Tb report Visit report Word File made By Sonal Patel

1. REPORT OF CLINICAL EXPERIENCE AT
DTC
We Student of S.Y. M.Sc. Nursing of Community Health Nursing Specialty got
opportunity to have clinical experience of State T.B. Training & Demonstration
Centre & District Tuberculosis centre civil hospital campus, Ahmadabad, for 2
week(17/6/2017 to 1/7/2017).

2. GENERALOBJECTIVE:
At the end of the clinical experience at district tuberculosis centre
the students will be able to develop experience and in depth understanding
about goals, strategies and implementation of RNTCP programme with a view
of comprehend role of nurse at D.T.C.
CONTRIBUTORY OBJECTIVES:
After completion of clinic students will be able to:
1) Describe the policy of TB hospital.
2) Write about objectives and strategies of RNTCP programme.
3) Draw the physical set up of TB hospital.
4) Draw the organization chart of TB hospital.
5) Describe diagnostic algorithm of tuberculosis.
6) Describe treatment strategies for tuberculosis.
7) Know the DOT and DOTS plus therapy.
8) Learn to prepare sputum smear in laboratory.
9) Maintain the records and reports of department.
10) Discuss different departmental activities of TB hospital.
11) Know the role of nurse in D.T.C.

3. PHYSICAL LAYOUT:
ENTRY
INCHARGE ROOM NURSING STATION
DOCTORROOM
STORE
ROOM
RNTCP ROOM SISTER ROOM
GENERAL
WARD
FEMALE
WARD
ICU
OPERATION
THEATER
MALE
WARD
DOTS
PLUS
ROOM
1st
FLOOR
GROUND FLOOR

4.  OBJECTIVE OF RNTCP:
 To achieve and maintain a TB treatment success rate of at least 85%
among new sputum positive patients.
 To achieve and maintain detection of at least 70% of the estimated new
sputum positive people in the community.
 STRATEGY OF RNTCP:
 The program strategy achieved and sustained the target detection rate of
70% of all estimated cases and a cure rate of 85% in new cases and led to
the decrease in incidence of TB in the country.
 With progress in achieving objectives outlined in the DOTS strategy of
the 11th five year plan the program defined the new targets of universal
access to TB care. Under the 12th five year plan of government of India as
the total estimated cases and a cure rate of 90% in new and 85% in re-
treatment cases.
 Improve communication and outreach
 Screening clinically and socially vulnerable risk groups for TB.
 Deployment of higher-sensitivity diagnostic tests for TB suspects and
decentralized DST services
 Promptly and appropriately treating TB, increasingly guided by DST.
 Decentralized DST at district level for early MDR detection.
 Improved information system for PMDT
 In rural areas the RNTCP can focus integration through the National
Rural Health Mission.
 In urban areas the RNTCP can integrate through the private sector and the
evolving National Urban Health Mission.
 Reduce the TB deaths by 75%, and save 17 lakh lives from TB.

5. 1. ASSESSMENT:
As per the syllabus of the community health nursing-II, we have
To acquire knowledge about State T.B. Training & Demonstration Centre
& District Tuberculosis Centre.
2. PREPLANNING PHASE:
Community Health Nursing Department did proper
correspondence to the office of DTC & STDC, Civil hospital Campus,
Ahmadabad and also takes verbal permission from Head of Department.
3. IMPLEMENTATION PHASE:
I reached there at 9:00A.M .Meet Dr. K.S. Shah.HOD of T B
Hospital, I gave my introduction and also intimate her about our objectives for
one week posting. Share some information about institution how R.N.T.C.P is
running With Dr Kalpesh.

6. DEPARTMENT:
RoomNo Department
1 Case Window
2 RNTCP State Drug Store
3 X Ray Room
4 X Ray Room
5 RNTCP State Drug Store RoomII
6 Store Room
7 Store Room
8 Driver Room
9 Laboratory
10 Laboratory
11 AMC DMC Laboratory & DOTs Centre
12 Laboratory BJMC & DMC
13 TB Ward
14 Drug Distribution
15 RNTCP DOTs Pluse State drug Store
16 Drug Store RoomII
17 Drug Store Room District Ahmedabad ( R )
18 Medical Officer Room
19 Leprosy drug Store
20 Laboratory
21 O.P.D.
22 O.P.D.

