Pneumonia CAP

download Pneumonia CAP

of 38

Transcript of Pneumonia CAP

  • 7/24/2019 Pneumonia CAP

    1/38

    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

    #$%&

  • 7/24/2019 Pneumonia CAP

    2/38

    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

  • 7/24/2019 Pneumonia CAP

    3/38

    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!"! %!

  • 7/24/2019 Pneumonia CAP

    4/38

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

  • 7/24/2019 Pneumonia CAP

    5/38

    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"

  • 7/24/2019 Pneumonia CAP

    6/38

    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 )

  • 7/24/2019 Pneumonia CAP

    7/38

    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

  • 7/24/2019 Pneumonia CAP

    8/38

    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

  • 7/24/2019 Pneumonia CAP

    9/38

    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# +(&&;

  • 7/24/2019 Pneumonia CAP

    10/38

    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+'

  • 7/24/2019 Pneumonia CAP

    11/38

    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

  • 7/24/2019 Pneumonia CAP

    12/38

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

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

    C' HEMAPTOE

    %' De/inisi

  • 7/24/2019 Pneumonia CAP

    13/38

    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% =h"u05s"!uss; O/! 19sin : !spi"in# !ni91!0ul!n# penisil!%in# 919!in L!in5l!in : en,1%e"i1sis# /"1n9i1lii!sis# 6isul! /"1n91pleu"!# /en,! !sin0#

    he%1pisis9"ip10eni9# !%il1i,1sis

    0' Pato/isio)o*i

  • 7/24/2019 Pneumonia CAP

    14/38

    1' Ge2a)a K)inis

    T!n,!5!n,! e"

    /; Te",en0!" !,!n-! 0ele%/un050ele%/un0 u,!"! /e"=!%pu" ,!"!h ,i ,!l!%

    s!lu"!n n!p!s=; Te"!s!!sin ,!"!h ,!n 0!!l ,i en001"19!n,; W!"n! ,!"!h -!n0 ,i/!u99!n %e"!h se0!" /e"=!%pu" /uih# /e/e"!p! h!"i

    9e%u,i!n .!"n! %en

  • 7/24/2019 Pneumonia CAP

    15/38

    6; 4is! /e"l!n0sun0/e/e"!p! h!"i

    &' Penata)asanaan Te,api

    Pen!!l!9s!n!!n ,il!9u9!n %el!lui i0! !h!p:

    !$ P"1e9si

    19si0en# 91"e9si 91!0ul!p!i# "esusi!si =!i"!n/$ L19!lis!si su%/e" pe",!"!h!n ,!n pen-e/!/ pe",!"!h!n ,!p! ,ilih! %el!lui h!sil

    611 1"!9s# 2T s=!n 1"!9s# !n0i10"!6i# /"1n91s91pi=$ Te"!pi spesi6i9 ,en0!n pe%/e"i!n 1/! ,!n !ni6i/"in1lii9 pen01/!!n pen-!9i

    p"i%e"n-!

    D' SUSPECT TB-MDR%' De/inisi

    T45 Muliple D"u0 "esisen !!u T4 ,en0!n "esisensi 0!n,! !,!l!h 9e!,!!n

    ,i%!n! /!sil M$ Tu/e"=ul1sis "esisen e"h!,!p "i6!%pisin ,!n is1ni!>i,# ,en0!n !!u

    !np! OAT l!inn-!$ T4 ini ,!p! /e"up! "esiensi p"i%e" ,!n "esisensi se9un,e"$

    Resisensi p"i%e" -!iu "esisensi -!n0 e"

    ,i,!p! sel!%! e"!pi p!,! 1"!n0 -!n0 se/elu%n-! sensii6 1/! 7S-!h"ini# +(();$

    #' Etio)o*i

    A,! /e/e"!p! h!l pen-e/!/ e"

    !!u ,ilin09un0!n e"se/u el!h e",!p! "esisensi -!n0 in00i e"h!,!p 1/! -!n0

    ,i0un!9!n$ Pe%/e"i!n 1/! -!n0 i,!9 e"!u"# %is!ln-! h!n-! ,i%!9!n ,u! !!u i0! %in00u

    l!lu /e"heni# seel!h ,u! /ul!n /e"heni 9e%u,i!n /e"pin,!h ,19e" %en,!p!

    1/! 9e%/!li sel!%! ,u! !!u i0! /ul!n l!lu /e"heni l!0i# ,e%i9i!n see"usn-!$ Fen1%en! !,,ii1n s-n,"1%e -!iu s!u 1/! ,i!%/!h9!n ,!l!% su!u p!,u!n

    pen01/!!n -!n0 i,!9 /e"h!sil$ 4il! 9e0!0!l!n iu e"

  • 7/24/2019 Pneumonia CAP

    16/38

    Koloni M. tuberculosis

    Mutan resisten

    Resisten obat TBsekunder (multipel)

    Resistensi obat TB

    primer (multipel)

    Resistensi obat TBprimer yang lebihbanyak (multipel)

    Pen-e,i!!n 1/! -!n0 i,!9 "e0ule"# 9!,!n059!,!n0 e"heni pen0i"i%!nn-!

    s!%p!i /e"/ul!n5/ul!n$7S-!h"ini# +(();

    0' Pato/isio)o*i

    7Lei=h GA# +(((;

    1' Ge2a)a K)inis

    Ge

    e"/!0i %en

    &$ Ge

    ses!9 n!p!s

    n-e"i ,!,!

