MODUL KASUS TERPILIH IRNA BEDAH

PRAKTEK KERJA PROFESI APOTEKER

BIDANG MINAT FARMASI RUMAH SAKIT

DI INSTALASI FARMASI RSUD Dr. SOETOMO

Jalan Mayjend Prof. Moestopo 6-8 Surabaya

Oleh :
Kelompok 3

1. Anggana Mahardhika A., S. Farm. (051613143007)

2. Astrid Aulia Hamidah, S. Farm. (051613143017)
3. Laily Asmaningsih, S. Farm. (051613143030)
4. Geza Ellyvia Azizah, S. Farm. (051613143052)
5. Delvi Dwi Ratnasari, S. Farm. (051613143062)
6. Silvia Nur Hamidah, S. Farm. (051613143081)
7. Yulinda Risma Raras D. W., S. Farm. (051613143098)
8. Nabilla Rahmi Ramadhani, S. Farm. (051613143117)
9. Risa Zulfiana, S. Farm. (051613143130)
10. Indira Dhany K., S. Farm. (051613143147)
11. Asita Rochmi, S. Farm. (051613143164)
12. Marita Luthfiah, S. Farm (051613143193)
13. Yesinta Kurniawati, S. Farm. (051613143203)
14. Putu Argianti Meyta Sari, S. Farm. (162211101011)
15. Nur Fatjria S., S. Farm. (162211101044)
 PATIENT DATABASE

Demographic and Administration Information

Name : Tn S Patient ID : 12.55.97.32 Room No. : Dahlia ()
Address : Sampang, Madura MD : dr. Adi
Age : 39 tahun Pharmacy : Silvia Nur Hamidah, S.Farm.
Height : 166 cm Weight: 55 kg Race : Madura Gender : Laki-laki
Admission Date : 10 Februari 2017 Religion : Islam
Discharge : Pandan II Occupation : Swasta

History of Present
Vital Sign/Laboratory Data Initial/Follow up
Illness:
10/ 12/ 13/ 14/ 15/ 16/ 17/ 18/ 19/ 20/ 21/ 22/ 23/ 24/ 25/ 26/
Batu UPJ (D), Date Nilai Normal 11/2 27/2
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Hydronefrosis (D)
pos nefrostomy, RR (16-20) x/menit 16 16 16 16 - 16 16 16 - 16 16 16 - 17 16 16 16 16
batu ureter distal HR (60-100) x/menit 75 72 72 75 78 81 80 76 - 76 76 80 80 80 72 72 72 72
(S), CKD stage 5, Temp (36-37)C 36,6 36,4 36,4 35,9 37,2 36,8 36,5 36,4 - 36,5 36,1 - 36 36,2 36,4 - - -
HN ringan (S), BP (100-120/60-80) mmHg 140 132 130 130 120 124 115/ 120 - 124 120 120 130 115/ 125 120 125 125/
hiperkalemia, /90 /80 /82 /82 /80 /80 80 /82 - /80 /85 /80 /80 80 /82 /80 /80 82
kolesistitis (25/2),
aPTT meningkat
(6/2), asidosis Hb (13,3-16,6) g/dL 6,8 10,1 9,5 8,8 10,6 9,0
metabolik berat Leko (3,37-10) .103/L 11, 11, 9,28 11, 10,
(2/2), anemia (1/2) 38 69 74 57
Tromb (150-400) /.103L 74 245 258 214 229 372
LED
PTT (9-12) detik 10,9 11,2 10,8 10,9
aPTT (23-33) detik 32,7 32,8 31,3 41,4
RBC (3,69-5,46).106/ L 2,41 3,78 3,54 3,31 3,93 3,43
Past Medical HCT (41,3-52,1)% 19,6 30,8 28 27 32 27
History/Surgery : MCV (86,7-102,3) fL 81,3 81,5 81,4 81,6 81,4 78,7
MCH (27,1-32,4) pg 28,2 26,7 26,8 26,6 27,0 26,3
Post nefrostomy
MCHC (29,7-33,1) g/dL 34,7 32,8 33,0 32,6 33,1 33,3
Family and Social Eo
History : Baso
Batang
Tidak ada
Seg
Limf
Mono
Life Style :
BUN (7-18) mg/dL 43
Tidak ada
SCr (0,6-1,3) mg/dL 29,3 7,13
CCr (ml/menit/1,73 m2) 10,
82
SGOT (0-50) /L 15 17 14 83
SGPT (0-50) /L 13 30 25 119
Bil Tot (0,2-1) mg/dL
Bl.Dir/ (0-0,2) mg/dL
 Indir
Albumin 3,6
Lifestyle:
Uric acid 13
Tidak ada pH (4,5-8,0) 7,5 7,0
Protein 2+ 1+
Leukosit 3+ 3+
Erotrosit race 2+
Warna & Kuning & jernih +
kejernihan

