STUDENT NAME: JAMES KARANJA MAINA

DISGNATION: D/NURS/887/2022

TITLE: COMMUNITY HEALTH CASE STUDY

COURSE: KENYA REGISTERED COMMUNITY HEALTH NURSING

SCHOOL: CONSOLATA NKUBU SCHOOL OF NURSING

CLASS: MARCH 2022

SUPERVISOR: MRS Murithi

INTRODUCTION TO COMMUNITY HEALTH CASE STUDY

It is a care given to an individual suffering to a communicable disease which is

goal orientated, whereby an individual is identified in the ward or comprehensive
care unit (ccc) department and followed back home for home assessment, to
identify contacts, health education, and to evaluate drug compliance till six weeks.

OBJECTIVES OF THE FOLLOWUP CARE

 To familiarize with the family members

 To assess the home environment
 To educate the client about the importance of adhering to the medication
regimen and complications of bad compliance
 Monitoring for adverse effects of antituberculosis drugs
 Providing support to help patients complete the full course of treatment
 Educating the family about ways to prevent TB, such as maintaining good
personal hygiene, improving ventilation in living spaces, and getting
vaccinated against TB if available.
 To educate my client on nutrition and balanced diet to ensure quick healing
prevent risk of malnutrition and promote health.
 To evaluate my clients understanding on the previous topics of discussion
and knowledge gained throughout the home visit and terminate the case
study.

BIODATA OF MY CLIENT

NAME: Morris Gitobu Gikunda

SEX: Male

AGE: 38 years

DIAGNOSIS: Pulmonary tuberculosis

MARITAL STATUS: Married

OCCUPATION: Farmer

EDUCATION: Secondary school

RELIGION: Christian

RESIDENCE: Kamachege

TEL NUMBER: 0796037128

NEXT OF KIN: Purity Ncabira

RELATIONSHIP: Spouse

OCCUPATION OF THE WIFE: Farmer

BRIEF HISTORY OF HOW I MET MY CLIENT

It was on Monday morning 27/03/2023 when I went to comprehensive care unit

(CCC) intending to find a client for my community health case study when
entering the chest clinic, I found a client by the name Morris Gitobu who was
coming for his first clinic after being diagnosed with the pulmonary tuberculosis I
introduced myself to him. When I went through his clinic card I found interest of
using him as my client for community health case study because he was in
intensive phase and his two children’s and his wife were on isoniazid 300 mg once
daily as prophylaxis treatment and pyridoxine 50mg once daily to counteract the
sides effects of isoniazid I then promised to inform him on arrangement for the
first home visit which he acknowledged and thanked him for the cooperation

HISTORY TAKING

Chief complaint

Morris was coming for his first clinic visit after being diagnosed with pulmonary
tuberculosis. He stated that he was maturating yellowish urine after which I
explained to him it is common for people taking antituberculars drugs due to
rifampicin he was given a tablet containing Rifampicin (150 milligrams) Isoniazid
(75 milligrams) Pyrazinamide (400milligrams) Ethambutol (275 milligrams) three
tabs daily and pyridoxine 50mg once daily for two weeks

Past medical and surgical history

He has no history of admission

Has no history of surgical operation

Has no history of blood transfusion

No history of exposure to radiation rays

Has no known drug or food allergy

Social economic history

The patient is married from 2010 to Purity Ncabira currently blessed with two
boys, both alive and well, first born age 13 years and the second born age 8years,
he has no history of cigarette smoking or alcohol abuse, and he is a farmer where
he keeps dairy cows.

Family history

The patient is the second born in a family of four siblings, two males and two
females, no history of any chronic illness and tuberculosis case in the family. He
lives on 2 acres of land with a semi-permanent house using a pit latrine. His wife
and children are on prophylaxis treatment for pulmonary tuberculosis that is
Isoniazid 300mg once daily and pyridoxine 50mg once daily to counteracts the
side effects of isoniazid

EXAMINATION

General Appearance

Clean and neat but appeared dull, sick looking in distress, and with minimal body
wasting –with current weight of 52kgs

Head to toe examination

Head PHYSICAL

On observation, short hair is clean and well distributed, no fungal infections or

other related infections of the skin, and the skin looks well hydrated.

Eyes

No jaundice, no discharge, pupil reaction to light was good, sense of sight okay on
observation

Ears

On observation, no discharge responds to sounds and voices, sense of hearing is

good.

Nose

On observation, no swelling, no discharge, no deformities

Mouth

On observation, lips had no lesions, mucous membrane well hydrated and not pale,
dentation good, and no gum inflammation.

Neck

On inspection, no swollen neck, swollen lymph nodes, and thyroid glands no

sweating but there is a remarkable enlargement of the glands, patient reports pain
on touch.

