MODUL 1 blok 3.3 Gangguan Respirasi

62
Blok 3.1 Neurobehaviour Audra Lovita Vianny Muhammad Ferdiansyah

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Mengenai gangguan respirasi tutorial skenario 1

Transcript of MODUL 1 blok 3.3 Gangguan Respirasi

Page 1: MODUL 1 blok 3.3 Gangguan Respirasi

Blok 3.1

Neurobehaviour

Audra Lovita Vianny

Muhammad Ferdiansyah

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MODUL 1

SKENARIO 1 : STROKE BERULANG

Bu Hasnidar, 60 tahun dirujuk dari RS Padang Panjang ke RS Dr M Djamil Padang dengan keluhan tiba

tiba lemah anggota gerak sebelah kanan saat ke kamar mandi. Pasien tidak mengeluh sakit kepala

dan tidak ada muntah, tapi terlihat seperti mengantuk dan masih menjawab bila dipanggil.Tiga

tahun yang lalu, pasien mengalami serangan stroke iskemik dengan kelemahan sisi kiri dan sudah

bisa beraktivitas tanpa bantuan.Sebelumnya dokter sudah menganjurkan untuk kontrol secara

teratur supaya hipertensi yang dideritanya dapat dikendalikan. Pada pemeriksaan di IGD RS Dr M

Djamil didapatkan TD 170/90 mmHg, nadi 72 x/mnt, suhu 36,8°C, kesadaran soporous dengan GCS

E3,V4 dan M5. Ditemukan paresis N VII dan XII kanan sentral dan hemiparesis kanan.Reflek Babinski

kanan (+), Hofman Tromer kanan (+), KPR dan APR kanan (+++).Dari hasil pemeriksaan Brain CT Scan

ditemukan gambaran lesi hiperdens di hemisfer kiri, kemudian pasien segera dirawat di ruang

emergensi neurologi dan mendapatkan berbagai jenis obat-obatan.

Di sebelah Bu Hasnidar, di ruang emergensi ini dirawat juga beberapa orang pasien, hampir

semuanya dengan penurunan kesadaran, seperti pada bed nomor satu, terbaring pasien muda usia

yang mengalami koma setelah kecelakaan lalu lintas, pada bed nomor lima, terbaring seorang pasien

dengan meningitis, juga dengan kesadaran menurun. Menurut kepala ruangan, semua pasien

diruang emergensi ini, walaupun dalam keadaan koma, tetap dilakukan fisioterapi pasif, untuk

mencegah kontraktur.

Bagaimanakah anda menjelaskan berbagai kondisi dengan gangguan kesadaran ini?

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TERMINOLOGY

1. Stroke Iskemik

kondisi medis yang ditandai dengan

terganggunya aliran darah ke dalam otak akibat

dari sumbatan pada pembuluh darah di dalam

otak oleh gumpalan darah.

2. Soporous

Disebut juga stupor yaitu keadaan mengantuk

yang dalam.Pasien masih dapat dibangunkan

dengan ransangan kuat tetapi pasien tidak

terbangun sempurna dan tidak dapat

memberijawaban verbal yang baik.

3. GCS E3,V4,M5

4. Paresis

suatu kondisi ditandai oleh lemahnya gerak

badan, atau hilangnya sebagian gerakan badan

atau adanya gangguan gerakan. (Kekuatan otot

berkurang)

5. Hemiparesis

kelemahan pada satu sisi tubuh

6. Reflek Babinski

tindakan refleks jari-jari kaki

7. Hofman tromer

Refleks pada jari-jari tangan

8. KPR

Knee Pess Refleks/Refleks Patella, refleks

sistem saraf berupa refleks kontraksi otot di

sekitar patela sehingga kaki akan terlihat

seperti menendang

9. APR

Achilles Pess Refleks/Refleks Achilles; reflex

pada tendon Achilles yaitu tendon di bagian

belakang tungkai bawah

10.Lesi hiperdens

Lesi: istilah kedokteran untuk merujuk pada

keadaan jaringan yang abnormal pada tubuh

Hiperdens : densitas(kepadatan) berlebihan

11.Koma

kondisi medis yang ditandai dengan hilangnya

kesadaran dan kewaspadaan, serta

ketidakmampuan untuk dibangunkan

12.Fisioterapi pasif

Terapi untuk mengembalikan fungsi tubuh yang

dilakukan secara pasif (dengan bantuan bukan

dengan dirinya sendiri)