    +$ Ge

    De%!%

    0e

    Mu!siAl!%i!h&

    S"!in "isesen !9i/! e"!pi-!n0 i,!9 !,e9u!+

    ! T"!ns%isise=!"!,1pleInfeksi HIVKontrolinfeksi yang tidakadekuatDiagnostik yang terlambat

    T"!ns%isi -!n0 le/ih

  • 7/24/2019 Pneumonia CAP

    17/38

    7Pe,1%!n Di!0n1sis ,!n Pen!!l!9s!n!!n Tu/e"9ul1sis ,i In,1nesi!;

    Sese1"!n0 ,i9!!9!n %en,e"i! u/e"=ul1sis %uliple ,"u0 91nCe"si ne0!i6$

    &' Penata)asanaan Te,api

    Ti0! h!l penin0 ,!n pe"lu ,ipe"h!i9!n p!,! pen!!l!9s!n!!n T4 %uliple ,"u0

    !,!l!h e9ni9 ,i!0n1si=# pe%/e"i!n 1/! ,!n 9ep!uh!n$ Unu9 ,!p! %en-usun

    p!n,u!n -!n0 ep! /!0i sei!p pen,e"i! ,ipe"lu9!n /e/e"!p! in61"%!si %en0en!i

    h!sil es "esisensi 9u%!n u/e"=ul1sis# "i.!-! pen01/!!n ,!n p1l! "esiensi 9u%!n

    ,i lin09un0!n %!s-!"!9! pen,e"i! %ene!p$

    Kei9! hen,!9 %e%ul!i e"!pi# -!n0 pe"lu ,iin0! !,!l!h

    7/ul!n;

    OAT Du"!si

    7/ul!n;

    OAT

    H3S R 3 3 E * R 3 E

    H3E3S +

    &

    R33A%93Ph#

    ,ii9uiR33Ph

    * R3Ph

    H 3 R 3 S 5* 3E3Ph3A%93Fn &) E3Ph3FnH 3 R 3 E 3 S 5* 3Ph3A%93Fn32-= &) Ph3Fn32-=

    H 3 R 3 3 E 3 S 5* Ph3A%93Fn32-=3P!s &) Ph3Fn32-=

    Kee"!n0!n :

    H Is1ni!>i, Ph p"1i1n!%i,eehi1n!%i,e

    R Ri6!%pisin P!s p5!%in1s!li=-li= !=i,

    pi"!>in!%i, A%9 !%i9!sinE e!%/u1l Fn 6lu1"1uin1l1n

  • 7/24/2019 Pneumonia CAP

    18/38

    S s"ep1%isin 2-= =-=l1se"ine

    Pilih!n e"!pi unu9 "esisensi 1/! -!n0 ,i9e!hui$ i9! ,i!su%si9!n /!n-!9

    1/! 70!0!l pen01/!!n seel!h e"!pi

    l!n0sun0;# e"!pi /ul!n ,en0!n !%in10li91si,!# p"1hi1n!%i,e# pi"!>in!%i,# ,!n

    6lu1"1uin1l1n ,ii9ui ,en0!n &) /ul!n p"1hi1n!%i,e ,!n 6lu1"1uin1l1ne$7Ke%pe"# e !l +((+;

    BAB III

    STUDI KASUS

    A' DEMOGRAFI PASIE

    &$ D!! P!sienN!%! : N-$ EEU%u" : '' !hunID P!sien : &&()'QQQS!us : KNAl!%! : M!l!n0MRS : ? O91/e" +(&8IRNA# Ru!n0 : H2U P!"u

    #' Keluh!n U!%! P!sien4!u9 ,!"!h

    $ Ri.!-! Pen-!9i S!! ini4!u9 & %in0u -!n0 l!lu# /!u9 ,!"!h 0el!s# + h!"i -!n0 l!lu /!u9 ,!"!h & 0el!s$

    P!0i hin00! %!l!% ini 0el!s# .!"n! %e"!h# 9e"in0! %!l!% 3# "i.!-! /uuh ,!"!h 3$

    Ses!9 & %in00u ini /il! /!u9 9!%/uh# ses!9 /il! /e"!9iCi!s# + h!"i ini i,u" s!%/il

    ,u,u9$ N-e"i ,!,! /il! /!u9 s!

  • 7/24/2019 Pneumonia CAP

    19/38

    /$ Sepsis=$ He%!p1e,$ M!l Nu"isie$ Susp T4 MDR

    *$ Tin,!9!n Ope"!si

    Ti,!9 !,!@$ Ale"0i: Ti,!9 !,!

