COMMUNITY CASE STUDY

[Link].

COLLEGE [Link] 23031 4767

CLASS.2023 MARCH

CLASS TUTOR. MR WANGA

[Link] CASE STUDY

[Link]

INTRODUCTION

This community case study contains provision of care and follow ups of clients in their
respective homes.

This case study helps me as a student in practicing health profession to follow up clients in order to
identify health problems and other needs present.

It’s a requirement of KRCHN for the award of a diploma nurse,i will be able to identify the clients home
and assess the sustainability of the follow up and attend a minimal of 3 home visits .

I will share health messages to my client thus gaining skills and knowledge.

I met my client who was diagnosed with tuberculosis when he came to the comprehensive care clinic for
his checkup.

I first introduce myself and explain about the purpose of follow up visits which I would carry.

The client consented to this and I began history.

OBJECTIVES OF THE STUDY

BROAD OBJECTIVES

To enable tuberculosis and provide quality care to a client suffering from tuberculosis.

SPECIFIC OBJECTIVE

To carry out home visit.

To educate the client and the family what TB is its causes risk factors management and prevention.

To encourage the client to adhere to medication eat balanced diet, and maintain hygiene.

To enhance TB understanding.
IMPORTANCE OF COMMUNITY CASE STUDY.

TO CLIENT AND COMMUNITY.

1 Helps understand the community better its causes risk factors treatment and preventives measures
hence reducing the chances of getting the disease.

2 Helps understand ways of maintaining environmental hygiene thus reducing the rate of communicable
diseases hence lowering mortality rate.

3 Community promote on ways of building houses which have ventilation spacious enough to serve
everybody in the family.

Good means of waste disposal also achieved through digging pit latrines and compost pit for disposing
wastes.

TO THE STUDENT NURSE.

1 Helps study the condition in depth thus gaining skills and knowledge.

2 Home visit help student understand better the community in which the client lives hence being able
to cope with their lifestyles and culture teaching.

3 Strong relationship is built between the community and nurses through interaction hence making
understanding easier through teaching.

HOW I MET MY CLIENT.

I met my client on 17 November 2024 in male ward where he was admitted and laboratory results of
pulmonary tuberculosis was positive after results were taken in Akala hospital before he was being
admitted to Bondo hospital.

I met my client while he was with his mother in hospital.

He was weak ,in sick looking state and unable to talk well .I met him before he was being initiated on
Anti TBs drugs

I greeted his mother and created a good rapport with her.

I explained to her about taking her child to be my client and she accepted my request.

BIODATA OF MY CLIENT.

NAME-RAJAB OTIENO MOSES

AGE-35

SEX-MALE

RELIGION-CHRISTIAN

OCCUPATION-FARMER

RESIDENCE-SINAPANGA
TELL NO-0741710327

STATUS-MARRIED

NEXT OF KIN-ELIZABETH

RELATIONSHIP-MOTHER

TELL NO-N/A

OCCUPATION-BUSSINESS WOMAN

DATE OF FIRST ENCOUNTER-17/11 /2024

DIAGNOSIS-PULMONARY TUBERCULOSIS

CHIEF COMPLAINS

1. Persistent coughing
2. Chest pain
3. Fever
4. Headache
5. Night sweats
6. Sore throat
7. Mouth sores

HISTORY OF PRESENTING ILLNESS.

Rajab Otieno was well with until 2 weeks ago when he developed persistent coughing chest pain
fever mouth sores and sore [Link] client also vomits when taking food as a result of it
coming in contact with the sores.
Rajab started developing the above symptoms on 16/11/2024 which then become persistent
and he decided to visit the nearest health center in Akala.
In Akala dispensary sputum was taken for investigation to diagnosed if the patient had TB.
On that day he was then referred to BONDO hospital for immediate care as results where been
awaited
Rajab was then given stat doses at OPD and he was admitted to male ward.3 days later
tuberculosis results came out and it was positive
On 18/11/24 Rajab was then initiated on ANTI-TBs drugs
Rajab further say that when he is sleeping and at rest the pain is goes away but when coughing
pain persist.

PAST MEDICAL/SURGICAL HISTORY.

Rajab has no history of the same disease before
Has history of admission when he was 4 years old due to malaria in Voi Hospital.
He has history of infusion and blood transfusion when he was 4 years old on the same time he
had malaria.
He has no history of chronic illness and any known food or drug allergies.

FAMILY HISTORY
Rajab Otieno is the third born in the family of ten members,4 boys ,5 [Link] boy died at 22
years due to road accident.
His mother is alive but his father died due to unknown cause
There is history of their aunt having cancer.
There is no history of anyone in the family having tuberculosis before.