13.Kontraktur

pemendekan permanen dari kulit dan atau

jaringan dibawahnya yang menyebabkan

deformitas dan keterbatasan gerak.

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IDENTIFIKASI MASALAH

1. Adakah hubungan usia& jenis kelamin Bu Hasnidar terhadap apa yang dideritanya?

2. Mengapa bu Hasnidar memiliki keluhan tiba-tiba lemah anggota gerak sebelah kanan?

3. Mengapa bu Hasnidar terlihat mengantuk tetapi masih menjawab ketika dipanggil? Apa kemungkinan

yang terjadi jika keluhan ini disertai dengan sakit kepala dan muntah?

4. Adakah hubungan kondisi ini dengan serangan stroke iskemik yang disertai kelemahan sisi kiri yang

dialami bu Hasnidar 3 tahun yang lalu?

5. Adakah hubungan hipertensi dengan apa yang dialami bu Hasnidar?

6. Apa interpretasi dari pemeiksaan fisik TD 170/90mmHg, nadi 72x/menit, suhu 36,8C, kesadaran

soporous dengan GCS E3, V4, dan M5?

7. Apa maksud dari ditemukannya paresis N VII dan XII kanan sentral dan hiperemis kanan?

8. Bagaimana cara melakukan pemeriksaan tes Babinski, Hoffman Tromer, KPR dan APR?

9. Mengapa perlu dilakukan pemeriksaan Brain CT Scan? Apa interpretasi dari ditemukannya gambaran

lesi hiperdens di hemisfer kiri?

10.Mengapa bu Hasnidar perlu dirawat di ruang emergensi neurologi? Jenis obat seperti apa yang

mungkin diberikan?

11.Mengapa pada pasien berikutnya dapat terjadi koma karena kecelakaan lalu lintas?

12.Mengapa pada pasien meningitis dapat terjadi juga penurunan kesadaran?

13.Apa tujuan dari dilakukannya fisioterapi pasif pada pasien koma? Bagaimana caranya?

14.Apa yang terjadi jika pasien mengalami kontraktur?

15.Bagaimana penatalaksanaan dan prognosis dari ketiga pasien dalam scenario ini?

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MODUL 2

SKENARIO 2 : KENAPA WANDI KEJANG LAGI ?

Wandi, 20 tahun berobat ke dokter keluarga dengan keluhan kejang berulang.Kejang pertama terjadi

sekitar dua bulan yang lalu, dan yang kedua kemarin sore. Menurut ibunya, pola kejangnya sama yaitu

dimulai dari lengan dan kaki kanan kemudian mengenai seluruh tubuh. Sebelum mengalami kejang,

Wandi sering mengeluhkan sakit kepala, awalnya pada malam dan pagi hari, tapi sekarang sepanjang

hari.Dari pemeriksaan ditemukan beberapa tanda peninggian tekanan intrakranial.Wandi segera dirujuk

ke Bagian Saraf RS Dr M Djamil Padang.

Setelah diperiksa di Poliklinik Saraf RS Dr M Djamil, Wandi dirawat untuk dilakukan pemeriksaan

penunjang.Sore harinya Wandi kejang lagi, setelah diberi satu ampul diazepam intravena, kejang berhenti

dan nampak Wandi tertidur.Dari pemeriksaan tanda vital didapatkan tekanan darah 140/90 mmHg, nadi

56 x/mnt dan suhu 36,80C. Pada funduskopi didapatkan kesan edema papil dengan perbandingan arteri :

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vena adalah 1 : 3. Keesokan harinya dilakukan pemeriksaan Brain CT Scan dengan hasil lesi hipodens yang

berbatas tegas, dan pada pemberian kontras tampak ring enhancement di regio frontotemporal kiri.