Chest

On inspection normal shape, respirations were at 36B\minute, on auscultation heart

rate was at 120B\minute

Arms

Both hands were of equal size and diameter, with no deformities, no swollen
lymph glands on palpation, good capillary refill, temperatures of 36.6, and blood
pressures of 125\68 mm\hg

Abdomen
On inspection, no scars or distension, on auscultation normal bowel sounds were
present, no on palpation organomegaly

Lower limbs

On inspection, limbs are equal, with no deformities, no edema, no varicose veins,

and no fungal infestation

Back

On inspection no scars or swellings

OBSERVATIONS

• Blood pressure: 126/65mmhg

• Pulse rate: 73b/m

• Respiration: 19c/min

• Temperature: 36.8°C

WEIGHT

52kiligrams

INVESTIGATIONS DONE DURING THE FIRST CLINIC

Acid alcohol fast bacilli smear for sputum was done on which was positive.

Elisa test was also done to test Human Immune deficiency virus which was
negative.

DIAGNOSIS

Known tuberculosis patient on follow up having been diagnosed on 10/03/23

TREATMENT PATIENT IS ON

My client was put on tuberculosis therapy first line medication which has an
intensive phase of 2 months and a continuation phase of four months. On intensive
phase he is taking a combination of four drugs which are;

Rifampicin (150 milligrams)

Isoniazid (75 milligrams)

Pyrazinamide (400milligrams)

Ethambutol (275 milligrams) Three tabs daily

Pyridoxine (50milligrams) I tab daily

ACTUAL DESCRIPTION OF THE CONDITION

Tuberculosis: It mostly affects the lungs though other parts of the body can be
affected except nails, teeth and nails

Two types of tuberculosis

o Pulmonary tuberculosis
o Extra pulmonary tuberculosis

Pulmonary tuberculosis

This is a systemic mycobacterial disease caused by mycobacterium tuberculosis

bacilli and rarely caused by mycobacterium bovis. It mostly affects the lungs
though other parts of the body can be affected.

Characteristics of micro-bacterium tuberculosis bacillus

o It has a waxy coat to protect against adverse environment.

o It has a rod shaped.
o It is aerobic, non-motile, gram negative.
Epidemiology

Normally tuberculosis is a disease of the lungs and transmitted through air droplets
by singing sneezing and laughing. When infected person coughs, bacteria are
suspended in air especially in crowded places where they will cause contamination.
Once one inhales they launch in the lungs. Bacilli may remain viable but dominant
and it is called latent tuberculosis if immune system is suppressed bacilli progress
to full blown tuberculosis.

Risk factors to tuberculosis

These are contributing factors to tuberculosis infection and development of

tuberculosis disease.

 Malnutrition

 People with low immunity

 Low social economic strategies

 Poor ventilation and natural lighting

 Habits including smoking which weakens the lungs

 Overcrowding

 Unhygienic cough

 Immunosuppressed drugs

 Chronic disease such as diabetic mellitus

 Age –there is increased susceptibility in the very young or old age

 Occupation-households that use biofuel emit smoke

 Those who have not received Bacillus Calmette Guerin

 Exposure to mycobacterium tuberculosis

Pathophysiology of pulmonary tuberculosis

When a susceptible person inhales mycobacterium tuberculosis the bacteria are
transmitted through airway to the alveoli, where they are deposited and begin to
multiply in the body’s immune system. This then activates the immune system to
send lymphocytes to lyse the bacilli and normal tissue.

The tissue reaction results in the accumulation of exudate in the alveoli causing
bronchopneumonia, new tissue masses of live and dead bacilli are surrounded by
macrophages which form a protective wall. They are transformed to a fibrous
mass, the central position of which is called tubercle.

The bacteria and macrophages become necrotic forming a cheesy mass, sometimes
the tubercle liquefies and discharges cheese like material into the airway and
patient will cough and produce purulent sputum which is full of tubercle bacilli.
Also there is destruction of blood vessels loading to lacroptosis at this point blood
can carry infection to any part of the body.

Classification of tuberculosis

 Category 1

Any new tuberculosis adult with sputum smear that is positive (+) is classified here

 Category 2

Any new tuberculosis adult with sputum smear negative and has extra pulmonary
diagnosed disease

 Category 3

Any patient with smear of sputum positive pulmonary tuberculosis relapses and
has treatment failure.

Signs and symptoms of tuberculosis

 Productive cough for more than two weeks

 Anorexia

 Blood in sputum
 Chest pains

 Enlargement of lymph nodes

 Night sweats

 Loss of weight

 Cough for more than 2 weeks

 Fever

 Localized wheezing

 Generalized tiredness

 Difficulty in breathing

In children

• Cough for more than 2 weeks

• Night sweats

• Loss of weight

• Fever

• Failure to thrive

• Stiff spine on walking

• Chronic diarrhea

Diagnostic findings

o A complete history of patient and other members of the family

o Physical examination that is there is wheeze sounds and crackles on
auscultation of the chest. Chest x ray which reveals lesions in the upper
lobes
o Acid fast bacilli smear contain mycobacterium which indicates tuberculosis
positive result
 o Tuberculin skin test Mantoux method. This tests whether the individual has
been exposed to mycobacterium tuberculosis and resulting skin reactions
does not necessarily imply current disease. Individuals with active disease
will generally have swelling at the injection site than that current disease
Induration of more than 12mm in diameter is very suggestive of tuberculosis
disease measures of more than 15 mm then proofs the disease
o Sputum microscopy, culture in both liquid and solid media, and nucleic acid
amplification
o Chest computed tomography,
o Histopathological examination of biopsy samples, and new molecular
diagnostic tests
o Gene experts for multiple drug resistance tuberculosis patient

