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PENDEKATAN PEMERIKSAANPASIEN ANAK

BAGIAN/SMF ILMU KESEHATAN ANAK,

RSUD DR.DORIS SYLVANUS-PSPD,UNIVERSITAS PALANGKA RAYA

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ANAMNESISPEMERIKSAAN FISIK

PEMERIKSAAN

PENUNJANG

DIAGNOSIS

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ANAMNESISBerdasarkan sumber informasi

! "ETEROANAMNESIS

! AUTOANAMNESIS

#a$ib men%uasai

! e&io'o%i

! (a&o)sio'o%i

! *ara (enu'aran! %e$a'a (en+aki&

! (er$a'anan (en+aki&

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Konse( (en%ambi'an anamnesis

! T"E FOUNDAMENTA,FOUR

! T"E SA-RED SE.EN

..anamnesis

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T/e Foundamen&a' Four

0 (okok informasi ri12 kese/a&an

32 Present illness:

a2 ke'u/an u&ama

b2 ri12 (en+aki& sekaran%

&/e sa*red se4en

52 Past health history62 Family health history

02 Personal/social history

..anamnesis

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32 PRESENT I,,NESS

a2 KE,U"AN UTAMAKe'u/an +an% mendoron% oran% &ua memba1a

anakn+a ke dok&er

b2 RI#2 PEN7AKIT SEKARANG

Deskri(sikan ke'u/an se*ara $e'as ana'isake'u/an d'm 8 dimensi

..anamnesis

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,O-ATION di mana9: (en+ebaran9

;UA,IT7 ma*am a(a9: sifa& k/as9

TIMING

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52 PAST "EA,T" "ISTOR7

a2 Ri12 (ersa'inan

se%era menan%is: memer'ukan resusi&asi: BB,: -ara

(ersa'inan

b2 Ri12 &umbu/ kemban%

!Mo&orik kasar

!Mo&orik /a'us

!Ba/asa dan Bi*ara

!Ada(&asi sosia'

*2 Ri12 Iimunisasi

d2 Ri12 (en+aki& &erda/u'u

e2 Ri12 Nu&risi

..anamnesis

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62 FAMI,7 "EA,T" "ISTOR7

(en+aki& da'am ke'uar%a

! kon%eni&a'

! dida(a& menu'ar 9

02 PERSONA,

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ANAK TE,ANJANG

PERIKSA SE-ARA KESE,URU"AN

-ARA PEMERIKSAAN

! INSPEKSI

! PA,PASI

! PERKUSI! AUSKU,TASI

PEMERIKSAAN FISIK

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32 STATUS PRESENT

KEADAAN UMUMkeadaan (asien saa& di(eriksa

Pen%ama&an me'i(u&i

a2 Kesan saki& rin%an: sedan%: bera&

b2 Sis&em +an% &erkena

*2 Kesadaran

! Kom(osmen&is sadar dan res(onadekua&

! A(a&is res(on adekua& $ika ada s&imu'us

..pemeriksaanfsik

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! Somno'en men%an&uk: ada res(on $ikaada s&imu'us a%ak kua& kmd &idur 'a%i

! So(or res(on sediki& &er/ada( s&imu'us+an% kua&: RF =>?

! Koma &idak ada res(on d% berba%ais&imu'us: RF =!?

! De'irium kesadaran menurun danka*au: disorien&asi: iri&a&if: /a'usinasi

..pemeriksaanfsik

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Tin%ka& kesadaran berdasarkan G-S

=G'as%o1 -oma S*a'e?! membuka ma&a

! res(on 4erba'! res(on mo&orik

d2 S&a&us men&a' dan &in%ka/ 'aku

&enan%: *eria: murun%: %e'isa/: ke&aku&an:

a%resif a&au /i(erak&if9

e2 Tan%isan

kua&: men$eri&: nada &in%%i =/i%/ (i*&/?9

..pemeriksaanfsik

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f2 Ke'ainan +an% nam(aksesak: nafas *u(in% /idun%: re&raksi:sianosis: udem: ik&erus

