Carlos Mancia , 48-year-old male, Spanish speaking migrant worker recently hospitalized for active
tuberculosis. Carlos presented with symptoms of blood-tinged mucous and a productive cough. His wife,
Maria exhibited s
...
Carlos Mancia , 48-year-old male, Spanish speaking migrant worker recently hospitalized for active
tuberculosis. Carlos presented with symptoms of blood-tinged mucous and a productive cough. His wife,
Maria exhibited symptoms of active tuberculosis, a productive cough and night sweats. Carlos initially
resisted referral for treatment from the public health department because he was fearful of being
discovered as an undocumented migrant worker. The community health nurse met with Carlos and his wife
and the nurse shared that tuberculosis is a reportable illness and must be reported to the public health
department using Centers of Disease Control Guidelines. Carlos met with the public health department and
home health visits were scheduled for directly-observed therapy (DOT) for medication administration. The
community health nurse tells Carlos and Maria about the option for video observation of medications.
Carlos and Maria are educated about their medications which must be given together at the same time
each day. Medications: NKDA Isoniazid (INH) 300 mg daily orally for 30 days Rifampin (RIF) 600 mg daily
orally for 30 days Pyrazinamide (PZA) 2000 mg four times daily orally (max 2 gm/day) by mouth for 30
days Ethambutol (EMB) 1600 mg daily orally for 30 days Pyridoxine 50 mg daily orally for 30 days Social
history: Carlos does not speak English. He lives in a three-bedroom, multigenerational home with his wife,
her mother, and Carlos and Maria’s three children, ages 22, 19 and 17, and 3-year-old granddaughter.
Carlos’s electronic health record states that he is “a form of Catholic” and that he is “devoted to his
religious practices.” Carlos works for a roofing company and works long hours. Maria and their two oldest
daughters, Teresa (22-year-old) and Maria Elena (19-year-old) clean houses. Their 17-year-old son,
Alejandro is a senior in high school and plays competitive soccer. Maria’s mother, Margarita, maintains the
home and prepares most of the meals. Margarita plays bunko at the senior center twice a week. Teresa’s
daughter, Josephine, goes to a day care center three days a week.
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