Differential diagnosis of tuberculosis

 Interstitial lung disease

 C.O.P.D
 Lung cancer
 Bronchiectasis
 Heart failure
 Chronic pulmonary embolism
A DIAGRAM OF THE RELATED BODY STRUCTURE AFFECTED BY
TUBERCLE BACILLI

MEDICAL MANAGEMENT

1. Rifampicin

Classification

Rimfamycin B derivatives

Mode of action

It inhibits DNA dependent ribonucleic and polymerase activity in susceptible

bacterial cells by entering phagocytic tubercle bacilli hence being bactericidal.
Indication

o Tuberculosis
o Leprosy
o Brucellosis

Presentation

Tablet

Dosage

150 milligrams

Route of administration

Oral administration

Pharmacokinetic

Absorption

Rifampin is readily absorbed from the gastrointestinal tract. Peak serum

concentrations in healthy adults and pediatric populations vary widely from
individual to individual. Following a single 600 mg oral dose of rifampin in
healthy adults, the peak serum concentration averages 7 mcg/mL but may vary
from 4 to 32 mcg/ml. Absorption of rifampin is reduced by about 30% when the
drug is ingested with food

Distribution

Rifampin is widely distributed throughout the body. It is present in effective

concentrations in many organs and body fluids, including cerebrospinal fluid.
Rifampin is about 80% protein bound. Most of the unbound fraction is not ionized
and, therefore, diffuses freely into tissues.

Half-life

In healthy adults, the mean biological half-life of rifampin in serum averages

3.35±0.66 hours after a 600 mg oral dose, with increases up to 5.08±2.45 hours
reported after a 900 mg dose. With repeated administration, the half-life decreases
and reaches average values of approximately 2 to 3 hours. The half-life does not
differ in patients with renal failure at doses not exceeding 600 mg daily, and,
consequently, no dosage adjustment is required.

Elimination

After absorption, rifampin is rapidly eliminated in the bile, and enter hepatic
circulation ensues. During this process, rifampin undergoes progressive
deactivation so that nearly all the drug in the bile is in this form in about 6 hours.
This metabolite has antibacterial activity. Intestinal reabsorption is reduced by
deactivation, and elimination is facilitated. Up to 30% of a dose is excreted in the
urine, with about half of this being unchanged drug.

CONTRAINDICATIONS

 Rifampin is contraindicated in patients with a history of hypersensitivity to

rifampin or any of the components, or to any of the rifampicin
 Rifampin is contraindicated in patients who are also receiving ritonavir-
boosted saquinavir due to an increased risk of severe hepatocellular toxicity.
 Rifampin is contraindicated in patients who are also receiving atazanavir,
darunavir, fosamprenavir, saquinavir, or tipranavir due to the potential of
rifampin to substantially decrease plasma concentrations of these antiviral
drugs, which may result in loss of antiviral efficacy and/or development of
viral resistance.
 Rifampin is contraindicated in patients receiving praziquantel since
therapeutically effective blood levels of praziquantel may not be achieved.
In patients receiving rifampin that needs immediate treatment with
praziquantel alternative agents should be considered. However, if treatment
with praziquantel is necessary, rifampin should be discontinued 4 weeks
before administration of praziquantel. Treatment with rifampin can then be
restarted one day after completion of praziquantel treatment.

SIDE EFFECTS

Systemic hypersensitivity reactions whose signs and symptoms include:

o Fever,
o Rash,
 o Urticaria,
o Angioedema,
o Hypotension,
o Acute bronchospasm,
o Elevated liver transaminases
o flu-like syndrome (weakness, fatigue, muscle pain, nausea, vomiting,
headache, chills, aches, itching, sweats, dizziness, shortness of breath, chest
pain, cough, syncope, palpitations)

2. ISONIAZID

Classification

A single agent antibiotic

Mode of action

Isoniazid inhibits DNA-dependent RNA polymerase activity in susceptible

Mycobacterium tuberculosis organisms. Specifically, it interacts with bacterial
RNA polymerase but does not inhibit the mammalian enzyme.

Indication

For treatment of tuberculosis in combination with other anti- tuberculosis drugs

Presentation

Tablets

Dosage

75 milligrams

Side effects

o Isoniazid can sometimes cause nausea, Vomiting, or loss of appetite.

Although Isoniazid works best on an empty stomach, adverse stomach
effects may be relieved by taking it with a snack.
 o Rarely, an allergic reaction with symptoms such as rash, fever, chills, joint
aches, and swollen glands may occur. If these effects occur, stop taking
isoniazid and immediately contact your doctor.
o In rare cases, isoniazid can cause vision problems or eye pain.

