DISCUSSION A As a BSN -prepared community health nurse, after Debbie has identified the group of migrant farm workers as being at highest risk for contracting tuberculosis (TB), the most appropriate next step for Debbie to take is to understand what factors are increasing their risk of infection

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DISCUSSION A

As a BSN -prepared community health nurse, after Debbie has identified the group of migrant

farm workers as being at highest risk for contracting tuberculosis (TB), the most appropriate

next step for Debbie to take is to understand what factors are increasing their risk of infection.

According to Center for Disease Control and Prevention (CDC) statistics (2016), in 2015,

Hispanics/Latinos accounted for 28 percent of the U.S. TB cases and of the TB cases among

foreign -born people, Lationos represented 32 percent in 2015 due to crowded housing and

malnutrition. As a result, transmission occurs rapidly amongst household members and can

easily target hosts who are weak from poor nutrition.

 

Debbie can implement interventions at all three leve ls of prevention; for the primary level

of prevention she can provide the community with education regarding TB and who is at highest

risk (Stanhope & Lancaster, 2020). The secondary level of prevention intervention can be one

or all of the following, admi nistering the TB skin test to the community, notify those who have

been in contact with those who test positive, and trace potential exposures to the community

(Stanhope & Lancaster, 2020). On the tertiary level of prevention, maintain long -term directly

observed therapy (DOT) for tuberculosis treatment, identify community resources for providing

supportive care (Stanhope & Lancaster, 2020). The listed levels of prevention are applicable to

the state of California as the number of Hispanic cases increased b y 11% compared to 2018, 75

percent were born outside the U.S. (California Department of Public Health (CDPH), 2019).

 

The considerations that are specific to my area are considering the challenges that the

COVID -19 pandemic brought upon such as decreased immigration from quarantine, delays in

seeking medical care, decrease in testing, as well as treatment for latent TB infections (CDPH,

2019). The end goal for any highly infectious communicable diseases is to eradicate, but we are

still managing the impac ts of a yearlong pandemic, therefore early intervention and prevention

are still the key players to having a fighting chance.

DISCUSSION B

As a community public health nurse (PHN), it would be important to find the common

determinants of health among the patients diagnosed and treated thus far. Determinants that have

been identified to this point are men of Hispanic origin, non -U.S. -born and farm workers. Using

the epidemiologic triangle, the infectious agent is tuberculosis (TB), the host are male migran t

farm workers, and the environment needs to be determined. The public health nurse would need to investigate the living and work conditions of these men. Possibilities may include crowded

living conditions, poor nutrition, working long hours in harsh cond itions, the work may be

difficult and stressful, if the men are injured or have health conditions requiring treatment, those

factors may be ignored and access to care may be costly. Social and economic factors the

community PHN need to consider are workers may not be educated, have a lower socioeconomic

status, may not speak English, lack support, and face discrimination (Stanhope & Lancaster,

2020).

The goal of the community PHN is to first understand the causal factors and how the TB

is being spread befor e interventions to treat this population and prevent further outbreak can

occur (Stanhope & Lancaster, 2020). The primary intervention would include education to the

farm workers about what TB is and symptoms of the disease, ensure their work environment a nd

standards of living are safe and do not contribute to the disease process (Stanhope & Lancaster,

2020). Health screening is an important part of the secondary intervention, find out which

workers have been exposed to TB and test all workers for TB with a simple tuberculin skin test,

read within 48 -72 hours for positive results (stanhope & Lancaster, 2020). The tertiary

intervention involves treatment and compliance to treatment, all positive workers will begin a 6 –

9 month course of antimycobacterial, wit h follow up appointments to ensure adherence and

possible drug reactions (CDC, 2018).

TB cases in California (CA) rose by 2,115 cases, 1% from 2018 to 2019

according to the California Department of Public Health (CDPH), a case rate of 5.3/100,0 00

people. CA is almost twice as high as the national average of 2.7/100,000 and 50% of cases were

among those of Asian origin (2020). Disparities between racial and ethnic groups continue,

Asians, Blacks, and Hispanics, born outside the U.S., have TB rate s respectively 46, 45, and 20

times higher than U.S. born whites. In CA, 82% of TB cases were from people born outside of

the U.S. and half of the cases in non -U.S. -born individuals did not have symptoms for 20 or

more yeas after arrival in the U.S. (CDPH, 2020). In Riverside County, where I live, there were

54 cases reported between 2015 -2017, the county’s crude rate is 2.3/100,000 with the national

objective at 1.0 (CDPH, 2019). I live in an agricultural area and my town is 69 miles from the Mexico border (according

to Google maps, n.d.). My community is very similar to Nurse Debbie’s and the clinic I work for

has a protocol in place for the high rates of Latent TB Infections (LTBI). Patients diagnosed in

my clinic with LTBI are started on medication, sees the Registered Nurse for a monthly follow

up to provide education, assess for possible adverse drug reactions, and address any barriers to

treatment compliance. The patient is given a booklet to bring with them to each appointment.

Baseline testing for li ver function is performed and patient is monitored for signs of hepatitis, if

symptoms occur, labs are drawn for comparison, patient is to stop medication and seek medical

attention. Once treatment is completed, patient is given all documentation pertainin g to their

diagnosis and treatment for possible future TB testing.

 

DISCUSSION C

Tuberculosis is a bacterial disease that affects the lungs. The bacterium responsible for the

spread of the disease is called Mycobacterium tuberculosis . Tuberculosis is an airborne disease

that spreads when people with the infection cough, sneeze, speak, or spits, and a healthy person

inhales the germs released. The bacterium mainly affects the lungs but can spread to other body

organs, including the brain, spine and kidneys (Li et al., 2021). The disease is preventable and

curable. If left untreated, the disease is fatal and can destroy the lung tissues, making breathing

difficult or impossible. The epidemiology triage concept is a formula for assessing a disease using

three concepts. It examines an external agent, a susceptible host and the environment (C DC, 2020).

The environment is responsible for bringing the agent and the host together. The host is the human

who contacts the disease, while the agent is the infectious microorganism.

Debbie must inform the local health department of the outbreak since tu berculosis affects

adults at the prime of their lives, and farmworkers are more likely to develop the disease when

compared to general workers. Debbie can then help round up and test other migrant workers with

the help of the local government to detect the disease early and prevent it from worsening. The

tertiary intervention that Debbie can help with is helping the migrant farmers improve the quality

of their lives and reducing the symptoms of tuberculosis by helping distribute the treatment for the

diseas e. Similar interventions can be applied in my community and its tuberculosis prevalence since

the health department works closely with the local government and is ready to respond to any

disease outbreak immediately. My community does not update its commu nity health profile. It

just records the patients in the electronic health record. The local hospital must keep and update a

community health record to monitor the prevalence of a disease in the community.