What resources existfor TB treatment in community health centers around the United States?

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Learning Goal: I’m working on a writing case study and need an explanation and answer to help me learn.CASE SCENARIOMaria is a 42-year-old single mother living in New York City with her three sons. Sheimmigrated to New York from Peru two years ago. About six months after she arrived, she begandeveloping 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 aneighbor told her that the local community clinic would see her and would not check herresidency status.Screening at the clinic included a questionnaire that addressed some of the problems she wasexperiencing. The nurse explained to Maria that she might have TB. The physician treatingMaria 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 havedied from TB.Physical exam findings showed abnormal lung sounds in Maria’s upper lobes bilaterally. Thephysician found cervical and axial lymphadenopathy. Maria was asked to leave sputum samplesto be tested for mycobacterium tuberculosis. A PPD was placed with instructions for Maria toreturn in two days to have it read. When Maria returned two days later, the result showed a 10mm raised, red reactive site. Maria was also screened for HIV at the time of initial exam becauseit is often found in patients with TB. In this case, she tested negative for HIV. Her sputumculture tested positive for M. tuberculosis.The physician explained that given the findings on the chest x-ray and the clinical findings onexam, he believed that she had reactivation TB. The physician informed Maria that he planned tostart her on a four-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol(Myambutol) for two months. The physician then explained that a “continuation phase” wouldfollow, which would consist of isoniazid and a rifamycin (rifampin, rifabutin [Mycobutin], orrifapentine [Priftin]) that is administered daily for four to seven months. He also informed herthat he would start her treatment at the hospital, where she would stay for least two days becauseshe was still considered contagious. Following the hospital stay, Maria would need to come tothe clinic for observed medication administration and to assure compliance.Two months passed and Maria continued about her day-to-day life including going to the clinicfor her medication. She attempted to work full time and to take care of her three sons. She foundthat her night sweats had become a nightly occurrence, and her cough had become productivewith blood along with intense coughing spells. Maria was compliant with the drug regimen butcalled the clinic because her symptoms were worsening. Maria was scheduled for a visit the verynext day.The follow up chest x-ray showed no improvement, and it was determined that Maria wasexhibiting signs of multidrug-resistant TB. Because multidrug-resistant and extensively drug-resistant tuberculosis requires at least 18 to 24 months of therapy, depending on the patient’sresponse to treatment, the physician decided to extend her therapy to 18 months, beyond the 4 to7 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 thiswas discussed with Maria at the time of the exam.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, theentire situation has put Maria under stress to the point that it is unclear how she will meet thischallenge and adequately handle her health crisis.DUE MAY 1 STASSIGNMENTConduct an evidence-based literature search to identify the most recent standards ofcare/treatment modalities from peer-reviewed articles and professional associationguidelines (www.guideline.gov (Links to an external site.)). These articles andguidelines can be referenced, but not directly copied into the clinical casepresentation. 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 forthis patient?4. What are the primary psychosocial concerns?5. What are the implications of the treatment regimen, as far as likelihood ofcompliance and outcomes? Search the Internet to research rates of patientcompliance in treatment of TB, as well as drug resistant TB.6. Identify the role of the community clinic in assisting patients, particularlyundocumented patients, in covering the cost of TB treatment. What resources existfor TB treatment in community health centers around the United States? Comparethe cost for treatment between subsidized 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 cover page and references page.Your resources must include research articles as well as reference to non-researchevidence-based guidelines. Use APA format to style your paper and to cite your sources. Your source(s) should beintegrated into the paragraphs. Use internal citations pointing to evidence in theliterature and supporting your ideas. You will need to include a reference page listingthose sources. Cite a minimum of three resources.Review the rubric for more information on how your assignment will be graded.

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