3. PYRAZINAMIDE

Classification

Miscellaneous anti tuberculosis agent and niacin amide derivative

Mode of action

Pyrazinamide is a prodrug that is converted into its active form, pyrazinoic acid, by
a mycobacterial enzyme, pyrazinamidase, as well as through hepatic metabolism.
Pyrazinoic acid is bactericidal to Mycobacterium tuberculosis at acid pH values but
not at neutral ph. The precise mechanism of action is unknown. Pyrazinamide is
inactive against atypical mycobacteria. Resistance develops rapidly if
pyrazinamide is used as sole ant tubercular agent.

Presentation

Each tablet contains: Pyrazinamide 400 mg

Contraindications

 Hypersensitivity to the active substance or to any of the excipients,

 Severe liver impairment or
 Acute gout.

Drug interaction

Probenecid: There is a complex pharmacokinetic and pharmacodynamics two-way

interaction between pyrazinamide and Probenecid. The appropriate dose of
Probenecid in co-treatment has not been established. Therefore, concomitant use
should be avoided.

Allopurinol: Co-administration increased the AUC of the active metabolite of

pyrazinamide, pyrazinoic acid. Since pyrazinoic acid inhibits urate elimination,
allopurinol is not effective in treating pyrazinamide-associated hyperuricaemia.

4. Ethambutol Hydrochloride

Classification

Miscellaneous antituberculosis agents

Mode of action

Ethambutol diffuses into actively growing mycobacterium cells such as tubercle

bacilli.

Ethambutol appears to inhibit the synthesis of one or more metabolites, thus

causing

Impairment of cell metabolism, arrest of multiplication, and cell death No cross

resistance with other available ant mycobacterial agents has been demonstrated.

Ethambutol has been shown to be effective against strains of Mycobacterium

tuberculosis but does not seem to be active against fungi, viruses, or other bacteria.

Presentation

Tablet: 275 milligrams

Precaution

Because this drug may have adverse effects on vision, physical examination should
include ophthalmoscopy, finger perimetry and testing of color discrimination. In
patients with visual defect such as cataracts, recurrent inflammatory conditions of
the eye, optic neuritis and diabetic retinopathy the evaluation of changes in visual
acuity is more difficult, and care should be taken to be sure the variations in vision
are not due to the underlying disease conditions.
Contraindication

o Optic neuritis

Side effects

• Tingling sensation of extremities

• Numbness

• Fever

• Dermatitis

• Gastrointestinal disturbances

5. Pyridoxine (VITAMIN B6)

Classification

A vitamin B complex

It used to prevent numbing and tingling of the hands or feet sometimes caused by
isoniazid or other TB medicines.

Presentation

By tablets 50mg and by injection form

Contraindication

It is not contraindicated to anyone

Side effects

 Nausea,
 Headache,
 Drowsiness,
 Abnormal skin sensations
 Pyridoxine can also decrease folic acid and sensation
6. Vitamin A

Classification

It is a fat soluble vitamin

It is used to boost the body immunity after been weakened by tuberculosis disease
and enhance quick recovery

Dosage

100000IU TO 200000IU in tablet formed

NURSING MANAGEMENT OF PULMONARY TUBERCULOSIS

The nursing management of Tuberculosis involves various aspects, including

prevention, screening, diagnosis, treatment, and monitoring. Nurses play a critical
role in the management of TB, as they are often the first healthcare professionals to
come into contact with patients with suspected or confirmed TB. Nurses must be
knowledgeable about the disease, understand its mode of transmission, and be
aware of the appropriate precautions to take to prevent infection.

 Prevention of TB involves identifying and addressing risk factors such as

close contact with a person with active TB, immunosuppression, and poor
living conditions. Nurses educate patients about ways to prevent TB, such as
maintaining good personal hygiene, improving ventilation in living spaces,
and getting vaccinated against TB if available.
 Screening for TB involves identifying individuals at increased risk for TB
infection or disease and conducting tests to detect TB. Nurses perform a
thorough assessment of patients to identify risk factors and recommend
screening tests such as the Mantoux skin test or the interferon-gamma
release assay (IGRA).
 Diagnosis of TB involves identifying the presence of M. tuberculosis in the
patient’s body. Nurses assist with collecting and processing specimens for
laboratory testing, such as sputum samples or other body fluids.
 Treatment of TB involves a combination of medications, typically taken for
several months. Nurses educate patients about the importance of adhering to
 the medication regimen, monitor for adverse effects, and provide support to
help patients complete the full course of treatment.
 Monitoring of TB involves regular follow-up to ensure that patients are
responding to treatment and to detect any potential complications. Nurses
monitor patients’ symptoms, provide ongoing education and support, and
collaborate with other healthcare professionals to ensure coordinated care.
 Overall, the nursing management of TB is a crucial aspect of preventing the
spread of this highly infectious disease. Nurses play a pivotal role in the
prevention, screening, diagnosis, treatment, and monitoring of TB and their
expertise is essential for improving outcomes for patients with TB.

Complications of tuberculosis

 Severe hemoptysis

 Respiratory failure in the lung

 Meningitis in the brain

 Renal failure in the kidney

 Vertebral collapse

 Pleural effusion

 Multi – drug resistance tuberculosis

PLAN FOR THE FIRST HOMEVISIT

OBJECTIVES OF THE FIRST HOMEVISIT

o To familiarize with the other family members

o To assess home environment
o To plan for appropriate interventions

FIRST HOME VISIT REPORT

It was on Monday 10/04/2023 when I and my colleague Kame Roba visited my

client at Kamachege. I met him with his wife, they welcomed us comfortably. I
introduced my colleague to my client and her family and they were glad to meet
us.