SOCIO-ECONOMIC HISTORY.
Rajab Otieno is a class six leaver living in his permanent house married to his wife and they are
blessed with 2 girls
they used well water for drinking and domestic used at home.
they used treated net to prevent them from malaria.
Rajab is a business man who works daily to feed for his family.
He has history of using alcohol and smoking cigarettes

PHYSICAL EXAMINATION
On general appearance Rajab was weak restlessness and in sick looking state unable to talk and
eat by himself
HEAD
On inspection hair was black well distributed no scars nor any lesions seen.
On palpation no tenderness was felt.
EYES
On inspection sclera was white with visible blood vessels conjunctiva was pink in color with no
discharge noted.
Eyes were symmetrical with the ears
There was no lesions no scars nor any bruises seen on both eyes.
Both eyes where well moistened.
EARS
On inspection both ears had the same size and shape.
They both aligned in symmetry.
There was no discharge of blood nor any pus seen.
Cerumen was presence aligning the auditory canal.
On palpation no tenderness nor any mass felt
On assessment of the patient hearing he respond well to sounds.

NOSE
Nose was centrally placed on its position
Nasal septum also centrally positioned
There was presence of hair in the nose
No discharge of blood nor pus was noted
Both nostrils were patent with a pink mucous membrane
On palpation no tenderness nor any mass was felt

MOUTH
On inspection all teeth were well aligned with a complete dental formula
There was presence of sores on the tongue and a white sticky substances noted on the tongue
The mouth looks unclean as a result of too much saliva on the mouth
The mucous membrane of the mouth was pink in color

NECK
On inspection no scars nor any bruises was noted
Patient was able to maintain a complete range of motion, that is turning left right downwards
and upwards
On palpation there was no enlargement of the thyroid gland and cervical lymph nodes
Patient was unable to swallow anything as a result of sore throat

CHEST
On inspection patient had normal chest movement without using the accessory muscles
Chest was normal in size and shape
No scars nor any bruises noted
Chest hair was present
Patient had normal breath sounds and respiratory rate of 22 breaths /minute.
On palpation no tenderness nor any mass was felt.
On auscultation heart murmurs was present with heartrate of 79 beats/min.

UPPER ARMS
On inspection both arms were equal in size and shape with no extra digits.
No joint dislocation nor any fracture noted.
On palpation lymph nodes and axillary nodes was not swollen.

ABDOMEN
On inspection abdomen was of normal size and shape with no distension.
No surgical scar bruises nor any lesions seen.
There was no involvement of abdominal muscles in respirations.
On palpation no enlargement of liver spleen nor any part felt.
Bowel sounds were presence on auscultation.

LOWER LIMBS
On inspection both limbs were equal in size and shape with no extra digits.
No scars nor any bruises seen.
On palpation of the inguinal area, no edema nor any tenderness felt,no enlargement of varicose
veins nor DVT noted.
GENITALIA
On inspection the external genitalia were clean with no abnormal discharge from urethral
meatus.
Pubic hair was presence.
Urethral opening was centrally placed. On palpation of the prostate no enlargement nor any
tenderness was felt.

BACK

On inspection there was complete continuation of the spinal cord.

There were
no scars no lesions nor any bruises noted.
On palpation there was no tenderness nor any breakage of the vertebral column.

VITALS SIGNS
BLOOD PRESSURE-126/76 mmhg
PULSE RATE-87 beats/min
OXYGEN SATURATION-97
TEMPERATURE-36.4
RESPIRATION-23 breath/min
WEIGHT-
HEIGHT-
BMI-

INVESTIGATION DONE
Gene expert test-a cartridge based nucleic and amplification test for simultaneous rapid TB
diagnose and rapid antibiotic sensitivity test.

PROCEDURE FOR GENE EXPERT TEST

Sputum sample is collected from the patient .the sample is processed and mixed with a buffer
solution kill the infectious agent and liquefy the mucus .the processed sample is placed into
gene expert cartridge and then into the machine.
The machine amplify the bacterial DNA using a polymerase chain reaction and detects TB
specific genetical material.
The test indicates whether TB bacteria are present.

CURRENT MANAGEMENT

Peter is currently on intensive phase of treatment of ANTI TB drugs for 2 months.

He uses Rifampicin R, isoniazid H, Pyrazinamide Z, and Ethambutol E, which he was given in
Bondo- subcounty hospital.
DESCRIPTION OF THE DRUGS USED.
RIFAMPICIN
MODE OF ACTION
Inhibits bacterial RNA synthesis by binding to RNA polymerase.
ROLE OF TREATMENT.
One of the most potent TB drugs, effective against actively replicating and dormant TB bacteria.
Prevents relapse when included in combination therapy.
SIDE EFFECTS.
Hepatotoxicity-liver damage
Flue-like symptoms in some cases
Orange discoloration of urine, sweat and tears.

