Clinicians use three methods to determine response to treatment: 1. Checking to see if the patient has continued symptoms of TB. 2. Conducting bacteriologic examination of patient’s sputum or other specimens. Specimens should be examined at least every month until culture results have converted from positive to negative.
What does the clinician ask the patient during a session?
Clinicians use three methods to determine response to treatment: 1. Checking to see if the patient has continued symptoms of TB 2. Conducting bacteriologic examination of patient ’ s sputum or other specimens. Specimens should be examined at least every month until culture results have converted from positive to negative. 3. Using chest x-rays to monitor patient ’ s …
What are the two lines of questioning by the clinician?
10.2. Monitoring the progress of treatment. Patients should be monitored closely for signs of treatment failure. Monitoring response to treatment is done through regular history taking, physical examination, chest radiograph and laboratory monitoring.
How do you determine whether a patient is responding to TB treatment?
By having a clear accounting of the person’s symptoms and how they affect daily functioning, we can decide to what extent the individual is adversely affected. Assuming a treatment is needed, our second reason to engage in clinical assessment will be to …
How do we decide if a treatment is even needed?
Dec 01, 2002 · Criterion 4.0 Guidelines should consider available evidence regarding patient-treatment matching. Some individuals with a given problem may respond better to certain treatments than to others, whereas a different patient with the same problem may show a different pattern of response. Patient-treatment matching may maximize efficacy.
How can clinicians determine whether a patient is responding to treatment TB?
Treating TB disease with an LTBI treatment regimen can lead to drug resistance (see the Preventing Drug Resistance section in this Module). To rule out TB disease, clinicians should determine whether the patient has symptoms of TB disease and evaluate the patient with a chest x-ray.
Which of the following tests should be used to monitor the success of treatment for a patient with pulmonary tuberculosis?
How do you know if TB treatment is working?
How often should patients be evaluated for signs and symptoms of adverse reactions?
What are the activities you would perform in order to monitor a patient's response to treatment?
What laboratory tests are used in the follow up care of patients being treated for TB?
How do you diagnose TB diagnosis?
The Mantoux tuberculin skin test is performed by injecting a small amount of fluid called tuberculin into the skin in the lower part of the arm. The test is read within 48 to 72 hours by a trained health care worker, who looks for a reaction (induration) on the arm.May 4, 2016
When does TB treatment start working?
What happens if I miss my TB medication?
What measures would be most effective to reduce adverse effects of medication administration?
How can we minimize ADRs in clinical setting?
- Avoid and be vigilant of high-risk drugs.
- Discontinue unnecessary drugs.
- Consider drugs as a cause of any new symptom.
- Avoid treating side effects with another drug.
- Avoid drug-drug interactions.
- Adjust dosing based on age and creatinine clearance.
- Address non-adherence.
How do you monitor the effects of medication?
What are the three critical concepts of assessment?
The assessment process involves three critical concepts – reliability, validity, and standardization . Actually, these three are important to science in general. First, we want the assessment to be reliable or consistent. Outside of clinical assessment, when our car has an issue and we take it to the mechanic, we want to make sure that what one mechanic says is wrong with our car is the same as what another says, or even two others. If not, the measurement tools they use to assess cars are flawed. The same is true of a patient who is suffering from a mental disorder. If one mental health professional says the person suffers from major depressive disorder and another says the issue is borderline personality disorder, then there is an issue with the assessment tool being used (in this case, the DSM and more on that in a bit). Ensuring that two different raters are consistent in their assessment of patients is called interrater reliability. Another type of reliability occurs when a person takes a test one day, and then the same test on another day. We would expect the person’s answers to be consistent, which is called test-retest reliability. For example, let’s say the person takes the MMPI on Tuesday and then the same test on Friday. Unless something miraculous or tragic happened over the two days in between tests, the scores on the MMPI should be nearly identical to one another. What does identical mean? The score at test and the score at retest are correlated with one another. If the test is reliable, the correlation should be very high (remember, a correlation goes from -1.00 to +1.00, and positive means as one score goes up, so does the other, so the correlation for the two tests should be high on the positive side).
What are the limitations of an interview?
The limitation of the interview is that it lacks reliability, especially in the case of the unstructured interview. 3.1.3.3. Psychological tests and inventories. Psychological tests assess the client’s personality, social skills, cognitive abilities, emotions, behavioral responses, or interests.
What is a psychological assessment?
Psychological tests assess the client’s personality, social skills, cognitive abilities, emotions, behavioral responses, or interests. They can be administered either individually or to groups in paper or oral fashion.
What is MRI imaging?
Images are produced that yield information about the functioning of the brain. Magnetic Resonance Imaging or MRI provides 3D images of the brain or other body structures using magnetic fields and computers. It can detect brain and spinal cord tumors or nervous system disorders such as multiple sclerosis.
What is the purpose of a CT scan?
Finally, computed tomography or the CT scan involves taking X-rays of the brain at different angles and is used to diagnose brain damage caused by head injuries or brain tumors. 3.1.3.5. Physical examination.
What is clinical diagnosis?
