Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
79Activity
0 of .
Results for:
No results containing your search query
P. 1
Gagal jantung Kongestif karena PJK

Gagal jantung Kongestif karena PJK

Ratings: (0)|Views: 2,858|Likes:
Published by marini

More info:

Published by: marini on Feb 27, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as TXT, PDF, TXT or read online from Scribd
See more
See less

06/15/2013

pdf

text

original

 
SKENARIOMr. SB 52 years old man admitted to hospital with the main complaint ofchest pain and shortness of breath since yesterday.2 months ago patient felt pain on his left chest. Since a month ago, heoften felt fatique and nausea. And 2 weeks ago, he felt very tired and slept insemi-fowler’s position. Then he visited a doctor, and was given medicine for gastric complaint.Past medical history: hypertension, smoking, family history of CAD (+).Physical exam :Orthopnoe, Ht 160 cm, Bw 80 kg, BP 100/60 mmhg, HR 124 bpm.RR 24x/m.PR 124 bpm,regular,unequal. RR 24x/mPale, JVP 5+2 mmHg, basal rales (+), wheezing (+), liver palpable 3 fingers below the arcus costae, and minimal ankle edema.Laboratory results :Hemoglobin : 14 g/dl, wbc: 6000./mm3, diff count : 0/2/10/60/22/6, ESR 20/mm3,Platelete : 200000/ m3.Total cholesterol 297 mg%, triglyceride 240 mg%.Blood glucose 265 mg%, glucose urine (++). Sediment : normal findings.SGOT 52 U/L, SGPT 43 U/L, total bilirubin 2,1 mg/dl.CK NAC 190 U/L, CK MB 25 U/L, Troponin 0,1 ng/ml.Chest X- ray :CTR > 50 %, signs of cephalization.ECG : Sinus rhytm, left axis 124 x/m, QS pattern in V1-4 with ST elevation, LV strain.Echo : Anteroseptal segment hypokinetic < normal value: , normal general wall motion >,normal valves, ejection fraction 35 % < normal value > 45%>, and thrombus attached to LV apex.I.TERM CLARIFICATION1.Chest Pain→ Rasa nyeri/ rasa tercekik/ rasa tidak nyaman di daerah retrosternal yang berat, dapat terjadi pada saat aktivitas fisik maupun istirahat.2.Shortness of breath→ Napas yang pendek.3.Gastric complaint
 
→ Keluhan rasa tidak nyaman pada daerah lambung.4.CAD→ Penyakit yang terjadi sebagai respon iskemik miokard akibat penyempitan arteria koronaria yang bersifat permanent atau sementara.5.Orthopnea→ Sesak napas yang dirasakan pada posisi berbaring dan hilang ketika duduk/ setengah duduk dan diganjal bantal.6.Semi fowler position : patient placed in semi up-right sitting position( patient head elevated 30- 45 degrees) and may have knees either bent/ straight7.Basal rales→ Ronchi basah, suara berisik dan terputus akibat aliran udara yang melewati cairan. Rales belum terdengar apabila transudasi terjadi di dalam rongga interstitial bukan ke dalam alveoli. Apabila transudasi ke dalam alveoli, rales terdengarmula- mula pada basal paru yang kemudian menyeluruh (meluas).8.Wheezing→ Ronchi kering yang tinggi nadanya dan panjang yang terdengar pada serangan asma. Wheezing yang terjadi akibat gagal jantung kiri dinamakan asma kardial. Biasanya pada umur > 40 tahun.→ Bunyi kontinu yang termasuk suara bersiul dengan nada tinggi, dianggap akibatudara yang mengalir melalui jalan napas yang sempit9.JVP (Jugularis Vein Pressure)→ Tekanan yang teraba pada vena jugularis.10.CTR (Cardiac-Thorax Ratio)→ Perbandingan panjang jantung dan panjang thorax.11.CephalizationSuatu keadaan yang menunjukan suatu kongesti vaskuler.12.Minimal ankle edema : an abnormal excess the accumulation of serous fluid in connective tisue13.Total bilirubin: reddish yellow pigment that accour specially in bile and blood and causes jaundice if accumulated in axcess14.CK NAC : Reagent hit for direct quantative determination of creatin kinase in human serum and plasma15.CK MB : Tested in persons who have chost pain to diagnose the heart attack16.Troponin : protein muscle that together with tropomyosin farma regulatory protein complex controlling17.Sinus rhytmRitme jantung normal yang berasal dari nodus sino-atrial18.LV strain : Pembesaran pada left ventricle yang disebabkan oleh kerja yang berlebihan.19.ECGa.pencatatan grafis pada potensial listrik yang ditimbulkan jantung pada saat jantung berkontraksi.b.Gambaran berbagai variasi potensial listrik yang disebabkan oleh eksitasi otot jantung dan dideteksi oleh permukaan jantung.20.Septal-Apex hypokinetik :→ Mobilisasi atau aktifitas atau fungsi motorik yang menurun secara abnormal.21.Anteroseptal segment : penurunan pergerakan aktivitas motorik pada bagian anteroseptal22.Ejection fraction (Ef)→ Fraksi dari darah yang dipompakan keluar dari ventrikel dengan setiap denyut jantung23.Thrombus→ Bekuan darah yang bersifat stasioner di sepanjang dinding pembuluh darah, sering menyebabkan obstruksi vaskuler.24.Echo→ Echocardiografi, perekaman posisi dan gerakan dinding jantung atau struktur dalam jantung melalui gema yang diperoleh dari pancaran gelombang ultrasonic yangdiarahkan lewat dinding thorax.
 
