sweats and unexplained fevers. Most recently, she has developed a persistent, worsening cough. Her illegal status has made her hesitant to seek medical treatment, but a neighbor told her that the local community clinic would see her and would not check her residency status.

Screening at the clinic included a questionnaire that addressed some of the problems she was experiencing. The nurse explained to Maria that she might have TB. The physician treating Maria performed a complete physical exam and discussed her questionnaire responses with her, including her response that in Peru, she lived with her grandfather who she believes may have died from TB.

Physical exam findings showed abnormal lung sounds in Maria’s upper lobes bilaterally. The physician found cervical and axial lymphadenopathy. Maria was asked to leave sputum samples to be tested for mycobacterium tuberculosis. A PPD was placed with instructions for Maria to return in two days to have it read. When Maria returned two days later, the result showed a 10 mm raised, red reactive site. Maria was also screened for HIV at the time of the initial exam because it is often found in patients with TB. In this case, she tested negative for HIV. Her sputum culture tested positive for M. tuberculosis.

The physician explained that given the findings on the chest x-ray and the clinical findings on the exam, he believed that she had reactivation TB. The physician informed Maria that he planned to start her on a four-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol (Myambutol) for two months. The physician then explained that a “continuation phase” would follow, which would consist of isoniazid and a rifamycin (rifampin, rifabutin [Mycobutin], or rifapentine [Priftin]) that is administered daily for four to seven months. He also informed her that he would start her treatment at the hospital, where she would stay for at least two days because she was still considered contagious. Following the hospital stay, Maria would need to come to the clinic for observed medication administration and to assure compliance.

Two months passed and Maria continued with her day-to-day life including going to the clinic for her medication. She attempted to work full time and take care of her three sons. She found that her night sweats had become a nightly occurrence, and her cough had become productive with blood along with intense coughing spells. Maria was compliant with the drug regimen but called the clinic because her symptoms were worsening. Maria was scheduled for a visit the very next day.

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The follow-up chest x-ray showed no improvement, and it was determined that Maria was exhibiting signs of multidrug-resistant TB. Because multidrug-resistant and extensively drug-resistant tuberculosis require at least 18 to 24 months of therapy, depending on the patient’s response to treatment, the physician decided to extend her therapy to 18 months, beyond the 4 to the 7-month time period he had projected. He also stopped the ethambutol and started moxifloxacin. Thoracic surgery for resection of lung lesions is often considered as adjunctive therapy, and this was discussed with Maria at the time of the exam. Pathophysiology Extended Case Study essay

Maria was devastated to learn about her multidrug-resistant TB because she needed to work. Fortunately, the clinic was able to fund Maria’s drugs at a discounted rate. Nonetheless, the entire situation has put Maria under stress to the point that it is unclear how she will meet this challenge and adequately handle her health crisis.
Review the patient’s TB questionnaire. (Page 1) (Page 2) ( SEE ATTACHMENT )
Conduct an evidence-based literature search to identify the most recent standards of care/treatment modalities from peer-reviewed articles and professional association guidelines (www.guideline.gov (Links to an external site.) https://www.ahrq.gov/gam/index.html

These articles and guidelines can be referenced, but not directly copied into the clinical case presentation. Cite a minimum of three resources.
Answer the following questions:
1. What is the transmission and pathophysiology of TB?
2. What are the clinical manifestations?
3. After considering this scenario, what are the primary identified medical concerns for this patient?
4. What are the primary psychosocial concerns?
5. What are the implications of the treatment regimen, as far as the likelihood of compliance and outcomes? Search the Internet to research rates of patient compliance in the treatment of TB, as well as drug-resistant TB.
6. Identify the role of the community clinic in assisting patients, particularly undocumented patients, in covering the cost of TB treatment. What resources exist for TB treatment in community health centers around the United States? Compare the cost for treatment, subsidized as it would be for a community health center, and unsubsidized.
7. What are the implications of TB for critical care and advanced practice nurses?
The use of medical terminology and appropriate graduate-level writing is expected.
Your paper should be 4–5 pages, (excluding the cover page and reference page).
Your resources must include research articles as well as references to non-research evidence-based guidelines.
Use Current APA Style to format your paper and cite your sources. Your source(s) should be integrated into the paragraphs. Use internal citations pointing to evidence in the literature and supporting your ideas. You will need to include a reference page listing those sources. Cite a minimum of three resources.
TEXTBOOK:
Pathophysiology: The Biologic Basis for Disease in Adults and Children
• Author: Kathryn L. McCance and Sue E. Huether
• Publisher: Elsevier
• Edition: 7th (2014). Pathophysiology Extended Case Study essay