Clinical diagnosis is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5 or I CD-10 (both will be described shortly). Any diagnosis should have clinical utility, meaning it aids the mental health professional in determining prognosis, the treatment plan, and possible outcomes of treatment (APA, 2013). Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors (APA, 2013). Likewise, a patient may not meet the full criteria for a diagnosis but require treatment nonetheless.
When was the DSM 5 published?
3.2.2.1. A brief history of the DSM. The DSM-5 was published in 2013 and took the place of the DSM IV-TR (TR means Text Revision; published in 2000), but the history of the DSM goes back to 1944 when the American Psychiatric Association published a predecessor of the DSM which was a “statistical classification of institutionalized mental patients” and “…was designed to improve communication about the types of patients cared for in these hospitals” (APA, 2013, p. 6). The DSM evolved through four major editions after World War II into a diagnostic classification system to be used psychiatrists and physicians, but also other mental health professionals. The Herculean task of revising the DSM began in 1999 when the APA embarked upon an evaluation of the strengths and weaknesses of the DSM in coordination with the World Health Organization (WHO) Division of Mental Health, the World Psychiatric Association, and the National Institute of Mental Health (NIMH). This collaboration resulted in the publication of a monograph in 2002 called A Research Agenda for DSM-V. From 2003 to 2008, the APA, WHO, NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) convened 13 international DSM-5 research planning conferences “to review the world literature in specific diagnostic areas to prepare for revisions in developing both DSM-5 and the International Classification of Disease, 11th Revision (ICD-11)” (APA, 2013).
What is treatment guidelines?
That is, treatment guidelines are patient directed or patient focused as opposed to practitioner focused, and they tend to be condition or treatment specific (e.g., pediatric immunizations, mammography, depression).
What is the most common classification system?
The most common classification system is the International Classification of Diseases ( ICD-10; World Health Organization, 1992) and, for mental disorders, the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV; American Psychiatric Association, 1994).
How to become a nurse?
Course work or ethical experiences should provide the graduate with the knowledge and skills to: 1 Use nursing and other appropriate theories and models, and an appropriate ethical framework; 2 Apply research-based knowledge from nursing and the sciences as the basis for practice; 3 Use clinical judgment and decision-making skills; 4 Engage in self-reflective and collegial dialogue about professional practice; 5 Evaluate nursing care outcomes through the acquisition of data and the questioning of inconsistencies, allowing for the revision of actions and goals; 6 Engage in creative problem solving8(p. 10).
What is the high performance expectation of nurses?
The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities. Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, ...
What is clinical reasoning in nursing?
In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking. The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking.
What is critical thinking?
Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes.
What is clinical judgment?
Clinical judgment requires clinical reasoning across time about the particular , and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments.
What is practical knowledge?
Practical knowledge is shaped by one’s practice discipline and the science and technology relevant to the situation at hand. But scientific, formal, discipline-specific knowledge are not sufficient for good clinical practice, whether the discipline be law, medicine, nursing, teaching, or social work.
What is medical decision making capacity?
Medical decision-making capacity is the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment). Capacity is the basis of informed consent. Patients have medical decision-making capacity if they can demonstrate understanding of the situation, ...
What is the basis of informed consent?
Capacity is the basis of informed consent. Patients have medical decision-making capacity if they can demonstrate understanding of the situation, appreciation of the consequences of their decision, and reasoning in their thought process, and if they can communicate their wishes. Capacity is assessed intuitively at every medical encounter ...
What is the difference between capacity and competence?
Although the terms are often used interchangeably, competence is a legal term that is determined by the court system, whereas capacity is a medical term that is determined by the treating physician.
What is lack of competence?
According to their strict definitions, lack of competence refers to global decision-making impairment (e.g., finances, property, wills), whereas lack of capacity refers to the inability to make decisions about proposed medical treatments and other aspects of care. Capacity can vary with circumstance; for example, ...
What are the causes of incapacity?
If there are no communication barriers, the next step is to evaluate for reversible causes of incapacity, such as infection, medication adverse effects, illicit drug use, hypoxia, metabolic derangements, acute neurologic and psychiatric disorders, delirium, and critical illness.
What is clinical application?
References. If a physician determines that a patient does not have the capacity to make a treatment decision, consent for treatment must be obtained from other sources. If the patient has an advance directive applicable to the clinical situation, it should be used to guide decisions.
What happens if a patient has no power of attorney?
If not, the physician should determine whether the patient has designated a medical power of attorney. If there is no valid medical power of attorney, the closest relative usually becomes the surrogate. The priority of relatives varies by state, but the typical order is spouse, adult children, parents, siblings, and other relatives.
What is the diagnosis of a 78 year old man with metastatic cancer?
A 78-year-old man has a recent diagnosis of metastatic cancer of unknown primary. He returned to the office today after having a computed tomography (CT) scan showing a pancreatic lesion that may be the primary cancer and is the only lesion accessible for biopsy. He requires large doses of narcotics for pain control and his level of consciousness fluctuates greatly. It is not clear if he understands his prognosis or that a tissue diagnosis will probably not affect treatment or outcome. When he is more lucid, he wants “the test”—a CT-guided pancreas biopsy. Does this patient have the capacity to consent to this procedure?
