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Skenario C blok 23
A female baby was born at Moh Hoesin Hospital from a 19 years old woman. Her mother, Mrs.
Nadia, was hospitalized at Moh Hoesin Hospital due to contraction. It was her first pregnancy.
She forgot when her first day of last period, but she thought that her pregnancy was about 8
months. She said that she never had hypertension or other illness during her pregnancy. Seven
hours after admitted, she delivered her female baby spontaneously. The labor process was 20
minutes, and ruptured of membrane was three hour before delivery. The baby was not cried
spontaneously after birth, and resuscitaion was done. APGAR Score at 1 minute was 1 and 5
minute was 3, and 10 minutes was 7. One hour later the baby stil grunting, and cyanosis.
On physical examination:
Body weight was 1300 grams, body length was 40 cms, and head circumference was 30 cm. The
muscle tone was decreased, she was poorly flexed at the limbs, she has thin skin, more lanugo
over the body and plantar creases 1/3 anterior. At 10 minutes of age, she still had grunting and
cyanosis of the whole body. The respiratory rate was 68bpm, heart rate was 152bpm, and the
temperature was 36,2C. There was chest indrawing. Other physical examinations were within
normal.
As a general practitioner please analyze the problem and the management.
Klarifikasi Istilah
1.
2.
3.
4.
Identifikasi Masalah
1.
2.
3.
4.
5.
6.
Kalimat 1+2
Kal 3+4
Kal 5+6+7
Kal 8
APGAR Score+grunting and cyanosis
Physical exam
Analisis masalah
1. Kalimat 1,2
a. Hubungan usia ibu dengan kehamilan ? 1,2,3
b. Apa makna klinis dari kontraksi uterus ? 4,5,6
2. Kalimat 3+4
a. Apa hubungan antara kehamilan pertama dengan kasus ? 7,8,9
b. Bagaimana cara menghitung usia kehamilan dengan menggunakan cara HPHT ?
10,11,12
c. Bagaimana cara menghitung usia kehamilan dengan cara Selain HPHT?13,1,2
d. Bagaimana perkembangan janin 8 bulan ? 3,4,5
e. Hubungan antara kehamilan 8 bulan dengan janin yang dilahirkan pada kasus ?
6.7.8
f. Etiologi persalinan preterm ? 9,10,11
g. Faktor resiko persalinan preterm ? 12,13,1
3. Kalimat 5+6+7
a. Bagaimana makna klinis tidak ada hipertensi dan penyakit lain pada kehamilan ?2,3,4
b. Berapa lama waktu persalinan normal pada primigravida ? 5,6,7
4. Kalimat 8
a. Makna klinis dari bayi tidak menangis saat lahir 8,9,10
b. Etiologi asfiksia ? 11,12,13
c. faktor resiko asfiksia ? 1,13,9
d. patofisiologi asfiksia ? 2,12,11
e. Perubahan fisiologi sistem respirasi janin saat sebelum dan sesudah lahir ? 3,11,7
f. Cara resusitasi pada bayi baru lahir ? 4,10,8
g. Makna klinis dari kelahiran cuman 20 menit dan ketuban pecah 3 jam sebelum
kelahiran ? 5,9,10
5. APGAR Score dll
a. Bagaimana menginterpretasi APGAR Score pada kasus ini ? 6,8,12
b. Etiologi dan patofisiologi dari grunting? 7,6,13
c. Etiologi dan patofisiologi daricyanosis ? 8,7,1
d. Makna klinis satu jam kemudian masih grunting dan cyanosis ? 9,5,2
6. Pem Fisik
a. Apa interpretasi dan mekanisme abnormal dari :
- Body weight was 1300 grams, body length was 40 cms, and head circumference
was 30 cm.10,4,3
- The muscle tone was decreased, she was poorly flexed at the limbs, she has thin
skin, more lanugo over the body and plantar creases 1/3 anterior.11,3,5
- At 10 minutes of age, she still had grunting and cyanosis of the whole body. The
respiratory rate was 68bpm, heart rate was 152bpm, and the temperature was
36,2C.12,2,4
- There was chest indrawing. Other physical examinations were within
normal.13,1,6
Template
1. HTD
- BBLR 1,4,7
- Asfiksia 2,5,8
- Respiratory Distress Syndrom 3,6,9
2. DD 10,5,4
3. WD 11,1,3
4. Epidemiologi 12,8,7
5. Faktor resiko 13,9,6
6. Tata laksana 10,11,2
7. Pemeriksaan penunjang 12,13,5
8. Komplikasi 10,9,4
9. Pencegahan dan edukasi 11,8,2
10. Prognosis 3,6,7
11. SKDU 1,4,6
Hipotesis
Ibu 19 tahun G1P1A0 melahirkan bayi perempuan pretrm dengan APGAR Score 7 yg menderita
asfiksia
Learning Issue
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2.
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4.
Jawaban Mulai dikumpul dari hari SENIN tanggal 2/2/2015 pukul 20.00 sampai dengan
hari SELASA tanggal 3/2/2015 pukul 19.30
Tolong yang rapi, TIMES NEW ROMAN 12, Spasi 1,5 justify
Tolong dijawab yoo.. jangan ngacipi sekmejny... soalny hari rabu laporanny sudah harus
jadi... TOLONG NIAN YOOO....
Ivan bersedia menjadi presentan dengan syarat teman-teman semua menjawab.
Untuk pengirim terakhir, nge print + jilid laporan yaaa
Terimakasiiih