%2 Sika( (asien

$a'an sendiri: dibo(on%: di%endon%9

membun%kuk

a(endisi&is

/2 Fasies

eks(resi 1a$a/ a&au ben&uk mukai2 Ke'ainan akiba& (en%ania+aan

..pemeriksaanfsik

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NADI

! ar&eri radia'is

! ar&eri femora'is

E4a'uasi hitung ! " #$nit i%&%$gu!$%, i%$gu!$% '$ngi(i&n '!itu) Pu!(u( ($!!$%* n&i +u&t g '!itu) !$&% In(u &)%t&, PDA, ti%)t)+(i+)(i( Pu!(u( '&%0u( $t t&%u(1 n&i +$2i! 3 !&t (t$n)(i( &)%t&

Pu!(u( &!t$%n&n1 '!itu) ($!&ng-($!ing +u&t &n !$#&h gg! 4t +i%i Pu!(u( $5(it1 %$+ $n6ut &'i+&! 4t !$ih $(&% % %$+ $n6ut n&i

..pemeriksaanfsik

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Den+u& nadi norma' (ada berba%ai umur

..pemeriksaanfsik

UmurUmur Den+u& nadi-"">

; t&hun; t&hun 78-""878-""8"8 t&hun"8 t&hun 78-""878-""8

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RESPIRASI

E4a'uasi

! frekuensi

ins(eksi: (a'(asi: ausku'&asi

! &i(e &oraka': &orako!abdomina': abdomina'

! keda'aman

..pemeriksaanfsik

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,a$u (erna(asan norma' (er meni&

..pemeriksaanfsik

UmurUmur Norma'Norma' Rera&a 1ak&uRera&a 1ak&u&idur&idur

Neona&usNeona&us 6@!@6@!@ 66

3 b'n!3&/3 b'n!3&/ 6@!@6@!@ 6@6@

3!5 &/3!5 &/ 5!@5!@ 55

5!0 &/5!0 &/ 5@!6@5@!6@ 5555

!C &/!C &/ 3!6@3!6@ 33

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Is&i'a/ (ernafasan

Eu(neu norma'Taki(nea *e(a&Bradi(nea 'amba&Dis(nea sesak nafas

"i(er(nea nafas da'amOr&o(nea sesak saa& is&ira/a&A(nea /en&i nafas

Bio& &ak &era&ur d% a(nea 'ama-/e+ne!S&okes &era&ur d'mke&idak&era&uranKusmau'' *e(a& dan da'am

..pemeriksaanfsik

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Ti(e (erna(asan

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TEKANAN DARA"

! Manse& 3

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Ni'ai norma' &ekanan dara/ (ada ba+i dan anak

..pemeriksaanfsik

UmurUmur Sis&o'ikSis&o'ik=mm"%?=mm"%?

Dias&o'ikDias&o'ik=mm"%?=mm"%?

Baru 'a/irBaru 'a/ir @!8@@!8@ 5@!@5@!@

3!35 b'n3!35 b'n @!C@@!C@ 0@!8@0@!8@

3!6 &/3!6 &/ 8!3@@8!3@@ @!8@!8

0! &/0! &/ @!33@!33 @!8@!8C!3 &/C!3 &/ !35!35 @!@@!@

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SU"U TUBU"

Tem(a& (en%ukuran

! Ke&iak Norma' 6:0@

-! Anus Norma' 68:@-

! Mu'u& Norma' 68@-

! Te'in%a

BERAT BADAN k%

TINGGI BADAN *m

Menen&ukan s&a&us %ii

..pemeriksaanfsik

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Indika&or

Bera& badan idea' Tin%%i badan ak&ua'

S&andar Baku

?D? 9888 @HO 988>

Kri&eria (rosen&ase =1a&er'o1? 78 KEP $%&t 78-;8 KEP ($&ng ;8 C 8 KEP %ing&n 8 C ""8 n)%#&!

