Presentasi Bronkopneumonia.pptx

7/23/2019 Presentasi Bronkopneumonia.pptx

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PRESENTASI KASUS

BRONKOPNEUMONIA

Pembimbing:

dr. Rachmat Hadi Santoso, Sp.A

SMF IKA RSUD JM!A"#

U"I$%RSI&AS MUHAMMADI'AH MA(A"#

)*+

-eh :

onita Hani/

)*+0.)**+*.+++.0)



Identitas Penderita

Nama : An. Az Umur : 6 bulan 14 hari

Jeni Kelamin : !a"i#la"i

A$ama : Ilam Su"u : Ja%a

Alama& : J'mban$

MRS : ( Januari )*1+ ,am : 16.1+

N'. RM : )4#*6#(6



Anamnei

Ke-1han Utama :

• ea"

Ri2a3at Pen3a4it Se4arang :• Paien "iriman I- /en$an "eluhan ea"0 ea"

mulai 1 ,am &era"hir SMRS0 ebelumna 2aienmen$eluh 2ana ba/an mulai ab&u 11#1*#14

,am 13.**. 2aien ,u$a men$eluh u mulai ,uma&&an$$al 1*#11#14. iba%a "e bi/an /an /iberi2uer &a2i /emam &i/a" re/a. Ti/a" mau minummulai ,am 1+.** + ,am SMRS. Mual 5#0 mum&ah5#. Ba&u" mulai ,uma& /ier&ai 2ile" 1*#1*#14.

BAK &era"hir ,am 17.(*. BAB &era"hir ,am 17.(*%arna "unin$0 &i/a" lembe"



Ri%aa& 2ena"i& /ahulu

• iba%a "e bi/an &a2i belum

re/a

Ri%aa&2en$'ba&an



Ri2 #i5i

Ri2 Im1nisasi

• Ri%aa& imuniai /i Bi/an0 P'li'18 0 9e2a&i& B )8

Ri2a3at Pen3a4it

Ke-1arga :

• Ti/a" a/a an$ ba&u" /i rumah

Ri2a3at Sosia- :

• Paien meru2a"an ana" &un$$alan$ "eeharianna &in$$al

berama "e/ua 'ran$ &ua.Keberihan /ari 'ran &ua "uran



Ri2 #i5i

•Se,a" lahir u/ah /iberiASI0 uu 'rmula 5#

Ri2a3atKe-ahiran :•

Paien lahir /i bi/an ;u"u2bulan0 lahir 2'n&an B0lan$un$ menan$i

"e&uban ,ernih /en$an



Pemeri"aan <ii"

&angga- *06+6+7Stat1s #enera-is

• Kea/aan Umum : !emah

• Kea/aran : 'mn'len

• BB : 6067 "$

• PB : 6* ;m

• =i&al Si$n :

T : 1**>3* mm9$ 9R : 1)*8>m

RR : 64 8>m

Tem2 : (?@



KEPA!A:

Anemi 5#0 i"&eru 5#0 ian'i 5#0 /2nea 5.

<arin$: hi2eremia 5#0 &'nil hi2er&r' 5#0 "ri2&ae 5#0/e&ri&u 5#.

!E9ER: &a" &am2a" 2embearan K-B

T9ORAC:

I: -era" /in/in$ /a/a ime&ri0 re&ra"i 5> u2ra&ernalP: $era" /in/in$ /a/a ime&ri0 &em remi&u e/i"i&menin$"a&

P: re/u2> re/u2

A: uara naa uara naa D > D 0 rh >0 %h #>#0

1#) &un$$al re$uler murmur5# $all'2 5#



ABOMEN :

I: /i&en/e/0 maa 5#

P: 'e0 neri &e"an ne$a&i0 he2ar &i/a"

&eraba0 lien &i/a" &eraba 5#NT

P: me&e'rimu 5#0 hi&in$ /ulne 5#A: BU 5 n'rmal

ECTREMITAS :A"ral han$a&0 e/ema 5#0 @RT F ) /&"