Wandi dikonsulkan ke Bagian Bedah Saraf dan direncanakan untuk tindakan operasi.

Kepada dokter yang merawat, ibu Wandi bertanya, apakah kejang yang dialami Wandi sekarang

berhubungan dengan riwayat kejang saat demam yang dialaminya beberapa kali di waktu kecil.Setelah

mendapat keterangan dari dokter, barulah ibunya tahu bahwa kejang yang sekarang berbeda dengan

kejang yang dialaminya saat masih bayi.

Pada ruangan yang sama dirawat juga seorang laki-laki sekitar 65 tahun dengan keluhan resting tremor,

face mask, jalan susah dengan langkah kecil-kecil dan posisi badan sedikit membungkuk. Walaupun

sudah minum obat secara teratur, penyakitnya dirasakan makin berat. Melihat berbagai macam penyakit

yang dirawat di bangsal saraf, ibu Wandi jadi bingung sendiri

Bagaimanakah anda menjelaskan berbagai kasus di atas ?

TERMINOLOGY

1. Kejang

Disebut konvulsi; merupakan perubahan fungsi

otak mendadak dan sementara sebagai akibat

dari aktivitas neuronal yang abnormal dan

pelepasan listrik serebralyang berlebihan.

2. Tekanan intrakranial

jumlah total dari tekanan yang mewakili

volume jaringan otak, volume darah

intrakranial dan cairanserebrospinalis.

3. Diazepam

kelompok obat benzodiazepine yang

memengaruhi sistem saraf otak dan

memberikan efek penenang

4. Funduskopi

tes untuk melihat dan menilai kelainan dan

keadaan pada fundus okuli (retina mata dan

pembuluh darah khoroidea keseluruhannya)

5. Edema papil

pembengkakan discus saraf optik sebagai

akibat sekunder dari peningkatan tekanan

intracranial

6. Ring enhancement

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Lingkaran terang yang muncul pada tomografi

yang timbul setelah dilakukan peyuntuikan

media kontras, menunjukan adanya abses.

7. Regio frontotemporal

Bagian frontal (depan) dari tulang kepala yang

mengandung bagian dari saluran telinga,

telinga tengah dan telinga dalam

8. Resting Tremor

tremor yang terjadi pada saat otot

rileks/istirahat dan menghilang ketika otot

digunakan

9. Face mask

Wajah kaku, kurang ekspresi, kurang senyum

dan mata jarang kedip

IDENTIFIKASI MASALAH

1. Adakah hubungan usia dengan apa yang dialami Wandi?

2. Mengapa Wandi mengalami kejang pertama pada 2 bulan yang lalu dan yang kedua kemarin sore?

3. Mengapa pola kejang yang dialami oleh Wandi sama yaitu dimulai dari lengan dan kaki kanan

kemudian mengenai seluruh tubuh? Adakah pola kejang yang lain? Serta mungkinkah pola kejang

berubah?

4. Mengapa Wandi mengeluhkan sakit kepala, awalnya pada malam da pagi hari akan tetapi sekarang

sepanjang hari?

5. Bagaimana melakukan pemeriksaan tekanan intracranial? Apa yang terjadi jika tekanan intracranial

meninggi?

6. Apa saja pemeriksaan penunjang yang mungkin dilakukan pada Wandi?

7. Mengapa Wandi diberikan satu ampul diazepam intravena? Bagaimana cara kerja diazepam sehingga

membuat kejang berhenti & Wandi tertidur?

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8. Apa interpretasi dari pemeriksaan tanda vital tekanan darah 140/90mmHg, nadi 56x/menit dan suhu

36,8C?