NAME OF MY CLIENT; Morris Gitobu

AGE; 38years

VILLAGE; Kamachege

SUB- LOCATION; Nkuene sub location

HOME ASSESSMENT

Type of house

They had a permanent house that was larger enough the walls were smooth and
free from cracks, the floor was free from potholes, had six windows adequate in
size which facilitated natural ventilation; it had three bedrooms, one sitting, and
one bathroom. They had a store and kitchen which was semi-permanent and

Separately built ten meters from the house

In the kitchen the utensils were well arranged and clean.

Cooking arrangement

My client family uses a gas cylinder to cook alternating with firewood’s using
improved Jiko

Cleanliness of the house

The house was very clean, neat and free from dampness

Sources of light

My client family uses electricity in lighting, but they also have a solar panel
installed in their house in case of blackout

Number of occupants

My client and her wife live with their two children’s a boy a girl

MEMBERS I MET
NAME; Morris Gitobu

AGE; 38 years

SEX; Male

OCCUPATION; Farmer

His wife

NAME; Purity Ncabira

AGE; 34 years

OCCUPATION; farmer

Their two children’s were in the school during the home visit

Source of water

Their main source of water was from the tap, originating from river Thingitho.
They were drinking the water without boiling reason.

They also had 10,000 liters’ tank for harvesting rain water which was full

Source of food

The main source of food was from their farm.

FOOD GROWN BY THE FAMILY

They had plenty of bananas and vegetables like kales, spinach in their garden

FOOD BOUGHT BY THE FAMILY

The family bought cereals like maize, legumes like beans from the market

Basic diet

The basic diet for the family is mainly ugali and githeri
They had two cows which provided them with milk for their tea and their always
manage to sell 5liters per day

They had kept sixty chickens for provision of meat and eggs and their always sell
some

Other structures within the family

Cow Shed

Morris family have a well-constructed cow shed divided into four cubicles ,30
meters from their house cow, it is sloppy to facilitate drainage, well sheltered to
prevent the cows from rain or direct sunlight, and it is well ventilated

Semi intensive poultry housing

It is a combination of free range and partly intensive type

It is well constructed with a wooden poultry house lifted 50 meters from the
ground Just Adjacent to cow shed 30 meters from the house

Disposal of refuse

The family had not dug a compost pit for disposal of refuse

They used to throw the waste at the corner of homestead and burned them

Latrines

The family had one ventilated improved pit latrine 15 meters from the house which
was cemented and was in good condition. There was no leaky can for handwashing
after visiting the toilets

Animals kept

They had two cows which was the source of milk

He also kept sixty chickens for provision of meat and eggs

Occupation of the head of house

Morris being the head of house he works as a farmer

The main source of income

The main source of income is farming by sell milk, eggs, spinach and kales, they
also own a matatu operating from Meru to Nairobi which help the family meet
their need

Family health status

There is no history of any hereditary disease in the family; mother reported that
their two boys were well and very healthy.
Community description

The area is densely populated with good all weather roads

The nearest health facility is Jekim hospital

Main houses around the area are semi-permanent

Resource’s available: For the family.

The family possess land 1.5 acre, they inherited the form their fore father’s on
which they farm, and they get their food staff and vegetables from the farm located
around their homestead from where they live. Morris report that it contains fruits
like mangoes and avocado and vegetables which they sell to generate income
during the fruits season. And it has a good water supply to irrigate in case of
draught
Nearest hospital
Consolata mission hospital Nkubu, where they seek medical intervention for
family well-fare using the NHIF card
Nearest school
The nearest school is Kamachege academy, but their two sons are in Stella Marris
in Nkubu where they travel by the school bus
Nearest road
Mitunguu _ Tharaka main tarmac road, which they use as their means of transport
either on matatu or motorcycles
Challenges faced during first home visit
The main challenge during first home visit was getting the direction of homestead
since the client the client homestead was interiorly two km from the main road
direction furthermore the client was poor in giving us direction

Challenges that I met in the family

They used to fetch and drink tap water directly without boiling

They did not a have a water tap for hand washing near the kitchen and the latrine

They did not have a compost pit for disposing solid refuse, and their used to
dispose even non-biodegradable waste anyhowly.

How I addressed the family challenges

I guided the client on how to construct a compost heap to enhance humus in the
soil and reduce environmental pollution, and to turn the content regularly to
enhance decomposition and to use the manure after 30 days in planting.

