48 Active Pulmonary Tuberculosis
BUY
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Active Pulmonary Tuberculosis
1. Admit to:
2. Diagnosis: Active Pulmonary Tuberculosis
3. Condition:
4. Vital signs: q shift
5. Activity: Up ad lib in room.
6. Nursing: Respiratory isolation.
7. Diet: Regular
8. Special Medications:
-Isoniazid 300 mg PO qd (5 mg/kg/d, max 300 mg/d) AND
Rifampin 600 mg PO qd (10 mg/kg/d, 600 mg/d max) AND
Pyrazinamide 500 mg PO bid-tid (15-30 mg/kg/d, max 2.5 gm) AND
Ethambutol 400 mg PO bid-tid (15-25 mg/kg/d, 2.5 gm/d max).
-Empiric treatment consists of a 4-drug combination of isoniazid (INH),
rifampin, pyrazinamide (PZA), and either ethambutol or streptomycin. A
modified regimen is recommended for patients known to have INH-resistant
TB. Patients are treated for 8 weeks with the four-drug regimen, followed
by 18 weeks of INH and rifampin.
-Pyridoxine 50 mg PO qd with INH.
Prophylaxis
-Isoniazid 300 mg PO qd (5 mg/kg/d) x 6-9 months.
9. Extras: CXR PA, LAT, ECG.
10. Labs: CBC with differential, SMA7 and 12, LFTs, HIV serology. First AM
sputum for AFB x 3 samples.
Cellulitis
1. Admit to:
2. Diagnosis: Cellulitis
3. Condition:
4. Vital signs: tid. Call physician if BP <90/60; T >38.5
C
5. Activity: Up ad lib.
6. Nursing: Keep affected extremity elevated; warm compresses prn.
7. Diet: Regular, encourage fluids.
8. IV Fluids: Heparin lock with flush q shift.
9. Special Medications:
Empiric Therapy Cellulitis
-Nafcillin or oxacillin 1-2 gm IV q4-6h OR
-Cefazolin (Ancef) 1-2 gm IV q8h OR
-Vancomycin 1 gm q12h (1 gm in 250 cc D5W over 1h) OR
-Erythromycin 500 IV/PO q6h OR
-Dicloxacillin 500 mg PO qid; may add penicillin VK, 500 mg PO qid, to
increase coverage for streptococcus OR
-Cephalexin (Keflex) 500 mg PO qid.