9. Bagaimana cara pemeriksaan funduskopi? Apa interpretasi dari ditemukannya edema papil dengan

perbandingan arteri : vena 1:3?

10.Mengapa perlu dilakukan Brain CT Scan? Apa interpretasi dari hasil lesi hipodens yang berbatas tegas?

11.Mengapa pada pemberian kontras tampak ring enhancement di regio frontotemporal kiri?

12.Apa tindakan operasi yang mungkin dilakukan terhadap Wandi?

13.Adakah hubungan kejang yang dialami Wandi sekarang dengan riwayat kejang saat demam yang

dialaminya beberapa kali waktu kecil?

14.Mengapa pada pasien berikutnya terdapat resting tremor, face mask, jalan susah dengan langkah

kecil-kecil dan posisi badan sedikit membungkuk?

15.Mengapa penyakitnya dirasakan semakin berat padahal sudah diberi obat secara teratur?

16.Adakah hubungan usia pasien tersebut dengan apa yang dialaminya?

17.Bagaimana penatalaksanaan dan prognosis dari kedua kasus tersebut di atas?

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MODUL 3

SKENARIO 3 : FITRI DAN KAKINYA

Fitri (18 tahun) seorang mahasiswi, datang ke puskesmas dengan keluhan, sejak satu minggu mengalami

kelemahan pada kedua kakinya, walaupun ia masih bisa berjalan dengan berpegangan. Kesulitan ini lebih

dirasakan bila ia harus berjalan mendaki atau naik tangga. Fitri juga mengeluhkan parestesia pada semua

jari tangan dan kakinya.Dari pemeriksaan dokter didapatkan kekuatan tungkai bawah 3/3/2, dan

kekuatan lengan dan tangannya 5/4/4. Ditemukan adanya hipoestesia dengan pola stocking and glove,

reflek biceps dan triceps +/+, KPR +/+ dan APR -/-. Dari anamnesis diketahui bahwa sebelum mengalami

kelemahan ada riwayat demam.

Dokter Puskesmas merujuk Fitri ke rumah sakit. Fitri juga melaporkan bahwa sejak satu tahun terakhir ia

berobat ke Poliklinik Saraf dengan keluhan sakit kepala berdenyut, berpindah-pindah, disertai mual dan

kadang-kadang sampai muntah, sering juga disertai fotofobia dan sonofobia, sehingga mengganggu

aktivitas kuliahnya. Ia menanyakan apakah kelemahan kakinya ini merupakan akibat dari obat sakit

kepala yang sering diminumnya?

Bagaimanakah anda menerangkan penyakit yang diderita Fitri?

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TERMINOLOGY

1. Parastesia

sensasi kulit abnormal, seperti terbakar atau

menusuk-nusuk, yang terjadi tanpa stimulus

dari luar.

2. Hipoestesia

turunnya sensitifitas terhadap rangsang nyeri

3. Pola stocking and glove

Kesemutan yang biasa dirasakan di kaki dan

tangan

4. Refleks Biceps & Triceps

Refleks trisep: pengujian untuk lesi di tingkat

C6-C7 di mana pasien menekuk lengannya atau

menempatkannya di pinggul.

Refleks bisep: tes dengan mengetuk tendon

otot bisep. Biasanya ada kontraksi dari otot-

otot bisep disertai dengan kedutan lengan

bawah.

5. Fotofobia

sensitivitas terhadap cahaya

6. Sonofobia

Ketakutan pada suara

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IDENTIFIKASI MASALAH

1. Adakah hubungan usia Fitri yang tergolong masih muda dengan kelemahan pada kedua kakinya?

Adakah kemungkinan jika nantinya Fitri tidak mampu berjalan lagi?