    B' TADA-TADA !ITAL DA KLIIS

    &$ T!n,! Vi!l

    P!"!%ee"

    Nil!i

    N1"%!l

    T!n00!l

    &(&( &&&( &+&(

    &&(

    Suhu 7(2; *5@ * * * *N!,i 7Q%eni; )(5)8 &(+ )) @( )(RR 7Q%eni; +( +* +' '( +)Te9$ D!"!h 7%%H0;

    &+()( &()()(8

    (

    ?(*

    (

    ?(*

    (

    +$ T!n,! Klinis

    Pa,amete, Tan**a)IRD 67%$ %$7%$ %%7%$ %#7%$ %07%$

    4!u9 D!"!h 3 3 3 5 5Ses!9 3 3 3 3 3Le%!h 3 3 3 3 3

    4!u9 4e",!h!9 5 5 5 3 3

    G2S '8* '8* '8* '8* '8*

    Rh1n9i 3

    3 5

    5

    3 3

    5

    5 5

    5

    5 5

    3

    5 5Whee>in0 5

    5 5

    5 5 5

    5 5 5

    3 3 5

    5 5 5

    C' HASIL LABORATORIUM

    Pa,amete, i)ai o,ma) SatuanTan**a)

    %$7#

    He%10l1/in &' &8#& 0,l 0,L 8#(

  • 7/24/2019 Pneumonia CAP

    20/38

    E"i"1si 7R42; 7'#( 8#(; Q &(* L @#+ Q &(

    *

    Leu91si 7W42;

    7'#@ & Q

    &( L '+ Q &(

    He%!19"i ) '+ B +?#8(

    T"1%/1si 7PLT; &'+ '+' Q &( L *& Q &(

    Al/u%in #8 8#8 0,L #*)

    ASTSGOT (5+ UL +@

    ALTSGPT (5 UL ?

    GD se.!9u +(( M0,L &&+

    U"eu% &*#*5')#8 M0,L &*#8(

    K"e!inin + M0,L (#*+

    N!"iu% 7N!; &*5&'8 M%1lL &)

    K!liu% 7K; #858#( M%1lL #@)

    Kl1"i,! 72l; &&( M%1lL &('

    4GA

    Suhu @#(

    H/ &(#8

    pH @#85@#'8 @#)

    p2O+ 85'8 #&

    pO+ &8*#& &8*#&

    H2O &?#@ &?#@

    O+S!u"!e ?8B B ??#

    4!se eQ=ess 75;573; 58#@

  • 7/24/2019 Pneumonia CAP

    21/38

    D' HASIL PEMERIKSAA

    4elu% ,i9e!hui h!sil ,!"i pe%e"i9s!!n p!,! p!sien$

    E' PROFIL TERAPI

    Oat Rute DosisRHCU

    %$7# %%7# %#7# %07#

    N!2l IVFD (#?B

    2ep"i!Q1ne IV +Q& 0"!% S1p S1p S1p

    LeC16l1Q!=in IV & Q @8( %0

    Me"1pene% IV + Q & 0"!% 5

    As!% T"!neQ!%! IV Q 8(( %0

    N1"epineph"in IV ' %0&((NS 5

    O%ep"!>1le IV &Q'( %0

    21%/iCen

    7Ip!"1piu% 4"1%i,! 3

    S!l/u!%1l;

    Ne/ul Qh!"i S1p S1p

    21,ein PO Q&( %0

    P2T PO Q8(( %0

    OAT K! II +FD2

    K1%p1sisi:Ri6!%pisinIs1ni!>i,

    PO Q se%in00u

    s!u !/leK1%p1sisi:&8( %0&8( %0

    5 5

    E!%/u1l PO '(( %0 5 5

    Vi 4* PO &Q&( %0 5 5

    A,1n!

    72!"/!%!>1=h"1%e;

    IV Q+8 %0 S1p S1p

    &$ 2e6"i!Q1ne

    In,i9!si : Se/!0!i !ni/i1i9 e%pi"is pneu%1ni! 2AP

    Me9!nis%e Ke"

    sinesis ,in,in0 sel /!9e"i

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,+Q& 0"!% De.!s! ,!n !n!9 E1sin1phili! 7*B; H/# R42# Suhu

  • 7/24/2019 Pneumonia CAP

    22/38

    &+ h: &5+ 0 se9!li

    seh!"i$

    Th"1%/1=-1sis

    78B;Di!"e# %u!l# %un!h

    7B;$ Penin09!!n

    "!ns!%in!se 7B;Leu91peni! 7+B;

    u/uh# TD# N!,i#

    RR# Leu91si

    +$ LeC16l1Q!=in

    In,i9!si : Se/!0!i !ni/i1i9 e%pi"is pneu%1ni! 2AP

    Me9!nis%e Ke"

    sehin00! e"

    @5&' h!"i !!u @8(

    %0 POIV se9!li

    seh!"i unu9 8 h!"i

    Mu!l 7@B;S!9i 9ep!l! 7*B;Di!"e 78B;Ins1%ni! 7'B;K1nsip!si 7B;

    Suhu u/uh#

    leu91si# RR# N!,i#

    TD# 6"e9uensi

    4A4# n-e"i# %u!l#

    s!9i 9ep!l!#

    91n!ip!si,i!"e

    $ Me"1pene%

    In,i9!si : Ani/i1i9 e%pi"is pneu%1ni! 2AP

    Me9!nis%e Ke"

    sei!p )

