TB Awareness Practice Nurses

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Presentation transcript:

TB Awareness Practice Nurses Sarah Hackforth & Sue George TB Specialist Nurse Practitioners The Shrewsbury and Telford Hospital

Introduction The TB prevention and control service across Shropshire Telford and Wrekin is led by two TB Clinical Nurse Specialists Contact details 01952 641222 ext 4480; 01743 261345 Sue George Mobile 07901518294 – e mail sue.george@sath.nhs.uk Sarah Hackforth Mobile 07837096740 - sarah.hackforth@sath.nhs.uk

What is Tuberculosis (TB) Caused by the bacteria Mycobacterium- includes M tuberculosis, M bovis, M africarnum. Spread through the air by droplets from an infected person. Is not always infectious. Can affect any part of the body. Is treatable/curable. Can present in a variety of ways. Arduous long course of treatment. Can be active or latent – Primary infection and primary complex.

TB Shropshire, Telford and Wrekin Low incidence area, but covers a large wide geographical area including into Powys. Treats both active and latent TB infection. Varied mixed group of patients. Presents in a variety of ways. NEVER straightforward.

Risk Factors TB history previously treated/partially treated Exposure – consider Bovine TB. Country of birth. Places where you have lived. Ethnicity. Travel. Profession. Co-morbidities. Lifestyle. HIV status. Medication.

Signs and Symptoms Persistent cough 3 + weeks or more. Haemoptysis Drenching night sweats. Fever (intermittent) more evening night time. Weight loss and poor appetite. Malaise. Lymphadenopathy Headaches/confusion. Back pain. Chest pain.

Diagnosis Tuberculin skin testing (Mantoux) IGRA-T,Spot CxR =/- CT scanning Sputum samples Bronchoscopy Biopsy CSF EMU Thorough history IDEALLY we want a culture

TB Management TB must be treated with several antibiotics over a number of months – usually six, but can exceed twelve. The great majority of TB bacteria are sensitive to the antibiotics used. Rifampicin. Isoniazid. Pyrazinamide. Ethambutol. MDRTB requires specialist management. Treatment is difficult, has many side effects and can be hepatotoxic. Concordance is the key to management and cure.

Role of TB Nurse Outreach work Nurse led TB clinics Contact tracing New Immigrant screening Education/teaching/research/audit Support and management of patients Support and advice to everyone Home visits to provide holistic care BCG Vaccination

What is important to know? Be aware of high risk countries and regular travel arrangements. Think latent TB new entrants/ asylum seekers/refugees. Think do they have chaotic lifestyle? Are they immunosuppressed?

Where do Practice Nurses fit in? Educate patients. Inform regarding travel.(Green book) Assist to dispel myths. Refer directly to TB nurses. If suspect arrange CxR, sputum samples fro TB Culture and refer.

Take home message THINK TB, active and latent. Extensive history taking, dig deep. Employment history. Lifestyle – drugs, alcohol, homeless, prison. If in doubt we are a phone call away - ASK for advice. New TB Guidelines focus on underserved groups. Any new patients from high incidence countries – please refer to us. Futher information is available on RCGP,PHE TB Alert who also provide a free e.learning course.