2. Mengapa kesulitan tersebut lebih dirasakan jika ia harus berjalan mendaki atau naik tangga?

3. Mengapa terjadi paraestasia pada jari tangan & kaki Fitri?

4. Bagaimana cara melakukan pemeriskaan kekuatan tungkai bawah? Apa maksud dari kekuatan tungkai

bawah 3/3/2?

5. Bagaimana cara melakukan pemeriksaan kekuatan lengan dan tangan? Apa maksud dari kekuatan

lengan dan tangan 5/4/4?

6. Apa interpretasi dari ditemukannya hipoestesia dengan pola stocking and glove, reflex bisep & triceps

+/+, KPR +/+, dan APR -/-?

7. Apa hubungan kelemahan yang dirasakan Fitri dengan riwayat demam?

8. Adakah hubungan sejak satu tahun terakhir Fitri mengalami sakit kepala berdenyut, berpindah-

pindah, disertai mual dan kadang sampai muntah serta sering disertai dengan fotofobia dan sonofobia

dengan apa yang dialaminya saat ini? Mengapa dapat terjadi hal demikian?

9. Apakah kelemahan kakinya merupakan akibat dari obat sakit kepala yang diminumnya? Jika ya, kira-

kira apa obat yang diminum Fitri dan bagaimana sampai terjadi hal tersebut?

10.Bagaimana penatalaksanaan dan prognosis Fitri?

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MODUL 4

SKENARIO 4 : PETAKA BAGI JASMINA

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Jasmina, seorang pelajar berusia 18 tahun dibawa ke dokter oleh karena orang tuanya menduga bahwa

dia telah diperkosa oleh supir angkot yang ditumpanginya.Dua hari yang lalu Jasmina menumpang angkot

sepulang bimbel.Menurut keterangan Jasmina, dia merupakan penumpang terakhir yang belum turun

dan dirayu oleh supir dan kenek angkot yang ditumpanginya, selain itu dia tidak mengingat apa-apa

lagi.Jasmina diantar pulang malam itu oleh petugas ronda/polisi yang menemukannya dalam keadaan

bingung di tepi jalan.

Pada pemeriksaan terlihat seorang wanita dewasa muda bertubuh langsing dengan gejala kebingungan,

ansietas dan depresi.Pada pemeriksaan didapatkan lebam bekas gigitan pada mammae kanan dan bagian

lateral kiri leher.Ketika ditanya dan diberi kesempatan bercerita Jasmina tampak ketakutan dan tidak

mampu bercerita selain menangis. Keluarga sangat khawatir Jasmina akan hamil, ketularan penyakit

kelamin, dan “stres” yang berkepanjangan. Menurut dukun, Jasmina “tasapo” dalam perjalanannya dari

bimbel ke rumah.

Menurut keterangan orang tua Jasmina di sekolah ia dikenal sebagai anak yang pintar, banyak teman,

walaupun pendiam. Bagaimana pendapat Anda mengenai keadaan yag dialami oleh Jasmina dan

penanganannya?

TERMINOLOGY

1. Ansietas

kondisi yang ditandai dengan kecemasan dan

kekhawatiran berlebihan atas peristiwa

Page 27: MODUL 1 blok 3.3 Gangguan Respirasi

kehidupan sehari-hari tanpa alasan yang jelas

untuk mencemaskan/ mengkhawatirkannya.

2. Depresi

gangguan mental umum yang ditandai dengan

kesedihan, kehilangan minat atau kesenangan,

perasaan bersalah, kesulitan berkonsentrasi,

tidur terganggu, nafsu makan berubah dan

energi rendah.

3. Stres

bentuk ketegangan dari fisik, psikis, emosi

maupun mental.

4. Tasapo

Demam yang disebabkan sebagai gangguan

makhluk halus

IDENTIFIKASI MASALAH

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1. Mengapa Jasmina tidak mengingat kejadian yang dialaminya? Apa yang menyebabkan Jasmina dalam

keadaan bingung saat diantar pulang?