ISONIAZID
MODE OF ACTION
Inhibit the synthesis of mycolic acid essential component of the bacterial cell wall .
ROLE OF TREATMENT
Highly effective against actively replicating TB bacteria .
Backbone of TB treatment regimens.
SIDE EFFECTS.
Peripheral neuropathy -due to vitamin B6 deficiency
Hepatotoxicity
Rarely hypersensitivity reactions.

Prevention of side effects-pyridoxine -vitamin B6 is given to prevent neuropathy.

PYRAZINAMIDE
MODE OF ACTION
Disrupts bacterial energy metabolism by targeting fatty acid synthesis in acidic environment.
ROLE IN TREATMENT
Actively against semi -dormant TB bacteria in acidic environment .
Shorten duration of TB treatment.
SIDE EFFECTS
Hepatotoxicity
Hyperuricemia-elevated urid acid levels,leading to joint pain ,pain and gout.
Nausea and vomiting.

ETHAMBUTOL
MODE OF ACTION
Inhibit synthesis of the bacterial cell wall by targeting arabinogalactan a key component of the
cell envelope.
ROLE IN TREATMENT
Prevents resistance to other TB drugs
Effective against drugs susceptible TB.

SIDE EFFECTS
Optic neuritis -vision changes
Rash and joint pain

COMBINATION THERAPY
These drugs are usually administered as a fixed dose combination to simplify treatment and
improve adherence .
Fixed dose combination tablet contains a combination of Rifampicin, Isoniazid, pyrazinamide
and ethambutol.

INTENSIVE PHASE DRUGS

DURATION-2 MONTHS
Goal-rapid reduction of bacterial load and prevention of resistance.
Monitoring-patient must be monitored for side effects especially liver function and vision.

LITERATURE REVIEW
TUBERCULOSIS
DEFINITION-tuberculosis is a highly infectious and contagious caused by mycobacterium
tuberculosis.
CAUSES
Mycobacterium tuberculosis bacterium cause TB.
It is spread through air when a person with TB whose lungs are affected cough, split, laugh or
talks.

TYPES OF TUBERCULOSIS
BASED ON LOCATION
[Link] TUBERCULOSIS
It affects the lungs
It’s the most common type
SYMPTOMS
1chronic cough -often with blood and tinged sputum
2chest pain and difficulty in breathing
Highly infectious as it spread through airborne droplets.

[Link]-PULMONARY TUBERCULOSIS
TB occurring outside the lungs
common sites include
[Link] nodes-causes swelling particularity in the neck.
[Link]-resultsin pleural effusion-fluid around the lungs.
[Link] and joint-potts disease affects the spine and other joints.
[Link] nervous system-causes TB, meningitis leading to headache, fever and neurological
symptoms.
[Link] system-affects kidneys, bladder or reproductive organs.
[Link]-involves intestines, peritoneum or mesenteric lymph.

BASED ON DISEASE PHASE

[Link] TB INFECTION
The bacteria are present but inactive in the body .
No symptoms and not contagious.
Can progress to active TB when left untreated especially in immunocompromised individuals.
Diagnosed with a tuberculin skin test or interferon gamma release assay.
[Link] PHASE
The bacteria are actively multiplying and causing symptoms.
Highly infectious especially in pulmonary TB.
Requires prompt treatment with ANTI-TB medications.

BASED ON DRUG RESISTANCE

[Link] SENSITIVE TB
TB bacteria that are susceptible to first line drugs for examples rifampicin, isoniazid.
Treated with standard 6 months regimen.

[Link] RESISTANCE TB
TB bacteria resistant to one or more TB drugs

These include.
a. MULTIDRUG-RESISTANT TB.
Resistant to at least rifampicin and isoniazid
The two are most powerful first line drugs.
Requires second line treatment which is longer and more toxic.

b. EXTENSIVELY DRUG RESISTANCE

[Link] to rifampicin, isoniazid, fluoroquinolones and at least one second line injectable
drugs for example Amikacin.
Its more challenging to treat.

C. RIFAMPICIN -RESISTANT TB
Resistant to rifampicin with or without resistance to other drugs.

BASED ON POPULATION
a. PRIMARY TB.
Occurs in individuals with no prior TB infections or immunity.
 Typically developed shortly after exposure to bacteria.
b. REACTIVATION TB

Develops in individual who had latent TB that becomes active due to weaken immunity for example HIV,
malnutrition.

c. TB IN HIV/AIDS PATIENTS.