""8 C "98 gi(i !$ih "98 )$($

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52 STATUS GENERA,

KEPA,A! ben&uk dan ukuran! UUB dan su&ura &erbuka

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TE,INGA

! fun%si (enden%aran

! serumen! *airan! benda asin%! &anda radan%

"IDUNG

! (an%ka' da&ar (ada(a'a&os*/iis

! (e'ana kuda fami'ia'

/+(er&e'orism: 'ues! (eriksa mukosa 1arna: se(&um:sekre&

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MU,UT

! *a*a& ! 'abios*/iis

! 'abio%na&os*/iis! 'abio%na&o(a'a&os*/iis

! Asime&ri (ara'ise n2 fasia'is a&au&ri%eminus

! mukosa adan+a (u*a&: sianosis

,IDA"

! Ora' &/rus/! kerin% a&au basa/

! (a(i' norma': besar a&au ra&a

! T+(/oid Ton%ue

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FARING

! (seudomembran

! &anda radan%

TONSI,

! ukuran &onsi' T @!0

! &anda radan%

,E"ER

K&+u +uu+ tgn +&n&n i&t&( && '%t, tgn+i%i #$n$+u+ !$h$%t&h&n&n P$#$(&%&n +$!$n4&%, 4!h, #)i!, n6$%i,ugu!&% 0$n)u( '%$(u%$

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DADA

&em(a& $an&un% dan (aru!(aru

Paru!(aru

Ins(eksiB$ntu+ th)%&+ 1 P$+tu( $+(+&0&tu#, '$+tu(+&%in&tu#, &%%$! 2h$(tSi#$t%i(it&( (t&ti(, ini(Ti'$ '$%n&&(&nA&n6& '$%&%&h&n &&h +u!itA&n6& $n4)!&n tu!&ng && %&+hiti( %)(&%6

R$t%&+(i ining && (u2)(t&!, int$%2)(t&!,(u'%&(t$%n&!

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Pa'(asi

Si#$t%i(it&( F%$#itu( (u&%& gn t$!&'&+ t&ng&n tu4uh 'u!uh tu4uh, (&&t #$n&ngi(.

B&ning+&n +&n&n +i%iM$ning+&t +)()!i&(i 'n$u#)ni&

M$nu%un )(t%u+(i 4! n&'&(, &t$!$+t&(i(, '!$u%iti(, $u(i '!$u%&, tu#)%

K%$'it&(i u&%& i &&h 4&%ing&n +u!it

P&(+& t%&+$)(t)#i.

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Perkusi

L&ng(ung #$ng$tu+ u4ung 4&%i !g( +$ g &&T&+ !&ng(ung #$!$t&++&n " 4&%i i&t&( g && +$tu+ g 4&%i !&in

M$n$ntu+&n &t&( '&%u h$'&% N)%#&! ()n)% An)%#&!1 Hi'$%()n)% $#5($#& '&%u/'n$u#)th)%&+ R$u'/'$+&+ 'n$u#)ni& !)&%i(, &t$!$+t&(i(, tu#)%T6#'&ni h$%ni& i&%&g#&ti+&

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Ausku'&asi bandin%kan kanan!kiri:

de(an be'akan%Su&%& n&'&( &(&%SN V$(i+u!$% 1 in('i%&(i +$%&( 3 '&n4&ng &%i $+('i%&(i

M$!$#&h ' '$n6$#'it&n %)n+u(M$ng$%&( ' %$()!u(i 'n$u#)ni&, tu#)% '&%uSN B%)n+i&!1 in('i%&(i +$%&(, $+('i%&(i !$ih +$%&(

