farmasi - case study
DESCRIPTION
asuhan kefarmasianTRANSCRIPT
LEMBAR PENGUMPUL DATA
N RM :
Nama : Ny Kasturi ( p )
Umur : 57 Tahun
TGL
RAW
AT
ANAMNESA
DIAGNOSAP.
LABORATORIUM
P.
PENUNJANGTERAPI OBATKELUH
AN,DLL
TD
(mm
H)
SB
(oC)
NADI
(x/Mnt
)
08/08/
2014
Perut
sebah
pada
bagian
kanan
atas,maki
n lama
makin
membesa
r. Mata
berwarna
kuning
Utama :
- Cholangiocarcinoma
Sekunder :
- Hipoalbuminemia
- Hiponatremia
- Hipokalemia
- Hepatomegali
- icterus obstructif.
Hemoglobin= 11,4
Hematokrit = 32,1
Eritrosit = 4,3
MCH = 26,8
MCV = 75,4
MCHC = 35,5
Leukosit = 5,2
Trombosit = 105
RDW = 18,9
Albumin = 2,6
Ureum = 13
Kreatinin = 0,34
Natrium = 139
Kalium = 3
hasil foto
rontgen
abdomen
didapatkan hasil
curiga efusi
pleura kanan
dengan ascites
Paracetamol tablet
Ranitidin tablet
vitamin B complex
Klorida =104
Gula darah = 77
09/08/
2014
90/60 37 68 20 Infus NaCl 16 Tpm
diet lunak 1700
kkal
11/08/
2014
100/9
0
37 72 18 Infus NaCl 16 Tpm
diet lunak 1700
kkal
Injeksi tramadol
100 mg p.r.n.
12/08/
2014
100/6
0
375 80 18
15/08/
2014
100/6
0
- 76 18 infus NaCl 16 Tpm
diet Lunak 1700
kkal
Injeksi tramadol
100 mg p.r.n.
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
16/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
Dulcolax 5 mg/ 2
tab malam
17/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
Injeksi tramadol
100 mg p.r.n.
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
Dulcolax 5 mg/ 2
tab malam
Transfusi PRC
18/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg / 12 jam
infus EAS 200 cc /
24 jam
Dulcolax 5 mg / 2
tab malam
19/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg / 12 jam
infus EAS 200cc /
24 jam
Dulcolax 5 mg / 2
tab malam
20/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
Dulcolax 5 mg/ 2
tab malam
21/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
Dulcolax 5 mg/ 2
tab malam
22/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
Dulcolax 5 mg/ 2
tab malam
27/08/
2014
Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
KCL 500 mg tab /
8 jam
28/08/ 110/7 36,8 88 20
2014 0
29/08/
2014
120/8
0
36,5 84 18
30/08/
2014
KCL 32,4 Meq
01/09/
2014
110/7
0
afeb
ris
76 18 Infus NaCl 16 Tpm
diet lunak 1700
kkal
Ursodheoxylat
colic acid
250mg/12jam
injeksi omeperazol
40 mg/ 12 jam
infus EAS
200cc/24 jam
infus aminofusin
500 ml
NaCl 500mg
Kapsul / 8jam
02/09/
2014
Spironolacton
100mg tablet /24
jam
lansoprazol 30mg/
12 jam PO
Omeprazol 40 mg/
12 jam IV
UDCA 250 mg/ 12
jam PO
03/09/
2014
spironolacton
100mg tablet /24
jam
04/09/
2014
Spironolacton
100mg tablet /24
jam
lansoprazol 30mg/
12 jam PO
Gentamisin 80
mg/12 jam IV
UDCA 250 mg/ 12
jam PO
Cefotaxim 1 g/8
jam IV
05/09/
2014
Spironolacton
100mg tablet /24
jam
lansoprazol 30mg/
12 jam PO
Gentamisin 80
mg/12 jam IV
UDCA 250 mg/ 12
jam PO
Cefotaxim 1 g/8
jam IV