# # #

# # #

# # #



ia$n'i

Su2e;& 2neum'nia



Pemeri"aan 5SOAP&angga- 06+6)*+7

Ke-1han: bat14 89, demam 89, sesa4 89,min1m asi men1r1n, !AK 89, !A! 89 ampas89

Stat1s #enera-is

• Kea/aan Umum : !emah

• Kea/aran : 'mn'len

• BB : 6067 "$

•

=i&al Si$n : T: 1**>3* mm9$

9R: 1)*8>m

RR: 64 8>m

Tem2: (? @



KEPA!A:

Anemi 5#0 i"&eru 5#0 ian'i 5#0 /2nea 5.

<arin$: hi2eremia 5#0 &'nil hi2er&r' 5#0 "ri2&ae 5#0/e&ri&u 5#.

!E9ER: &a" &am2a" 2embearan K-B

T9ORAC:

I: -era" /in/in$ /a/a ime&ri0 re&ra"i 5>u2ra&ernal

P: $era" /i/n/in$ /a/a ime&ri &em remi&ue/i"i& menin$"a&

P: re/u2> re/u2

A: uara naa uara naa D > D 0 rh >0 %h #>#0

1#) &un$$al re$uler murmur5# $all'2 5#



ABOMEN :

I: /i&en/e/0 maa 5#

P: 'e0 neri &e"an ne$a&i0 he2ar &i/a"&eraba0 lien &i/a" &eraba 5#NT

P: me&e'rimu 5#0 hi&in$ /ulne 5#

A: BU 5 n'rmal

ECTREMITAS :

A"ral han$a&0 e/ema 5#0 @RT F ) /&"

# # #

# # #

# # #



Pemeri4saanPen1n;ang

! : 9b: 110 6 $>/!

!eu"'i& : 14.***>;mm

9ema&'"ri& : ((0 4 G

Eri&r'i& : 4.43*. ***

Tr'mb'i& : 4?1.***>;mm



<'&' T'ra"

<'&' &h'ra8 : @'r : n'rmal

Pulm' : &am2a" ber;a"#ber;a" inl&ra&2arahilu "anan#"iri

Kean : Br'n;h'2neum'nia



ia$n'i

2neum'nia



Plannin$ Tera2i

O"i$en "anul ) li&er2ermeni&

1* H NS )+* ;;>)4 ,am

=i;;ilin 8 (8)+*

Mei8am (8)+*

Pre; (8 3 ;;

Nebulizeru;&i'n ;'mbien&>2ulmi;'r& )81am2elan$ elin$

ASI a&au uu 'rmula



Reume

Paien "iriman I- /en$an "eluhan ea"0 ea" mulai) hari SMRS0 ebelumna 2aien men$eluh 2anaba/an mulai ab&u 1#1#1+ ,am 11.** 5( hari ini. 2aien

,u$a men$eluh ba&u" /an 2ile" mulai ,uma& &an$$al (1#1)#14 5 4 hari ini. iba%a "e /r. S'e%ari0 S2.A /an/iberi 2uer &a2i /emam &i/a" re/a. BAB lebih erin$/ari biaana0 am2a 5 e,a" &an$$al )#1#)*1+ 5) hariini0 Mual 5#0 mun&ah 5#. BAK &era"hir ,am 16.**. BAB

&era"hir ,am 14.** %arna "unin$0 lembe". Pemeri"aani" /i/a2a&"an uara 2a/a naa menurun /an/i/a2a&"an r'n"hi 2a/a "e/ua la2an$ 2aru. Tam2a"ber;a"#ber;a" inl&ra& 2arahilu "anan#"iri.