Mostly likely to have extra-pulmonary or disseminated TB due to weakened immunity.

TB is the leading cause of death in people with HIV/AIDS.

d. MILIARY TB.
A severe disseminated form where TB bacteria spreads throughout the body via
bloodstream.
Affects multiple organs and present with non-specific symptoms like fever, weakness and
weight loss.

MODE OF TRASMISSION

Tuberculosis is caused by bacteria that spreads from person to person through microscopic
droplets released in air.

This can happen when someone with the untreated active form of tuberculosis coughs, sneezes, speaks,
laughs or sing.

RISK FACTORS OF TB.

People with compromised immune system are most at risk of developing active
tuberculosis, for instance HIV suppresses the immune system, making it hard for the body to
control TB bacteria.
People infected with both HIV and TB are around 20-30 more likely to developed active TB
than those who do not have HIV.
Tobacco use -has been found to increase the risk of developing active TB.
About 8 percent of TB cases worldwide are related to smoking.
People with the following conditions have an increased risk

1 diabetes

2 certain cancers
3 malnutrition
4 kidney disease

people who are undergoing cancer therapy, who are very young or old and people who
abuse drugs are at risk.

Travelling to certain countries where TB is more common increases the risk.

Countries with higher tuberculosis rates especially in Africa.

 PATHOPHYSIOLOGY OF TUBERCULOSIS.

Tuberculosis is caused by myco-bacterium tuberculosis, a bacterium transmitted through

airborne droplets once inhaled the bacteria reach the alveoli where they are engulfed by
microphages but evade destruction due to their waxy cell wall and inhibition of phagosome
Lysosomes fusion.
This triggers an immune response, with t-cells activating macrophages to form granulomas
which walls of the infection.
In latent TB, bacteria remain dormant within the granulomas and individual shows no
symptoms.
However, if the immune system suddenly weakens, the granulomas breakdown releasing
the bacteria and causing active TB.
Active TB is characterized by lung tissue destruction, cavitation and causes necrosis leading
to symptoms such as chronic cough, fever, night sweats, weight loss and fatigue.

In severe cases, the bacteria can spread through the bloodstream on lymphatic system causing
disseminated symptoms or military TB, which affects multiple organs.

TB persistence and chronicity stem from its ability to survive within immune cells and its
slow replication

CLINICAL MANIFESTATION.
1. Productive cough of any duration
2. Coughing of blood
3. Persistent coughing
4. Chest pain
5. Unexplained weight loss
6. Fatigue
7. Fever
8. Night sweats

DIAGNOSIS.

To diagnose TB, physical and medical history of the patient is first done to determine
signs of TB.

TEST DONE.
1. GENE EXPERT TEST
A cartridge based nucleic acid amplification test for simultaneous rapid TB diagnosis
and rapid antibiotic sensitivity test.
2. SPUTUM CULTURE
 A test to detect and identify fungi that infects the lungs or breathing passage
positive for mycobacterium in early stages of infections.
3. SPUTUM FOR ACID FAST BACILLUS TEST
Is a differential test to detect Pulmonary Tuberculosis
It called acid fast stain because mycolic acid within their walls which resist ordinary
stains like gram stain.
4. IMAGING TEST
A chest x-ray part of the initial evaluation
Chest x-ray is an imaging test that uses small amount of radiation to produce
pictures of chest organ and tissues.

LATENT TB.
The Monteux tuberculin skin test also called purified protein derivatives.
Its based on the fact that infection with tuberculosis produces a delayed type of
hypersensitivity skin reaction to certain components of the bacterium
Tuberculin is injected under the skin and a small pale bump forms under the skin.

TREATMENT.
Initial treatment involves 6 months of a combination of antibiotics.

INTENSIVE PHASE.
Its consist of rifampicin, isoniazid, pyrazinamide and ethambutol for the first 2
months.
CONTINUATION PHASE
Consist of rifampicin and isoniazid for 4 months where resistance to isoniazid is
high.
Ethambutol may be added for the last 4 months as an alternative.