I advised the client on how to construct a simple hand washing point using a
kibuyu a wood and a sling

I advised the client to boil water for drinking and store in a clean Jeri can in the
sitting room, for easy access

PLAN FOR THE SECOND HOME VISIT

OBJECTIVES
To assess the progress of my client
To health educate the family members on tuberculosis drug compliance
To evaluate the interventions of the first visit
SECOND HOMEVISIT REPORT
It was on 20/04/2023 when I was permitted by my tutor at 2 pm to go visit my
client at Kamachege accompanied by my fellow student kame Roba. We boarded a
motorcycle outside the hospital and by 25minutes we had reached at my client
home place where we were warmly welcomed
HOME ASSESSMENT
Since first visit they had no tap water outside the toilet for handwashing, on
assessment they had constructed one.
They had a clean boiled water for drinking stored in a clean Jerrican well cocked as
emphasized during the first home visit
On medications my client and his family were taking the medications as prescribed
HEALTH STATUS OF THE FAMILY
They were no complications arising since my client had a good drug compliance

HEALTH MESSAGE DURING THE SECOND VISIT

Name of the client: Morris Gitobu

Name of the facilitator: James Karanja

Venue: Morris home

Time: 30 minutes

BROAD OBJECTIVE: By the end of the lesson my client will have knowledge on
tuberculosis drug compliance, importance and complications due to failure of drug
of compliance.

TIME SPECIF CONTEN TEAC TEAC TEAC LEAR EVALU

IC T HING HING HERS NERS ATION
OBJEC METH AID ACTIV ACTIV
TIVE OD ITY ITY
Introdu Introduc I greeted lecture Written explain listenin
Self-
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self and introduce t on and
topic of d self and topic of
discussi topic of coverage
on discussion well done
Lesson By the Involves Interact Written explain listenin Client
plan end of taking ive handou ing g gained
phase the drugs as lecture t knowledg
1 5 lesson prescribed e on what
minute client by the is drug
s will physician complian
have following ce
knowle right drug,
dge on time ,
drug route, and
complia frequency
nce
Lesson By the -Prevents Interact Written Explain Listeni Client
plan of the multituber ive handou ing and ng and answered
phase lesson culosis lecture t asking asking all
2 my drug questio questio questions
10min client resistance ns ns as
utes will -Enhances expected
have faster
knowle recovery
dge on -reduces
importa morbidity
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drug -prevents
complia one from
nce tuberculos
is
complicati
ons
-lowers
cost of
patients
care and
improves
public
health
Lesson By the -Leads to Interact Written Explain Listeni Client
plan end of multituber ive handou ing and ng and gained
phase the culosis lecture t answeri answeri knowledg
3 lesson drug ng ng e on
15min my resistance questio questio complicat
utes client
-increased ns ns ions due
will cost of to failure
have living due of drug
knowle
to medical complian
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care ce
complic
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ations
in
due to
morbidity
failure
rate
of drug
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complia
wastage
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medicatio
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to disease
progressio
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pulmonar
y
tuberculos
is
Lesson summar Summariz Interact Written explain listenin Client
plan y ed by ive handou ing g appreciat
phase thanking dialogu t ed for the
42 my client e knowledg
minute for her e offered
s cooperatio
n

PLAN FOR THE THIRD HOMEVISIT

OBJECTIVES OF THE THIRD HOMEVISIT
To assess the progress of my client
To health educate the family members on nutrition body requirement when taking
anti tuberculosis drugs
To evaluate the interventions of the second home visit.
THIRD HOME VISIT REPORT

It was on 05/05/2023 when I was permitted by my tutor at 2 pm to go visit my

client at Kamachege accompanied by my fellow student Doris Kanana. We
boarded a motorcycle outside the hospital and by 25minutes we had reached at my
client home place where we were warmly welcomed

HOME ASSESSMENT

On medications my client and his family were taking the medications as prescribed

The environment was clean and tidy

MEMBERS I MET

NAME; Morris Gitobu

AGE; 38 years

SEX; Male

OCCUPATION; Farmer

His wife

NAME; Purity Ncabira

AGE; 34 years

OCCUPATION; farmer

Children’s

Their two children’s were at home since they had closed school. They were two
males namely:

Kelvin Kimathi who is 13 years

Andrew Gikunda who is 8 years

They were well with no signs of malnutritional diseases like kwashiorkor and
marasmus
 HEALTH STATUS OF THE FAMILY

They were no complications arising since my client and his family had a good drug
compliance

HEALTH MESSAGE DURING THE THIRD HOME VISIT

Name of the client: Morris Gitobu

Name of the facilitator: James Karanja

Venue: Morris home

Time: 30 minutes from 3:10pm to 3:40pm

Topic: Dietary requirement in antituberculosis therapy

BROAD OBJECTIVE: By the end of the lesson my client will have knowledge on
dietary requirement in antituberculosis therapy.

TIME SPECIFI CONTENT TEACHIN TEAC TEAC LEAR EVALUA

C G HING HERS NERS TION
OBJECTI METHOD AID ACTIV ACTIV
VE ITY ITY

Introdu Introducti I greeted the lecture Written explaini listenin Self-

ction on of self client handout ng g introducti
and topic introduced on and
of self and topic topic of
discussio of discussion coverage
n well done

Lesson By the  Leafy, Interactive Written explaini listenin Client

plan end of the dark- lecture handout ng g gained
phase 1 lesson colored knowledg
5 client will greens e on diet
like kal
minutes have require
es and
knowledg spinach when
e on diet , for taking
requireme their antituberc
nt for high ulosis
person iron drugs
taking and B-
vitamin
antituberc
content
ulosis  Plenty
drugs of
whole
grains,
like
whole
wheat
pastas,
breads,
and
cereals

 Antioxi
dant-
rich,
brightl
y-
colored
vegetab
les,
such as
carrots,
peppers
, and
fruits,
like
tomato
es.