ia$n'i

Pneum'nia

: Br'n;hi'li&i

Ama br'n;hiale



Plannin$ Tera2i

O"i$en "anul ) li&er2ermeni&

1* H NS )+* ;;>)4 ,am

=i;;ilin 8 (8)+*

Mei8am (8)+*

Pre; (8 3 ;;

Nebulizeru;&i'n ;'mbien&>2ulmi;'r&)81am2 elan$ elin$

ASI a&au uu 'rmula



M'ni&'rin$

Kea/aan umum /an i&al i$n

ea"

Keluhan P8



E/u"ai

• Pen,elaan "e2a/a "eluar$a &en&an$ "'n/ii /an 2ena"i&Paien

• Men,ela"an ma;am#ma;am 'ba& an$ /iberi"an /anee"na

•

Ji"a u/ah "eluar RS : "'n&r'l ru&in /i 2'li ana"• Pen,elaan &en&an$ 2en&in$na /an ba$una ASI e""lui

/iban/in$"an uu 'rmula

• Menaran"an a$ar elalu ru&in menimban$ bera& ba/ane&ia2 bulanna /i 2'an/u &er/e"a& un&u" men$e&ahui

&umbuh "emban$ ana"• Imuniai ana" euai ,a/%al an$ /i&en&u"an

• 9in/ar"an ana" /ari lin$"un$an an$ &er;emar 5aa2 r'"'"/ll



Per"emban$an harian*(#*1#)*1+ *4#*1#)*1+

S Ba&u" 5 ber/aha"Sea" 5 emam 50 mual 5#0

mun&ah 5#0 BAK 5 0 BAB5 am2a5

Ba&u" 5 ber/aha"Sea" 5 emam 50 mual 5#0

mun&ah 5#0 BAK 5 0 BAB5 am2a5

O KU: ;u"u29R: 1)*8>mn&0 RR: 648>mn&0 &: (?@Ke2ala: A>I>@> #>#>#>

Th'ra8: ime&ri0re&ra"i 5u2ra&ernalPulm' : rh'n"i 5>0%hezin$ #># @'r:

S1S) &un$$al0 m5#0 $5#Ab/'men

In2e"i : a&0 re&ra"ie2i$a&rium 5#0 biin$ uu 5n'rmal0 &im2ani

E"&remi&a : a"ral han$a&

KU: ;u"u29R: 1)48>mn&0 RR: +78>mn&0 &: (70+@Ke2ala: A>I>@> #>#>#>

Th'ra8: ime&ri0 re&ra"i 5u2ra&renalPulm' : rh'n"i 5>0 @'r: /bn

Ab/'menIn2e"i : a&0 re&ra"ie2i$a&rium 5#0 biin$ uu 5n'rmal0 &im2ani


A Su2e;& br'n"'2neum'nia

Oberai ebri hari "e/ua

2neum'nia

P O) naal )l2mInu + H NS )+*;;>)4,In, i;;ilin 8 (8 )+*m$Nebulizeru;&i'n;'mbien&>2ulmi;'r& )81am2 elan$elin$Mei8am (8 )+*

Pre8 (83 ;; 5K>PAi > Pai

O) naal )l2mInu + H NS )+*;;>)4,In, i;;ilin 8 (8 )+*m$Nebulizeru;&i'n;'mbien&>2ulmi;'r& )81am2 elan$elin$Mei8am (8)+*