PREVENTIVES MEASURES
1. Though BCG vaccination that is in infant
2. Using personal protectives equipment like mask.
3. Isolating infectious patients in well ventilated rooms.
4. Early detection and treatment.
5. Provide isoniazid preventive therapy to individuals with latent TB.
6. Educating communities on TB transmission, symptoms and early treatment
7. Educating people about cough etiquettes-covering mouth and nose when
coughing or sneezing.
8. Reduce overcrowding and improve ventilation in home and public spaces.
9. Promote measures to prevent HIV infections and major risk factors of TB.
10. Integrate TB and HIV care program.
COMPLICATIONS
Without treatment, tuberculosis can be fatal.
Untreated active disease typically affects the lung but can spread to other parts
of the body through the bloodstream
EXAMPLES OF TB COMPLICATIONS INCLUDE.
1. Spinal pain-back pain and stiffness are common
2. Heart disorders
3. Joint damage-tuberculosis arthritis usually affects the hips and knees.
4. Swelling of the membranes that cover the brain that causes lasting
intermittent headache that occur for weeks.
5. Liver or kidney problems.

MANAGEMENT OF THE PATIENT DURING TREATMENT PERIOD.

1. Ensuring adherence to treatment-patient should take medication as
prescribed and complete the full course even if the patient starts feeling
better.
2. Ensuring good hygiene -by advising the client to cover the mouth while
coughing or sneezing to prevent spread of bacteria.
3. Monitoring the patient for side effects after taking medications for
example jaundice and blurred vision.
4. Encouraging the patient to adopt a healthy lifestyle like eating balanced
diet to support immune system.
5. Preventing transmission to others by encouraging the patient to avoid
overcrowded places and ensuring good ventilation.
6. Advising the patient to attend follow up appointment and keeping all
schedule visits

HEALTH MESSAGES ON DISCHARGE.

1. Adherence to medication-reminding the patient to take all
medication exactly as prescribed even if they feel better.
2. Infection control by maintaining proper hygiene that is-covering the
mouth and nose while coughing or sneezing and dispose of sputum
safely in a sealed bag and washing hands frequently.
3. Health lifestyle by maintaining good nutrition, emphasize of
balanced diet to support the immune system.
 4. Advising patient to recognize the warning signs like, persistent
coughing or night sweats.
5. Reassure the patient that TB is treatable and emphasize the
importance of continuing treatment to achieve full recovery.
6. Regular check ups -encourages attending all follow up appointment
and monitor progress.

FIRST HOME VISIT AS ON 4/12/24.

OBJECTIVES

[Link] know the client home.

[Link] familiarize with other members of the family.

[Link] assess the progress of the client.

[Link] assess the condition and type of house my client stays.

[Link] assess my client surrounding environment and advise on improvement if noted.

[Link] confirm if the client adheres to the health messages given on discharge .

[Link] identify the source of water and food of the client.

[Link] identify food grown and livestock kept by the client family and source of income.

[Link] educate the client family members about the preventive measures to prevent diseases.

[Link] identify my client needs and provide health education on his current health status.

A LESSON PLAN OF FIRST HOME VISIT AS ON 4/12/24.

VENUE- RAJAB MOSES HOME

TIME- 4.00 PM

AUDIENCE-RAJAB WIFE AND KIDS

DATE-4/12/2024

PRESENTER-JANET KIAYI

DURATION-30 MINUTES
LESSON PLAN FOR FIRST HOME VISIT AS ON 4/12/24.

DURATION OBJECTIVES CONTENT TEACHING LEARNING TEACHING EVALUATION

METHOD ACTIVITY AID

1O minutes Introduction Creating Discussion, Listening Explaining Client and

to the rest of good explaining and and used of a the family
the family rapport with and answering name tag. understood
Assess client the client listening questions. well.
environment. family and
explaining
the aim of
the visit.
Going
around the
compound
with my
client and
assessing it.
10 minutes Identifying Teaching on Discussion Active Used of soft At the end
the source of dietary and listening copy and my client
water, food modification listening and asking hard copy had a well
and also the Identifying question. notes. equipped
type of food the type of knowledge
grown and food taken about diet
livestock mostly. and ways of
kept. Education treating
on the drinking
essential water.
nutritious
food to my
client.
Teaching on
water
treatment
techniques.

10 minutes Teaching my Treatment listening Asking Used of soft At the end,

client about of water question copy and my client
various involves use and hard copy was able to
method of s of the listening notes. explain on
treating following how to treat
water techniques drinking
Boiling water.
Chlorination
decanting
5 minutes Giving health Encouraging Discussion listening Used of soft At the end
messages to my client to and copy and my client
my client always eat explanation hard copy gain
concerning well notes. knowledge
diet and nutritious on diet and
hygiene. food. hygiene.
Advising him
to maintain
hygiene of
self and the
environment

5 minutes Doing a brief Tuberculosis discussion Asking Used of my At the end

introduction is a questions shorthand my client
on contagious notes of TB. understood
tuberculosis disease that well about
normally tuberculosis.
affect the
lungs.
 3 minutes Summary of Recap of the listening Asking Used of soft At the end
the whole whole questions copy and my client
topics content. hard copy was able to
covered notes explain on
diet
modification
methods and
how to treat
drinking
water.

