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SKENARIO C BLOK 24 TAHUN 2016

A male baby was born at type C public hospital from a 41 years old women. Her mother,
Mrs.Anita was hospitalized at the hospital due to uterine contraction. It was her third
preganncy. She forgot when her first day of last period, but she thought that her pregnancy
was about seven month. Her other children were born preterm too, about eight month. Now
they are 4 years old and 2 years old.
Four hours after admitted, she delivered her baby spontaneously. The labor procces was 30
minutes, and rupture of membran was one hour before delivery. The liquor was clear. The
baby was not cried spontaneously after birth, but grunting and his whole body was cyanosis.
Pediatricts resident who resusitate the baby did first step of resusitation to the baby. APGAR
score at first minute was 3 and fifth minute was 7.
On physical examination:
Body weight was 1350 grams, body length was 41 centimeters, and head circumference was
31 cm. The muscle tone was decreased, he was poorly flexed at the limbs, he has thin skin,
more lanugo over the body and plantar creases 1/3 anterior. At 10 minutes of age he still had
grunting and cyanosis of the whole body, respiratory rate was 86 breaths/minute, there were
epigastric retraction, breathing sound decreased. Heart rate 156 beats/minute. Saturation 85%
with nasal oxygen.
I.

Klasifikasi Istilah
No
1
2

Istilah
Lanugo
APGAR score

Klarifikasi
Rambut halus pada tubuh janin.
Sebuah metode sederhana untuk menilai kondisi
kesehatan bayi baru lahir sesaat setelah kelahiran.
Menggunakan 5 kriteria sederhana dengan skala

Grunting

nilai 0, 1, dan 2.
Suara nafas abnormal yang dalam, pendek, dan
besar sering disertai nyeri dada pada orang dewasa
sering disebabkan oleh pneumoni, edem paru, atau
patah

Preterm

tulang

rusuk

pada

disebabkan oleh atelaktasis.


Sebelum menyelesaikansatu

bayi

baru

periode

lahir
penuh;

mengacu pada kehamilan atau bayi. Suatu partus

dari hasil konsepsi yang dapat hidup tetapi belum


aterm dnegna berat janin anatara 1000-2500 gram
atau kehamilan antara 28 minggu sampai 36
5

Resusitation

minggu.
Menghidupkan

Plantar crease

tampaknya meninggal.
Tampilan kerutan atau lipatan anterior pada

kembali

seseorang

yang

telapak kaki, berhubungan dengan flexi kaki


didalam uterus dan disebababkan oleh dehidrasi
7

Epigastric retraction

kulit.
Tarikan dinding dada bagian bawah kedalam
ketika menarik nafas.

II.

Indentifikasi Masalah
1. A male baby was born at type C public hospital from a 41 years old women. Her
mother, Mrs.Anita was hospitalized at the hospital due to uterine contraction. It
was her third preganncy. She forgot when her first day of last period, but she
thought that her pregnancy was about seven month. Her other children were born
preterm too, about eight month. Now they are 4 years old and 2 years old.
2. Four hours after admitted, she delivered her baby spontaneously. The labor
procces was 30 minutes, and rupture of membran was one hour before delivery.
The liquor was clear.
3. The baby was not cried spontaneously after birth, but grunting and his
whole body was cyanosis. Pediatricts resident who resusitate the baby did
first step of resusitation to the baby. APGAR score at first minute was 3 and
fifth minute was 7.
4. On physical examination:
Body weight was 1350 grams, body length was 41 centimeters, and head
circumference was 31 cm. The muscle tone was decreased, he was poorly flexed
at the limbs, he has thin skin, more lanugo over the body and plantar creases 1/3 b
anterior. At 10 minutes of age he still had grunting and cyanosis of the whole
body, respiratory rate was 86 breaths/minute, there were epigastric retraction,
breathing sound decreased. Heart rate 156 beats/minute. Saturation 85% with
nasal oxygen.

III.

