LAPORAN TUTORIAL

SKENARIO B BLOK 24

Kelompok: B8

Tutor: dr.

M Billy Darisma 04011128152017

Ilsyafitri Bonita 04011381520094
Dita Marisca 04011381520098
Muhammad Ammar Lutfi 04011381520100
Zabilla Adwie 04011381520109
Andhika Diaz Maulana 04011381520101
Bhagatdeep Kaur Kaur 04011381520185
Muhammad Ikmal 04011381520187
Nur Fatihahemani 04011381520189
Sredaran Nair 04011381520191

PENDIDIKAN DOKTER UMUM

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
TAHUN 2018
KATA PENGANTAR

Puji syukur kepada Tuhan Yang Maha Kuasa atas berkat, rahmat, dan karunia-Nya lah
kami dapat meyusun laporan tutorial ini sesuai dengan waktu yang telah ditentukan.
Laporan ini merupakan tugas Tutorial Blok 24 Pendidikan Dokter Umum Fakultas
Kedokteran Universitas Sriwijaya tahun 2018. Laporan ini membahas kasus berdasarkan
sistematika klarifikasi istilah, identifikasi masalah, menganalisis, meninjau ulang dan menyusun
keterkaitan antar masalah, serta mengidentifikasi topik pembelajaran.
Bahan laporan ini kami dapatkan dari hasil diskusi antar anggota kelompok dan bahan ajar
dari dosen-dosen pembimbing.
Kami juga mengucapkan terima kasih kepada orang tua, tutor dr. dan anggota kelompok
yang telah mendukung baik moril maupun materil dalam pembuatan laporan ini.
Kami mengakui dalam penulisan laporan ini terdapat banyak kekurangan. Oleh karena itu,
kami memohon maaf dan mengharapkan kritik serta saran dari pembaca demi kesempurnaan
laporan kami di kesempatan mendatang. Semoga laporan ini dapat bermanfaat bagi para pembaca.

Palembang, Februari 2018

Kelompok B8
 DAFTAR ISI

Kata Pengantar……………………………………………………………………………..
Daftar Isi…………………………………………………………………………………...
I. Skenario.................................................................................................................
II. Klarifikasi Istilah...................................................................................................
III. Identifikasi Masalah……………………………………………………………..
IV. Analisis Masalah…………………………………………………………………
V. Template................................................................................................................
VI. Learning Issues ..... …………………………………………………………………...
VII. Kerangka Konsep………………………………………….……………………..
VIII. Kesimpulan………………………………………………………………………
IX. Daftar Pustaka……………………………………………………………………
 I. SKENARIO B BLOCK 24 TAHUN 2018.

Mrs. Helen, 19-year old pregnant woman G1P0A0 38- weeks pregnancy, was brought by her
husband to the polyclinic RSUD Lahat to ANC. She has been complaining of headache, epigastric
pain, vomitting and visual blurring for the last 2 days. Patient also complain of uterine contraction
since 12 hours ago, also complain of bloody show, but did not complain of watery discharge.
According to her husband, on her last ANC, 3 days ago the midwife found that her blood pressure
was high, and advice to deliver the baby in the hospital. After that patient was deliver to emergency
room for further treatment.

In the examination findings:

Upon admission,

Height = 153 cm; Weight = 76 kg;

Sense : Compos mentis, GCS : 15

BP: 180/110 mmHg. HR: 100x/min, RR: 21x/m.

Pretibial edema

Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
120x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.

Lab: Hb 10,2 g/dL; PLT :180.320/mm3, WBC : 9.600/mm3 and she had 4+ protein on urine,
cylinder (-), LDH: 982g/dl, Ureum: 22mg/dl, Creatinin: 0,51 mg/dl, SGOT: 99 mg/dl, SGPT: 77
mg/dl, Uric acid: 8,23 mg/dl.
In emergency room patient was plan for stabilization, patient was in bedrest position. But 2 minute
after transfer to emergency room, patient having convulsion about 2 minute. And after that, patient
underwent decrease of consciousness with GCS 13.

Examination findings

Sense : decrease of consciousness, GCS : 13

BP: 170/110 mmHg, HR: 123x/min, RR: 28x/m.

Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
115x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.
II. KLARIFIKASI ISTILAH

No Istilah Definisi
1 G1P0A0 Gravida 1 (hamil pertama), Partus 0 (belum pernah
melahirkan), Abortus 0 (tidak ada riwayat aborsi).
2 Contraction Kontraksi Rahim ( HIS ) yang terjadi empat kali dalam
4x/10’/40” sepuluh menit dengan durasi setiap HIS adalah 40 detik.
3 HII Hodge II penurunan kepala janin setinggi bagian bawah
simpisis yang diperiksa melalui pemeriksaan dalam.
4 Vertex Persentasi dengan puncak kepala bayi merupakan bagian
presentation terendah janin.
5 Convulsion Kontraksi involunter atau serangkaian kontraksi otot-otot.
6 Effacement Pemendekan dan penipisan servik selama tahap pertama
salinan.

7 Headache
8 Epigastric
pain
9 Visual
blurring
III. IDENTIFIKASI MASALAH.
1. Mrs. Helen, 19-year old pregnant woman G1P0A0 38- weeks pregnancy, was brought to
the polyclinic RSUD Lahat to ANC. She has been complaining of headache, epigastric
pain, vomitting and visual blurring for the last 2 days. Patient also complain of uterine
contraction since 12 hours ago, also complain of bloody show, but did not complain of
watery discharge.
2. According to her husband, on her last ANC, 3 days ago the midwife found that her blood
pressure was high, and advice to deliver the baby in the hospital. After that patient was
deliver to emergency room for further treatment.
3. In the examination findings:

Upon admission,

Height = 153 cm; Weight = 76 kg;

Sense : Compos mentis, GCS : 15

BP: 180/110 mmHg. HR: 100x/min, RR: 21x/m.