 Unsatu
rated
 fats
like
vegetab
le or
olive
oil,
instead
of
butter

Lesson By the of  Skip Interactive Written Explain Listenin Client

plan the lesson tobacco lecture handout ing and g and answered
phase 2 my client in all asking asking all
10minu will gain forms. questio questio questions
 Don't
tes enough ns ns as
drink
knowledg alcohol expected
e on what — it
to avoid can add
when to the
taking risk of
antituberc liver
damage
ulosis
from
some
of the
drugs
used to
treat
your
TB.
 Limit
coffee
and
other
caffein
ated
 drinks.
 Limit
refined
product
s, like
sugar,
white
breads,
and
white
rice.
 Avoid
high-
fat,
high-
cholest
erol red
meat
and
instead
load up
on
leaner
protein
sources
like
poultry,
beans,
and
fish.
Lesson By the  Prevent  Inte Written Explain Listenin Client
plan end of the s major racti handout ing and g and gained
phase 3 lesson my adverse ve answeri answeri knowledg
client will effects lect
15minu ng ng e on
gain of ure
tes knowledg questio questio importanc
antitub
e on erculos ns ns e of
importanc is taking
e of  Enhanc right diet
proper
 diet es when
during quick taking
antituberc recover antituberc
ulosis y
ulosis
therapy  Helps
drugs
in good
absorpt
ion of
antitub
erculos
is drugs

Lesson summary Summarized Interactive Written explaini listenin Client

plan by thanking dialogue handout ng g appreciate
phase 4 my client for d for the
2 his knowledg
minutes cooperation e offered

PLAN FOR THE FOUTH HOME VISIT

OBJECTIVES
To assess the progress of my client
To health educate the family members on ways tuberculosis spreads and risk
factors to avoid
To evaluate the interventions of the 3rd visit
FOURTH HOME VISIT REPORT
It was on 16/05/2023 when I was permitted by my tutor at 2 pm to go visit my
client at Kamachege accompanied by my fellow student Mercy Maina. We
boarded a motorcycle outside the hospital and by 30 minutes we had reached at my
client home place where we were warmly welcomed
HOME ASSESSMENT
On medications my client and his family were taking the medications as prescribed
The environment was clean and tidy
On dietary requirement patient adhered to my previous health talk on right diet on
antituberculosis therapy and was feeding well.
MEMBERS I MET
NAME; Morris Gitobu
AGE; 38 years
SEX; Male
OCCUPATION; Farmer
His wife
NAME; Purity Ncabira
AGE; 34 years
OCCUPATION; farmer
Children’s
Their two children’s were at school since they had opened school.
HEALTH STATUS OF THE FAMILY
They were no complications arising since my client and his family had a good drug
compliance and proper dietary as I advised previously.
HEALTH MESSAGE DURING THE THIRD HOME VISIT
Name of the client: Morris Gitobu
Name of the facilitator: James Karanja
Venue: Morris home
Time: 30 minutes from 3:10pm to 3:40pm
Topic: The ways in which tuberculosis spreads and risk factors
Date 16/05/2023
 BROAD OBJECTIVE: By the end of the lesson my client will have knowledge on
on ways tuberculosis spreads and risk factors

TIME SPECIF CONTENT TEACHIN TEACH TEACH LEARN EVALUA

IC G ING ERS ERS TION
OBJEC METHOD AID ACTIVI ACTIVI
TIVE TY TY

Introdu Introduc I greeted the lecture Written explaini listening Self-

ction tion of client handout ng introductio
self and introduced n and
topic of self and topic of
discussi topic of coverage
on discussion well done

Lesson By the Tuberculosi Interactive Written explaini listening Client

plan end of s is an lecture handout ng gained
phase 1 the airborne knowledge
disease, and
5 lesson on ways
can be
minutes client caught by tuberculos
will aerosolized is spreads
have air droplets
knowled from an
ge on infected
ways person
through the
tubercul
following
osis ways:
spreads o Breat
hing.
o Coug
hing.
o Talki
ng.
o Singi
ng.
o Sneez
ing.
Lesson By the Risks Interactive Written Explaini Listenin Client
plan of the factors lecture handout ng and g and answered
phase 2 lesson include: asking asking all
o HIV
10minut my question question questions
infect
es client s s as
ion
will gain (the expected
enough virus
knowled that
ge on cause
risk s
factors AIDS
)
of o Subst
tubercul ance
osis abuse
.
o Silico
sis.
o Diabe
tes
mellit
us.
o Sever
e
kidne
y
disea
se.
o Low
body
weig
ht.
o Orga
n
trans
plants
.
 o Head
and
neck
cance
r.
Lesson By the o Preve  Inter Written Explaini Listenin Client
plan end of nts activ handout ng and g and gained
phase 3 the furthe e answeri answeri knowledge
lesson r lectu
15minut ng ng on
my sprea re
es client question question importanc
d of
will gain active s s e of
knowled tuber awareness
ge on culosi on causes
importa s and risk
nce of o Redu factors of
awarene ces tuberculos
ss on burde
causes is.
n on
and risk healt
factors hcare
of work
tubercul ers
osis o Redu
ce
conge
stion
in
healt
h
facilit
y
o Redu
ces
the
chanc
es of
acqui
ring
 active
tuber
culosi
s

