Skenario D Blok 24 Kelompok 7.docx

SKENARIO D BLOK 24 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 ruptured 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 hypertension during the last trimester of pregnancy. 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 1st minute and 2 for 5th minutes and 5 at 10th minute. The baby had difficulty while breathing, and had grunting. The midwife then referred him to Moh Hoesin Hospital. Physical examination revealed body weight was 2300 gram. Body length 48 cm, head circumference 34 cm. His temperature was 36oC. He looked hypoactive and tachypnoe, RR 73 breath perminute, there was chest indrawing, grunting could be heard using stethoscope, breathing sound was normal, he still looked cyanotic even after been giving nasal oxyen. Sucking reflex was weak. HR 174 beats per minute. Abdomen was tender with normal bowel sound. There were meconeunum staining at umbilical cord and skin. Other examination within normal. I. Klarifikasi istilah No. 1. 2. 3. 4.

5.

6. 7.

Isitilah Klarifikasi Primigravida Kehamilan pertama kali Premature of membrane Ketuban Pecah Dini. Pecahnya ketuban sebelum tanda-tanda ruptured inpartu Hypertension during Peningkatan tekanan darah >140/90 mmHg yang terjadi saat pregnancy usia kehamilan lebih dari 20 minggu. Apgar score Metode yang digunakan untuk menilai kondisi kesehatan bayi pada usia 1 menit dan 5 menit setelah kelahiranya berupa penilaian: A: Appearance/warna kulit P: Pulse/Denyut Jantung G: Grimace/ Reflek gerakan A: Activity/ aktivitas otot R: Respiration/Pernapasan Hypoactive Penurunan abnormal aktivitas motorik dan kognitif ditandai dengan melambatnya pemikiran, pembicaraan, dan pergerakan. Tachypnoe Frekuensi pernapasan yang lebih dari 60x/menit (pada neonates) Chest indrawing Tarikan dinding dada bagian bawah ke dalam (retraksi dada) ketika bayi bernapas dan merupakan tanda dari respiratory distress

8.

Grunting

9

Cyanotic

10.

Meconeum

11.

Umbilical cord

Bunyi pernapasan abnormal saat ekspirasi yang menunjukkan bahwa glottis telah menutup aliran udara dari paru terdengar seperti merintih. Perubahan warna kulit dan membrane mukosa menjadi kebiruan akibat konsentrasi hemoglobin tereduksi yang berlebihan dalam darah Bahan berlendir yang berwarna hijau tua di dalam usus bayi cukup bulan Struktur yang menghubungkan janin dan plasenta, dan berisi pembuluh darah yang mengalirkan darah janin ke plasenta dan sebaliknya.

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 ruptured of membrane since 4 days ago. The liquor was thick, smelly and greenish. 2. She had fever since one day before delivery. She also had history of hypertension during the last trimester of pregnancy. The pregnancy was full term, 39 weeks. The baby was not cried spontaneously after birth. 3. 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 1st minute and 2 for 5th minutes and 5 at 10th minute. The baby had difficulty while breathing, and had grunting. The midwife then referred him to Moh Hoesin Hospital. 4. Physical examination revealed body weight was 2300 gram. Body length 48 cm, head circumference 34 cm. His temperature was 36oC, RR 72 breath perminute, HR 174 beats per minute 5. He looked hypoactive and tachypnoe, there was chest indrawing, grunting could be heard using stethoscope, breathing sound was normal, he still looked cyanotic even after been giving nasal oxyen. Sucking reflex was weak. Abdomen was tender with normal bowel sound. There were meconeum staining at umbilical cord and skin. Other examination within normal. II. 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 ruptured of membrane since 4 days ago. The liquor was thick, smelly and greenish. a. Apa makna klinis dari kalimat di atas? KAK ENOT, DIBYO b. Apa hubungan usia ibu dan primigravida dengan keluhan pada kasus? ZIANA, RIZKA c. Apa kemungkinan penyebab ketuban pecah dini pada kasus? RIZKA, JURGEN

