2. CP TB Pediatric
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RSUP Dr. Sardjito Pediatric Tuberculosis RSUP Dr. Sardjito Yogyakarta No. Dokumen No. Revisi Halaman …/2 Tanggal Terbit 1 November 2014 Disusun oleh SMF KESEHATAN ANAK Diperiksa oleh DIR. MEDIK & KEPERAWATAN Ditetapkan Direktur Utama, Clinical Pathway Dr. Mochammad Syafak Hanung, SpA NIP. 196010091986101002 Patient name: …………………………………… Age: …..……. year …………...month Body weight: ………….. kg Body height: …………… cm MR No Admission diagnosis: …………………………………………………… ICD-10: ……………….. Length of stay: 4 days Ward: ……………………….. Class: III / II / I / VIP Admission: …. / .…../ …... Time : ___ . ___ Discharge:. . . / … / … Time: ___ . ___ Length of stay: ……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 examination □ Nutritional status □ Lymphadenoph aty □ Bone/joint edema 1
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clinical pathway tuberculosis
Transcript of 2. CP TB Pediatric
RSUP Dr. Sardjito
Pediatric TuberculosisRSUP Dr. Sardjito Yogyakarta
No. Dokumen No. Revisi Halaman
…/2
Tanggal Terbit
1 November 2014
Disusun olehSMF KESEHATAN ANAK
Diperiksa olehDIR. MEDIK & KEPERAWATAN
Ditetapkan Direktur Utama,
Clinical Pathway Dr. Mochammad Syafak Hanung, SpA
NIP. 196010091986101002
Patient name: ……………………………………Age: …..……. year …………...month
Body weight: ………….. kg
Body height:…………… cm
MRNo
Admission diagnosis:……………………………………………………
ICD-10:………………..
Length of stay: 4 days
Ward:………………………..
Class: III / II / I / VIP
Admission:…. / .…../ …...Time : ___ . ___
Discharge:. .. / … / …Time: ___ . ___
Length of stay:……days
Aktivitas pelayanan Day 1 Day 2 Day 3 Day 4DIAGNOSIS1. Medical assessment □ Visite
a. Anamnesis □ Contact TB person□ Loss weight gain□ Fever > 2 weeks□ Cough > 3 weeks□ Specific: ………......□ …………………......
b. Physical examination
□ Nutritional status
□ Lymphadenophaty□ Bone/joint edema
c. Specific related to organ
□ …………………….................................
2. Medical investigation □ Tuberculin test □ Induced sputum □ Induced sputum □ Induced sputum□ Chest x-ray AP +
right lateral□ Gastric aspiration □ Gastric aspiration □ Gastric aspiration
□ Effusion aspiration
□ Lumbal puncture□ Smear test □ Smear test □ Smear test□ MTb culture □ MTb culture□ Needle biopsy□ Histology
assessmentNURSING CARE1. Nutritional assessment □ □ □ □2. Vital sign monitoring □ □ □ □3. Personal hygiene □ □ □ □DIET AND FLUID REQUIREMENT1. Enteral feeding □ Oral:……………….
□ NGT:……………….□ Oral:……………...□ NGT:……………..
□ Oral:……………….□ NGT:……………….
□ Oral:……………….□ NGT:……………….
2. Parenteral feeding □ ……………………. □ …………………… □ ……………………. □ …………………….
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□ …………………….□ …………………….
□ ……………………□ ……………………
□ …………………….□ …………………….
□ …………………….□ …………………….
3. Extra meal □ ……………………. □ …………………… □ ……………………. □ …………………….4. Fluid □ Oral:……………….
□ IV:………………….□ Oral:……………..□ IV:………………..
□ Oral:……………….□ IV:………………….
□ Oral:……………….□ IV:………………….
ACTIVITIES1. Fall risk management □ ……………………. □ …………………… □ ……………………. □ …………………….2. Transmision risk
management□ ……………………. □ …………………… □ ……………………. □ …………………….
3. □ □CONSULTATION AND TEAM COMMUNICATION1. Consultation to □ ……………………. □ …………………… □ ……………………. □ …………………….2. Referring to □ ……………………. □ …………………… □ ……………………. □ …………………….PSYCHOSOCIAL COUNSELING1. Patient □ ……………………. □ …………………… □ ……………………. □ …………………….2. Family □ ……………………. □ …………………… □ ……………………. □ …………………….MEDICATION1. Anti TB regimen
(2RHZ/4RH)□ Rifamicin: …..…..
……………□ INH:
……………………………………..
2. Steroid □ …………………….OUTCOME
□ □□ □
EDUCATIONDischarge Plan □ Diagnosis is defined □ DOTS registration
□ Adequate nutrition □ Routinely visit□ Anti TB available □ Transmission□ Longterm medication □ Treatment and side effect
VariansNurse Diagnosis ICD 10 Procedure ICD 9-CM……………………………... □ VisitDoctors □ Induced sputum……………………………... □ Gastric aspirationResident □ Effusion aspiration……………………………... □ Needle biopsy……………………………... □ CounselingVerificator……………………………...
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