N)%#&! i %)n+u( $(&%, '&%&(t$%n&! &n && $'&n 3

int$%(+&'u!& $!&+&ngAn)%#&!1 +)n()!i&(i !u&(SN B%)n+)0$(i+u!$%1 +)#in&(i (n 0$(i+u!$% 3 %)n+i&!SN A#)%i+1 #$n6$%u'&i un6i tiu'&n ' )t)! +)()ng'

+&0$%n&SN ?)g h$$! %$&th ()un1 SN t$%'utu(-'utu(, t+

+)ntin6u &i+ (&&t ( in'( 3 $+('. Dit$#u+&n ' &h$(i'!$u%& 3 tu$%+u!)(i( iniM$th)%'h)(ing %$&th ()un1 #u!&i 0$(i+u!$%

%)n+hi&!

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SN T&h&n R)n+i &(&h1 0i%&(i t$%'utu(-'utu( &+i&t g$t&%&n 6g t4 +&%$n& 2&i%&n !4!n n&'&( 6g i!&!ui u&%& @h$$Jing #$ngi* %)n+hi +$%ing 6g !$ih ()n)%

F&($ In(' )(t (&! n&'&( &g &t&( u$# !&%ing, $n& &(ingF&($ E+(' )(t (&! n&'&( &g &&h &(#&, %)n+hi)!iti(

K%$'it&(i 1 (u&%& #$#u+&n6& &!0$)!i 'n$u#)ni& !)&%i( P!$u%&! %i2ti)n %u1 un6i g$($+&n '!$u%& ' '!$u%iti( 5%in)(&

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JANTUNG

-ara (emeriksaan

INSPEKSI

32 Pasien &er'en&an%

52 Pemeriksa di sisi kanan (asien

62 E4a'uasi sime&risi&as

02 Per/a&ikan adan+a (u'sasi di a(eks:e(i%as&irum: dan su(ras&erna'

PA,PASI

menen&ukan ik&us kordis: kua& an%ka&:ak&i)&as 4en&rike' dan %e&aran bisin% =&/ri''?

Th%i!! t$!&'&+ t&ng&n Ku&t &ng+&t u4ung 4&%i RV H$&0$ LV i#'u!(

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PERKUSI menen&ukan ba&as $an&un% (adade1asa

AUSKU,TASI#$ng$t&hui &+ti5t&( 4&ntung #$!&!ui (u&%&4&ntung g (t$t)(+)'Mu!&i % &'$+

Suara $an&un%

S3 saa& nadi berden+u&: ok (enu&u(anka&u( a&rio4en&riku'er =M3T3?

S5 ok (enu&u(an ka&u(4en&riku'oar&ria' =A5P5?S6 ok a'iran dara/ +an% *e(a& daria&rium ke 4en&rike'S0 ok kon&raksi a&rium

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BISING JANTUNG

suara arus &urbu'en ber/ub2 d%*e(a& arus: &ekanan ser&a 'uas

s&ruk&ur ba%ian $an&un% +an% di'a'uiE4a'uasi! fase bisin% ! (en$a'aran! kon&ur bisin% ! &in%%i nada

! kua'i&as bisin% ! (eruba/an in&esi&as! in&ensi&as =%r 3!? ! (un*&ummaksimum

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PA,PASIPemeriksaan &ur%orTiu% t$%!$nt&ng ?uit (u+ut&n &$%&h &)#$n

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As*i&esShiting u!n$((1 '$%+u(i % u#i!i+u( +$ (i(i '$%ut&%i t6#'&ni +$ %$u', '$n$%it& #i%ing +$ +i%i&$%&h %$u' &+&n $%'in&hG$!)#&ng unu!&(i1 ' &(2it$( 6g &n6&+ 3 '$%ut6g t$g&ng. P t$%!$nt&ng tgn +i%i i (i(i '$%ut, tg+&n&n i (i(i 6g !&in. G$%&+&n g '$%ut i2$g&h

g #$!$t&++&n tg '$n)!)ng i&t&( g &)#$n.K$tut g '$%ut &n i%&(&+&n ' tgn 6g$%!&&n&n.Kn$$ 2h$(t ')(iti)n1 &$%&h %$u' ' &g

t$%$n&h '$%ut '&& ')(i(i '$n$%it& t$ng+u%&'. ' &n&+ $(&% 3 4!h &(2it$( ($i+it

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Pembesaran %in$a' *ara ballotement

adan+a n+eri

PERKUSI

Norma' &im(ani

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GENETA,IA

Ure&ra sekre& =>? abnorma'

S&adium (uber&as =&anner?