    K1nsip!si# ,i!"e#

    %u!l# %un!h

    Re!9si

    hipe"sensii6i!s#%u!l# %un!h#

    6"e9uensi 4A4#

    Suhu u/uh#

    Leu91si# N!,i#

    TD# RR

    '$ N1"epinep"in

    In,i9!si : Menin09!9!n e9!n!n ,!"!h p!,! 91n,isi s-19 sepsis

  • 7/24/2019 Pneumonia CAP

    23/38

    Me9!nis%e Ke"

    dan !&'# ,!n %en-e/!/9!n penin09!!n e9!n!n ,!"!h

    DosisE/e Sampin* Monito,in*Pasien Lite,atu,

    ' %0

    NS

    (#(& %=090

    %eni

    4"!,i9!",i# hipe"ensi#

    !"i%i!# =e%!s

    N!,i# RR# Suhu

    u/uh# e9!n!n

    ,!"!h

    8$ O%ep"!>1le

    In,i9!si : se/!0!iprofilaksis stress ulcer

    Me9!nis%e Ke"

    sehin00! %en0h!%/! se9"esi !s!% l!%/un0

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,

    & Q '( %0 '( %0 se9!li seh!"i S!9i 9ep!l!# n-e"i

    !/,1%en# ,i!"e# %u!l#

    %un!h

    N-e"i l!%/un0#

    %u!l# %un!h

    *$ 21%/iCen 7Ip!"1piu% 4"1%i,! ,!n S!l/u!%1l;

    In,i9!si : %en0!!si ses!9 Me9!nis%e Ke"

    Kuli 9e%e"!h!n# "!sh#

    0!n00u!n GI 7%u!l#%un!h# ,i!"e;#

    Nil!i SGOT#

    SGPT# suhu u/uh

  • 7/24/2019 Pneumonia CAP

    24/38

    "!ns!%in!se

    )$ As!% T"!neQ!%!

    In,i9!si : Men=e0!h e"

    Me9!nis%e Ke"

    e"/!0i ,!l!% &5+

    ,1sis

    Pe%/e"i!n se=!"!

    =ep! ,!p!

    %en-e/!/9!n "!s!

    9u"!n0 n-!%!n ,!n

    hip1ensi# 0!n00u!n

    GI

    Te9!n!n ,!"!h#

    6"e9uensi

    pen,!"!h!n

    ?$ Vi 4*

    In,i9!si : P"16il!9sis neu"iis pe"i6e" !9i/! e6e9 s!%pin0 Is1ni!>i,

    Me9!nis%e Ke"

    %!0nesiu% ,iu/!h %en! !9i6n-! pi"i,19s!l58561s6!$ ! ini/e"pe"!n penin0 se/!0!i 915en>i% p!,! %e!/1lis%e p"1ein ,!n

    !s!%5!s!% !%in1# sinesis GA4A#

    C1lu%e u"in#

    6"e9uensi 4A4

    &($ A,1n! 72!"/!%!>1=h"1%e;

    In,i9!si : A0en He%1s!i9

    Me9!nis%e Ke"

    pe"%e!/ili!s 9!pile"# %enin09!9!n "esisensi 9!pile"

  • 7/24/2019 Pneumonia CAP

    25/38

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,

    Q +8 %0N!2l

    (#?B +( p%

    +8 %0 Penu"un!n n!6su

    %!9!n

    Mu!l# %un!h#

    0!n00u!n

    pen=e"n!!n#6"e9uensi

    pen,!"!h!n

    7he%!p1e;

    &&$ 21,ein

    In,i9!si : Coughsupressant

    Me9!nis%e Ke"

    %en-e/!/9!n ,ep"esi pe"n!6!s!n# C!s1,il!!si pe"i6e"# inhi/isi 0e"!9

    pe"ilis!i9 usus# si%ul!si 9"e%1"esep1" ,!n pene9!n!n "e6le9

    /!u9

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,

    Q &( %0 @#85+( %0 PO '5*

    9!li seh!"i PRN

    i,!9 le/ih ,!"i &+(

    %0+'

    K1nsip!si#

    %en0!nu9# hip1ensi#

    !9i9!",i !!u

    /"!,i9!",i

    Te9!n!n ,!"!h#

    n!,i# 6"e9uensi

    /!u9# 6"e9uensi

    4A4

    &+$ Ri6!%pisin

    In,i9!si : Aniu/e"9ul1sis

    Me9!nis%e Ke"

    %en0!9i/!9!n sines! RNA %i9"11"0!nis%e ,ih!%/!