II. PROBLEM IDENTIFICATION1.Mr. SB 52 years old man admitted to hospital with the main complaint ofchest pain and shortness of breath2.2 months ago patient felt pain on his left chest. Since a month ago, heoften felt fatique and nausea. And 2 weeks ago, he felt very tired and slept insemi-fowler’s position.3.Then he visited a doctor, and was given medicine for gastric complaint.4.Past medical history: hypertension, smoking, family history of CAD (+).5. Physical examination : Orthopnoe, Ht 160 cm, Bw 80 kg, BP 100/60 mmhg,HR 124 bpm.RR 24x/m.PR 124 bpm,regular,unequal. RR 24x/mPale, JVP 5+2 mmHg, basal rales (+), wheezing (+), liver palpable 3 fingers below the arcus costae, and minimal ankle edema.6.Laboratory results :Hemoglobin : 14 g/dl, wbc: 6000./mm3, diff count : 0/2/10/60/22/6, ESR 20/mm3,Platelete : 200000/ m3.Total cholesterol 297 mg%, triglyceride 240 mg%.Blood glucose 265 mg%, glucose urine (++). Sediment : normal findings.SGOT 52 U/L, SGPT 43 U/L, total bilirubin 2,1 mg/dl.CK NAC 190 U/L, CK MB 25 U/L, Troponin 0,1 ng/ml.7.Additional examination : Chest X- ray : CTR > 50 %, signs of cephalization. ECG : Sinus rhytm, left axis 124 x/m, QS pattern in V1-4 with ST elevation, LV strain. Echo : Anteroseptal segment hypokinetic < normal value: , normalgeneral wall motion >,normal valves, ejection fraction 35 % < normal value > 45%>, and thrombus attached to LV apexIII. PROBLEM ANALYSIS1.What is the anatomy and physiology of heart anda corronary?2.How is the mechanisme of chest pain?3.What is the causes of chest pain?4.What is the causes of shortness of breath?5.How is the mechanisme of shortness of breath?6.How is the correlation chest pain and shortness of breath?7.What is the cause of fatigue and nausea?8.Is there any correlation of fatigue and nausea with pain on his left chest?9.Why the fatigue become worse since 2 weeks ago?10.Why he slept in semi fowler position?11.Why the doctor gave him medicines for gastric?12.What is the correlation between gastric compailnt with sign anf symptoms?13.How is the correlation between past medical history with sign and symptoms?14.What is the pathogenesis of CAD?15.What is the patopysiology of CAD?16.What are the risk factor for CAD? (include family hisrtory)17.Is there any correlation between the risk factor with CAD?18.How is the interpretation of physical examinations?19.How is the pathophysiology of physical examinations?20.How is the interpretation of laboratory examinations?21.How is the pathophysiology laboratoryexaminations?22.How is the interpretation of additional examinations?

Activity (79)

You've already reviewed this. Edit your review.
1 hundred reads
1 thousand reads
phydt liked this
Aq Cayank Firman liked this
Bang Dony liked this
Saptiko Irfan liked this

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->