Pre8 (83 ;; 5K>PAi > Pai



*+#*1#)*1+ 6#1#)*1+

S Ba&u" 5 ber/aha"Sea" menurun0 emam5#0 mual5#0 mun&ah 5#0 BAK 50BAB5am2a 5

Ba&u" ber"uran$0 ea" 5#0/emam5#0 mual5#0 mun&ah 5#0 BAK50 BAB 5am2a 5

O KU: ;u"u29R: 1)*8>mn&0 RR: +)8>mn&0 &:(30+@Ke2ala: A>I>@> #>#>#>#

Th'ra8: ime&ri0re&ra"i 5#

Pulm' : rh'n"i 5#>#0%hezin$ #>#@'r: S1S) &un$$al0 m5#0 $5#Ab/'men

In2e"i : a&0 re&ra"ie2i$a&rium 5#0 biin$ uu50 &im2ani


KU: ;u"u29R: 1)*8>mn&0 RR: 468>mn&0 &:(3@Ke2ala: A>I>@> #>#>#>#

Th'ra8: ime&ri0re&ra"i 5#

Pulm' : rh'n"i 5#>#0%hezin$ #># @'r:S1S) &un$$al0 m5#0 $5#Ab/'men

In2e"i : a&0 re&ra"ie2i$a&rium 5#0 biin$ uu 5n'rmal0 &im2ani


A Pneum'nia 2nem'niaP Inu + H NS )+* ;;>)4,

In, i;;ilin 8 (8 )+*m$Mei8am (8)+*Pre8 (83 ;; 5S&'2Ai > Pai

Inu + H NS 1**;;>)4,In, i;;ilin 8 (8 )+*m$Mei8am (8 )+*Pre8 (83 ;; 5&'2Ai > Pai



PNEUMONIA



enii 2neum'nia

Pera/an$an 2a/a /aerah br'n"u /an/aerah 2aren"im 2aru

Ini/en 2neum'nia 2a/a ana" F+&ha/alah )#4 "au>1**ana">&hn

Pneum'nia in ;hil/ren u2/a&e:

)*11

Pe/'man 22elaanan IAI :)*1*



E&i'l'$i 2neum'nia5erin$$ir1s

Respiratory Syncytial Virus Inuenza A a&au B Parainuenza 10) /an ( A/en'iru Rin'iru. M'rbili

!a4teri S&re2&'"'" 2neum'niae 9em'lu inuenzae

S&al'"'" aureu S&re2&'"'" $ru2 B Mi"'2lama 2neum'nia

Klami/ia &ra"'ma&i Klami/ia 2neum'niae



E&i'l'$i 2neum'nia5,aran$

$ir1s

$arise-a65oster <orona=ir1s SARS Param3>o=ir1s SARS %ntero=ir1s 8co>sac4ie ? echo <3tomega-o=ir1s Herpes simp-e4s, d--

!a4teri Anaerob 8S mi-eri,

peptostrepto4o4 K-ebsie-a pne1monae %.4o-i "eiseria meningitidis (egione-a Pse1domonas spp (eptospira, d--

F1ng1s

Histop-asma 4aps1-at1m, d--

!-astomises dermatitidis



( 2enebab &ererin$ : S&re2&';';;u Pneum'nia

9. Inuenza

S&a2hl';';;u aureu

Mar/,ani Sai/0 )**1



E&i'l'$i 2neum'nia5uia F ( bulan

Strepto4o4 gr1p !

Sta@-o4o4 a1re1s

K-amidia tra4omatis

!a4teri #ram negati/



E&i'l'$i 2neum'nia5uia ( bulan # + &ahun

Sering S. 2neum'niae

9. inuenzae Jarang S. aureu

S&re2&'"'" $ru2A



E&i'l'$i 2neum'nia5uia + &ahun

Mi"'2lama 2neum'niae

Klami/ia 2neum'niae S 2neum'niae 9 inuenzae an lain#lain



K!ASI<IKASI PNEUMONIA BERASARKAN !OKASI Pneum'nia l'bari "'n'li/ai men$enai 1 lubu > l'bu#l'bu

2aru

Pneum'nia l'bulari>br'n;h'2neum'ni ine"i a"u& an$ men$enai ,arin$an 2aru#2aru5ale'li beramaan /en$an 2r'e ine"i a"u&

