Diagnostic Overview and Management of Adult Pulmonary Tuberculosis Patients Inpatient at RSU Royal Prima Medan in 2020

Tuberculosis is an inflammatory disease of the lung parenchyma caused by infection with Mycobacterium tuberculosis. This research aims to find out the description of the diagnosis and management of adult pulmonary TB patients hospitalized at RSU Royal Prima Medan in 2020. This study is a descriptive study. This study is based on medical record data on inpatients with a diagnosis of pulmonary TB at the Royal Prima General Hospital Medan in 2020. The youngest patient was 18 years old and the oldest was 82 years old. The main complaint was shortness of breath (53%), additional complaints were cough (48%), symmetrical physical examination of the thorax (91%), positive sputum smear examination (72%), combined medical management of pulmicort + fumadryl + paracetamol + levofloxacin + OAT category I (72%), the longest length of stay was 7-8 days (38%), the shortest was 11-12 days (1%). In conclusion, pulmonary TB occurs more in men in the 3745 year age group (22%), the most complaints are shortness of breath (53%), and the most widely used combination treatment is pulmicort + fumadryl + paracetamol + levofloxacin + drugs anti tuberculosis category I (72%).


Introduction
Pulmonary tuberculosis (TB) is still a burden of health problems in Indonesia today. 1  cases, including 34% women and 66% men, including 1% children and 99% adults with CNR-tuberculosis with smear-positive 83% and CDR 66%. According to these data, there are 3 districts/cities with the highest incidence of pulmonary TB, namely Medan City at can come back to life. TB treatment is an antibiotic to suppress M. tuberculosis. If there is a pause in taking medication or treatment is not completed, it will cause drug resistance (multi-drug resistance). TB, MDR-TB).
In Indonesia alone, the coverage of TB treatment with the DOTS method in 2018 was only around 53%. The diagnostic and management procedures for pulmonary TB are well known. 4.5 However, as medical techniques and medical technology continue to develop, variations in diagnostic and management procedures may occur due to different places and times. This research aims to find out the description of the diagnosis and management of adult pulmonary TB patients hospitalized at RSU Royal Prima Medan in 2020.

Methods
The type of research used is research with a descriptive and retrospective case study design. This study is based on medical record data related to diagnostic and management features of inpatient pulmonary TB patients at the Royal Prima General Hospital Medan in 2020. The research subjects were all inpatients with a diagnosis of pulmonary TB, of which 100 study subjects had medical records that were fully included in this study. This study uses secondary data using medical records of research subjects, where the data collection process is carried out by purposive sampling so that a minimum of 100 subjects is obtained.
Secondary data from medical records that were displayed and explored included sociodemographic data, data on complaints of research subjects, data on physical examination findings found in research subjects, data on supporting examination findings, medical therapy data, non-medical therapy data,

Results
The youngest patient was 18 years old and the oldest was 82 years old. Based on the age group, the highest was in the age group 37-45 years (25%) with the proportion of men 22% and the proportion of women 3% and the least in the age group of 73-82 years (3%) with the proportion of men 2% and women 1 %. Based on the main complaint, the most common was shortness of breath (53%) and the least was vomiting (3%). Based on additional complaints, the most coughing was 48% and the least was chest pain (3%). As shown in Tables 2 and 3. The proportion of adult pulmonary TB patients  Pulmicort + Levofloxacin + Fumadryl + Ranitidine + OAT Category I 5 5 Paracetamol + Fulmadryl + Ceftriaxone + OAT Category I 7 7 Paracetamol + Fulmadryl + Ceftriaxone + OAT Category II 3 3 Fumadryl + Pulmicort + Levofloxacin + Curcuma + OAT Category I 2 2 Fumadryl + Pulmicort + Levofloxacin + Curcuma + OAT Category II 5 5

Total 100 100
The distribution of the proportion of adult pulmonary TB patients based on complications was pleural effusion (55%), and those with the least was hemoptysis (14%).

Discussion
In quantity more males than females who suffer from pulmonary TB but in terms of quality have almost the same opportunity, it can be seen from the proportional analysis. Gender is not a risk factor for the incidence of pulmonary TB because the role of women at this time has many activities outside the home such as work, social activities, worship activities, social gathering so that contacts with pulmonary TB sufferers also increase. 6 In addition, men who suffer from pulmonary tuberculosis and women who are nearby

Conclusion
The highest age group is 37-45 years (25%) and the least is 73-82 years (3%). The most frequent chief complaint was shortness of breath (53%) and the least was vomiting (3%). The most additional complaint was cough (48%) and the least was chest pain 3%. Physical examination; inspection, symmetrical thorax (91%), thoracic palpation data not recorded in medical records, dim thoracic percussion (85%), and auscultation revealed rhonchi (94%). Supporting investigation; Chest X-ray showed infiltrates in the right and left lung fields. All TB patients with AFB sputum examination were smeared positive (72%), negative (20%), and 8 patients were not recorded in the medical record. The highest number of medical treatments were category I (72%), and category II (28%).