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,

    '8( %0 Qse%in00u

    Unu9 ,1sis DOT Q se%in00u: &(5+(

    %090 7%!9s *((

    %0;

    U"in %e"!h# %u!l#s!9i pe"u# i,!9 n!6su

    %!9!n# penin09!!n

    nil!i "!ns!%in!se

    SGPT# SGOT# u!l

    &$ Is1ni!>i,

    In,i9!si : Aniu/e"9ul1sis

    Me9!nis%e Ke"

    penin0 ,in,in0 sel %i91/!9e"iu%

  • 7/24/2019 Pneumonia CAP

    26/38

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,

    '8( %0 7 Q

    se%in00u;

    &8 %090 %!9s:

    ?((%0,1sis; +5

    9!li pe"%in00u

    Penin09!!n nil!i

    "!ns!%in!se# Neu"iis

    pe"i6e"

    SGOT# SGPT# R!s!

    p!n!s e"/!9!" ,i

    9!9i# 9ese%u!n#n-e"i 9!9i# 9e/!s

    &'$ E!%/u1l

    In,i9!si : Aniu/e"9ul1sis

    Me9!nis%e Ke"

    e"h!%/! ,!n sel %!i

    DosisE/e Sampin* Monito,in*

    Pasien Lite,atu,&+(( %0 Q

    pe"%in00u

    +85( %090#

    Q%in00u

    Men00!n00u se9"esi

    !s!% u"!# 0!n00u!n

    pen0lih!!n ,!n /u!

    .!"n!

    K!,!" !s!% u"!#

    pen0lih!!n#

    &8$ N!2l

    In,i9!si : "esusi!si =!i"!n u/uh

    Me9!nis%e Ke"

    pen00un!!n C1lu%e

    /es!" 7/i!s!n-! p!"u;#

    !9u%ul!si n!"iu%

    K!,!" ele9"1li

    u/uh# N!# K# 2l

    F$ SOAP

    Ha,i

    8pe,a9ata

    n e-:

    Su2e5ti3e O2e5ti3e Assessment P)an

    &(5&(5+(&8

    7H!"i 9e5&;

    P!sien

    %en0!l!%i

    /!u9

    ,!"!h#

    TD

    &()(

    S @

    N &(+

    P!sien ,i!0n1s!

    pneu%1ni! 2AP#

    he%!p1e# !n, suspe=

    T45MDR$

    M1ni1"in0:

    - F"e9uensi

    he%!p1e$- RR# Rh# Wh- F"e9uensi /!u9

  • 7/24/2019 Pneumonia CAP

    27/38

    ses!9#

    n-e"i ,!,!#

    ,e%!%

    RR +*

    Leu91si:

    '+$(((ul

    He%!1="i

    : +?#8(

    P!sien %en,!p!

    e"!pi:

    N!2l (#?B +( p%

    5 In< 2e6"i!Q1ne + Q &

    0"!%

    5 In< LeC16l1Q!=in & Q

    @8( 0"!%

    5 As!% T"!neQ!%!

    Q 8(( %0

    5 21%/iCen Ne/ul Q

    seh!"i

    5 21,ein Q &( %0

    5 P!"!=e!%1l Q 8((

    %0

    5 OAT K! II FD2

    !/ 7Ri6!%pisin &8(

    %0# Is1ni!>i, &8( %0;

    3 !/ E!%/u1l '((

    %0

    5 Vi 4* & Q &( %0

    5 A,1n! Q +8 %0

    DRP:

    Ti,!9 ,ie%u9!n

    DRP

    - Suhu u/uh

    - Penin09!!n

    SGPT SGOT

    - Pen0lih!!n

    p!sien

    - W42

    - P1ensi ESO

    Aniu/e"9ul1si

    s

    &&5&(5&8

    7H!"i 9e5+;

    4!u9

    ,!"!h/e"9u"!n0#

    ses!9

    /e"9u"!n0#

    p!sien

    %en0!l!%i

    penu"un!n

    e9!n!n

    ,!"!h

    TD: )(8(

    %%H0N!,i: ))

    RR: +'

    T : *(

    DQ: s!%! ,en0!n h!"i

    pe"!%! 3 S-19 SepsisTQ:

    5 Te"!pi s!%! ,en0!n

    h!"i pe"!%!# %inus

    OAT ,!n Ci 4*

    5 P!sien %en,!p!

    e"!pi N1"ephinep"in

    ' %0 ,!l!% &(( NS

    ' ==

    M1ni1"in0 sesu!i

    h!"i pe"!%!$M1ni1"in0

    e9!n!n ,!"!h$

    T!"0e: MAP *8

    %%H0

  • 7/24/2019 Pneumonia CAP

    28/38

    5 2e6"i!Q1ne

    ,iheni9!n ,!n

    ,i0!ni ,en0!n

    %e"1pene% +Q&

    0"!% se/!0!i e"!pi

    pilih!n p!,! p!sien

    seCe"e sepsisH/ 8#( DQ: Ane%i!

    P!sien %en,!p! PR2

    DRP %un=uln-! e6e9

    s!%pin0 1/! ,!n

    ine"!9si 1/!$

    5 F"e9uensi

    pe%/e"i!n

    %e"1pene% i,!9

    sesu!i lie"!u"

    5 P!sien %en0eluh

    ses!9# PR2 & l!/u

    ,is1p

    T"!ns6usi PR2 +

    l!/uh!"i

    T!"0e:

    5 T"!ns6usi hin00!

    H/ &( 0",l5 M1ni1"in0

    "e!9si he%1lii9

    7N!,i# RR# ,!n

    suhu# %u!l#

    %un!h;# H/

    5 Men!%/!h9!n

    1%ep"!>1le

    se/!0!i e"!pi

    !%/!h!n unu9

    %en0hin,!"i

    s"ess ul=e"