2. Mengapa pada pemeriksaan ditemukan gejala ansietas dan depresi serta lebam bekas gigitan pada

mammae kanan dan bagian lateral kiri leher? Adakah hubungan luka tersebut dengan apa yang

dialaminya?

3. Mengapa Jasmina tidak mampu bercerita dan menangis? Adakah hal yang bisa dilakukan untuk

membuat Jasmina bercerita?

4. Adakah kemungkinan Jasmina hamil, tertular penyakit kelamin serta stress yang berkepanjangan?

Bagaimana penanganan yang tepat?

5. Apakah sifat Jasmina yang tergolong pendiam merupakan salah satu factor resiko akan stress yang

berkepanjangan?

6. Bagaimanae penatalaksaanaan yang tepat pada Jasmina?

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MODUL 5

SKENARIO 5: MINUM SEDIKIT TAPI MABUK SEBOTOL

Tuan Graha , 42 tahun, pramugara pada penerbangan komersil, dibawa ke dokter di sebuah poliklinik

oleh karena mengamuk di suatu pesta tahun baru yang diadakan teman sesama karyawan. Menurut istri

dan beberapa teman yang mengantarkannya, pasien mendadak marah-marah setelah meneguk sedikit

champagne.Istrinya mengatakan, selama beberapa bulan terakhir, beban pekerjaan pasien lebih

meningkat, tampak lebih irritable, pemarah, sampai memukul keluarga, mengalami insomnia, dan

resah.Dia khawatir kalau suaminya seperti tetangganya yang selalu memukuli istrinya hanya karena

masalah sepele.

Selama ini pasien kadang-kadang merokok dan meminum alkohol, akan tetapi tidak pernah mabuk. Istri

mengkhawatirkan suaminya akanaddiction dengan resiko di “grounded”. Dia juga menginginkan

suaminya untuk tidak terlibat dengan NAPZA.

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Bagaimana anda menjelaskan dan mengatasi masalah pada Tn.Graha?

TERMINOLOGY

1. Champagne

minuman anggur putih bergelembung, yang

mengandung kadar CO2 dan alkolhol yang

tinggi.

2. Irritable

Keadaan mudah marah dan tersinggung

3. Insomnia

gejala kelainan dalam tidur berupa kesulitan

berulang untuk tidur atau mempertahankan

tidur walaupun ada kesempatan untuk itu

4. Grounded

Pengurungan

5. NAPZA

Narkotika, Alkohol , Psikotropika dan Zat adiktif

lain; bahan / zat yang dapat mempengaruhi

kondisi kejiwaan / psikologi seseorang ( pikiran,

perasaan dan perilaku ) serta dapat

menimbulkan ketergantungan fisik dan

psikologi.

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IDENTIFIKASI MASALAH

1. Adakah hubungan usia Tn. Graha serta pekerjaannya dengan apa yang dialaminya?

2. Mengapa Tn. Graha mendadak marah-marah setelah meneguk sedikit champagne?

3. Apakah hubungan beban pekerjaan Tn. Graha lebih meningkat dengan Tn.Graha yang mudah marah

sampai memukul keluarganya, irritable, insomnia, dan resah?

4. Apakah kelakuan Tn. Graha yang seperti ini dapat memberikan pengaruh kepada istri dan

keluarganya? Jika ya, apa pengaruhnya?

5. Apakah kebiasaan merokok dan meminum alcohol menjadi factor resiko terhadap apa yang dialami

Tn.graha?

6. Mengapa biasanya Tn.Graha tidak pernah mabuk ketika minum alcohol namun sekarang hanya minum

seteguk menjadi seperti ini?