What are clinical scenarios?
Four clinical scenarios are described 1 that should alert physicians to assess a patient's decision-making capacity more carefully than usual. The first occurs when patients have an abrupt change in mental status. This change may be caused by hypoxia, infection, medication, metabolic disturbances, an acute neurologic or psychiatric process, ...
What causes a change in mental status?
This change may be caused by hypoxia, infection, medication, metabolic disturbances, an acute neurologic or psychiatric process, or other medical problem.
What is the second refusal?
The second occurs when patients refuse recommended treatment, especially when they are not willing to discuss the refusal, when the reasons for the refusal are not clear or when the refusal is based on misinformation or irrational biases.
What is decision making capacity?
Decision-making capacity, medical or otherwise, is always specific to the task requiring the decision. 1, 4 Certain patients may be able to decide some aspects of their care, but not others. For example, a patient with mild-tomoderate Alzheimer's disease who experiences chest pain may be able to understand the need for antibiotics ...
What are the ancillary tests?
Ancillary tests may be needed, depending on the individual circumstances, including history from therapists or other caregivers, physical assessment, laboratory evaluation and possibly even neuroimaging studies. These tests may all help clarify whether the current level of functioning and, possibly capacity, is likely to improve. Table 1 1, 4 – 6 outlines specific patient abilities to be assessed along with suggested questions to assess each ability during a directed clinical interview. After these abilities are assessed, a general mental status examination also must be performed to determine whether any serious psychopathologic factors may be unduly influencing patient thinking. The clinician's final assessment of whether a patient has medical decision-making capacity depends on whether the clinician believes that the patient is free of significant psychopathologic-impaired thinking and possesses sufficient abilities to make the specific decision in question.
What are the tools used to assess capacity?
Two such tools are the Aid to Capacity Evaluation (ACE) 3, 12 and the MacArthur Competence Assessment Tool (MacCAT). 1 Both use standardized questions and scoring systems to achieve a more objective assessment of capacity than an interview. The abilities assessed, however, are the same as those assessed in a clinical interview and the scores still require interpretation by an evaluator. The MacCAT is a lengthy, comprehensive tool designed for patients with complex psychiatric or neurologic conditions whose capacity determination is especially difficult. The assessment can be administered and scored in approximately 30 minutes. The ACE ( Figure 2) is a short, more clinically oriented tool that can be administered and scored in five to 10 minutes. The ACE can also be found on the Web site of the University of Toronto Joint Centre for Bioethics: http://www.utoronto.ca/jcb/_ace. General instructions are simple: clinicians are directed to address communication barriers, discuss treatment information and answer patient questions before administering the assessment.
Case
Dr. Rose, a family medicine practitioner, is seeing patients at her outpatient clinic. The nurse, Jack, hands her the chart saying, “Room two is ready. It’s Dr. Little; she brought in her son, Andrew.” Not having had time to look at the chart, Dr.
Commentary
Dr. Rose finds herself in a tough situation, perhaps one that many clinicians find equally uncomfortable: a medically unwarranted request from a colleague.
Navigating Conflicts in the Treatment of Colleagues
In the above case study, there are a number of conflicts or issues that Dr. Rose must navigate in addition to balancing her role as the primary care physician of a colleague’s child.
What Are the Next Steps?
I would argue that Dr. Little is in no way being “difficult”: she is being a mother who is concerned and wants the best care possible for her child. As discussed, Dr. Little’s request may be driven by emotional cues—such as anxiety over a sick child, fear of a “rare thing” or undiscovered illness, or fear of the unknown.
Conclusion
In this situation, Dr. Rose should not order further imaging because there is no clinical indication to do so. Instead, she should respond to Dr. Little’s emotional cues with empathy and explore the request for imaging both with Dr. Little and Andrew. Dr.
Author Information
Andrew Thurston, MD is a clinical assistant professor of medicine at the University of Pittsburgh and the medical director of the supportive and palliative care service at UPMC Mercy Hospital in Pittsburgh.
What are the risks of low literacy?
The Risks of Low Literacy Patients. Patients with low literacy are at much higher risk of errors and poorer than expected outcomes in the modern health care delivery system than they would have been 30 years ago.
Why is it important to move to a more accessible approach for all patients?
Since approximately half the population will have difficulty with health care information, it makes sense to move to a more accessible approach for all patients. That means consciously leaving time in the discussion with the patient to ensure his or her understanding of the information. One recent study found that physicians assess patients' understanding of their instruction only two percent of the time. This is clearly an area with room for improvement.
What is the National Adult Literacy Survey?
In 1992, the U.S. Department of Education conducted the National Adult Literacy Survey (NALS), to examine literacy in terms of everyday functional tasks. 1 Of the 26,000 American adults interviewed, 15 percent were born outside the United States; the majority with low literacy were white and native born.
What percentage of Americans are illiterate?
22 percent of adult Americans are functionally illiterate (they cannot read the front page of a newspaper). Another 25 percent have difficulty with tasks involving words and numbers (they cannot read a bus schedule).