Pretibial edema

4. Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
120x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.

Lab: Hb 10,2 g/dL; PLT :180.320/mm3, WBC : 9.600/mm3 and she had 4+ protein on urine,
cylinder (-), LDH: 982g/dl, Ureum: 22mg/dl, Creatinin: 0,51 mg/dl, SGOT: 99 mg/dl, SGPT: 77
mg/dl, Uric acid: 8,23 mg/dl.
 5. In emergency room patient was plan for stabilization, patient was in bedrest position. But
2 minute after transfer to emergency room, patient having convulsion about 2 minute. And
after that, patient underwent decrease of consciousness with GCS 13.

6. Examination findings

Sense : decrease of consciousness, GCS : 13

BP: 170/110 mmHg, HR: 123x/min, RR: 28x/m.

7. Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
115x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.
IV. ANALISIS MASALAH
1. Mrs. Helen, 19-year old pregnant woman G1P0A0 38- weeks pregnancy, was brought to
the polyclinic RSUD Lahat to ANC. She has been complaining of headache, epigastric
pain, vomitting and visual blurring for the last 2 days. Patient also complain of uterine
contraction since 12 hours ago, also complain of bloody show, but did not complain of
watery discharge.
a) Apa hubungan umur ibu, status kehamilan (G1P0A0 38- weeks pregnancy ) dengan
keluhan Mrs. Helen?
b) Apa makna klinis dari keluhan yang dialami oleh Mrs.Helen selama 2 hari ?
c) Apa saja etiologi dan mekanisme dari complaining of headache, epigastric pain,
vomitting and visual blurring for the last 2 days terkait kasus ? ( cece )
d) Apa makna klinis complain of uterine contraction since 12 hours ago, also
complain of bloody show, but did not complain of watery discharge ?
e) Bagaimana mekanisme kontraksi rahim, bloody show tapi tidak ada watery
discharge?

2. According to her husband, on her last ANC, 3 days ago the midwife found that her blood
pressure was high, and advice to deliver the baby in the hospital. After that patient was
deliver to emergency room for further treatment.
a) Apa saja yang diperiksa dalam ANC ?
b) Apa pilihan persalinan yang tepat untuk Mrs. Helen dan indikasinya ?

3. In the examination findings:

Upon admission,

Height = 153 cm; Weight = 76 kg;

Sense : Compos mentis, GCS : 15

BP: 180/110 mmHg. HR: 100x/min, RR: 21x/m.

Pretibial edema

a) Bagaimana interpretasi dan makna klinis dari hasil pemeriksaan fisik ?

 b) Bagaimana mekanisme abnormalitas hasil pemeriksaan fisik ?

4. Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
120x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.

Lab: Hb 10,2 g/dL; PLT :180.320/mm3, WBC : 9.600/mm3 and she had 4+ protein on urine,
cylinder (-), LDH: 982g/dl, Ureum: 22mg/dl, Creatinin: 0,51 mg/dl, SGOT: 99 mg/dl, SGPT: 77
mg/dl, Uric acid: 8,23 mg/dl.

a) Bagaimana interpretasi dan makna klinis dari hasil pemeriksaan luar dan dalam obstetric?
b) Bagaimana mekanisme abnormalitas hasil pemeriksaan luar dan dalam obstetric ?
c) Bagaimana interpretasi dan makna klinis dari hasil pemeriksaan lab?
d) Bagaimana mekanisme abnormalitas hasil pemeriksaan lab ?
e) Bagaimana prosedur pemeriksaan vaginal toucher ?

5. In emergency room patient was plan for stabilization, patient was in bedrest position. But
2 minute after transfer to emergency room, patient having convulsion about 2 minute. And
after that, patient underwent decrease of consciousness with GCS 13.
a) Apa etiologi dari mekanisme kejang pada kasus?
b) Apa dampak kejang terhadap kehamilan ?
c) Bagaimana tatalaksana awal kejang pada ibu hamil?
 Examination findings

Sense : decrease of consciousness, GCS : 13

BP: 170/110 mmHg, HR: 123x/min, RR: 28x/m.

6) Obstetric examination:

Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR:
115x/min, EFW : 3100g

Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation,
amniotic fluid (+), HII, transverse occiput.

a) Bagaimana interpretasi dan makna klinis dari hasil pemeriksaan fisik ?

b) Bagaimana mekanisme abnormalitas hasil pemeriksaan fisik ? ( setelah kejang )
c) Apa makna klinis dari perubahan FHR setelah ibu mengalami kejang ?

HIPOTESIS
Mrs.Helen 19 tahun hamil 38 minggu G1P0A0 mengalami hipertensi dalam kehamilan.
 V. TEMPLATE
1. Dd
2. How to diagnose ?
3. Wd
4. Definisi
5. Epidemiologi
6. Etiologi
7. Faktor resiko
8. Patogenesis dan patofisiologi
9. Manifestasi klinis
10. Tatalaksana
11. Pencegahan dan edukasi
12. Komplikasi
13. Prognosis
14. SKDI

VI. Learning Issues

VII. Kerangka Konsep
VIII. Kesimpulan
IX. Daftar Pustaka