Kata Pengantar

Puji dan syukur kami panjatkan kepada Tuhan Yang Maha Esa, karena berkat rahmat dan

karunia-Nya penulis dapat menyelesaikan laporan ini tepat pada waktunya. Laporan ini ditulis dan

disusun saat penulis melaksanakan kepaniteraan Ilmu Kesehatan Masyarakat di Puskesmas

Kecamatan Kembangan pada tanggal 8 Desember 2014 – 31 Januari 2015.

Dengan bekal pengetahuan, pengarahan serta bimbingan yang diperoleh sebelum dan selama

kepaniteraan ini, penulis mencoba menyusun laporan kasus yang berjudul Laporan Kunjungan Kasus

Hipertensi Tidak Terkontrol pada Ny. M dengan Pendekatan Kedokteran Keluarga di Wilayah Kerja

Puskesmas Kecematan Kembangan, Periode 11 Desember 2014 – 15 Januari 2015.

Pada kesempatan ini penulis ingin mengucapkan terimakasih yang sebesar-besarnya kepada :

Pimpinan dan staf Suku Dinas Kesehatan Jakarta Barat.

Pimpinan dan staf Puskesmas Kecamatan Kembangan

Pimpinan dan staf Fakultas Kedokteran Universitas Tarumanagara

Pimpinan dan staf Bagian Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas

Tarumanagara

Dan semua pihak yang telah membantu baik secara langsung maupun tidak sehingga

laporan ini dapat selesai pada waktunya.

Walaupun penulis telah berusaha menyelesaikan ini dengan sebaik-baiknya, penulis

menyadari bahwa laporan ini masih sangat jauh dari kesempurnaan. Oleh karena itu dengan rendah

hati penulis mengharapkan saran dan kritik yang membangun agar dimasa mendatang penulis dapat

menyusun laporan yang lebih baik lagi dan memberi manfaat bagi kita semua.

Akhir kata penulis memohon maaf yang sebesar-besarnya apabila dalam penyusunan laporan

ini terdapat kesalahan-kesalahan dan kekurangan.

Jakarta, Januari 2015

Daftar Isi

Kata Pengantar............................................................................................................................i

Daftar Isi....................................................................................................................................ii

BAB I

PENDAHULUAN

I.1. Latar Belakang............................................................................................................1

I.2. Perumusan Masalah.....................................................................................................2Pernyataan Masalah.....................................................................................................2

I.2.2. Pertanyaan Masalah.............................................................................................2

I.3. Tujuan..........................................................................................................................2

I.3.1. Tujuan Umum..............................................................................................................2

I.3.2. Tujuan Khusus.............................................................................................................3

BAB II

KERANGKA TEORI

II. 1 Definisi...............................................................................................................................4

II. 2 Etiologi...............................................................................................................................4

II. 3 Klasifikasi Hipertensi.........................................................................................................5

II. 4 Patofisiologi......................................................................................................................6

II. 5 Kerangka teori....................................................................................................................7

BAB III

DATA KLINIS

III.1 Identitas pasien............................................................................................................8

III.2 Anamnesa....................................................................................................................8

III.2.1 Keluhan Utama dan Keluhan Tambahan.............................................................8

III.2.2 Riwayat Perjalanan Penyakit:.................................................................................8

III.2.3 Riwayat Kebiasaan...............................................................................................9

III.2.4 Riwayat Penyakit dahulu....................................................................................10

III.2.5 Riwayat Penyakit Keluarga................................................................................10

III. 2. 6 Riwayat Pengobatan......................................................................................... .10

III.3 Pemeriksaan Fisik......................................................................................................10

III.3.1 Keadaan Umum :................................................................................................10

II.3.2 Status Generalis..................................................................................................10

III.3.2 Status Gizi..........................................................................................................11

III.3.4 Keadaan Regional..............................................................................................14

III.3.5 Pemeriksaan Neurologis............................................................................................17

III.3.6 Status Lokalis............................................................................................................17

III.4 Pemeriksaan Penunjang.............................................................................................17

III.5 Diagnosis...................................................................................................................18

III.5.1 Diagnosis Kerja.........................................................................................................18

II.5.2Diagnosa banding........................................................................................................18

III.5.3 Diagnosa Tambahan..................................................................................................18

III.5.4 Terapi yang Telah Diberikan di Puskesmas..............................................................18

BAB IV....................................................................................................................................19

DATA KELUARGA DAN LINGKUNGAN..........................................................................19

IV.1 Struktur Keluarga yang Tinggal Serumah.............................................................19

IV.2 Genogram...............................................................................................................20

IV.3 Riwayat Imunisasi..................................................................................................20

IV.4 Riwayat Kesehatan Keluarga.................................................................................21

IV.5 Kondisi ekonomi....................................................................................................21

IV.6 Pola Berobat :.........................................................................................................21

IV.7 Pola Makan............................................................................................................22

IV.8 Kondisi rumah :.....................................................................................................24

IV.9 Denah Lokasi...............................................................................................................27

IV. 10 Denah Rumah............................................................................................................28

IV. 11 Mandala of health......................................................................................................29

IV.11.1 Uraian......................................................................................................................28

V.11.2 Gambar.....................................................................................................................32

DIAGNOSTIK HOLISTIK......................................................................................................33

V.1. Resume.........................................................................................................................33

V.2 Diagnostik Holistik.......................................................................................................34

V. 4Siklus Kehidupan Keluarga...........................................................................................37

BAB VI....................................................................................................................................42

RENCANA PENATALAKSANAAN HOLISTIK DAN KOMPREHENSIF........................38

BAB VII...................................................................................................................................40

BAB VII INTERVENSI, HASIL INTERVENSI DAN PROGNOSIS.................................42BAB VIII KESIMPULAN DAN SARAN............................................................................47VIII.1 Kesimpulan........................................................................................................47VIII.2 Saran..................................................................................................................49Lampiran.......................................................................................................................50DAFTAR PUSTAKA...................................................................................................52

Daftar Gambar

Gambar 1. Kerangka Teori....................................................................................................7

Gambar 2. Denah rumah pasien...........................................................................................28

Gambar 3. Gambar Mandala of Health...............................................................................32

Gambar 4. Siklus Kehidupan Keluarga Ny. M...................................................................37

Gambar 5. Gambar sudut kamar Ny. M...........................................................................49

Gambar 6. Kamar Ny. M..................................................................................................50

Gambar 7. Dapur Ny. M.....................................................................................................50

Gambar 8. Kamar mandi keluarga Ny. M...........................................................................51

Gambar 9. Tampak teras depan rumah.................................................................................51

Gambar 10. Ny. M................................................................................................................51

Daftar Tabel

Tabel 1. Kriteria Hipertensi berdasarkan JNC 8.................................................................6

Tabel 2. Kriteria Hipertensi berdasarkan JNC 8..............................................................14

Tabel 3. Hasil pemeriksaan tanda-tanda vital Ny. M........................................................14

LAPORAN KUNJUNGAN KASUS HIPERTENSI TIDAK TERKENDALI

PADA NY. M (62 TAHUN) DENGAN PENDEKATAN KEDOKTERAN KELUARGA DI WILAYAH KERJA PUSKESMAS KECAMATAN

KEMBANGAN

JAKARTA BARAT PROVINSI DKI JAKARTA

PERIODE 12 DESEMBER 2014-15 JANUARI 2015

DISUSUN OLEH :

SABRINA OKTARIANTI 406102002

Pembimbing : dr. Tri Mulyati, SKM

BAGIAN ILMU KESEHATAN MASYARAKAT

FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA

JAKARTA

2015