7. Mengapa istri Tn.Graha mengkhawatirkan suaminya akan addiction dengan resiko di grounded?

8. Apa yang terjadi jika Tn.Graha terlibat dengan NAPZA?

9. Apa yang sebaiknya dilakukan untuk menangani kasus Tn.Graha?

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MODUL 6

Ny. Sansara (41 tahun) telah dirawat tiga hari di puskesmas dengan keluhan demam turun naik sejak 10

hari yang lalu, sangat letih dan apatis.Diagnosis kerja dokter Puskesmas adalah tifus abdominalis

sedangkan menurut dukun pasien “tasapo” karena berhujan-hujan satu hari sebelum sakit di bawah

pohon besar yang terkenal angker.Sejak satu hari ini, pasien kadang-kadang terlihat bingung, meracau

dan kadang-kadang agak baikan.Keluarganya khawatir penyakit lama pasien kambuh, sebab tiga tahun

yang lalu pasien pernah dirawat inap di bagian psikiatri rumah sakit dengan diagnosis “Gangguan afektif

bipolar tipe manik dengan gejala psikotik”.

Pada pemeriksaan, didapatkan suhu berkisar 38-39,2 C, kesadaran berkabut (clouding of consciousness),

terdapat disorientasi, perhatian kurang, kadang-kadang marah tanpa alasan, sleep-wake disturbance dan

terlihat sangat lemah. Ketika suami membicarakan dengan dokter, dokter berpendapat tidak perlu

dikonsultasikan ke psikiater karena keadaan ini adalah komplikasi yang lazim pada tifus abdominalis dan

dapat diatasi dengan pemberian antibiotika, diet dan bed rest.

Bagaimana Anda menjelaskan apa yang terjadi pada Ny. Sansara dan bagaimana penatalaksanaannya ?

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TERMINOLOGY

1. Apatis

keadaan kesadaran yang segan untuk

berhubungan dengan sekitarnya, sikapnya acuh

tak acuh.

2. Tifus abdominalis

penyakit infeksi yang terjadi pada usus halus

yang disebabkan oleh Salmonella thypii

3. Meracau

berbicara tidak karuan

4. Gangguan afektif bipolar

dikenal juga dengan gangguan manik depresi,

yaitu gangguan pada fungsi otak yang

menyebabkan perubahan yang tidak biasa pada

suasana perasaan, dan proses berfikir. Disebut

Bipolar karena penyakit kejiwaan ini didominasi

adanya fluktuasi periodik dua kutub, yakni

kondisi manik (bergairah tinggi yang tidak

terkendali) dan depresi.

5. Clouding of consciousness

Penurunan kesadaran yang disertai dengan

gangguan persepsi dan sikap

6. Disorientasi

Tidak memiliki arah; kacau

7. Sleep-wake disturbance

Ketidakteraturan pola tidur, dimana biasanya

seseorang lebih banyak menghabiskan tidur di

siang hari daripada di malam hari.

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IDENTIFIKASI MASALAH

1. Mengapa Ny. Sansara terlihat sangat letih dan apatis?

2. Mengapa dokter mendiagnosa Ny. Sansara mengalami tifus abdominalis?

3. Adakah hubungan Ny.Sansara yang kehujanan dengan apa yang dialaminya?

4. Mengapa sejak satu hari ini Ny.Sansara terlihat bingung, meracau, dan kadang agak baikan?

5. Apakah hubungan antara kondisi Ny.Sansara sekarang dengan penyakit gangguan afektif bipolar tipe

manik dengan gejala psikotik yang dulu dialaminya?

6. Apakah ada kemungkinan penyakit Ny.Sansara 3 tahun lalu dapat kambuh?

7. Mengapa pada pemeriksaan didapatkan suhu berkisar antara 38-39,2C, kesadaran berkabut, terdapat

disorientasi, perhatian kurang, kadang marah tanpa alasan, sleep-wake disturbance, dan terlihat

sangat lemah?

8. Mengapa dokter berpendapat tidak perlu dikonsultasikan ke psikiater? Bagaimana keadaan yang tepat

untuk dikonsultasikan ke psikiater?

9. Bagaimana tifus abdominalis dapat mempengaruhi kondisi mood seseorang?

10.Apa penatalaksanaan yang tepat terhadap kondisi Ny.Sansara?

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