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Tuberculosis

  • Admission orders

    • Admit: Floor; Negative Pressure Room and Airborne Isolation Precautions
    • Diagnosis: Pulmonary Tuberculosis
    • Condition: Stable
    • Vital Signs: Routine
    • Allergies:
    • Nursing: Weigh patient on admission
    • Diet: Regular
    • Activity: As tolerated, within the room
    • Labs:
      • CBC with differential
      • Chem, creatinine
      • LFTs
      • sputum AFB and culture qday x 3 days (if no sputum, try induce or lavage)
      • CXR (PA and lateral)
      • PPD if unknown
      • HIV serology after consent
    • IV: None
    • Special: if suspect multidrug-resistant TB, consult ID, public heath
    • Medications:
      • Isoniazid 5 mg/kg PO qd (not to exceed 300 mg PO qd)
      • Rifampin 10 mg/kg PO qd (not to exceed 600 mg PO qd)
      • Pyrazinamide 25 mg/kg PO qd
      • Ethambutol 15-25 mg/kg PO qd
      • Pyridoxine 25-50 mg PO qd
      • Tylenol 325-650 mg orally q 4-6 hours as needed for fever; not to exceed 4 g in 24 hours
  • Discharge

    • isolation: can d/c home if isolated, remain isolation until 3 negative sputum smears
    • meds: tx duration is at least 6 months, directly observed therapy
    • report and f/u with public heath department
    • education: side effects (hepatotoxicity, renal toxicity), avoid EtOH, come back of nausea, RUQ pain, jaundice

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