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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the typical signs and symptoms of active pulmonary tuberculosis.

  • Design a therapeutic regimen for the treatment of a patient with newly diagnosed active pulmonary tuberculosis based on patient-specific history and physical characteristics, history of present illness, subjective and objective findings, and desired clinical response.

  • Develop a monitoring plan for a patient receiving treatment for active pulmonary tuberculosis to ensure efficacy and prevent/minimize toxicity.

  • Provide patient education on the proper administration of drug therapy for active pulmonary tuberculosis including directions for use, the administration of therapy in relation to meals, the importance of adherence, and potential side effects of the medications.

  • Recognize potential drug interactions that may occur with agents used in the treatment of active pulmonary tuberculosis.

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PATIENT PRESENTATION

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Chief Complaint

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“I have been coughing up blood for the past 3 days.”

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HPI

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Jose Rodriguez is a 35-year-old Hispanic man who presents to the ED at the county hospital in Indianapolis, Indiana, with a 3- to 4-week history of a productive cough, which was originally productive of yellow sputum but is now accompanied by the presence of blood in the sputum for the past 3 days. Along with the cough, the patient also complains of subjective fevers, chills, night sweats, dyspnea, fatigue, and an unintentional 20-lb weight loss over the past several weeks.

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PMH

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None

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FH

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Mother has DM and HTN.

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Father died of MI 6 months ago.

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SH

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  • The patient moved to the United States from Mexico 4 years ago but has not recently traveled.

  • Patient has a 10-pack-year history of smoking but quit several weeks ago when the current illness started. The patient denies illicit drug use, but does report drinking alcohol on weekends.

  • Patient is a laborer and is currently working for cash on a new home construction project in close contact with other workers. Several of his coworkers have recently moved to the United States from Mexico and have similar respiratory symptoms. The patient does not have any medical insurance.

  • Patient is homeless and stays at homeless shelters or friends’ houses as needed.

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Meds

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OTC antitussives, which have not provided any relief

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All

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No known drug allergies

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ROS

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Patient complains of a productive cough with hemoptysis for the past few days. He also complains of shortness of breath that worsens with exertion, subjective fevers, chills, night sweats, fatigue, and a 20-lb weight loss over the past several weeks.

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Physical Examination

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Gen
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Somewhat thin-appearing Hispanic male in mild respiratory ...

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