Pneumonia CAP

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    LAPORAN STUDI KASUS

    Pneumonia CAP + Sepsis +Hemaptoe + Susp TB-MDR

    OLEH:

    MAHASISWA PKP APOTEKER

    FAKULTAS FARMASI UNIVERSITAS AHMAD DAHLAN YOGYAKARTA

    ANGKATAN XXIX

    Disusun Oleh:

    Sepi M!"! S!"i# S$F!"% &'()(*+&*&

    Wi,-! Sis.!"! M!,,!# S$F!"% &'()(*++')

    PROGRAM STUDI PROFESI APOTEKER

    FAKULTAS FARMASI

    UI!ERSITAS AHMAD DAHLA

    "OG"AKARTA

    #$%&

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    Le%/!" Pen0es!h!n

    LAPORAN STUDI KASUSPneu%1ni! 2AP 3 Sepsis 3He%!p1e 3 Susp T45MDR

    Di RSUD D"$ S!i6ul An.!" M!l!n0

    FAKULTAS FARMASI UNIVERSITAS AHMAD DAHLANDI RUMAH SAKIT UMUM DAERAH DR$ SAIFUL ANWAR MALANG

    78 O91/e" ' Dese%/e" +(&8;

    Oleh :MAHASISWA PROGRAM PROFESI APOTEKER FAKULTAS FARMASI

    UNIVERSITAS AHMAD DAHLAN ANGKATAN XXIX

    L!p1"!n ini el!h ,iseu

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    BAB I

    PEDAHULUA

    A' Epi(emio)o*i Pneumonia CAP

    In6e9si s!lu"!n n!p!s /!.!h %!sih e!p %e"up!9!n %!s!l!h u!%! ,!l!% /i,!n0

    9eseh!!n# /!i9 ,i ne0!"! -!n0 se,!n0 /e"9e%/!n0 %!upun -!n0 su,!h %!!$ Insi,ensi pneu%1ni! 91%unii ,i A%e"i9!

    !,!l!h &+ 9!sus pe" &((( 1"!n0 pe" !hun ,!n %e"up!9!n pen-e/!/ 9e%!i!n u!%!!9i/! in6e9si p!,! 1"!n0 ,e.!s! ,i ne0!"! iu$ An09! 9e%!i!n !9i/! pneu%1ni! ,i

    A%e"i9! !,!l!h &( B$ Di A%e"i9! ,en0!n =!"! inC!si6 pun pen-e/!/ pneu%1ni! h!n-!

    ,ie%u9!n 8(B$ Pen-e/!/ pneu%1ni! suli ,ie%u9!n ,!n %e%e"lu9!n .!9u /e/e"!p!

    h!"i unu9 %en,!p!9!n h!siln-!# se,!n09!n pneu%1ni! ,!p! %en-e/!/9!n 9e%!i!n

    /il! i,!9 se0e"! ,i1/!i# %!9! p!,! pen01/!!n !.!l pneu%1ni! ,i/e"i9!n !ni/i1i9!

    se=!"! e%pi"is$ H!sil Su"Cei Keseh!!n Ru%!h T!n00! Dep9es !hun +(( pen-!9i

    in6e9si s!lu"!n n!p!s /!.!h %ene%p!i u"u!n 9e5+ se/!0!i pen-e/!/ 9e%!i!n ,iIn,1nesi!$ Pneu%1ni! 91%unii %en,u,u9i pe"in09! 9ee%p! ,!n sepuluh pen-!9i

    e"/!n-!9 -!n0 ,i"!.! pe" !hun$

    B' Epi(emio)o*i Sepsis

    Sepsis !,!l!h pen-e/!/ u!%! 9e%!i!n p!,! p!sien -!n0 %en,e"i! s!9i /e"! ,!n

    ,i"!.! ,i"u%!h s!9i# insi,en sepsis pe"!hun ,i ne0!"! %!