REPORT OF THE FIRST HOME VISIT.

It was on Wednesday 4, December 2024 at 4.00pm when I decided to visit my client at his place

We had earlier agreed with him that on that day, I will visit him at his home place and he agreed.

On that day our classes ended earlier and I decided to visit my client.

I took a motorcycle at BONDO town Up to his residence place in SINAPANGA, which only took me 20
minutes to reach his home place.

I called him and he directed me to his homestead, 10 minutes later, I reached on his home, where his
wife welcomed me warmly

I then introduced myself to his wife and the rest of the family.

HOME DESCRIPTION AND ASSESSMENT.

They lived in a permanent house built of bricks and stones.

It has 2 bed-room lay-out, bedroom and living room

There house was well ventilated with good lighting.

There pit latrine was located 30 meters away from their home and on assessment they were clean and
well ventilated.

They used solar panel as their main source of electricity.

They also use tap water which is 10 meters away from their home for drinking and domestic used at
home.

SOURCE OF FOOD AND WATER

There main source of water is tap water which is 10 meters away from their home.

They get their daily food from the harvest of their small scale - farm and they sometimes buy food from
the market.

REFUSAL AND EXCRETA DISPOSAL

Their domestic waste is disposed in a pit situated some meters away from the kitchen.

Rajab reported that they burn wastes after every week

They have pit latrines where they dispose their wastes.

DIET

The basic diet of the family is ugali, fish, kales, beans and maize.

They also take chapati, legumes and fruits for example oranges, bananas and mangoes.

1. NUMBER OF BEDS-they have 2 beds.

2. COOKING ARRANGEMENT-they used gas to cook, have utensils
3. FOOD GROWN – kales and maize
4. ANIMALS KEPT-chickens
5. CONDITION OF THE COMPOUND-compound was clean and conducive.
6. OCCUPATION OF THE HEAD OF FAMILY-main source of income is from Rajab since he is a
business man.

IDENTIFIED NEEDS AND PROBLEMS.

1. Lack of good dietary modification.

2. Lack of proper method of treating water.

ACTION TAKEN

For my next visit, I will prioritize all the objectives from the needs I identify which are-

1. Teaching on good dietary modification.

2. Teaching on proper ways of treating drinking water.
COCLUSION.

After we had finished with the discussion, I gave him chance to ask any question and I answered them
appropriately.

I then thanked him for the cooperation and we planned to meet again on next visit on 12/12/24

SECOND HOME VISIT AS ON 12/12/24.

OBJECTIVES.

1. To assess the progress of the client.

2. To assess treatment progress.
3. To educate my client about TB, its causes and risk factors.
4. To educate my client about mode of transmission of TB.
5. To teach my client about various ways of preventing TB transmission.
6. To monitor infection control measures.
7. Assessing my client environmental surrounding, checking for adequate ventilation and reduced
risk of spreading TB.
8. Educating my client and his wife on diet modification.
9. Educating my client on proper ways of treating drinking water.

A LESSON PLAN FOR SECOND HOME VISIT.

1. VENUE-Rajab Moses home

2. TIME-4.30PM
3. AUDIENCE-Rajab wife and kids.
4. DATE-12/12/24.
5. PRESENTER-Janet
6. DURATION-26 minutes
 LESSON PLAN FOR SECOND HOME VISIT AS ON 12/12/24.

TIME SPECIFIC CONTENTS TEACHIN LEARNING TEACHIN EVALUATIONN

OBJECTIVES G ACTIVITY G AID
ACTIVITY
3 To assess the Doing a Discussion Listening and Used of my At the end my
MINUTE progress of complete and asking question previous client was in a
S my client and physical explaining shorthand good state.
the treatment examination notes.
progress starting from
the head to
toes to help
detect any
abnormal
signs.

5 minutes To educate Tuberculosis is Discussion Asking Used of soft At the end my

my client a contagious and questions and hard client understood
about disease that explaining copy notes. well about
tuberculosis, it normally affect tuberculosis.
causes and the lungs
risk factors. PTB, caused
by
mycobacterium
tuberculosis,
which spreads
when an
infected person
sneezes,
coughs or talks
Risk factors
-low body
weight.
Previous
history of TB
DM and
malnutrition.
5 minutes Educating my Transmission explaining Active listening Used of soft At the end my
client about of PTB, occurs and active and hard client understood
various modes when an participation copy notes. about various
of pulmonary infected person modes of PTB
tuberculosis with infectious transmission.
transmission. microbes,
coughs,
sneezes or
talks.