d. Apa kemungkinan penyebab cairan amnion kental, berbau, dan berwarna kehijauan? AYU JURGEN e. Bagaimana mekanisme Ketuban Pecah Dini? ULLY, DESTI f. Bagaimana mekanisme cairan amnion kental, berbau, dan berwarna kehijauan? AYU, JURGEN g. Apa dampak KPD dan cairan amnion kental, berbau, dan berwarna kehijauan terhadap ibu dan bayi? MEL, DESTI h. Bagaimana tatalaksana awal ketuban pecah dini pada kasus?ZIANA ULLY 2. She had fever since one day before delivery. She also had history of hypertension during the last trimester of pregnancy. The pregnancy was full term, 39 weeks. The baby was not cried spontaneously after birth. a. Apa makna klinis dari kalimat di atas? DESI, DESTI b. Apa kemungkinan penyebab bayi tidak menangis secara spontan setelah dilahirkan? ZIANA, RIZKA c. Apa hubungan hipertensi dengan keluhan pada kasus? RIZKA, AYU d. Bagaimana karakteristik bayi lahir normal dan sehat? MEL DESI e. Bagaimana mekanisme bayi tidak menangis spontan saat dilahirkan pada kasus? KAK ENOT, DIBYO f. Apa dampak bayi tidak menangis spontan saat dilahirkan? DIBYO DESI 3. 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 1st minute and 2 for 5th minutes and 5 at 10th minute. The baby had difficulty while breathing, and had grunting. The midwife then referred him to Moh Hoesin Hospital. a. Apa makna klinis dari kalimat di atas? MEL ULLY b. Apa indikasi dan kontraindikasi dilakukannya manual suction and patting baby’s feet? DESTI ULLY c. Bagaimana cara melakukan manual suction and patting baby’s feet? KAK ENOT, DIBYO d. Apa saja kriteria Apgar score, nilai normalnya, dan bagaimana cara menghitungnya? DESI, AYU e. Kapan dilakukannya penilaian Apgar score? MEL DESTI f. Bagaimana mekanisme kesulitan bernapas dan grunting pada kasus? ZIANA, RIZKA g. Bagaimana tatalaksana awal untuk bayi pada kasus oleh dokter umum? RESUSITASI NEONATUS ULLY, MEL 4. Physical examination revealed body weight was 2300 gram. Body length 48 cm, head circumference 34 cm. His temperature was 36oC, RR 72 breath per minute, HR 174 beats per minute

a. Bagaimana interpretasi dari hasil pemeriksaan fisik umum di atas? DESI, AYU b. Bagaimana mekanisme abnormal dari hasil pemeriksaan fisik umum di atas? MEL DIBYO c. Bagaimana klasifikasi berat bayi terhadap usia kehamilan? DESTI 5. He looked hypoactive and tachypnoe, there was chest indrawing, grunting could be heard using stethoscope, breathing sound was normal, he still looked cyanotic even after been giving nasal oxygen. Sucking reflex was weak. Abdomen was tender with normal bowel sound. There were meconeum staining at umbilical cord and skin. Other examination within normal. a. Bagaimana interpretasi dari hasil pemeriksaan fisik spesifik di atas? ULLY DESI b. Bagaimana mekanisme abnormal dari hasil pemeriksaan fisik spesifik di atas? KAK ENOT, RIZKA c. Apa makna ditemukan meconeum pada kasus? AYU, KAK MEL d. Apa dampak ditemukan meconeum pada bayi? DIBYO, JURGEN III. Hipotesis Bayi laki-laki baru lahir diduga mengalami Respiratory Distress Syndrome et causa Bronchopneumonia. DD: aspirasi meconeum Pem. Penunjang: rontgen, CBC, IT ratio, bilirubin, CRP, LED, Pro-calcitonin, Kimia darah: Gula darah, analisis gas darah (gangguan asam basa?), Lumbal pungsi, Mikroblogi: kultur bakteri dari darah bayi Tatalaksana:     

Diinkubator (rentan hipotensi) Vitamin K Oksigen Harus puasa  infuse (tidak boleh menyusui) Antibiotik empiris (cari kemungkinan bakteri penyebab sesak)

Komplikasi: Prognosis: imunitas rendah!!!! SKDI: 3B

Learning Issue:

1. Anatomi dan Fisiologi Sistem respirasi pada neonates DESI, RIZKA, MEL 2. Respiratory Distress Syndrome ATAU ASFIKSIA PERINATAL (CARILAH SESUAI KASUS) KARENO DAK YAKIN!!!! a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q.

Pemeriksaan Penunjang DESI, AYU, DIBYO, DESTI Diagnosis Banding Algoritma Penegakan Diagnosis Diagnosis kerja Definisi Epidemiologi Etiologi ZIANA, RIZKA, JURGEN Faktor Risiko Patogenesis Patofisiologi Klasifikasi Manifestasi klinis KAK ENOT, ULLY, KAK MEL Tatalaksana Komplikasi Prognosis Edukasi dan Pencegahan SKDI

3. Ketuban Pecah Dini ZIANA, ULLY, DESTI 4. BBLR KAK ENOT, DIBYO 5. Infeksi pada Neonatus AYU, JURGEN

a.