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    %en0!9i/!9!n 9e%!i!n hin00! %en=!p!i +((#(((

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    BAB II

    TI.AUA PUSTAKA

    A' PEUMOIA CAP

    %' De/inisi

    21%%uni- !=ui"e, pneu%1ni!72AP; !,!l!h pneu%1ni! in6e9sius p!,! sese1"!n0

    -!n0 i,!9 %en

    #' Etio)o*i

    !$ 4!9e"i

    5 ipi9 : 0"!% p1sii6 %!upun 0"!% ne0!i6# /!9e"i!e"1/%!upun!n!e"1/

    5 !ipi9 :%-=1pl!s%!#le0i1nell!# =l!%-,i!#Ci"usin6luen>!e#SARS/$ !%u"

    =$ P"11>1!

    Tae) I'D!6!"Mi9"11"0!nis%e -!n0 %en-e/!/9!n Pneu%1ni! 7e"e%-# +((@;

    0' Pato/isio)o*i

    Pneu%1ni! se/!0i!n /es!" /e"!.!l ,!"i !spi"!si 9u%!n !!u pen-e/!"!n l!n0sun0

    %el!lui 1"16!"in0$V1lu%e !spi"!si 9e=il e"

    %u91s! 1"16!"in0;# n!%un pneu%1ni! ,!p! e"

    pe"iC!s=ul!"$ In6e9si !9!n /e"9e%/!n0 %en0!9i/!9!n e"

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    7pen0elup!s!n; epiel ,!n !9!n e"/enu9 e9su,! he%1"!0i9$ In6il"!si 9e ine"sii!l

    s!n0!

    p"e,isp1sisi e"

    7L1s=!l>1# et al., +(&(;$

    1' Ge2a)a K)inis

    Di!0n1sis pneu%1ni! 91%unii ,i,!p!9!n ,!"i !n!%nesis# 0e

    !!u le/ih 0e

    Pen!!l!9s!n!!n pneu%i1ni! 91%unii ,i/!0i %en

    !; Pen,e"i! "!.!

    5 4il! p!n!s in00i pe"lu ,i91%p"es !!u %inu% 1/! penu"un p!n!s

    5 4il! pe"lu ,!p! ,i/e"i9!n %u91lii9 ,!n e9spe91"!n

    Pe%/e"i!n !ni/l1i9 h!"us ,i/e"i9!n 7sesu!i /!0!n; 9u"!n0 ,!"i )

    T!np! 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%!se Den0!n 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%se !!u

    6lu1"19uin1l1n "espi"!si 7leC16l19s!sin# %19si6l19s!sin# 0!i6l19s!sin; 4il! ,en0!n pneu%1ni! !ipi9 : %!9"1li, /!"u 7"19si1%isin# 9l!"i1%isin#

    !>i"1%isin;$

    /; Pen,e"i! "!.! in!p ,i "u!n0 "!.! /i!s!Pen01/!!n sup1"i6 si%p1%!i9

    5 Pe%/e"i!n e"!pi 19si0en

    5 Pe%!s!n0!n in6us unu9 "ehi,"!si ,!n 91"e9si 9!l1"i ,!n ele9"1li

    5 Pe%/e"i!n 1/! si%p1%!i9 !n!"! l!in !nipi"ei9# %u91lii9

    Pen01/!!n !ni/i1i9 h!"us ,i/e"i9!n 7sesu!i /!0!n; 9u"!n0 ,!"i )

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    T!np! 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%!se

    in"!Cen! !!u se6!l1sp1"in 0ene"!si +# 0ene"!si in"!Cen! !!u

    6lu1"19uin1l1n "espi"!si in"!Cen! Den0!n 6!91" %1,i6i9!si : se6!l1sp1"in 0ene"!si +# 0ene"!si in"!Cen! !!u

    6lu1"19uin1l1n "espi"!si in"!Cen! 4il! ,en0!n pneu%1ni! !ipi9 : %!9"1li, /!"u

    =; Pen,e"i! "!.! in!p ,i Ru!n0 R!.! Inensi6Pen01/!!n sup1"i6 si%p1%!i9

    5 Pe%/e"i!n e"!pi 19si0en

    5 Pe%!s!n0!n in6us unu9 "ehi,"!si ,!n 91"e9si 9!l1"i ,!n ele9"1li Pe%/e"i!n

    1/!

    si%p1%!i9 !n!"! l!in !nipi"ei9# %u91lii9 Pen01/!!n !ni/i1i9 7sesu!i /!0!n$; 9u"!n0 ,!"i )

    Ti,!9 !,! 6!91" "esi91 in6e9si pseu,1%1n!s : se6!l1sp1"in 0ene"!si

    in"!Cen! !!u 6lu1"19uin1l1n "espi"!si in"!Cen! A,! 6!91" "esi91 in6e9si pseu,1%1n!s : s

    5 se6!l1sp1"in !ni pseu,1%1n!s in"!Cen! !!u 9!"/!pene% in"!Cen!

