Sample Answer for NURS 4211/4210 WK 2 AN EPIDEMIC IN THE COMMUNITY WALDEN Included After Question

How Should Debbie Respond?

The first step Debra should take, according to CDC guidelines, is when TB is suspected or identified, the health department should immediately be contacted so that contacts can be screened and additional diagnostic, preventative, or patient care treatments can be started. (Prevention and Control of Tuberculosis in Migrant Farm Workers Recommendations of the Advisory Council for the Elimination of Tuberculosis *, n.d.) In this case, Debbie should report the outbreak to the doctor immediately so he can take the necessary steps to contact the CDC and help get the problem under control. Then taking into consideration the stigmas, language barriers, and complex issues migrant workers may have in accessing healthcare, Debbie should then proceed with making sure access to general healthcare is available and monitor for common symptoms of TB; prolonged cough, fever, chills, night sweats, fatigue, loss of appetite, weight loss, and, occasionally, hemoptysis (coughing up blood). “66% of TB cases are diagnosed when a patient makes a doctor visit rather than through TB screening or contact tracing; therefore, access to general health services is vital to TB care” (Littleton et al., 2008). Debbie should offer TB education to anyone who comes into the clinic and encourage them to invite others to come to the clinic for a screening. She should also publish an article in the local newspaper and community health promotion initiatives. Due to the population being cared for, Debbie must tread a fragile line between acknowledging and dealing with the realities of TB in some migrant workers groups, re-stigmatizing these groups, and driving the problem underground. (Littleton et al., 2008) Anyone Debbie suspected of having pulmonary tuberculosis should be reported to the doctor and evaluated immediately. This evaluation should include a medical history and physical exam, a chest x-ray, a Mantoux tuberculin test, at least three sputum samples (collected on different days) for an acid-fast bacilli (AFB) smear, a culture, drug susceptibility testing, and HIV-antibody counseling and testing. Anyone who is actively diagnosed with a case of TB should be placed in AFB isolation and treated immediately. Debbie should provide education on the reason for the quarantine and the steps that must occur throughout the process.

A regimen of isoniazid, rifampin, pyrazinamide, and ethambutol should be used to treat migrant workers and their family members who have uncomplicated pulmonary TB. Drug-resistant TB should also be a consideration because it necessitates different treatment protocols and because social and ethnic groups that make up the majority of the migrant farm labor force have greater rates of resistance. Debbie and other affiliated healthcare professionals should closely watch patients for toxicity, adherence, and therapy response. Patients should ideally receive directly observed therapy from a well-trained outreach worker who shares their cultural and linguistic background. (Prevention and Control of Tuberculosis in Migrant Farm Workers Recommendations of the Advisory Council for the Elimination of Tuberculosis *, n.d.) Debbie should monitor responses and adherence to treatment throughout therapy. If a migrant farm worker is known to be leaving the area and needs treatment for active TB, preventive treatment, or diagnostic services, healthcare professionals managing their care should get in touch with the TB control officers at their state health department to ensure that the farm worker is followed up on and the TB control officers are informed on where the patient might be going next. This process guarantees that the patient’s information is communicated correctly and that the required follow-up is started. State health authorities should handle Communications regarding TB care sent from outside the state. After the migrant worker leaves for another location, the healthcare provider or health department should receive a TB laboratory report. The next area’s health department or healthcare professional should be contacted right away by phone or as soon as possible by mail with the information. (Prevention and Control of Tuberculosis in Migrant Farm Workers Recommendations of the Advisory Council for the Elimination of Tuberculosis *, n.d.)

TB Prevalence in a Rural Community

Evanston, Wyoming, is a rural community roughly 10 miles from the Utah border. It consists mainly of ranch and farmlands throughout. The biggest problem with this type of community is the mindset that you don’t visit a doctor unless you absolutely cannot stand whatever is ailing you anymore. Then they reluctantly drag themselves, or their friend or loved one takes them to the doctor for a visit. Keeping this in mind:  Rural settings have a 70% higher risk of death due to TB than urban settings. The risk of loss to follow-up was twice as high in rural than in urban. The prevalence of recurrent TB was 15.3% in urban communities and 11.3% in rural communities. (Mutembo, et al., 2018) The steps to control an outbreak of TB in this area should be treated in the same manner as Debbie’s population of migrant farm workers, only without the worry that the farmers or ranchers will leave the state. The other difference is, as stated above,  the farmers and ranchers are reluctant to seek out medical help because of stubbornness, lack of ability to pay the doctor’s bill, the mindset that they are too busy, or the belief they shouldn’t seek out medical care until they are so sick, they have to. Because of this, education should be provided regarding seeking medical help sooner rather than later. The healthcare provider should re-enforce to patients that when isolated because of the risk of exposure to others, it is imperative not to work on the ranch or farm and to seek out help for these chores until they are well enough to be released from isolation. The medical professional should also stress that the patient should continue to take their medications until the regimen is completed. Most people in this community believe they no longer need their prescribed medications as soon as they feel better.

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Prevention and Control of Tuberculosis in Migrant Farm Workers Recommendations of the Advisory Council for the Elimination of Tuberculosis *. (n.d.). to an external site.

Littleton, J., Park, J., Thornley, C., Anderson, A., & Lawrence, J. (2008). Migrants and tuberculosis: analyzing epidemiological data with ethnography. Australian and New Zealand Journal of Public Health32(2), 142–149. to an external site.

Mutembo, S., Mutanga, J. N., Musokotwane, K., Kanene, C., Dobbin, K., Yao, X., Li, C., Marconi, V. C., & Whalen, C. C. (2018). Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia. BMC Infectious Diseases19 to an external site.

A Sample Answer For the Assignment: NURS 4211/4210 WK 2 AN EPIDEMIC IN THE COMMUNITY WALDEN


Tawni, I enjoyed your post. It was very in-depth regarding treatment for Debbie’s migrant farm worker’s plan of care. Unfortunately, given the living conditions of this group of people, they are in immediate danger of both transmission within the group of workers as well as become resistant to treatment due to the lack of finishing a complete treatment protocol (Centers for Disease Control and Prevention, 2021). Local health department efforts to screen recent migrants for tuberculosis are one of the most important components of broader TB control goals. In 2012, the TB incidence was 11.5 times greater in foreign-born individuals than in the American population (Nuzzo et al., 2015). It was estimated by the CDC that 4 out 5 active TB cases among foreign-born people were likely due to the reactivation of TB that was likely acquired before the arrival in the U.S.

 To reduce the chances that TB will be introduced from abroad, U.S. policy requires immigration applicants to undergo a prearrival medical exam that includes TB screening (Nuzzo et al., 2015). I can imagine the largest part of this problem stems from illegal immigration and the immigrant being too scared to receive medical intervention in fear of deportation. In the scenario you discussed, I would also imagine keeping up with migrant farm workers under treatment as they move from state to state would be very difficult, with many falling through the cracks.

 The hospital policy in my area requires an annual TB skin test. If there is suspected exposure, we may be tested more frequently. What does the policy at your location call for? I work in the ED and feel like it is possible that we come in contact with this more frequently than we know, especially given the symptoms of the recent pandemic. It makes me wonder if we should be tested more frequently.


Centers for Disease Control and Prevention. (2021). Core curriculum on tuberculosis: What the clinician should know (7th ed.).

Nuzzo, J. B., Golub, J. E., Chaulk, P., & Shah, M. (2015). Postarrival tuberculosis screening of high-risk immigrants at a local health department. American Journal of Public Health, 105(7), 1432–1438.

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