7. RoomNo.18 M.O Room& OPD
Dr. P.K.Chhaya M.O & Mr.Mahendra Parmar TBHV has given Information
regarding RNTCP programme
Directly ObservedTreatment, Short –Course (DOTs)
Five Point Strategy:
1. Political & Administrative Commitment.
2. Diagnosis by Sputum microscopy.
3. Uninterrupted supply of goods quality.
4. Direct Observation Treatment.
5. Systematic monitoring and accountability.

8. RoomNo.11 AMC DMC Laboratory & DOTs Centre
DIAGNOSTIC ALGORITHM FOR PULMONARY TB
COUGH FOR 2 WEEKS OR MORE
2 Sputum smears
1 or 2 Positives 2 Negatives
Sputum Positive Antibiotics 10-14 days
PTB (Anti- TB Treatment)
Cough Persists
Repeat 2 sputum Examinations
2 Negative 1 or 2 Positives
X-Ray Sputum Positive
PTB (Anti-TB
Treatment)
Negative for TB Suggestive of TB
NON TB Sputum Smear
Negative PTB
(Anti- TB Treatment)

9. Following activities are carried out by lab technicians at lab.
1. Registration:
2. Sputum Collection:
 According to new strategy from 1st April’09 only two sputum samples are
required for confirmation of Tuberculosis.
3. Sputum MicroscopicExamination by Ziehl NelsonStaining Method
4. Records and Reports:
5. Preservationof stainedslides:
 In laboratory there are provision of preserving of stained slides for 3
months
6. DisposalofStained slides and sputum container:
 Checked stained slides are submerge in 5% phenyl for 30 minutes,
then discard them in yellow bags ,then send it to incinerator for
discard.
 Roomno. 17 Drug Distribution
Medicine are used in DOTS are as follows.
1. Z = Pyrazinamide - 1500mg
2. E = Ethambutol Hydrochloride – 1200gm
3. H = Isoniazide – 600gm
4. R = Rifampicin – 450gm
5. Inj Strptomycine – 0.75g

10. Medicine are used in paediatric TB patients are as follows.
Z = Pyrazinamide - 35mg/kg
E = Ethambutol Hydrochloride – 30mg/kg
H = Isoniazide – 10-15gm/kg
R = Rifampicin – 10mg/kg
Inj Streptomycin – 15m/kg
PHASES OF DURATION OF DOTS TREATMENT
There are two phase in DOTS Therapy Treatment.
1. Intensive Phase
2. Continuous Phase
Categ
ory
Intensive
Phase
Continuous
Phase
Total Remarks
I 8 weeks (24
doses)
HRZE*2months
pt take three
times in a week.
18 weeks (54
doses)
HR*4 months
pt take three
times in a week.
26 weeks
(78 doses)
If after 2 months
sputum come
positive than
Incentive phase
Treatment will
extent for one
more month.
II 12 weeks (36
doses)
HRZES*2months
22 weeks ( 66
doses)
HRZE*1 months
HRE*5 months
34 weeks
(102
doses)
If after 3 months
sputum come
positive than
Incentive phase
Treatment will
extent for one
more month

12.  DOTS PLUS-MDR patient intensive phase treatment ward :
This ward is located at first floor. Male Staff Brother Mr. Kanubhai
Patel is working there as a male staff nurse. He explained regarding types of
patients admitted here .e.g. the patients those are having resistance of
Isoniazide and Rifampicin are admitted here. Their culture and sensitivity
test will be done here to confirmed resistance.
Following treatment are given according 4, 5, category
Patient’s Weight Below
45 Kg
Patient’s Weight Above 45
Kg
CAT-5(XDR)
Inj.Kenamycine-500gm Inj.Kenamycine-750gm Injcapreomycine0.
75mg
Tab. Levoflox- 750mg Tab. Levoflox- 1000mg Tab INH-300mg-
3
Tab. Ethnocide 250gm*2 Tab. Ethnocide – 250gm*3 Tab Moxiflox-1
Cap Cyclocerine-
250gm*2
Cap Cyclocerine- 250gm*3 Side effects are
suicidal tendency,
depression and
psychosis.
Tab.Ethambutol-800gm*1 Tab.Ethambutol-800gm*1
-200gm*1
Tab Augmentine-
2
Tab Pyridoxine-100gm*1 Tab Pyridoxine-100gm*1 Tab Clofazine-2
Tab.Pyrazinamide-750*1 Tab.Pyrazinamide-750*2 PAS-Sodium
cristal-9.2gm
TOTAL DRUGS-10 TOTAL DRUGS-13

