The Global Health Case Study

ScenarioYou are a new nursing graduate assigned to a busy Emergency Department (ED) at a level I Trauma Center. The ED has just been notified by local EMS that a multiple vehicle pile-up on the interstate has just occurred with several injuries. The first victims to arrive in your ED is a family of four who recently immigrated to the United States from Nigeria in hopes of finding a better way of life. The family consists of a father, mother, and two pre-school children, ages 2 years and 4 years. None of their injuries appear life threatening. As an interpreter is interviewing the family you observe that the father has a very productive cough and you notify the ED physician immediately. The physician orders a stat chest x-ray. The radiologist quickly informs the physician that the chest film reveals bilateral upper lobe infiltrates suggesting active pulmonary tuberculosis (TB). In assessing the father more thoroughly, he reports a 30-pound weight loss over the last 6 months, extreme fatigue, and night sweats. The ED physician gives the order to place the father in a negative pressure room located in the ED. Based on the above information, answer the following questions in narrative format:
1.What anti-tuberculosis medications would the physician likely order for the father? Provide name, route, and possible doses of the medications.
2.What, if any, TB medications would be different for this father based on his country of origin?
3.In addition to the chest x-ray, what other lab testing(s) that would be appropriate for the physician to order on the father?
4.How should the mother and two children be evaluated to determine their TB status? If their TB skin tests are positive, what follow-up is recommended?
5.What is the technique for reading a TB skin test?
6.The mother’s TB skin test is 0 mm; the
2-year old’s TB skin test reading is 6 mm; and the 4-year old’s TB skin test reading is 2 mm. Which readings would be interpreted as positive and why?
7.In preparing the family for discharge home, what community agencies and resources would you contact?
8.Describe the global burden of TB. Which countries have the highest rates of TB? What are the challenges in TB treatment and control in high-risk countries?
Helpful references in completing the Case Study: CDC: https://www.cdc.gov/tb/World health Organization:http://who.int/tb/en/Course textbook