    ,i!%/!h 6lu1"19uin1l1n !ni pseu,1%1n!s 7sip"16l19s!sin; in"!Cen! !!u

    !%in10li91si,! in"!Cen!

    5 /il! ,i=u"i0!i ,ise"!i in6e9si /!9e"i !ipi9 : se6!lsp1"in !ni pseu,1%1n!sin"!Cen! !!u 9!"/!pene% in"!Cen! ,i!%/!h !%in10li91si,! in"!Cen!#

    ,i!%/!h %!9"1li, /!"u !!u 6lu1"19uin1l1n "espi"!si in"!Cen!$

    4il! !,! in,i9!si pen,e"i! ,ip!s!n0 Cenil!1" %e9!ni9

    7Pe"hi%pun!n D19e" P!"u In,1nesi!# +((;

    B' SEPSIS%' De/inisi

    Sepsis ,i,e6inisi9!n se/!0!i 9e!,!!n 9linis -!n0 ,i!n,!i 1leh sin,"1% "esp1n

    in6l!%!si sise%i9 7SIRS; ,ise"!i !,!n-! /!9e"i p!h10en 7in6e9si; -!n0 ,ie%u9!n

    %el!lui 9ulu" !!u pe.!"n!!n 0"!% ,!"i spesi%en u/uh sepe"i ,!"!h# spuu%# 6eses#

    u"in ,!n spesi%en u/uh l!inn-! !!u ,ie%u9!n 619us in6e9si sepe"i lu9! ,en0!n pus

    pu"ulen !!u !,!n-! u,!"! /e/!s p!,! "1n00! !/,1%en -!n0 ,ie%u9!n p!,! s!!

    1pe"!si -!n0 /e"!s!l ,!"i s!lu"!n pen=e"n!!n$

    #' Etio)o*i

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    Sepsis /i!s!n-! ,ise/!/9!n 1leh in6e9si /!9e"i# Ci"us !!u

    aureus, dan Streptococcus pneumonia$ Spesies Ene"1=1==us# Kle/siell!# ,!n

    Pseu,1%1n!s !; Pe%/enu9!n "1%/in -!n0 ,ipe"!n!"!i TF

    Tranfer factor ,ie9sp"esi9!n p!,! pe"%u9!!n sel en,1el# %1n1si# ,!n pl!ele

    9ei9! sel5sel ini ,isi%ul!si 1leh 19sin# si19in !!u %e,i!1" l!in$ A,!n-!en,119sin %en-e/!/9!n penin09!!n /e/e"!p! si19in p"1in6l!%!si sepe"i

    tumor necrosisfactor 7TNF;5,!n ine"leu9in 7IL;5*$ Si19in IL5* %e"up!9!n

    si19in p"1in6l!%!si -!n0 p!lin0 /e"hu/un0!n ,en0!n 9linis sepsis ,!n

    91%pli9!si$Pe%/enu9!n "1%/in -!n0 ,ipe"!n!"!i 1leh TF %e"up!9!n !h!p

    penin0 ,!"i p!10enesis sepsis$ Se=!"! 6isi1l10is pe%/enu9!n ini se0e"!

    ,ih!%/! 1leh !ni"1%/in# n!%un ,en0!n pe%/enu9!n "1%/in -!n0 s!n0!

    =ep!

