Lap Tutorial Blok 23
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KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN UNIVERSITAS SRIWIJAYA FAKULTAS KEDOKTERAN UNIT PENDIDIKAN KEDOKTERAN (UPK) Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 – 580061 atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 – 352342, Fax. 0711 – 373438, Skenario E Blok 23 Tahun 2014 A male newborn was referred to Moh.Hoesin Hospital by a midwife - who helped his mother, Mrs Utami’s delivery - with chief complain of grunting. Mother’s history was taken from the midwife. She said that Mrs Utami’s pregnancy was full term. The baby was born 3 hours ago with Apgar score 5 for 1 st minute and 8 for 5 th minutes, birth body weight was 3 kg. The mother had premature rupture of membrane 2 days ago and had bad smell liquor. From the physical examination the baby was hypoactive and tachypnoe, no sucking reflex, and there was chest indrawing. As a general practitioner, please analyze the problems and the management. ------------------------------------------------------------ ------------------------------------------------ For Tutors Only Learning Objectives: - Student must be able to understand the importance of neonatal infection - Student must be able to recognize risk factor which predispose new born infant to infection - Student must be able to diagnose neonatal infection - Student must be able to implement infection control to prevent infection Klarifikasi Istilah Dirujuk Bayi merintih Anamnesis Nilai Apgar Ketuban pecah Air ketuban berbau busuk Reflek isap Napas cepat
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Transcript of Lap Tutorial Blok 23
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERANUNIT PENDIDIKAN KEDOKTERAN (UPK)
Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 – 580061atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 – 352342, Fax. 0711 – 373438,
Skenario E Blok 23 Tahun 2014
A male newborn was referred to Moh.Hoesin Hospital by a midwife - who helped his mother, Mrs Utami’s delivery - with chief complain of grunting. Mother’s history was taken from the midwife. She said that Mrs Utami’s pregnancy was full term. The baby was born 3 hours ago with Apgar score 5 for 1st minute and 8 for 5th minutes, birth body weight was 3 kg. The mother had premature rupture of membrane 2 days ago and had bad smell liquor. From the physical examination the baby was hypoactive and tachypnoe, no sucking reflex, and there was chest indrawing.
As a general practitioner, please analyze the problems and the management.
------------------------------------------------------------------------------------------------------------
For Tutors OnlyLearning Objectives:
- Student must be able to understand the importance of neonatal infection- Student must be able to recognize risk factor which predispose new born infant to
infection- Student must be able to diagnose neonatal infection- Student must be able to implement infection control to prevent infection
Klarifikasi Istilah Dirujuk Bayi merintih Anamnesis Nilai Apgar Ketuban pecah Air ketuban berbau busuk Reflek isap Napas cepat Retraksi sela iga
Identifikasi Masalah1. Bayi baru lahir dengan hamil cukup bulan dan berat lahir 3000 gram2. Nilai Apgar 5–93. Merintih, napas cepat dan terdapat retraksi sela iga4. Hipoaktif dan reflek isap tidak ada5. Ketuban pecah 2 hari sebelum bayi lahir6. Air ketuban berbau busuk
Analisis Masalah1. Berat badan 3000 gram dan hamil cukup bulan. Berdasarkan berat badan lahir dan
usia gestasi, bayi ini diklasifikasikan sebagai apa? 2. Ketuban pecah 2 hari sebelum bayi lahir dan air ketuban berbau busuk. Apa yang
mungkin terjadi pada bayi ini?
3. a. Bayi merintih, napas cepat dan terdapat retraksi sela iga. Gejala apa yang
diderita bayi ini? b. Penyakit apa yang mungkin menyebabkan gejala ini?4. Hipoaktif dan reflek isap tidak ada. Dari gejala ini, adakah penyakit lain yang
diderita bayi ini atau apa diagnosis bandingnya? 5. Apa kemungkinan diagnosisnya?6. Pemeriksaan apa yang diperlukan oleh penderita ini?7. Bagaimana tatalaksana penderita ini?8. Apa komplikasinya?
HipotesisBayi baru lahir, cukup bulan, SMK (sesuai masa kehamilan), lahir spontan dengan gangguan pernapasan (respiratory distress). Kemungkinan penyebabnya (diagnosisnya) adalah bronkopneumonia + sepsis neonatorum (klinis sepsis)
Sintesis1. Berdasarkan berat lahir 3000 gram dan usia kehamilan cukup bulan, bayi ini
diklasifikasikan sebagai bayi baru lahir cukup bulan sesuai dengan masa kehamilan.
2. Ketuban pecah 2 hari sebelum bayi lahir dan air ketuban berbau busuk. Kemungkinan bayi ini telah mengalami infeksi intrauterin, karena ketuban pecah >18 jam dan ketuban berbau busuk merupakan faktor risiko terjadinya infeksi intrauterin.
3. Bayi merintih, napas cepat dan terdapat retraksi sela iga. Dengan menggunakan Downe’s score maka bayi ini mengalami respiratory distress. Kemungkinan penyakit penyebab respiratory distress ini adalah bronkopneumonia
4. Hipoaktif dan reflek isap tidak ada. Dari gejala ini, penyakit lain yang mungkin pula diderita bayi ini selain bronkopneumonia adalah sepsis neonatorum.
5. Kemungkinan diagnosis bayi ini adalah bronkopneumonia + sepsis neonatorum.6. Pemeriksaan yang diperlukan pada penderita ini:
a. Rontgen dadab. Pemeriksaan darah (Hb, leukosit, hitung jenis, trombosit, CRP)c. Kadar gula darahd. Pungsi lumbal (bila bayi mengalami sepsis neonatorum)e. Kultur darah
7. Tatalaksana penderita ini:a. Pertahankan suhu tubuh dalam batas normal (rawat dalam inkubator) b. Beri vitamin K1 1 mg intramuskulerc. Parenteral feeding d. Beri oksigene. Beri antibiotikaf. Monitoring
9. Komplikasi yang paling sering adalah meningitis.
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
UNIVERSITAS SRIWIJAYAFAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN (UPK)Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 – 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 – 352342, Fax. 0711 – 373438,
Skenario E Blok 23 Tahun 2014
A male newborn was referred to Moh.Hoesin Hospital by a midwife - who helped his mother, Mrs Utami’s delivery - with chief complain of grunting. Mother’s history was taken from the midwife. She said that Mrs Utami’s pregnancy was full term. The baby was born 3 hours ago with Apgar score 5 for 1st minute and 8 for 5th minutes, birth body weight was 3 kg. The mother had premature rupture of membrane 2 days ago and had bad smell liquor. From the physical examination the baby was hypoactive and tachypnoe, no sucking reflex, and there was chest indrawing.
As a general practitioner, please analyze the problems and the management.
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERANUNIT PENDIDIKAN KEDOKTERAN (UPK)
Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 – 580061atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 – 352342, Fax. 0711 – 373438,
Skenario E Blok 23 Tahun 2014
A male newborn was referred to Moh.Hoesin Hospital by a midwife - who helped his mother, Mrs Utami’s delivery - with chief complain of grunting. Mother’s history was taken from the midwife. She said that Mrs Utami’s pregnancy was full term. The baby was born 3 hours ago with Apgar score 5 for 1st minute and 8 for 5th minutes, birth body weight was 3 kg. The mother had premature rupture of membrane 2 days ago and had bad smell liquor. From the physical examination the baby was hypoactive and tachypnoe, no sucking reflex, and there was chest indrawing.
As a general practitioner, please analyze the problems and the management.
