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Tiara Mangiwa
0815081
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Nama penderita : An. A
TTL : Bandung, 14 Mei 2012
Umur : 5 bulan
Kiriman dari : Masuk dari IGD
Dengan diagnosis : Bronchopneumonia duplex
Tanggal dirawat : 15 Oktober 2012
Tanggal diperiksa : 18 Oktober 2005
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Ayah
Nama : Tn. X
Umur : 30
tahun
Pendidikan : SMA
Pekerjaan :
Karyawan
swasta
Alamat : Bandung
Nama : Ny. Y
Umur : 32
tahun
Pendidikan : SMP
Pekerjaan : Ibu
rumah
tangga
Alamat : Bandung
Ibu
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Seorang bayi laki-laki, usia 5
bulan, dengan BB 5.8 kg, panjang
badan 64 cm, status gizi kurang (
78% standar BB/U menurut NCHS
WHO), dirawat di RSI dengan
keluhan utama demam dan batuk
Pada anamnesis lebih lanjut
didapatkan…
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H-3 masuk
RS
H-1 masuk
RS
Datang ke IGD
3 hari dirawat
•Demam,
Naik turun,
terutama
malam
•Kejang –
•Batuk +
dahak susah
keluar
•Pilek –
•Demam s/d ±39oC
•Kejang –
•Batuk + dahak susah
keluar
•Sesak +
•Muntah –
•Mencret +
cair, ampas+, lendir -,
darah -, ± ¼ gelas
akua
•Haus, menyusu terus
•Rewel
•Masih demam
•Kejang –
•Batuk +
•Sesak +
•Muntah –
•Mencret +
•Diberi penurun
panas
•Dipasang
oksigen
•Nebulizer 1x
•Dirawat di RSI
•Demam ↑↓
•Kejang –
•Batuk +, dahak sulit
keluar
•Sesak +, agak ↓
•Muntah + bila dahak
susah keluar
•BAB >kental, ±3-4x/hr
•Sangat haus, menyusu
terus, cepat lelah
•Lemas & menangis tidak
kuat
•Bintik-bintik putih di
lidah
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R.Alergi : Asthma -, alergi obat -,
rhinitis alergika -.
Lingkungan :
Penderita TB (+) (tetangga sebelah,
sudah pengobatan 6 bulan, dan sekarang
menjalani pengobatan ulang),
perokok (+) (ayah).
Status imunisasi : Imunisasi dasar belum
lengkap, namun sesuai jadwal,
ulangan belum dilakukan.
Tumbuh kembang : Tumbuh kembang anak
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KU : compos mentis,
KS : sakit sedang, anak terbaring,
tampak sesak dan lemas.
Menangis tidak kuat
Tanda Vital:
Nadi : 140 x/menit,
Respirasi : 69 x/menit,
Suhu : 37.4 0C (aksiler)
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Kulit : Pucat -, ikterik –, sianosis –, turgor agak lambat
Kepala : Simetris Kiri = kanan, ubun-ubuncekung. Muka lebar, dagu kecil, muka mongoloid
Rambut : botak
Mata : Fisura mata obliq. Epicanthic skin fold +/+, konjungtiva anemis -/-, sklera ikterik -/-, pupil isokor, RC +/+, Cekung +,
air mata –
Telinga : sekret (-), hiperemis (-), low set ears
Hidung : PCH +, sekret -, Flat nassal bridge +
Tenggorok: Tonsil dan faring hiperemis -
Mulut : Bibir mukosa mulut basah, sianosis-,
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Leher : Short Neck +, KGB tidak teraba membesar
Dada : bentuk dan pergerakan simetris kiri=kanan,
retraksi (+) epigastrium, subcostal, intercostal,
supraternal.
Paru : VBS +/+, ronkhi +/+ , wheezing -/-, slem +/+
Jantung : bunyi jantung murni S1S2, reguler, murmur –
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Perut : Cembung, timpani, soepel
, hepar teraba membesar
2cm di bawah arcus costa.
Konsistensi kenyal, tepi
tumpul, permukaan
rata, defense muscular -. Lien ttm
Extremitas : Tonus otot
kurang, pergerakan minimal,
akral hangat, CRT < 2 detik, Simian
line +/+
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15 Oktober 2012
Hematologi : Ht 33.4% (↓)
Foto thoraks PA : Bronkopneumonia
bilateral.
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Diagnosis Banding :
Bronkopneumonia bilateral e.c viral
infection + bakteri non spesifik
Bronkopneumonia bilateral e.c viral
infection + bakteri spesifik
Diagnosis Kerja :
Bronkopneumonia bilateral e.c viral
infection + bakteri non spesifik
Diagnosis Tambahan :
Diare cair akut + Candidosis oral + Susp.