K (3,5-5,1) mol/L 4,2 3,3 3,2 3,9

Na (136-145) mol/L 121 134 131 133
Cl/ (98-107) mol/L/ 82 93/ 93/ 92
Phos (2,5-4,9) mg/dL 3,6 -
Ca/ (8,5-101) mg/dL 11,5 7,8/
Mg 8,1 -

GDA <100 mg/dL 99

112
pH (7,35-7,45) 7,32 7,42 7,34 7,34 7,32
pCO2 (35-45) mmHg 27 32 28 29 38
pO2 (80-100) mmHg 118 112 99 87 26
HCO3 (22,0-26,0) mol/L 13,9 20,8 15,1 15,6 19,6
BE (-3,5-2,00) mol/L -12,2 -3,7 -10.7 -10.6 -6,5
TCO2 (23-30) mol/L 14,7 21,8 16,0 16,5 20,8
SO2 (94-98)% 98 98 97 96 42
A-202 0 mmHg -2 -2 16 26 76
%FiO2 0% 21,0 21,0 21,0 21,0 21,0
Acute and Chronic Data Serum Concentration9828
Medical Problems :
-
 Current Drug Therapy
Drug Name/Dose/Strength/Route Duration Start Compliance/Dos
Prescribed Schedule
Stop Dates ing Issue
1) Ciprofloxacin 200 mg iv Setiap 12 jam 10 20 Feb
2) Ceftazidim 1 g iv Setiap 8 jam 21 24 Feb
3) Vitamin K 1 amp Setiap 8 jam 10 20 Feb
4) Asam traneksamat 500 mg iv bolus Setiap 8 jam 10 25 Feb
5) Na bikarbonat tab 650 mg Setiap 8 jam 10 20, 22 27 Feb
6) N-asetil sistein tab 200 mg Setiap 8 jam 19 20, 22 27 Feb
7) Kalitake 1 sachet dalam 30 mL air Setiap 8 jam 10 19 Feb
8) Laxadin susp 1C Setiap 8 jam 10 11 Feb
9) Antrain 500 mg iv drip Setiap 8 jam 21 22 Feb
10) Tramadol tab 50 mg Setiap 12 jam bila perlu 23 Feb

Medication PTA
-
Time Line: Circle actual administration times and record appropriate medications and meals
Allergies/Intolerances:
below. Social Drug Use Cost Meds/month
Alcohol : Tidak ada Insurance : Yes No
Allergen Reaction Caffein : Tidak ada Copay :-
6 7 8
Tidak ada 9 10 11 12 1
Tidak ada 2 3 4 5
Tobacco 6: 7 8
Tidak 9
ada 10 11 12 1
Medicaid 2 3 :4- 5
Ciprofloxacin Ceftazidim Ciprofloxacin Annual income: -
Ceftazidim
Ceftazidim Vitamin K Tramadol Vitamin K
Vitamin K Asam Asam
Asam
Notes: Tranexamat Tranexamat
Tranexamat NaBic NaBic
NaBic N-asetil N-asetil
N-asetil sistein sistein
(20 januari 2017) Hasil Kultur spesimen sistein
Kalitake Kalitake Kalitake
Spesimen
Laxadin
diambil : 18 januari 2017 Laxadin
Laxadin
Pemeriksaan
Metamizol selesai : 20 januari 2017
Metamizol Metamizol
Bahan
Tramadol : air kemih (aliran tengah)
Pemeriksaan : Pengecatan Gram, kultur aerob.
Hasil pemeriksaan :
Gram: ditemukan bentukan kuman batang gram negatif nampak PMN 3-9 PLF
Hitung koloni :> 105 CFU/ML
Biakan/kultur : pseudomonas aeruginosa
Sensitivitas : amikacin, tebramycin, gentamycin, astreonam, pepiracillin tazobactam,
ceftazidime, cefoperazone sulbactam, ciprofloxacin, levfloxacin, fosfomycin,
meropenem
Resisten : amoxicilin-clavulanic acid, ampicillin, ampicullin sulbactam, cephazolin,
cefotaxime, ceftriaxone, cotrimaxazol, tetracycline, chloramphenicol,
nitrofurantion, ertapenem
Intermediet : -

