70161.docx

LAPORAN TUTORIAL SKENARIO D BLOK 22

Tutor : dr. Nursanti, Sp.PA

Disusun oleh: Kelompok B6 Kelas Beta 2016 Frilla Adhany Marsya

04011181621048

Ima Suryani

04011181621222

Evalina

04011181621124

Challis Malika Ravantara

04011181621126

Tiara Putri Yosineba

04011181621134

Muhammad Daffa Alfarid

04011181621143

Afrida Yolanda Putri

04011181621145

Emilia Intan Sari

04011181621146

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA TAHUN AJARAN 2019/2020

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KATA PENGANTAR

Puji syukur kami panjatkan kepada Tuhan yang Maha Esa atas segala rahmat dan karunia-Nya sehingga kami dapat menyelesaikan laporan tutorial yang berjudul “Laporan Tutorial Skenario D Blok 22” sebagai tugas kompetensi kelompok. Kami menyadari bahwa laporan tutorial ini jauh dari sempurna. Oleh karena itu kami mengharapkan kritik dan saran yang bersifat membangun guna perbaikan di masa mendatang. Dalam penyelesaian laporan tutorial ini, kami banyak mendapat bantuan, bimbingan dan saran. Pada kesempatan ini, kami ingin menyampaikan syukur, hormat, dan terima kasih kepada : 1. Tuhan yang Maha Esa, yang telah merahmati kami dengan kelancaran diskusi tutorial, 2. dr. selaku tutor kelompok B6 3. Teman-teman sejawat FK Unsri, terutama kelas PSPD Beta 2016 Semoga Tuhan memberikan balasan pahala atas segala amal yang diberikan kepada semua orang yang telah mendukung kami dan semoga laporan tutorial ini bermanfaat bagi kita dan perkembangan ilmu pengetahuan. Semoga kita selalu dalam lindungan Tuhan.

Palembang, 21 Februari 2019

Kelompok B6

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DAFTAR ISI

Kata Pengantar ................................................................................................... ii Daftar Isi ............................................................................................................iii Kegiatan Diskusi ................................................................................................ 1 Skenario .............................................................................................................. 2 I.

Klarifikasi Istilah ..................................................................................... 3

II. Identifikasi Masalah ................................................................................ 4 III. Analisis Masalah ..................................................................................... 5 IV. Keterbatasan Ilmu Pengetahuan ................................................................ V. Sintesis ...................................................................................................... VI. Kerangka Konsep ...................................................................................... VII. Kesimpulan................................................................................................ Daftar Pustaka .......................................................................................................

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KEGIATAN DISKUSI

Tutor

: dr.

Moderator

:

Sekretaris 1

: Ima Suryani

Sekretaris 2

:

Pelaksanaan

: 19 dan 20Februari 2019 Pukul 10.00-12.30 WIB

Peraturan selama tutorial: 1. Semua peserta wajib aktif dalam kegiatan diskusi 2. Mengangkat tangan sebelum menyampaikan pendapat. 3. Menjawab dan menyampaikan pendapat apabila telah diizinkan oleh moderator. 4. Tidak langsung menyanggah pendapat orang lain. 5. Tidak diperbolehkan mengoperasikan hp setelah tahap klarifikasi istilah. 6. Meminta izin terlebih dahulu dari moderator jika hendak keluar

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Skenario C Blok 22 Tahun 2019

A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36 years old woman, priimigravida. Mrs. Siti, the baby’s mother had premature rupture of membrane since 4 days ago. The liquor was thick, smelly and greenish. She had fever since one day before delivery. She also had history of hypertention during the last trimester ofpregnancy. The pregnancy was full term, 39 weeks. The baby was not cried spontaneously after birth. The midwife cleared the baby’s airway using manual suction and stimulate the baby by patting his feet. The midwife said Apgar score 1 for 1”minute and 2 for 5th minute and 5 at 10th minute. The baby had difficuality while breathing, and had grunting. The midwife then refered him to Moh Hussen Hospital. Physical examination revealed body weight was 2300 grams. Body length 48 cms, head circumference 34 cms. His temperature was 36oC. he looked hypoactive and tacypnoe, respiratory rate72 beaths perminute, there were chest indrawing, grunting, could be heard using steshoscope, breathing sound was normal, he still looked cyanostic even after been giving nasal oxygen. Sucking reflex was weak. Heart rate was 174 beats per minute. Abdominal was tenderwith normal bowel sound. There were meconium staining at umbilical cord and skin. Other examinatiooon within normal.

I. Klarifikasi istilah No.

Istilah

Klarifikasi

1.

primigravida.

Kehamilan pertama

2.

Premature

ruptur

of Ketuban pecah dini ; pecahnya ketuban sebelum

membrane

adanya tanda-tanda inpartu

3.

Manual suction

Alat untuk menghisap cairan

4.

Apgar score

Suatu metode penilaian yang digunakan untuk mengkaji kesehatan neonatus dalam menit pertama dan lima menit setelah bayi lahir

2

6.

grunting

Merintih

7.