2a/a br'n"umeru2a"an "'n'li/ai ber;a" $ ber2ua& /ie"i&ar br'n;hu $ men$alami 2era/an$an

mul&i'"al /an biaana bila&eral

PATO<ISIO!O-I PNEUMONIA



PATO<ISIO!O-I PNEUMONIA

•A/ana 2ena"i&2ener&a an$ bera&

•

Tin/a"an be/ah•Pemberianan&ibi'&i"a

•Oba& a&au &in/a"aninaie 2a/a

aluran 2ernaaan•Paai ba"&eri2en;ernaan "e2aru

•Penebaran

hema&'$en



Pneum'nia

Ringan

• Ba&u" /an"euli&an

bernaa – Naa ;e2a&:

– Umur )bln#11bln+*8>mn&

– Umur 1&hn#+&hn4*8>mn&

!erat

• Ba&u" a&au "euli&an bernaa /i&ambah

minimal alah a&u:

– Ke2ala &eran$$u"#an$$u"

– Pernaaan ;u2in$hi/un$

– Tari"an /in/in$ /a/aba$ian ba%ah "e

/alam – <'&' /a/a $ambaran

2nem'nia 5inl&ra&lua



Manie&ai "lini

Naa ;e2a& Umur F)bln : 6*8>mn& Umur )#11bln : +*8>mn& Umur 1#+&hn : 4*8>mn&

Suara merin&ih Pa/a au"ul&ai &er/en$ar r'n"hi alam "ea/aan bera& /a2a& /i,um2ai

Ti/a" /a2a& menuu a&au ma"an>

memun&ah"an emuana Ke,an$0 le&ar$i a&au &i/a" a/ar Sian'i



Pemeri"aan Penun,an$o Ra/i'l'$i :

biaana $ambaran /iu bila&eral /en$an2enin$"a&an ;'ra"an br'n"'a"ular /aninl&ra& "e;il &erebar /i la2an$ 2aru

o !ab'ra&'rium :

!e"'i&'i Line"i iru le"'i& n'rmal a&aumenin$"a& 5&i/a" melebihi )**** mm/en$an lim'i& 2re/'minan

Analia $a /arah biaana menun,u""an

hi2'"emia0 hi2er"arbia0 2a/a &a/ium lan,u&/a2a& ai/'i re2ira&'ri"



In/i"ai MRSa. A/a "eu"aran bernaa0 &'"i

b. Sian'i

;. Umur "uran$ 6 bulan

/. A/a 2enuli&0 mialna : mun&ah#mun&ah0 /ehi/rai0 em2iema

e. i/u$a ine"i 'leh S&a2hl';';;u

. Imun'"'m2r'mi

$. Pera%a&an /i rumah "uran$ bai"

h. Ti/a" re2'n /en$an 2emberian an&ib'i&i" 'ral.



Pena&ala"anaan

O"i$enai : 2aien &am2a" ea"

Pa/a 2nem'nia bera& a&au au2an 'ral "uran$0/iberi"an ;airan in&raena

Pemberian an&ibi'&i" Ne'na&u#)bln :am2iilin $en&amiin

)bln: lini 2er&ama am2iilin 1**m$>"$>hari0 bila /alam( hari &i/a" a/a 2erbai"an /i&ambah"an "l'rameni"'l

1**m$>"$>hari0 lini "e/ua ;e&ria8'n +*m$>"$>"ali /'i&un$$al ma8 )$ram

Nu&rii Pa/a /i&re naa bera&0 in&a"e 'ral /ihin/ari. Ma"anan

/a2a& /iberi"an melalui N-T

&em1an 4-inis Pembahasan



Ana" Az0 6 bulan 14 hari0Paien "iriman I- /en$an"eluhan ea" e,a" ) hariSMRS.0 2ana ba/an mulai

ab&u *1#*1#1+ ,am 11.**.2aien ba&u" /an 2ile" mulai ,uma& &an$$al (1#1)#14. iberi2uer &a2i /emam &i/a" re/a.BAB lebih erin$ /ari biaana0am2a e,a" &an$$al )#1#

)*1+. Mual 5#0 mum&ah 5#.BAK &era"hir ,am 16.**. BAB&era"hir ,am 14.** %arna"unin$0 lembe".Pemeri"aan i" /i/a2a&"anuara 2a/a naa menurun /an

/i/a2a&"an r'n"hi 2a/a "e/uala2an$ 2aru.

