Tuberculosis Case Study A homeless 50 yr old male presents t

Tuberculosis Case Study: A homeless 50 yr old male presents to the Emergency Department with weight loss, lethargy, a low grade fever, and a productive cough. He is also HIV positive and has a history of schizophrenia but has never complied with treatment for either disease process. His chest x-ray indicates a suspicious area in his right middle lobe, and sputum cultures come back positive for mycobacterium tuberculosis. He will be treated with a combination of antimycobacterial drugs. Here is what is needed for quality care of this patient: CDC notification of active TB Public health Dept notification All of his personal contacts to be evaluated for TB and for prophylactic treatment It is crucial he take his medications as prescribed to prevent spread of the disease He must return to the clinic monthly for sputum evaluations for at least 6 months He is started on Isoniazid (INH) and rifampin therapy. He continues to refuse treatment for his HIV and schizophrenia. It is not clear whether he will take the medication for his TB.1. What do you need to know about your local city government and treatment of TB in the homeless population in order to ensure safe and effective care? 2.What treatment plan can you develop with the patient in order for him to take his medications and comply with protocol? 3.What makes compliance to the drug therapy for TB so difficult?4. How is the patient’s HIV going to affect his cure rate? 5.Rifampin has a specific side effect that all people will experience, what is it?6. What is a common side effect of INH therapy? please cite references

Solution

3.tuberculosis should be treated with multiple drugs for prolonged periods of time. The patient must comply to the dosage directions in a strict manner for better prognosis. Hence it is difficult to comply.

4.HIV along with tuberculosis is a serious condition. The immune system is weakened with HIV as cell mediated immunity is suppressed with the decrease in the T Helper cell counts. Cell mediated immunity plays a major role in fighting tuberculosis. So in this case, the cure is not going to be quick as he is having HIV.

5.Rifampin side effects include Elevated liver function test (LFT) results, Rash, Epigastric distress, Anorexia, Nausea, Vomiting.

Reference : http://reference.medscape.com/drug/rifadin-rimactane-rifampin-342570#4

6.Isoniazid side effects include Severe and sometimes fatal hepatitis may occur within the first 3 months of treatment and many months after treatment. Risk is related to age and increased with daily alcohol consumption.Loss of appetite, Nausea, Vomiting, Stomach pain, Weakness, Dizziness, Slurred speech.

Reference : http://reference.medscape.com/drug/isoniazid-342564#4