13.  According to RNTCP patients should be not get admitted in hospital, but
will be treated at home.
 When Dr. will confirm category, then patient will get 1 week DOTS
medicine in hand.
 Here he will fill up Referral for treatment forms in 3 copies. One for
patient, second for referral to district T.B. officer and third for referral
PHC.
 He also maintains Referral for treatment register at centre to have copyof
all patients sanded to different referral unit and their feedback.
 He also gives health education to patients and their relatives about
importance of completion of treatment and follows up.
 He also explains about importance of diet with this treatment.
 We also got opportunity to see report which is maintained at centre and it is
going to represent in meeting to Commissioner Sir.
 They put the patients on DOTS treatment for first 2 months and ask him to
come for follow up. That time they will repeat investigation to see effect of
DOTS in that patient. Like this they will make the patient to complete all
prescribe treatment and finally check the effect.
 NURSES ROLE:
1. Caregiver/Care provider – the traditional and most essential role
o functions as nurturer, comforter, provider
o “mothering actions” of the nurse
o provides direct care and promotes comfort of client
o activities involves knowledge and sensitivity to what matters and
what is important to clients
o shows concern for client welfare and acceptance of the client as a
person

14. 2. Teacher– provides information and helps the client to learn or acquire
new knowledge and technical skills
o Encourages compliance with prescribed therapy.
o Promotes healthy lifestyle
o Interprets information to the client
3. Counselor-helps client to recognize and copewith stressful psycho logic
or social problems; to develop an improve interpersonal relationships and
to promote personal growth
o provides emotional, intellectual to and psychological support
o Focuses onhelping a client to develop new attitudes, feelings and
behaviors rather than promoting intellectual growth.
o Encourages the client to look at alternative behaviors recognize the
choices and develop a sense of control.
4. Change agent-initiate changes or assist clients to make modifications in
themselves or in the system of care.
5. Client advocate-involves concern for and actions in behalf of the client
to bring about a change.
o Promotes what is best for the client, ensuring that the client’s needs
are met and protecting the client’s right.
o Provides explanation in client’s language and supportclients
decisions.
6. Manager– makes decisions, coordinates activities of others, allocate
resources, and evaluate care and personnel
o Plans, give direction, develop staff, monitor operations, give the
rewards fairly and represent both staff and administrations as needed.
7. Researcher– participates in identifying significant researchable
problems
o participates in scientific investigation and must be a consumer of
research findings
o Must be aware of the research process, language of research, a
sensitive to issues related to protecting the rights of human subjects.

15. WEEKLY ACTIVITY:
DAY 1:
 Reported at ward
 Great the sister incharge
 Do the orientation of the TB hospital
 Know about the routine of the ward
DAY 2:
 Reported at ward
 Do the routine work of the ward
 Know about the RNTCP
 Help the sister in ward work
DAY 3:
 Reported at ward
 Do the routine work of the ward
 Know about the organization of the TB hospital
 Know about the DOTS and DOTS plus treatment
DAY 4:
 Reported at ward
 Help the sister in her routine work
 Went to OPD for the collect the information regarded diagnostic
algorithm of tuberculosis
 Know about the MDR
 Know about the treatment strategy for the patient of tuberculosis.
DAY5:
 Reported at ward
 Help the sister in work of ward
 Know about the sputum smear preparation
 Know about the microscopydiagnosis of tuberculosis

16. DAY 6:
 Reported at ward
 Do the daily routine work of ward
 Know about the roles and responsibility of the nurse
CONCLUSION:
I gained valuable knowledge about administration and management
related RNTCP. I am very much thankful to all staff of DTC for their co
operation and our H.O.D. of the community health department of JGCON
Mrs. Reeta Patel for her guidance and arrangement for the plan for such
experience.