Pneum'nia /i"lai"ai"anber/aar"an uia0 /imana 2a/a "auini &ermau" /alam "lai"ai2neu'm'ni ( bulan # + &ahun. Kuman

2a&'$en mau" "e/alam &ra"hea0 /i/alam &ra"hea "uman ebenarnau/ah /iha/an$ *leh ( me"anime2er&ahanan &ubuh0 ai&u 2er&ahananme"ani"5e2i&el /an ilia /an "e&i"a /ibr'"n"u /i la%an 'leh 0 re2'n imun

elular /an hum'ral0 /i /alambr'n"u /an /aerah &erminalbr'n"i'lu inilah mere"aber"'l'niai0 &er,a/i 2erla%anan /arii&em imun &ubuh an$ meran$an$me/ia&'r inamai0 ehin$$a &er,a/i

"era/an$an /i /aerah br'n"u0"eran$an &erebu& meran$an$&er,a/ina ba&u" /an 22enin$"a&ane"rei ;airan mu"u / br'n"uehin$$a &er,a/i r'n"hi. K'l'niai&erebu& ,u$a meneba"an &er,a/ina

"'n'li/ai 52en$eraan 2a/a2aren"im ehin$$a uara naa



!eu"'i&'iRO: inl&ra& /i 2arahilu /e"&raini&ra

9al ini euai /en$an &e'ri/imana 2enebab /aribr'n"'22neum'nia a/alah "uman0 ba"&eri0 "e&i"a &er,a/i ine"iba"&eri ma"a ma"r'a$ /animuni&a &ubuh an$ lainmenin$"a& menu,u /aerah an$&erine"i melalui /arah0 ehin$$a"e&i"a /i2eri"a /arahna &er,a/i2enin$"a&an leu"'i&Inl&ra& /i /aerah 2arahilu "anan/an "iri meru2a"an $ambaran"ha ra/i'l'$i /aribr'n"'neum'nia



Keim2ulan

Ana" Az0 6 bulan 14 hari0 /en$an "eluhan ea"e,a" ) hari SMRS0 2ana ba/an mulai ab&u 1#1#1+ ,am 11.**. 2aien ba&u" /an 2ile" mulai ,uma&

&an$$al (1#1)#14. iberi 2uer &a2i /emam &i/a"re/a. BAB lebih erin$ /ari biaana0 am2a e,a"&an$$al )#1#)*1+0 . Mual 5#0 mum&ah 5#. BAK&era"hir ,am 16.**. BAB &era"hir ,am 14.** %arna"unin$0 lembe". Pemeri"aan i" /i/a2a&"an uara

2a/a naa menurun /an /i/a2a&"an r'n"hi 2a/a"e/ua la2an$ 2aru. Tam2a" ber;a"#ber;a" inl&ra&2arahilu "anan#"iri. ari i&u /i&ari" ua&u/ia$n'i ai&u 2neum'nia.



A/a2un /ia$n'i ban/in$ a/alah a&hmabr'n"iale /an br'n"i'li&i.

Pena&ala"anaanna eba$ai beri"u& O) naal

)l2m0 Inu + H NS 1**;;>)4,0 In, i;;ilin 8 (8)+*m$0 in, Mei8am (8 )+*m$0Nebulizeru;&i'n ;'mbien&>2ulmi;'r&)81am2 elan$ elin$0 Pre8 (83;; 5bila/emam.

M'ni&'rin$ 2a/a 2aien ini a/alah Kea/aanumum /an i&al i$n ea"0 Keluhan Paien0

er&a ee" am2in$ /ari 2en$'ba&an



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