Head circumference

Lingkar kepala

8.

hipoactive

Penurunan abnormal aktifitas

10.

Chest indrawing

Tarikan dinding dada bagian bawah kedalam saat anak menarik napas

11.

Cyanotic

Perubahan warna kulit dan membran mukosa menjadi kebiruan akibat konsentrasi hemoglobin tereduksi yang berlebihan dalam darah

12.

Sucking reflex

Reflek menghisap pada bayi

13.

Meconeum

Bahan berlendir yang berwarna hijau tua didalam usus bayi cukup bulan

14.

Umbilical cord

Tali pusar

II. Identifikasi masalah 1.

A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36 years old woman, primigravida. Mrs. Siti, the baby’s mother had premature rupture of membrane since 4 days ago. The liquor was thick, smelly and greenish. She had fever since one day before delivery.

2.

She also had history of hypertention during the last trimester of pregnancy.

3.

The pregnancy was full term, 39 weeks. The baby was not cried spontaneously after birth. The midwife cleared the baby’s airway using manual suction and stimulate the baby by patting his feet. The midwife said Apgar score 1 for 1”minute and 2 for 5th minute and 5 at 10th minute. The baby had difficuality while breathing, and had grunting. The midwife then refered him to Moh Hussen Hospital.

4.

Physical examination revealed body weight was 2300 grams. Body length 48 cms, head circumference 34 cms. His temperature was 36oC. he looked hypoactive and tacypnoe, respiratory rate72 beaths perminute, there were chest indrawing, grunting, could be heard using steshoscope, breathing sound was normal, he still looked cyanostic even after been giving nasal oxygen. Sucking reflex was weak. Heart rate was 174 beats per minute. Abdominal was tenderwith normal bowel sound. There 3

were meconium staining at umbilical cord and skin. Other examinatiooon within normal. 5. III. Analisis Masalah 1.

A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36 years old woman, primigravida. Mrs. Siti, the baby’s mother had premature rupture of membrane since 4 days ago. The liquor was thick, smelly and greenish. She had fever since one day before delivery. a. Apa kemungkinan penyebab dari kpd? Ridha daffa b. Bagaimana hubungan umur dan primigravida terhadap ketuban pecah dini? Ima ridha c. Apa makna “Mrs. Siti, the baby’s mother had premature rupture of membrane since 4 days ago. The liquor was thick, smelly and greenish.”? Ima eva d. Bagaimana keterkatian antara demam yang dialamii mrs. Siti dengan kpd? Malika emil e. Bagaimana dampak kpd terhadap bagi ibu dan janin? Malika emil f. Bagaimana mekanisme dari kpd? eva frilla g. Bagaimana anatomi dari amnion sac? Daffa ridha

2.

She also had history of hypertention during the last trimester of pregnancy. a. Bagaimana keterkaitan antara hipertensi selama trimester terakhir dengan kpd? frilla tiara

3.

The pregnancy was full term, 39 weeks. The baby was not cried spontaneously after birth. The midwife cleared the baby’s airway using manual suction and stimulate the baby by patting his feet. The midwife said Apgar score 1 for 1”minute and 2 for 5 th minute and 5 at 10th minute. The baby had difficuality while breathing, and had grunting. The midwife then refered him to Moh Hussen Hospital. a. . apa kemungkinan penyebab keluhan pada bayi? Ima malika b. Apa makna klinis dari kalimat diatas?

Emil malika

c. bagaiman cara menghitung skor apgar? Ridha tiara 4

d. bagaiman mekanisme susah bernapas pada bayi dalam kasus? eva tiara e. bagaimana tatalaksana awal dari masalah ini? (respiratory distress) emil frilla

4.

Physical examination revealed body weight was 2300 grams. Body length 48 cms, head circumference 34 cms. His temperature was 36oC. he looked hypoactive and tacypnoe, respiratory rate72 beaths perminute, there were chest indrawing, grunting, could be heard using steshoscope, breathing sound was normal, he still looked cyanostic even after been giving nasal oxygen. Sucking reflex was weak. Heart rate was 174 beats per minute. Abdominal was tenderwith normal bowel sound. There were meconium staining at umbilical cord and skin. Other examinatiooon within normal. a. bagaimana inerpretasi dari hsil pemeriksaan diatas?ima daffa b. bagaimana mekanisme abnormal dari pemeriksaan diatas? Eva tiara

IV. SINTESIS 1.

RDS MAS (respiratory distress syndrome mekonium aspiration syndrome) a.

Diagnosis banding (ima, malika)

b.

Algoritma Penegakan Diagnosis

c.

Diagnosis kerja

d.

Definisi

e.

Etiologi

f.

Epidemiologi

g.

Faktor risiko (eva, daffa, ridha)

h.

Patofisiologi

i.

Patogenesis

j.

Klasifikasi

k.

Manifestasi klinis 5

l.

SKDI

m. Komplikas (emil, frila, tiara) n.

Prognosis

o.

Edukasi dan pencegahan

p.

Tatalaksana dan algoritma

q.

Indikasi rujukan

r.