(1 februari 2017) Hasil Kultur spesimen

Spesimen diambil : 27 januari 2017
Pemeriksaan selesai : 1 februari 2017
Bahan : Air kemih (PNS)
Pemeriksaan : Pengecatan Gram, kultur aerob.
Hasil pemeriksaan :
Gram: ditemukan bentukan kuman batang gram negatif pmn 25/LPF
Hitung koloni : 17 x 103 CFU/ML
Biakan/kultur : pseudomonas aeruginosa
Sensitivitas : amikacin, gentamycin, astreonam, pepiracillin tazobactam,
ceftazidime,cefoperazone sulbactam, cotrimaxazol, tetracycline, , levfloxacin,
fosfomycin, meropenem
Resisten : amoxicillin-clavulanic acid, ampicillin, ampicillin sulbactam, cephazolin,
cefotaxime, ceftriazone, nitrofurantion, ertapenem
Intermediet : -

(1 februari 2017) Hasil Kultur spesimen

Spesimen diambil : 28 januari 2017
Pemeriksaan selesai : 1 februari 2017
Bahan : Air kemih (aliran tengah)
Pemeriksaan : Pengecatan Gram, kultur aerob.
Hasil pemeriksaan :
Gram: ditemukan bentukan kuman batang gram negatif tidak tampak pmn
Hitung koloni : 105 CFU/ML
Biakan/kultur : Moraxella catarrhalis
Sensitivitas : amikacin, gentamycin, ampicillin sulbactam, pepiracillin tazobactam,
ceftazidime, cefoperazone sulbactam, , levofloxacin
Resisten : amoxicillin-clavulanic acid, cotrimaxazol, chloramphenicol, meropenem
Intermediet : astreonam, ceftriazone, fosfomycin
 DRUG THERAPY ASSESSMENT WORKSHEET (DTAW)
Are there symptoms or medical
problems that may be drug
Adverse Drug induced ?
Events
What is the likelihood that the
problem is drug related ?
Are there drug-drug interactions ?
Are they clinically significant ?
Are any medications
contraindicated(relatively or
Interactions : absolutely) given patient
Drug-drug, characteristic and current/pass
Drug-Disease disease states ?
Drug-nutrient, and
Drug-Laboratory Are there drug-nutrient
Test interactions ?
Are they clinically significant ?
Are there drug-laboratory test
interactions ?
Are they clinically significant ?
Is the patients current use of
social drugs problematic ?
Social or
Recreational Could the sudden decrease or
Drug Use discontinuation of social drugs be
related to patient symptoms (e.g.,
withdrawal) ?
Pemberian vitamin K memiliki efek samping
1. A problem exists
anafilaksik, nyeri dan bengkak di lokasi injeksi
(Mc Evoy, 2011).
2. More information is needed for
a determination.
3. No problem exists or an
intervention is not needed.
1. A problem exists.
2. More information is needed
for a determination.
Ciprofloxacin sebagian besar tersekresi pada
3. No problem exists or an
urin tanpa dimetabolisme. Pada urin yang basa
intervention is not needed.
akibat terapi na bicarbonat dapat menurunkan
kelarutan ciprofloxacin dalam urin.
1. A problem exists.
Perlu menggali informasi lebih lanjut kepada
2. More information is needed
pasien maupun keluarga pasien, apakah pasien
for a determination
mengkonsumsi obat, suplemen atau vitamin
yang dapat mempengaruhi gaya hidup
3. No problem exists or an
intervention is not needed.
 Has the patient failed to receive 1. A problem exists.
medication due to system error or
noncompliance? 2. More information is needed for
Failure to Receive
a determination
Therapy
Are there factors hindering the
achievement of therapheutic 3. No problem exists or an
efficacy? intervention is not needed.
Financial Impact Is the chosen medication(s) cost 1. A problem exists.
effective?
2. More information is needed for
Does the cost of drug therapy a determination
represent a financial hardship for
the patient? 3. No problem exists or an
intervention is not needed.
Patient Does the patient understand the 1. A problem exists.
Knowledge of purpose of his or her
Drug Therapy medication(s), how to take it and 2. More information is needed for
the potential side effect of a determination
therapy?
3. No problem exists or an
Would the patient benefit from intervention is not needed.
educationtool (e.g., writen patient
education sheets, wallet cards and
reminder packaging)?
 DAFTAR PUSTAKA

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Larry, K., et al. 2013. Renal Pharmacotherapy; dosage adjustment of medications eliminated
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