    /; G!n00u!n %e9!nis%e !ni91!0ul!n

    Te",!p! i0! %e9!nis%e !ni91!0ul!n -!n0 e"0!n00u p!,! sepsis -!iu : Sise% !ni"1%/in

    Se=!"! e1"i !ni"1%/in %e%ili9i pe"!n penin0 ,!l!% 9e9!=!u!n 91!0ul!si

    p!,! sepsis# ,i/u9i9!n ,en0!n

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    P"1ein 2 ,isinesis ,i h!i ,!n ,i!9iC!si %en

    -!n0 /e"6un0si ,!l!% %en0h!%/! FVIII ,!n FV$& P!,! sepsis# e"

    ,ep"esi sise% p"1ein 2 -!n0 ,ise/!/9!n 1leh pen00un!!n -!n0 /e"le/ih!n#

    0!n00u!n h!i# pe"e%/es!n C!s=ul!"# ,!n !9iC!si TNF5J$

    Tissue factor pathway inhibitor 7TFPI;

    Tissue factor pathway inhibitor ,ise9"esi 1leh sel en,1el ,!n /e"6un0si unu9

    %en0h!%/! !9iC!si FX 1leh 91%ple9s TF5FVII!$ Penu"un!n TFPI ,!p!

    ,i

    p"1,u9si "1%/1si -!n0 e"0!n00u# penin09!!n pe%!9!i!n %!upun ,es"u9si

    !!u se9ues"!si "1%/1si ,i li%p!$

    7F!"!ni!# e !l# +(&&;

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    Gama, %' Pato/isio)o*i Sepsis

    1' Ge2a)a K)inis

    Ge

    sepe"i ,e%!%# %en00i0il# ,!n 0e

    eses l!/1"!1"iu%$ K"ie"i! Di!0n1si9 sepsis %enu"uCC!"SCC# !hun +((& ,!n

    $nternational Sepsis %efinitions Conference, !hun +(( :

    V!"i!/el U%u% Suhu /!,!n )( 2 !!u *( 2 He!" R!e ?O%eni T!9ipne! Penu"un!n s!us %en!l E,e%! !!u /!l!n=e =!i"!n -!n0 p1sii6 +(%l90+'

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    Penin09!!n pl!s%! p"1=!l=i1nin V!"i!/el He%1,in!%i9 Hip1ensi !""i!l 7Sis1li9 ?(%%H0 !!u penu"un!n sis1li9 '(%%H0 ,!"i

    se/elu%n-!##ean artrial pressure @(%%H0;

    S!u"!si Cen! 7SCO+ @(B; K!",i!9 In,e9s #8 L%%

    V!"i!/le Pe"6usi !"in0!n

    Se"u% l!9! &%%1lL Penu"un!n 9!pile" "e6il

    V!"i!/le Dis6un0si O"0!n

    A""i!l hip19se%i! 7P!O+ Fi O+ ((; A9u 1li0u"i! !!u u"ine 1upu (#8 %l90

    Hipe"/ili"u/ine%i! 7pl!s%! 1!l /ili"u/in '%0,l

    &' Penata)asanaan Te,api

    Pen!!l!9s!n!!n !ni/i1i9 e%pi"i9 %enu"u Dipi"1 e,isi 9e u

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    Gama, #' Antimi,oa empi,is pa(a sepsis

    Gama, 0' A*en 3asop,eso, pa(a s4o5 sepsis

    C' HEMAPTOE

    %' De/inisi

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    4!u9 ,!"!h %e"up!9!n su!u 0e

    4!u9 ,!"!h!!u he%1pisis !,!l!h e9spe91"!si ,!"!h !9i/! pe",!"!h!n p!,! s!lu"!n

    n!p!s ,i /!.!h l!"in0# !!u pe",!"!h!n -!n0 9elu!" %el!lui s!lu"!n n!p!s /!.!h

    l!"in0$

    #' Etio)o*i

    Pen-e/!/ /!u9 ,!"!h s!n0! /e"!0!% !n!"! l!in :

    In6e9si : u/e"9ul1sis# s!ph-l1=1==us# 9le/siell!# le0i1nell!;#

    e%6ise%!/ul1s! Ne1pl!s%! : 9!n9e" p!"u# !,en1%! /"1n=hi!l# u%1" %e!s!sis Kel!in!n he%!1l10i : ,is6un0si "1%/1si# "1%/1si1peni!#

    ,isse%in!e,in"!C!s=ul!" =1!0ul!i1n 7DI2; Kel!in!n #

    li%6!n0i10"!6i Kel!in!n sise%i9 : sin,"1% 011,p!su"e# i,i1p!hi= pul%1n!"- he%1si,e"1sis#

    sise%i9 lupus e"-e%!1sus# C!s9uliis 70"!nul1%!1sis .!0ene"# pu"pu"!

    hen1=hs=h1enlein# sin,"1%