Pemeriksaan tambahan dan penunjang

2. KPD a.

Algoritma Penegakan Diagnosis (ima, kak rida, daffa)

b.

Diagnosis banding

c.

Definisi

d.

Etiologi

e.

Faktor risiko (eva, frilla, tiara)

f.

Patofisiologi

g.

Klasifikasi

h.

Manifestasi klinis (malika, kak emil)

i.

Tatalaksana dan algoritma

j.

Komplikasi

k.

SKDI

Hipotesis Seorang bayi laki-laki baru lahir mengalami respiratory distress et causa mekonium aspiration syndrome

VI. Kesimpulan

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DAFTAR PUSTAKA

Manuaba IBG, Manuaba IAC, Manuaba IBGF. Hipertensi dalam kehamilan. In : Astuti NZ, Purba Dl, Handayani S, Damayanti R, editors. Pengantar kuliah obstetri. Jakarta : Penerbit Buku Kedokteran ECG; 2003. Marks, Dawn B. dkk. 2000. Biokimia Kedokteran Dasar: Sebuah Pendekatan Klinis. Diterjemahkan oleh dr. Brahm U. Pendit. Jakarta: EGC. Maurin OH. HELLP syndrome: recognition and 4. perinatal management. American Family Physician. 1999; 60(3): 829-36. Mills JS, Maguire LS, Barker MJ. Preeklampsia and eklampsia. In: The clinical anaesthesia viva book. New York: Cambridge University Press; 2002. p.118-21. Kementrian kesehatan republik Indonesia. Buku saku pelayanan kesehatan ibu di fasilitas kesehatandasar dan rujukan Saefuddin, A. 2002. Buku Panduan Praktis Pelayanan Kesehatan Maternal dan Neonatal. Jakarta : YBP-SP Cunningham FG, et al. (2014). Williams Obstetric (Ed.24). New York: McGraw-Hill. 7

Gupte, Sanjay & Wagh, Girija. (2014). Preeclampsia-Eclampsia. J Obstet Gynaecol India. 64(1):4-13. Diakses pada www.ncbi.nlm.nih.gov/pmc/articles/PMC3931898/, 12 Februari 2019. Prawirohardjo, Sarwono. (2016). Ilmu Kebidanan. Jakarta: P.T. Bina Pustaka Sarwono Prawirohardjo. Andriana R. Wanita usia 19 tahun, primigravida hamil 38 minggu dengan intrapartum eklampsia. J Medula Unila. 2015; 4(2):155-60. Kemenkes RI. Buku saku: pelayanan kesehatan ibu di fasilitas kesehatan dasar dan rujukan. Jakarta: WHO, POGI, IBI; 2013. Rachimhadhi S, Wiknjasastro T. Hipertensi dalam kehamilan. Dalam: Prawirohardjo S. Ilmu Kebidanan. Edisi ke-4. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo; 2008 Ross MG. Eclampsia [internet]. USA: Medscape; 2016 [diakses pada 5 Oktober 2016]. Tersedia dari: http://emedicine.medscape.com/article/2 53960-overview# Anggraeni, Winda, 2013. Analisis Faktor Risiko terhadap Luaran Maternal dan Perinatal pada Persalinan dengan Eklampsi. Diakses dari http://eprints.undip.ac.id/44202/3/Winda_Anggraeni_G2A009162_Bab2KTI.pdf pada 12 Februari 2019. Prawirohardjo,S. 2016. Ilmu Kebidanan. Edisi ke-4. Jakarta:PT Bina Pustaka Sarwono Prawirohardjo. Efendi, Lukas. 2013. Penanganan Terkini Preeklamsia. Diakses dari https://med.unhas.ac.id/obgin/wp-content/uploads/2016/08/PENANGANANTERKINI-PEB-EL-final.pdf pada 12 Februari 2019. Santoso, Budi Iman. 2014. Preeklampsia-Eklampsia. Diakses dari http://staff.ui.ac.id/system/files/users/budi.iman/material/preeklampsiaeklampsia. pdf pada 12 Februari 2019. Giyanto, Candra. 2015. Perbandingan Profil Hematologi pada Preeklampsia/ Eklampsia dengan Kehamilan Normotensi di Rsup dr. Kariadi Semarang. Diakses dari http://eprints.undip.ac.id/46164/3/Candra_Cahyaningtyas_Giyanto_22010111130 090_Lap.KTI_BAB_II.pdf pada 12 Februari 2019. Kementrian Kesehatan Republik Indonesia. 2013. Buku Saku Pelayanan Kesehatan Ibu. Diakses dari http://www.searo.who.int/indonesia/documents/976-602-235-265-5buku-saku-pelayanan-kesehatan-ibu.pdf?ua=1 pada 12 Februari 2019. Denantika, Oktraria., Serudji, Joserizal, dan Revilla, Gusti. Hubungan Status Gravida dan Usia Ibu terhadap Kejadian Preeklampsia di RSUP Dr. M. Djamil Padang Tahun 2012-2013. Jurnal Kesehatan Andalas: http://jurnal.fk.unand.ac.id/index.php/jka/article/ view /224. 12 februari 2019.

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