4 minutes Educating my Avoiding Discussion Asking Used of soft At the end my

client about crowded places and questions and hard client understood
various ways Ensuring explaining copy notes. well on various
of preventing appropriate ways of
PTB ventilation of prevention
transmission. the rooms against
Avoiding pulmonary
taking tuberculosis.
unpasteurized
milk.
Practicing
good coughing
techniques
Isolation at
home to avoid
infecting
others.
4 minutes Educating my Treatment of discussion Active listening Use of soft At the end my
client on drinking water and asking and hard client knew about
various ways involves the questions copy notes various methods
of treating use of the of treating water.
drinking water following
at home. techniques
Boiling
Chlorination
and decanting.
5 minutes Summary of Recapping of listening Asking Used of soft At the end my
the whole the whole questions and hard client understood
topics content. copy notes. about the
covered. tuberculosis, it
causes, risk
factors,
preventive
measures,
complications
and mode of
acquisition.

REPORT OF SECOND HOME VISIT AS ON 12/12/24.

It was on Thursday, afternoon on 12/12/24 at 4.30pm, when I decided to visit my client since he
confirmed to me that he will be available.

I went alone to his home place and I was welcomed warmly by his wife as she was fetching water from
the tap.

PROGRESS OF MY CLIENT.

My client Moses was doing well and adhering to his medication as instructed.

There was no signs of coughing nor chest pain.

He informed me that he was now sleeping well, his appetite had increase and his body strength was
stronger than earlier.

He also informed me that the lesions he had on the mouth and the throat had resolved and he no longer
had vomiting episodes.
I encouraged him to continue adhering to medications as instructed and also advised his wife to provide
psychological support to her husband.

I informed my client about my third visit and we schedule together to be on 16/12/24, since he will be
available.

I thanked my client and the family for their time and dedication as I leaved their home place.

HEALTH MESSAGES GIVEN TO MY CLIENT.

1. I encouraged my client to adhere to his medication at home.

2. I educate my client about TB, stating the causes, risk factors and complications.
3. Teaching my client about different modes of TB transmission.
4. Encouraging my client to avoid crowded places, as it might increases the risk of getting TB.
5. Educating my client on various ways of treating drinking water.
6. Advising him to always adhere to subsequent visits to the hospital and to also report of any
unusual signs encounter.
7. Offering psychological and emotional support to my client to align anxiety and enhances
comfort.

THIRD HOME VISIT AS ON 5/1/25.

OBJECTIVES

1. To assess the progress of my client.

2. To assess treatment progress.
3. To monitor infection control measures.
4. Assessing my client environmental surrounding if its conducive for good health.
5. To evaluate the objectives of second home visit.
6. To discuss the effects of poor waste disposal
7. To discuss types of waste disposal methods.
8. To discuss the importance of good waste disposal.
9. To prepare the client for termination follow up.
LESSON PLAN OF THE THIRD HOME VISIT.

DATE-5/1/25

TIME-3.00PM

VENUE-MOSES HOUSE

AUDIENCE-MOSES FAMILY

PRESENTER-STUDENT NURSE JANET

DURATION-50 MINUTES.

LESSON PLAN FOR THIRD HOME VISIT AS ON 5/1/25.

DURATION OBJECTIVES CONTENT TEACHING LEARNING TEACHING EVALUATION.

METHOD. ACTIVITY AID
2 minutes to evaluate Assess and Discussion Listening Used of At the end of the
the objectives evaluate if the And and asking soft and session my client
of the second objectives of the explaining, questions hard copy had fully
home visit. previous visit notes implemented on
were fully good ventilation of
implemented like the houses.
improvement on
good ventilation
and hygiene.

3 minutes To assess the Conducting a Discussion Listening Used of my At the end my client
progress of my physical and and asking shorthand was in an improved
client and his examination explaining questions notes. state of his health.
treatment from the head to
status toes so as to
detect any
abnormal signs.
5 minutes To discuss on Poor waste explaining Listening Used of At the end my client
the effects of disposal can lead and asking soft and understood well on
poor waste to health hazards questions hard copy the effects of poor
disposal whereby poor notes. waste disposal.
waste disposal
attract pest and
diseases carrying
vectors
increasing the
risk of infection.
Environmental
pollution
whereby there is
contamination of
soil, water and
air
5 minutes To discuss Composting-this Discussion listening Used of At the end my client
about various is where the and hard and understood well on
methods of organic waste is explaining soft copy various modes of
waste disposal decomposed by notes waste disposal.
microorganism
resulting to
nutrients rich
compost that can
be used in the
soil
Recycling-this is
where waste
materials are
processed to
form new
products
 5 minutes To discuss on Proper waste Discussion Asking Used of my At the end of the
the disposal helps and questions soft copy session my client
importance of Environmental explanation and hard was able to outlined
good waste protection copy notes. the importance of
disposal Effective waste proper waste
disposal reduces disposal.
the risk of
infections.
Resource
conservation
through recycling
Proper waste
management
contribute to
clean and health
living
environment