Lesson summar Summarize Interactive Written explaini listening Client

plan y d by dialogue handout ng appreciate
phase 4 thanking d for the
2 my client knowledge
minutes for his offered
cooperation

PLAN FOR FIFTH HOME VISIT

OBJECTIVES

o Evaluation for all intervention

o To assess the well-being of the client and that of the family members.

o To make summary of the health messages shared during previous home

visits.

o To answer any questions and clarify any misunderstanding concerning the

patient’s condition

o Terminate the follow up

FIFTH HOME VISIT REPORT

LAST HOMEVISIT REPORT (TERMINATION)

It was on 20/05/2023 Saturday when my colleague Kame Roba accompanied

me at kamachege to visit my client. We found my client sitting in his table room
with his wife and his two children’s waiting for us, He welcomed us and I
introduced my colleague to him

HOME ASSESSMENT

He had adhered to all health message shared

The environment was clean

HEALTH MESSAGES

Since it was my last visit, I summarized all the previous teaching on i.e. on
drug compliance, dietary requirement in antituberculosis therapy and ways in
which tuberculosis spreads and risk factors I asked a number of questions based on
the discussed topics and the response towards each question was excellent since
they could remember everything. Finally, I gave a short summary on the discussed
topics after which I appreciated him for welcoming me and allowing me to be his
health care adviser and to be a frequent visitor to his home. I again thanked him for
his co-operation and the support he gave me and even accommodating me for that
short period. The family also appreciated us since he had benefited from us
through the health talks that will forever help them live a healthy life.

SUMMARY OF THE CASE STUDY

How I met my client

I met my client at comprehensive care clinic, we created rapport and he

accepted to be my client for case study

First home visit

The main aim was for;

o To familiarize with the other family members

o To assess home environment
o To plan for appropriate interventions

Second home visit

The main aim was;

 o To assess the progress of my client
o To health educate the family members on tuberculosis drug compliance
o To evaluate the interventions of the first visit
Third home visit
The main aim was;

To assess the progress of my client

To health educate the family members on nutrition body requirement when taking
anti tuberculosis drugs
To evaluate the interventions of the second home visit.
Fourth home visit
The main aim was;

To assess the progress of my client

To health educate the family members on ways tuberculosis spreads and risk
factors to avoid
To evaluate the interventions of the 3rd visit
Fifth home visit
The main aim was;

o Evaluation for all intervention

o To assess the well-being of the client and that of the family members.

o To make summary of the health messages shared during previous home

visits.

o To answer any questions and clarify any misunderstanding concerning the

patient’s condition

o Terminate the follow up

EVALUATION OF THE CASE STUDY

 Throughout the case study I learnt a lot, I interacted with my client family
and learnt a lot from them

I am also convinced that my client family learnt a lot throughout the case study and
follow up

PROBLEM ENCOUNTERED

Transport was the main problem encountered during my case study.

FAMILY RESPONSE TO FOLLOW UP

Morris and his family were very cooperative throughout the follow up

Whenever I visited they appreciated me and welcomed me happily and showed a

lot of interest

They benefited a lot from the health message shared

ACHIEVEMENTS

I managed to assess the progress of my client during the scheduled visit.

I managed to identify the problems that were becoming an obstacle to Morris and I
guided him through health messages like, drug compliance and dietary requirement
in antituberculosis therapy, risk factors of tuberculosis and preventive measures.

TO CLIENT AND THE FAMILY

They had great improvement upon learning about, drug compliance, dietary
requirement in antituberculosis therapy, risk factors of tuberculosis and preventive
measures.

The topics were well understood and kept them in practice in their daily life.

VOTE OF THANKS

I sincere wish to thank my client, and his wife and all the family members for
positive attitude towards me and also willingness to be followed

ACKNOWLEDGEMENT
 I acknowledge the work of my tutor Mrs. Murithi, who tirelessly and willingly
guided me through the case study. She actively impacted a lot of knowledge and
skills and altitude through the case study

I thank my client Morris for accepting to be my client for follow up and positive
attitude towards me

I acknowledge my fellow colleague who agreed to accompany me to my client

home and also share health message with them.

CONCLUSION
Patient follow up should be put in practice to all patients after discharge from the
hospital especially those patients with communicable illness. This will enhance
their recovery as the health worker will reinforce some things that might be
ignored by the patient at home.

REFERENCE
1. Communicable diseases 4th edition by Dr Erik Nordberg, Dr Timothy
Kingondu
2. https://acphd.org/communicable-disease