    5 Kl!"i6i9!si 9e

    ,19e" e"9!i

    6"e9uensi

    pen00un!!n

    %e"1pene% -!n0

    seh!"usn-! 9!li

    seh!"i&+5&(5&8

    7H!"i 9e5;

    Ses!9

    /e"9u"!n0#

    /!u9

    ,!"!h

    TD: ?(*(

    %%H0

    RR:

    '(Q%eni

    DQ: s!%! ,en0!n h!"i

    9e +

    TQ:

    5 S!%! ,en0!n h!"i 9e

    M1ni1"in0

    6"e9uensi ses!9$

    Te9!n!n ,!"!h

    e!p h!"us ,i

  • 7/24/2019 Pneumonia CAP

    29/38

    /e"heni#

    4!u9

    /e",!h!9

    N!,i:

    @(Q%eni

    +

    5 P!sien %en,!p!

    !%/!h!n e"!pi

    1%ep"!>1le unu9

    %en0hin,!"i stress

    ulcer

    5 21%/iCen ,i

    heni9!n

    pen00un!!nn-!

    5 A,1n!

    ,iheni9!n

    pen00un!!nn-!

    %1ni1"in0

    P!sien %en,!p!

    e"!pi "!ns6usi PR2 &

    l!/u

    M1ni1"in0 H/

    p!sien# "e!9si

    hipe"sensii6# s-19

    7TD# RR# N!,i;#

    suhu u/uhDRP

    P!sien /elu%%en,!p! e"!pi

    unu9 /!u9

    /e",!h!9 DRP h!"i 9e ,u!

    /elu% %en,!p!

    !n00!p!n 4!u9 ,!"!h p!sien

    /e"heni#pen00un!!n !s!%

    "!neQ!%!

    se/!i9n-!

    ,iheni9!n

    5 Me%/e"i9!n

    %u91lii9 N5!=eils-sein

    unu9

    %e%u,!h9!n

    pen0elu!"!n

    ,!h!9

    5 Men0heni9!n

    pen00un!!n

    !s!% "!neQ!%!

    &5&(5&8

    7H!"i 9e5';

    Ke!,!!n

    u%u%

    p!sien

    %e%/!i9$

    N!,i: )(

    RR: +)

    Te9 D!"!h:

    ?(*(

    DQ: s!%! ,en0!n h!"i

    9e

    TQ:

    5 S!%! ,en0!n h!"i 9e

  • 7/24/2019 Pneumonia CAP

    30/38

    %%H0

    Suhu *(

    5 Me%/e"i9!n "ei, &8( %0;

    3 !/ e!%/u1l '((

    %0 3 Ci 4* &( %0H/ ?#' T"!ns6usi PR2 & l!/u M1ni1"in0 hin00!

    H/ p!sien &(

    0",l# "e!9si

    hipe"sensii6# s-19

    7TD# RR# N!,i;#

    suhu u/uhP!sien

    %en0!l!%i

    /!u9

    /e",!h!9$

    DRP P!sien /elu%

    %en,!p! e"!pi unu9

    /!u9 /e",!h!9

    DRP h!"i 9e /elu%

    %en,!p! !n00!p!n

    Re91%en,!si

    pe%/e"i!n

    %u91lii9

    G' DRP; REKOMEDASI DA RECAA MOITORIG

    .enis DRPTipe

    DRPPen2e)asan Inte,3ensi Hasi)

    Un,e",1se:

    Me"1pene%

    A9u!l F"e9uensi

    pe%/e"i!n%e"1pene% !np!

    0!n00u!n 0in

    !,!l!h sei!p )

    Suhu# N!,i# RR#

    Leu91si# TD

    Menin09!9!n

    ,1sis %e"1pene%

    %en

    6"e9uensi ,1sis

    %e"1pene%#

    %1ni1"in0 e!p

    ,il!9u9!n$Ine"!9si 1/!

    Ip!"1piu%

    /"1%i,! 3

    P1ensi!

    l

    Ani91line"0i9 /is!

    %enin09!9!n e6e9

    19si9 !n!l0esi9

    V1lu%e u"in# 6"e9

    4A4$

    4elu% %un=ul

    e6e9 s!%pin0

    19sisi!s =1,ein#

  • 7/24/2019 Pneumonia CAP

    31/38

    s!l/u!%1l

    =1,ein

    1pi1i,$ Khususn-!#

    "esi91 91nsip!si

    ,!n "eensi u"in

    -!n0 %enin09!

    ,en0!n 91%/in!si

    ini

    M!n!0: %1ni1"in0

    91nsip!si ,!n

    "eensi u"in p!sien$

    F"e9uensi

    ses!9RR

    %1ni1"in0 e!p

    ,il!9u9!n$

    Ine"!9si 1/!