Down’s Syndrome
Status Gizi :
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NON MEDIKAMENTOSA
O2 2 l/mnt/nasal
Nebulizer
Infus NaCL 0.45% +
Glukosa 5%
700ml/hari
Edukasi orang tua
mengenai pemberian
asi dan nutrisi yang
adekuat, serta
tumbuh kembang
Ceftriaxone i.v 1 x 300 mg
Paracetamol drop 3x0,6cc
Ambroxol syr 2 x ½cth
Nystatin 4 x 1-2 ml
Zinc 1 x ½ tablet (dilarutkan padasusu atau minumanuntuk anak)
MEDIKAMENTOSA
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• Test Mantoux
• Analisa gas darah
• Urinalisis
• Biakan jamur
Infeksi
• Feses rutin
• Clini TestDiare
• GDS
• Elektrolit
• Kadar albuminKEP
• Analisis KromosomDown’s
Syndrome
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Quo ad vitam : ad bonam
Quo ad functionam : ad bonam
Quo ad sanationam : dubia
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Umum
Hindari anak dari asap rokok dan polusi Kebersihan anak dijagaHindari kontak dengan yang sedang
sakit
Imunisasi ASINutrisi adekuat
KhususMembuat ventilasi udara yang cukup
dirumah
Memperhatikan posisi anak pada saat
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Suatu bentuk pneumonia
Peradangan saluran respiratorik bagian bawah danparenkim paru
Konsolidasi eksudatif pada bagian lobuler paru
Disebabkan oleh infeksi mikroorganisme (bakteri & virus) dan sebagian kecil disebabkan oleh penyebabnon infeksi (aspirasi, radiasi, dll)
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AGE GROUP FREQUENT PATHOGENS (IN ORDER OF FREQUENCY)
Neonates
(<1 mo)
Group B streptococcus, Escherichia coli, other gram-negative bacilli,
Streptococcus pneumoniae, Haemophilus influenzae B
1–3 mo
Febrile
pneumonia
Respiratory syncytial virus, other respiratory viruses (parainfluenza
viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae B
Afebrile
pneumonia
Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum,
cytomegalovirus
3–12 mo Respiratory syncytial virus, other respiratory viruses (parainfluenza
viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae B,
C.trachomatis, Mycoplasma pneumoniae, Streptococcus A
2–5 yr Respiratory viruses (parainfluenza viruses, influenza viruses,
adenoviruses), S. pneumoniae, H. influenzae B, M. pneumoniae, Chlamydophila
pneumoniae, S. aureus, group A streptococcus
5–18 yr M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae B, influenza
viruses, adenoviruses, other respiratory viruses
≥18 yr M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae B, influenza
viruses, adenoviruses, Legionella pneumophila
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Pertahananlower
respiratory
Mukosiliari IgA Respon Batuk Makrofag
Bronchiolus
Alveolus
Steril
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Viral invasion
Oedem Airway obstruksi
Hipoksemia
Atelektasis
Interstitial edema
Ventilation-perfusion mismatch
Perlekatan bakteri diparenkim paru
Inhibisikerja silier
Destruksisel
Respon inflamasidi submucosa
Debris seluler
PMN
MukusPenyebaran infelsi
lewat brohiol
Injuri epitel Sekresiabnormal
Debris seluler
Secondary Bacterial infection
Gangguandefense
mekanisme
Gangguansekresi
Modifying the bacterial flora
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Mikroorganismeterhisap
Masuk ke paruperifer
Respon inflamasijaringan
Edema
Proliferasi danpenyebaran
kuman ke jar. Sekitar > mudah
Paru mengalamikonsolidasi
Sebukan PMN, fibrin, eritrosit,
edema, kuman +
Stadium Hepatisasi
merah
Fibrin >>, PMN >>, proses
fagositosis cepat(hep. Kelabu)
Makrofag >>, seldegenerasi, fibrin
<, kuman dandebris <
resolusi
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Usia 5 bulan
Status imunologis down’s syndrome + ASI-
Kondisi lingkungan perokok +, tetangga TB+
Status imunisasi
Faktor host (penyakit penyerta, malnutrisi) down’s syndrome, Diare, KEP ringan, Kandidosis oral
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Anamnesis Non Respiratorik
Demam, sakit kepala, anoreksia, lemas, muntah, diare, sakit perut, distensi abdomen
Respiratorik Batuk, sakit dada
Pemeriksaan fisik Takipnea, grunting, PCH, retraksi, Ronchi Hepatomegali Hiperinflasi paru
Radiologis
Laboratorium Virus : Leukosit normal atau tinggi (<20.000), limfosit predominan Bakteri: leukositosis (15.000-40.000), neutrofil predominan
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Empiema
Perikarditis
Pneumotoraks
Pneumotokel
Meningitis bakterialis
Artritis supuratif
Osteomielitis
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Antibiotik B-laktam + klorampenikol Gentamisin, amikasin, sefa
losporin Berat: sefalosporin
generasi 3
Simtomatik Paracetamol drop 0.6cc 3x1
prn Vometa
Suportif
Cairan dan Nutrisi
Pertimbangan pemilihanobat: Jenis mikroba Berat ringan penyakit Riwayat pengobatan
sebelumnya Ada tidaknya penyakit
yang mendasari
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Trisomy 21
↑ Risk pada wanita hamil >35thn
Cognitive delayed
Learning disabilities
Perkembangan terhambat Terlambat bicara
Terlambat berjalan (2~4 thn)
Memiliki karakteristik yang khas pada wajah
Penderita D.S memiliki ukuran otakYang lebih kecil, dan struktur yangBerbeda t.u daerah hipocampus dancerebellum
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Congenital Heart Disease
Cancer
Thyroid Disorders
Gastrointestinal
Infertility
Eye & Hearing disorders
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Lingkungan
Imun ↓
Diare
BP
Oral Candidosis
Down’s syndrome
Keterlambatanperkembangan
Belum bisabalik badan
Tertawasosial -
Duduk denganbantuan -
Refleks tonus otot leher
belum simetris
ASI < 2 bl
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