NURSES ROLE IN THE CARE AND MANAGEMENT OF MDR-TB

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Presentation transcript:

NURSES ROLE IN THE CARE AND MANAGEMENT OF MDR-TB PRESENTER: DRAJORU CLARE PRINCIPAL NURSING OFFICER MULAGO NATIONAL REFERRAL HOSPITAL AT HOTEL AFRICANA- 9TH SEPTEMBER 2011

MDR T.B prevalence to 2.3% both new and retreatment cases INTRODUCTION Multi-drug resistant T.B is reality in Uganda so far 171cases have been notified to the National T.B leprosy Programme since 2008 t0 July 2011. MDR T.B prevalence to 2.3% both new and retreatment cases

MULTI DRUG RESISTANT RESISTANT EXTENSIVE DRUG RESISTANT TB TYPES OF RESISTANT T.B MONO- RESISTANT TB Mono Resistant TB ,TB in patient whose infecting isolates of Macbaterium tuberculosis are confirmed to resistant in vitro one first line anti TB drug POLY RESISTANT TB T.B in patient whose infecting isolates are resistant in Vitro to more than one other than isoniazid and Rifampicin MULTI DRUG RESISTANT RESISTANT T.B is active TB involving mycobacterium tuberculosis organisms that are resistant to at to at least both isonizedand rifampicin the two most powerful anti TB agents.An MDR TB strai n can be resistant to more than these two antibiotics and in most cases it is resistant to first line drugs EXTENSIVE DRUG RESISTANT TB Defined as resistant to at least rifampicin and isoniazid in addition to any fluoroquinolone and at least one of the injectable in second line drug(SLD) e.g amikacin Kanamycin and Capremycin

NURSES’ ROLES NURSING IS THE PROTECTION, PROMOTION AND OPTIMIZATION OF HEALTH AND ABILITIES, PREVENTION OF ILLNESS AND INJURY, ALLEVIATION OF SUFFERING THROUGH DIAGNOSIS AND TREATMENT OF HUMAN RESPONSE AND ADVOCACY IN THE CARE OF INDIVIDUALS, FAMILIES AND COMMUNITIES

Management of MDR-TB patients presents several challenges to Nurses. ROLES CONT’D Nurses are responsible for educating and supporting patients with T.B, detecting medication side effects. Management of MDR-TB patients presents several challenges to Nurses.

Objective of the presentation To share the experience in the care & management of MDR-T.B patients in Mulago a pilot treatment program .

Over 50 patients were screened and confirmed with MDR-TB. Cont’d The pilot MDR-TB treat project was carried out between 2003 – 2007 under the welcome trust research project. Over 50 patients were screened and confirmed with MDR-TB.

Who are involved in MDR-TB case management Patients with MDR-TB Multidisciplinary team of Health workers Peers/ relatives of the person with MDR-TB Members of the community

Treatment course in pilot project Enrolled 13 patients: 5(42%)females/8(58%) males Treatment was individualized regimen of 5 to 6 second line drugs (SLD) with at least an injection and fluoroquinolone Treatment lasted for 18-24 months IM injections of Amikacin (130- 155) Strict DOT was observed-Each swallowed or not was marked on a therapy sheet and signed.

What was done to support patients during treatment Continuous counseling to patients/ care takers Weekly weight monitoring Regular ward rounds to discuss individual patient progress Provisional of nutritional support (WFP)

Achievements 100% cure rate in all the 13 patients Nurses gained competencies in the care and management of MDR-TB patients No injection Abscesses encountered

Challenges in MDR-TB Management Pill burden Painful injection sites Socio-economical difficulties Stigma Patient/staff motivation Lack of man power Work conflicts Space

MDR-TB patients isolated. INFECTION CONTROL MDR-TB patients isolated. N95 masks were used. Patients educated to cover their mouth / nose when moving out and coughing.

Way forward National survey required urgently Indentified cases treated urgently. strengthen human resource to manage MDR-TB Health care providers with compromised immunity should not be allocated to attend to MDR-TB patients. A register has been opened for all identified MDR-TB cases awaiting treatment on ward 5 & 6. Risk allowances required

conclusion It’s hard for patients to take anti-TB drugs regularly during the 6-8 months but harder in case of MDR-TB which lasts 18-24 months. Early detection and proper treatment of TB should be observed. MDR-TB is curable with determination and commitment.

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