Pediatric Tuberculosis

RSUD SCHOLOO KEYEN

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Tanggal Terbit Ditetapkan,

Plt.Direktur BLUD RSUD SCHOLOO KEYEN
Clinical
Pathway dr. Felix Duwit, M.Sc., MPH, Sp. PD
NIP. 19670812 199712 1 001

Patient name: …………………………………… Body weight: Body height: MR

Age: …..……. year …………...month ………….. kg …………… cm No
Admission diagnosis: ICD-10: Length of stay: 4 days
…………………………………………………… ………………..
Ward: Class: Admission:…. / .…../ …... Discharge:. .. / … / … Length of stay:
……………………….. III / II / I / VIP Time : ___ . ___ Time: ___ . ___ ……days
Aktivitas pelayanan Day 1 Day 2 Day 3 Day 4
DIAGNOSIS
1. Medical assessment □ Visite
a. Anamnesis □ Contact TB person
□ Loss weight gain
□ Fever > 2 weeks
□ Cough > 3 weeks
□ Specific: ………......
□ …………………......
b. Physical □ Nutritional status
examination
□ Lymphadenophaty
□ Bone/joint edema
c. Specific related to □ ……………………..
organ ...............................
2. Medical investigation □ Tuberculin test □ Induced sputum □ Induced sputum □ Induced sputum
□ Chest x-ray AP + □ Gastric aspiration □ Gastric aspiration □ Gastric aspiration
right lateral
□ Effusion
aspiration
□ Lumbal puncture
□ Smear test □ Smear test □ Smear test
□ MTb culture □ MTb culture
□ Needle biopsy
□ Histology
assessment
NURSING CARE
1. Nutritional assessment □ □ □ □
2. Vital sign monitoring □ □ □ □
3. Personal hygiene □ □ □ □
DIET AND FLUID REQUIREMENT
1. Enteral feeding □ Oral:………………. □ Oral:……………... □ Oral:………………. □ Oral:……………….
□ NGT:………………. □ NGT:…………….. □ NGT:………………. □ NGT:……………….
2. Parenteral feeding □ ……………………. □ …………………… □ ……………………. □ …………………….

1
 □ ……………………. □ …………………… □ ……………………. □ …………………….
□ ……………………. □ …………………… □ ……………………. □ …………………….
3. Extra meal □ ……………………. □ …………………… □ ……………………. □ …………………….
4. Fluid □ Oral:………………. □ Oral:…………….. □ Oral:………………. □ Oral:……………….
□ IV:…………………. □ IV:……………….. □ IV:…………………. □ IV:………………….
ACTIVITIES
1. Fall risk management □ ……………………. □ …………………… □ ……………………. □ …………………….
2. Transmision risk □ ……………………. □ …………………… □ ……………………. □ …………………….
management
3. □ □
CONSULTATION AND TEAM COMMUNICATION
1. Consultation to □ ……………………. □ …………………… □ ……………………. □ …………………….
2. Referring to □ ……………………. □ …………………… □ ……………………. □ …………………….
PSYCHOSOCIAL COUNSELING
1. Patient □ ……………………. □ …………………… □ ……………………. □ …………………….
2. Family □ ……………………. □ …………………… □ ……………………. □ …………………….
MEDICATION
1. Anti TB regimen □ Rifamicin:
(2RHZ/4RH) …..…..……………
□ INH:………………
……………………..
2. Steroid □ …………………….
OUTCOME
□ □
□ □
EDUCATION
Discharge Plan □ Diagnosis is defined □ DOTS registration
□ Adequate nutrition □ Routinely visit
□ Anti TB available □ Transmission
□ Longterm medication □ Treatment and side effect
Varians
Nurse Diagnosis ICD 10 Procedure ICD 9-CM
……………………………... □ Visit
Doctors □ Induced sputum
……………………………... □ Gastric aspiration
Resident □ Effusion aspiration
……………………………... □ Needle biopsy
……………………………... □ Counseling
Verificator
……………………………...