    21,ein

    Is1n!>i,#

    Ri%6!%pisin

    P1ensi!

    l

    Is1ni!>i, ,!n

    Ri6!%pisin

    %en0u"!n0i e6e9

    e"!peui9 ,!"i

    91,ein

    F"e9uensi /!u9#

    n-e"i

    P!sien %en0!l!%i

    /!u9# e!pi /!u9

    e"se/u

    %e"up!9!n

    %!ni6es!si 9linis

    T42 ,!n

    pneu%1ni!#

    %1ni1"in0 e!p

    ,il!9u9!n$

    Ine"!9si 1/!Ip!"1piu%

    N1"epinep"in

    P1ensi!l

    A0ensi%p!1%i%ei9

    /is! %enin09!9!n

    e6e9 19si9 !0en

    si%p!1%i%ei9

    l!in

    M!n!0: %1ni1"e9!n!n ,!"!h# RR

    4elu% !,! e6e9s!%pin0 19sisi!s#

    %1ni1"in0 e!p

    ,il!9u9!n$

    Ine"!9si 1/!

    P!"!=e!%1l

    Is1ni!>i,

    P1ensi!

    l

    Is1ni!>i,

    %enin09!9!n e6e9

    ,!"i p!"!=e!%1l

    ,en0!n %en-e"!n0

    en>i% hep!i9

    2YP+E&

    %e!/1lis%e$

    M!n!0:

    %1ni1"in0

    e"

    hep!119si9

    7SGPT#SGOT;

    Ti,!9 e"

    penin09!!n

    SGOTSGPT#

    %1ni1"in0 e!p

    ,il!9u9!n$

    Ine"!9si 1/!

    P!"!=e!%1l

    Ri6!%pisin

    P1ensi!

    l

    %enin09!9!n e6e9

    ,!"i p!"!=e!%1l

    ,en0!n %en-e"!n0en>i% hep!i9

    M!n!0: Suhu

    u/uh# SGPT#

    SGOT

    Ti,!9 e"

    penin09!!n

    SGOTSGPT#%1ni1"in0 e!p

  • 7/24/2019 Pneumonia CAP

    32/38

    2YP+E&

    %e!/1lis%e$

    M!n!0: %1ni1"in0

    e"

    hep!119si9

    7SGPT#SGOT;

    ,il!9u9!n$

    Ine"!9si 1/!

    P2T

    21,ein

    P1ensi!

    l

    Menu"un9!n

    !/s1"psi ,!"i

    p!"!=e!%1l$ %in1"

    M1ni1"in0 suhu

    u/uh

    Suhu u/uh ,!l!%

    /!!s n1"%!l#

    %1ni1"in0 e!p

    ,il!9u9!n$Ine"!9si O/!

    Ri6!%pisin O%ep"!>1le

    P1ensi!

    l

    IO: %enu"un9!n

    91nsen"!si1%ep"!>1le

    Mu!l Ti,!9 !,! !n,!

    e"

    ,il!9u9!n$

    H' KOSELIG ASUHA KEFARMASIA

    &$ Pen00un!!n !ni/i1i9 LeC16l1Q!Qin i,!9 /1leh %ele/ihi &' h!"i unu9 %en=e0!he"

    /is! %en

    unu9 %en=e0!h e"

  • 7/24/2019 Pneumonia CAP

    33/38

    BAB I!

    PEMBAHASA

    N- EE %!su9 "u%!h s!9i ,en0!n 9eluh!n /!u9 ,!"!h$ P!sien %!su9 ,i Ru%!h

    S!9i S!i6ul An.!" p!,! !n00!l ? O91/e" +(&8 %el!lui Ins!l!si G!.! D!"u"! 7IGD;$

    P!sien %en0eluh /!u9 ,!"!h -!n0 /!n-!9 se

    %en091nsu%si 1/! !niu/e"9ul1sis se

  • 7/24/2019 Pneumonia CAP

    34/38

    6i/"in1lii9 ,en0!n %e9!nis%e %en=e0!h ,e0"!,!si ,!"i /en!n0 6i/"in# ,e0ene"!si pl!ele#

    penin09!!n 6"!0ili!s pe%/uluh ,!"!h ,!n %e"!n0s!n0 6!91"56!91" 91!0ul!si# se,!n09!n

    A,1n! /e9e"

    p!sien %en,!p! e"!pi =1,ein -!n0 /e"6un0si se/!0!i coughsupressant sehin00!

    %en0u"!n0i pe%i=u e"

    1leh penin09!!n leu91si -!n0 %en=!p!i '+$'((ul# ,e%!%# n-e"i ,!,! /il! /!u9# ,!n

    pe%e"i9s!!n "h1n9i$ Pneu%1ni! -!n0 ,i!l!%i p!sien /e"!s!l ,!"i 6!91" "esi91# -!iu

    u/e"9ul1sis -!n0 9e%u,i!n /e"e%/!n0 %en

    pen-e/!/ pneu%1ni! ,en0!n %e%/e"i9!n !ni/i1i9$ P!,! !.!l %!su9 "u%!h s!9i# &(

    O91/e"# p!sien ,ie"!pi !ni/i1i9 2e6"i!Q1ne ,!n LeC16l1Q!=in$ K1%/in!si !ni/i1i9

    e"se/u %e"up!9!n e"!pi e%pi"is unu9 p!sien pneu%1ni! -!n0 ,i"!.! ,i "u!n0 inensi6

    sesu!i ,en0!n Pe,1%!n Di!0n1s! ,!n Pen!!l!9s!n!!n D19e" P!"u In,1nesi!$ P!,! !n00!l

