Bed Site Teaching (BST)

Lilia Muspida
(712014050)

Preceptor :
dr.Rizal Daulay,Sp.OT.,MARS

Identification

Name : Mr.Sapta.H
Age : 35 years old
Gender : Male
Religion : Moslem
Address : On Aitu A.Wahab
street,RT 17/RW 01.,Tuan
Kentang Village, Kertapati
Subdistrict, South of
Sumatera.Palembang.

Chief Complain

Pain in his right

ankle and unable
to stand

Clinical History
And
6
He
Previously
3
weeks
sometimes
then
feel fever, often sweating and he

Finally, on February 2nd

2016 , he get surgery
procedure for clean pus in
his right ankle

Local state
General condition : well
Sensory
: compos mentis
Vital sign
:
blood preasure : 110/70 mmHg
Pulse : 89x/minutes
RR : 23x/minutes
Temp : 37,6 C

Local State

Right foot area

Look : scar (+), bleeding (-), bone
expose (-), skin loss(-), deformity(+),
swollen (+), skin colour same like left
ankle area, multiple pustules (+)

Local State
Right foot area
Feel : hard (+), crepitation
(-), sensibility is good, hot
(+), NVD (dorsalis pedis
arterial pulse (+),
capillary refill time < 2s)
Move : limited movement

Clinical Photo

X-Ray

X-Ray

X-Ray

Intra-operatif

Intra-operatif

Post-Operatif (4 february 2016)

Laboratory Result

Hemoglobin : 10,7g/dl
Leukocyt : 11.600/cmm
LED : 15mm/hours
Diffcount : 1/0/1/76/12/10
Clooting time : 9
Bledding time : 3
HBSag
: (-)
BSS
: 115mg/dl

Susp.
Tuberculous Of
bone and Giant
tumor

Planning

Surgical debridement

THANK YOU