Analisis Masalah
1. A male baby was born at type C public hospital from a 41 years old women. Her
mother, Mrs.Anita was hospitalized at the hospital due to uterine contraction. It

was her third preganncy. She forgot when her first day of last period, but she
thought that her pregnancy was about seven month. Her other children were born
preterm too, about eight month. Now they are 4 years old and 2 years old.
a. Bagaimana hubungan usia, riwayat kehamilan, dan riwayat persalinan pada
kasus? (ALBA, SINTA)
b. Bagaimana cara menghitung usia kehamilan dengan menggunakan New
Ballard Score? (CIUS, SAVERO)
c. Apa hubungan riwayat anak sebelumnya yang preterm dengan kasus? ( RIDO,
WASIS)
d. Apa makna klinis dari jarak persalinan anak pertama dan anak kedua terhadap
kasus? ( AULIA, JEJE)
e. Bagaimana mekanisme terjadinya kontraksi uterine padahal usia kehamilan
masih 7 bulan? (KARISYA, ICA)
f. Apa dampak adanya kontraksi pada usia kehamilan 7 bulan? (KARISYA, ICA)
2. Four hours after admitted, she delivered her baby spontaneously. The labor
procces was 30 minutes, and rupture of membran was one hour before delivery.
The liquor was clear.
a. Apa makna klinis dari kalimat diatas? ( ALBA, SINTA)
b. apa yang dimaksud dengan KPD dan apa dampaknya? (JEJE S, NURUL)
3. The baby was not cried spontaneously after birth, but grunting and his whole
body was cyanosis. Pediatricts resident who resusitate the baby did first step of
resusitation to the baby. APGAR score at first minute was 3 and fifth minute was
7.
a. Apa makna klinis dan mekanisme dari tidak menangis spontan grunting dan
cyanosis seluruh tubuh pada kasus? (CIUS, SAVERO)
b. Apa makna klinis dari APGAR score dan apa saja yang perlu diniliai? ( RIDO,
WASIS)
c. Apa indikasi dan bagaimana cara memberi resusitasi pada bayi baru lahir?
(JEJE S, NURUL)
4. On physical examination:
Body weight was 1350 grams, body length was 41 centimeters, and head
circumference was 31 cm. The muscle tone was decreased, he was poorly flexed
at the limbs, he has thin skin, more lanugo over the body and plantar creases 1/3
anterior. At 10 minutes of age he still had grunting and cyanosis of the whole
body, respiratory rate was 86 breaths/minute, there were epigastric retraction,
breathing sound decreased. Heart rate 156 beats/minute. Saturation 85% with
nasal oxygen.

a. Apa interpretasi dan meknaisme abnormal dari pemeriksaan fisik diatas?


- Body weight was 1350 grams, body length was 41 centimeters, and head
-

circumference was 31 cm. (AULIA,JEJE)


The muscle tone was decreased, he was poorly flexed at the limbs, he has
thin skin, more lanugo over the body and plantar creases 1/3 anterior.

(KARISYA, ICA)
At 10 minutes of age he still had grunting and cyanosis of the whole
body, respiratory rate was 86 breaths/minute, there were epigastric
retraction, breathing sound decreased. Heart rate 156 beats/minute.
Saturation 85% with nasal oxygen. (ALBA, SINTA)

b. Apa saja yang perlu diperiksa pada bayi baru lahir? ( CIUS, SAVERO)
5. Analisis Aspek Klinis
a. Bagaimana cara menegakkan diagnosis pada kasus? (RIDO, WASIS)
b. Apa DD pada kasus? ( AULIA, JEJE)
c. Apa WD dari kasus dan apa definisi dari WD? ( NURUL, JEJE S)
d. Apa saja etiologi pada kasus? (ALBA, SINTA)
e. Bagaimana epidemiologi pada kasus? ( CIUS, SAVERO)
f. Apasaja faktor resiko dari kasus? ( NURUL, JEJE S)
g. Bagaimana patofisiologi dari kasus? (RIDO, WASIS)
h. Bagaimana manifestasi dari kasus? ( AULIA, JEJE)
i. Bagaimana tatalaksana pada kasus? (KARISYA ICA)
j. Bagaimana pencegahan dan edukasi pada kasus? (CIUS, SAVERO)
k. Bagaimna komplikasi pada kasus? (RIDO, WASIS)
l. Bagaimana prognosis dari kasus? (AULIA, JEJE)
m. Apa SKDI pada kasus? (NURUL, JEJE S)
IV.

V.
VI.

VII.

Hipotesis
Mrs. Anita 41 tahun, melahirkan bayi laki-laki VLBW disertai adanya respiratory
distress at causa persalinan preterm.
Kerangka Konsep
Learning Issues
1. VLBW (ALBA, SINTA, WASIS, JEJE)
2. Respiratory distress (NURUL, JEJE S, RIDO, KARISYA)
3. Persalinan preterm (CIUS,SAVERO, AULIA, ICA)
Kesimpulan