    && O91/e"# pen00un!!n =e6"i!Q1ne ,iheni9!n ,!n ,i0!ni ,en0!n %e"1pene%$ H!l e"se/u

    /e",!s!"9!n pe"i%/!n0!n 91n,isi p!sien -!n0 %en0!l!%i sepsis /e"!$ Sel!in e"!pi e"se/u#

    p!sien ,ie"!pi ,en0!n 21%/iCen -!n0 %e"up!9!n /"1n91,il!1"# unu9 %en0!!si ses!9

    -!n0 ,i!l!%i p!sien$

    P!,! !n00!l && O91/e" +(&8 p!sien %en0!l!%i s-19 sepsis -!n0 ,i!n,!i ,en0!n

    penu"un!n e9!n!n ,!"!h se=!"! i/!5i/! %en=!p!i )(8( %%H0$ S-19 sepsis e"

    ,iun

  • 7/24/2019 Pneumonia CAP

    35/38

    P!,! !n00!l && O91/e" %!l!%# p!sien ,i,i!0n1s! %en0!l!%i !ne%i! ,en0!n nil!i

    H/ 8#( %0,l$ T!n00!l &+ O91/e"# p!sien 9e%u,i!n ,i/e"i "!ns6usi PR2 ,en0!n !"0e H/

    &( %0,l$ Te!pi# p!,! !n00!l & O91/e"# H/ p!sien /elu% %en=!p!i !"0e sehin00!

    %!sih ,i"!ns6usi PR2$ Ane%i! -!n0 ,i!l!%i p!sien !,!l!h ,ise/!/9!n 1leh /!u9 ,!"!h -!n0

    ,i!l!%in-! se

    P!sien e!p %en,!p! e"!pi l!n

    se,!n09!n p!,! lie"!u" pen00un!!n %e"1pene% !np! 0!n00u!n 0in

    7 Q seh!"i;$

    Ine"!9si 1/! pe"!%! !,!l!h !n!"! =1%/iCen 7!ni91line"0i9; ,en0!n =1,ein

    ,i%!n! e6e9 19si9 =1,ein !9!n %enin09! 7p1ensi!l;# "esi91 91nsip!si# ,!n penin09!!n

    "eensi u"in$ Sel!ni,"i6!%pisin 1le /is! %enu"un ,en0!n !,!n-! "i6!%pisin$

    M1ni1"in0 -!n0 inens ,i/uuh9!n unu9 %en=e0!h e"

  • 7/24/2019 Pneumonia CAP

    36/38

    BAB !

    KESIMPULA

    N-$ EE ,en0!n ,i!0n1sis Pneu%1ni! 2AP 3 sepsis 3 he%!p1e 3 suspe= T45MDR

    ,i9e!hui p!sien %!su9 RS p!,! !n00!l ?5&(5+(&8 ,i"u!n0 H2U (high care unit) p!"u$

    K1n,isi p!sien s!%p!i !n00!l &5&(5+(&8 su,!h se%!9in %e%/!i9 ,!n ,ipin,!h9!n 9e

    "u!n0 + in6e9si unu9 p"1ses pe%ulih!n$

    &$ P!sien %en,!p!9!n "e0i%en pen01/!!n su,!h sesu!i ,en0!n 0ui,eline+$ DRP i,!9 %en,!p!

  • 7/24/2019 Pneumonia CAP

    37/38

    DAFTAR PUSTAKA

    2en"!l Tu/e"=ul1sis DiCisi1n# Minis"- 16 He!lh !n, F!%il- Wel6!"e$'evised ational

    Tuberculosis Control !rogramme %*TS!lus +uidelines .Ne. Delhi$ +(&(Dipi"1# 1seph T e !ll$ Ph!"%!=1he"!p- A P!h1ph-si1l10i= App"1!=h @h e,ii1n# The

    M=G"!.5Hill 21%p!nies$ +(()F!"!ni!#T ,99# +angguaan oagulasi pada SepsisSari !ediatri# V1l$ N1$ # O91/e"

    +(&&N!i1n!l Sepsis See"in0 21%%iee. Sepsis #anagement ational Clinical +uideline o.

    -. /01

    Pe"hi%pun!n D19e" P!"u In,1nesi!. !edoman %iagnosis dan !enatalaksanaan di

    $ndonesia. //2P"i-!n1"1 K ,99$ +angguan fungsi 3antung pada eadaan Sepsis 3urnal ardiologi

    $ndonesia. V1l$ N1$ $ Sepe%/e"5Dese%/e" +(&(R!s%in# Men!l,i$Editorial4 5E#*!T$S$S$ Dep!"e%en Pul%1n1l10i Z Il%u Ke,19e"!n

    Respi"!si FKUI5SMF P!"u RSUP Pe"s!h!/!!n.

    6urnalrespirologi.org"6urnal"pril/7"HEMOPTISIS8/editorial.pdf

    S-!h"ini# Hen"-$ Tuberkulosis !aru 'esistensi +anda$ Dep!"e%en Il%u Pen-!9i D!l!%

    R$S$U$P A,!% M!li9 Me,!n F!9ul!s Ke,19e"!n UniCe"si!s Su%!e"! U!"!

    +(()

  • 7/24/2019 Pneumonia CAP

    38/38