Tuberculosis Presentation

The impact on occupational performance is variable (not fixed to a standard pattern), it depends on the client’s factors, access to health services, and SDOHs.

Medical management can also be a challenge d/t social barriers.


ADLs:

  • reduced physical capacity

  • limits activities like bathing/showering + weakness can increase risk of falls (especially during the acute phase)

  • in later stages of Tuberculosis, if there’s severe lung destruction, a variety of ADL activities may be harder w/out shortness of breath


IADLs:

  • in the infectious period, the need to self-isolate (even if client has adequate physical capacity) limits a client’s ability to participate in IADLs like shopping, hunting, and social gatherings (religious activities and/or caregiving)

  • over time (depends on the extent of lung damage) IADLs can become increasingly difficult d/t poor activity tolerance and muscle weakness



Health Management:

  • may be affected by the need for an ongoing medication regime (plan for taking medicines) that can be hard to maintain w/out access to health services and different envrionmental factors that increase vulnerability to poor health


Work + Education:

  • can be disrupted by requirement for self-isolation during the infectious period.

  • diminished lung capacity can restrict the ability to do work requiring high levels of cardiorespiratory demand (like manual labor)


Play + Leisure:

  • when returning to group activities, client may not be ablr to particiate at their previous level d/t fatigue or long-term lung damage; level of impact will depend on the amount of permanent lung impairment.

  • usually activities that don’t require a high level of respiratory function + can be done alone won’t be impacted (crafting, puzzles)


Social Participation:

  • can be affected by physical limitations + need to self-isolate.

  • social attitudes + policies can be limiting; paternalistic attitudes to the treatment of clients w/TB take away their agency

  • the fear associated w/Tb contagion can make it hard for people who have recovered from TB to re-integrate into society; can affect their long-term ability to earn an income/contribute to their family + community in toher meaningful ways (like caregiving!)





WHAT’S IN THE DOCUMENT:


Occupation 1: Shopping w/friends

  • Muscle weakness and extent of lung impairment could make it harder for the individual to walk around for long periods of time and even carry and/or lift purchased items or groceries; or put groceries away in their home if they must self-isolate 

  • If self-isolation is a requirement, the individual’s friendships could become impaired or biases of the infection could also impair friendships; which can limit the individual’s social interaction in person and could online as well 

  • Shopping/obtaining prescriptions or solidifying a medicine regime can be difficult d/t the potential necessity to self-isolate; access to certain health services may also be limited



OT Practice Considerations

  • Assess the state of the infection to see if it is safe for the client to go out into public areas and their extent of lung impairment to determine adequate respiratory functioning

  • Educate the client about the necessity for self-isolation during the infectious period of the infection and find ways for the client to engage online with friends or family to respect the client’s autonomy and social needs.

  • Don PPE equipment in case you must see assess certain aspects of the client’s occupational performance in person



Occupation 2: Feeding + Eating

  • An upset stomach, nausea and loss of appetite, vision changes, joint pain and numbness in the hands/feet can induce the client to stop trying to eat

  • Numbness and/or tingling in the hands and feet and joint pain can prevent proper grip strength on certain utensils for the client to feed themselves. Vision impairment can affect hand-eye coordination when bringing food to the mouth.

  • A risk factor of micro/nutrient malabsroption can limit the absortion of nutrients from healthy foods; which can further decrease the client’s health (Pub med course!)


OT Practice Considerations:

  • Provide ideas of alternative plain foods for consumption (rice, crackers, oatmeal, mashed potatoes, plain yogurt, clear/broth-based soups, soft-cooked/scrambled eggs)

  • Conserve energy and joint protection with lightweight modifications to still promote feeding and eating

  • Make texture and presentation adjustments with other professions such as an SLP or Nutritionist to provide the most adequate adjustments for the client





Person and Population Considerations:

  • Socioeconomic Status (SES): access to quality healthcare, adaptible employment, medications can be expensive depending on payer requirements

  • Society’s view on Tuberculosis: lack of education and the strong stigma on the contagious nature of the infection

  • Living Environments: stairs, layout of the house in terms of gait, poor ventilation, support systems and the family role(s) the client may represent

  • Health Management: access to treatment, safety, awareness of present stage of infection

  • OT focus: Education and prevention of transmisson, environmental and personal modifications, supportive envrionments

  • OT Goal: Maintain meaningful participation in different occupations to manage friendships, client’s health, the client’s medicine regime, and overall health and well-being.





















Key takeaways:

  • Always acquire the state of the infection, as this will determine whether you can administer an OT setting in person or online, which could further limit certain information you can recieve on muscle strength

  • Determine if the client has a caregiver or other ways of receiving care based on the state of their infection and ordered commands to follow from their provider, as well as their medication regime and access to health services

  • Don PPE equipment in case you must see assess certain aspects of the client’s occupational performance in person