ANUS

! im(erfora&e anus

! )s&u'a rek&o4a%ina! )sura ani

! (ro'a(s mukosa! *a*in% kremi

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S&d &anner

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EKSTREMITAS SUPERIOR

INFERIOR

E4a'uasi! adan+a sianosis! (u*a&

! *'ubbin% )n%er! &ena%a: &onus: &ro)k: reeks! edema di daera/ &un%kai

ba1a/

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Reek Fisio'o%is

R$$+ i($'1 +$t)+ t$n)n i($' '$n$%it& $+(i ' ($ni (i+u R$$+ T%i($'1 Tgn +i%i '$#$%i+(& #$n)'&ng (i+u '$n$%it& ')(i(i ($t$ng&h $+(i

3 %i!$+(, +$t)+ t$n)n t%i($' '$n$%it& $+(t$n(i ' ($ni (i+u R$$+ '&t$!&1 tgn +i%i '$#$%i+(& #$n$+u+ !utut (hg !utut $+(i 3 %i!$+(, +$t)+

t$n)n '&t$!& '$n$%it& $+(t$n(i ($ni !utut R$$+ &2hi!$(1 '$#$%i+(& #$n$+u+ !utut '$n$%it& (hg +&+i t+ #$n6$ntuh &!&(,

+$t)+ t$n)n &2hi!$( '$n$%it&, $+(i '!&nt&% +&+i

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Reek Pa&o'o%isR$$+ B&in(+i1 Tgn +i%i #$#$g&ng '$%g$!&ng&n+&+i '$n$%it&, tgn +&n&n #$ngg)%$( '$%#u+&&n'!&nt&% +&+i #u!&i tu#it it&%i+ +$&t&( t$'i !&t$%&!#$n6i!&ng +$ #$i&! i h '&ng+&! 4&%i +&+i $+t$n(i iu 4&%i i($%t&i '$#$+&%&n 4&%i !&inn6&R$$+ )'$nh$i#1 t$+&n t!g +$%ing '$n$%it& g 4&%i

&n ig$($% +$ &&h $+t$n(i iu 4&%ii($%t&i '$#$+&%&n 4&%i !&inn6&R$$+ ?h&)+1 g)%$( &hi&n !&t$%&! +&+i $+t$n(i iu 4&%i i($%t&i '$#$+&%&n 4&%i !&inn6&

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Menin%ea' Si%n

K$%nig (ign1 Tgn +&n&n #$n$+u+ tung+&i &t&( (hg')(i(i t$g&+ !u%u(, tgn +i%i #$n&h&n !utut'$n$%it&. Tgn K&n&n 6g #$#$g&ng tu#it#$!u%u(+&n tung+&i h '&& ($ni !utut t&h&n&n !# #$!u%u(+&n !ututB%uJin(+i I1 Tgn +i%i '$#%i+(& i h +$'&!&

'&(i$n, tgn +&n&n i && '&(i$n, +$#ui&n+$'&!& i$+(i+&n ($2&%& '&(i $+(i '+$u& !utut &n '&nggu!.B%uJin(+i II1 $+(i ' tung+&i '$n$%it& ' ($ni

'&nggu! (2% '&(i $+(i ' ($ni !utut 3'&nggu! +)nt%&!&t$%&!

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MATURMATUR

SUKSMASUKSMATERIMA KASIH