5 minutes Summary of Recapping of the Discussion Active Used of my At the end of the
the whole whole content and listening soft and lesson my client was
lesson explaining and hard copy able to remember
answering notes all that we had
questions learned.

REPORT ON THE THIRD HOME VISIT AS ON 5/1/25.

It was on 5/1/25, when I and my friend Pauline visited my client at his home in SINAPANGA, SIAYA
COUNTY.

On arrival, we met my client waiting for us whereby he welcomed us warmly he was able to remember
and recognize me very well with my names.

After greeting I introduce my friend to my client family members since it was her first time seeing them.

After greetings and introduction of my friend, he allowed us to continue with our objectives.

I started by asking my client about his progress whereby he reported on improvement after being on
medication.

I reassured him that through follow up care and adherence to drugs, it will make him recover completely
from TB.

After that, we the proceed to discuss about waste disposal, methods of waste disposal, effects of poor
waste disposal and importance of good waste disposal.

We then started stating the effects of poor waste disposal, which may cause infection and disease to
human beings.

We also stated some methods of waste disposal where my client list about composting and burning and
this was clear indication that he had gain knowledge.

After the discussion I informed my client that I would like to terminate the follow up care of the next
home visit since we had achieved our main objectives.

My client told me that he is happy he is recovering and asked me if in any case he has concern he may
call me as I will be there to help him.

After that I allowed my client to ask any question, but he didn’t have any question.

We did a recap on what we had discussed and I thanked my client for his time cooperation and we
scheduled to meet again for my termination visit.

TERMINATION VISIT AS ON 20/1/25.

It was on 20/1/25, when I paid a visit to my client home for termination after agreeing with him to be on
that day.

After communicating with him, he told me that he was at his home.

Upon arrival at about 4.00pm I found my client waiting for me and he welcomed me warmly.

I asked him on his progress and he told me he was progressing well and he was conversant with the
condition and also the drugs regimen.
I asked my client questions briefly about the condition especially on prevention and he was able to
outline.

On assessment my client had implemented most of what was taught in the previous visit.

I insisted on the importance of maintaining what has been implemented.

I encourage my client to keep the knowledge he had acquired and to also teach other community
members on the same to improve the health of the community at large.

I also thanked the family of Rajab for their full support and time and also the effort based on the
teaching during the previous visit.

They also thanked me for the knowledge they had acquired from me.

I appreciate them as a leaved their home place.

EVALUATION OF THE CASE STUDY.

The case study has been of importance and beneficial for both me and my client and also the
community at large will benefit since my client is a member and will share on what he has learned.

My client was able to acquire knowledge concerning Tuberculosis and also prevention of other
communicable diseases.

My client acquire knowledge during the previous visits and was able to implement on what was taught,
which is beneficial to their life especially on the health state.

CHALLENGES ENCOUNTERED IN CASE STUDY.

Whether

Time limit

Expenses-Distance-my client home was far from my place.

SUMMARY OF THE CASE STUDY.

The study was started on Saturday about tuberculosis which focuses on all health issues concerning
knowledge especially on drug adherence and preventive measures.

It also included prevention of other communicable diseases especially on hygiene practices.

It involves 3 home visits, where all the objectives were achieved in each visit.
DATE

1. 5/12/24-FIRST HOME VISIT

2. 12/12/24-SECOND HOME VISIT
3. 5/1/25-THIRD HOME VISIT
4. 20/1/25-TERMINATION VISIT

RECOMMENDATION.

Public awareness and sensitization to be done on preventive measures of tuberculosis in the

community.

BIBLIOGRAPHY.

1. Brunner and Suddath textbook on medical surgical nursing.

2. Rose and Wilson, anatomy and physiology textbook.
3. Clinical pharmacology textbook.
4. Nanda 1.

ACKNOWLEGMENT.

First I thank GOD for allowing me to carry out my case study till completion.

I also thanked my supervisor MR WANGA for the guidance throughout the case study.

Special thanks to my client RAJAB MOSES and the entire family for their support and cooperation.