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LAPORAN Sementara SKENARIO C BLOK IX-2
LAPORAN Sementara SKENARIO C BLOK IX-2
Group 5
Lecturer of Tutor : dr. RA. Tanzila, M.Kes
1. Ahmad Winarto (702018032)
2. Shabrina Ananda Heparrians (702015024)
3. Tasya Aulia Dita (702018019)
4. Rindi Amelia (702018023)
5. Radicha Maurisha (702018027)
6. Nabila Tahiyyah (702018035)
7. Msy. Nabila Muthiaddinda (702018042)
8. Rahmi Nurbadriya Ningsih (702018062)
9. Dinda Nafatilana (702018068)
10. M. Zulisandi Ghifari (702018094)
FACULTY OF MEDICINE
MUHAMMADIYAH UNIVERSITY PALEMBANG
2019/2020
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CHAPTER I
INTRODUCTION
1.1. Background
Blok endocrine is the twelfth block in the second semester IV of
the competency based curriculum of Doctors of the Faculty of Medicine,
Universitas Muhammadiyah Palembang.
On this occasion carried out a case study tutorial as a learning
ingredient to face the actual tutorial on an upcoming occasion. The author
of this time explained the case given about Mrs. A, a 48 years old woman,
brought to the emergency department of RSMP by her family with a chief
complain of shortness of breath that keeps on worsening since 4 hours ago.
1.3. Benefits
1. In order to practice analyzing an issue
2. In order to know the process in the tutorial
3. In order to apply the program based learning method in a case
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CHAPTER II
DISCUSSION
2.2 Rules
1. Deactivate the phone or condition the phone to silence
2. Bend the hand when you will make an opinion
3. Request permission when going out of room
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According to her family, Mrs. A had a medical history of Diabetes
Mellitus since the age of forty, but she didnt take her medicine regularly,
and seldomly control her condition to the Puskesmas.
Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW 40 kg
Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable
Laboratory Examination:
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Fever A fever is any body temperature elevation over 100ºF
(37, 8ºC). (Dorland, 2015)
Antibiotic Chemical substances are usually produced by a microor
ganism or semi-synthesis that has the ability to kill or in
hibit the growth of microorganism. (Dorland, 2015)
Urine Urine is the residual fluid of metabolic results excreted
from the body. The urine is composed of water with dis
solved residual metabolism (such as urea), dissolved sal
ts, and organic matter. (Dorland, 2015)
Productive cough A cough accompanied by expectoration of ingredients f
rom the bronchi. (Dorland, 2015)
Apathic Is a condition where someone does not care or feel shy
about the surrounding environment. (Dorland, 2015)
Turgor Circumstances to be turgit or normal or other full
sensations. (Dorland, 2015)
Diabetes mellitus A disorder of carbohydrate metabolism, usually
occurring in genetically predisposed individuals,
characterized by inadequate production or utilization of
insulin and resulting in excessive amounts of glucose in
the blood and urine, excessive thirst, weight loss, and in
some cases progressive destruction of small blood
vessels leading to such complications as infections and
gangrene of the limbs or blindness. (Dorland, 2015).
Keton Is a metabolism product of fatty acids and proteins
consisting of 3 compounds namely asetoacetic acid,
acetone and beta hydroxybutyric acid, when the body
experiences metabolic disorders, especially
carbohydrate metabolism disorders, the body will use
the deposits of fatty acids and proteins as fuel to
produce energy. (Dorland, 2015)
Bowel movement Tenderness in the bladder at the time of palpation.
(Dorland, 2015)
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2.3. Identification of Problem
1. Mrs. A, a 48 years old woman, brought to the emergency department
of RSMP by her family with a chief complain of shortness of breath
that keeps on worsening since 4 hours ago. The shortness of breath
were not triggered by activity or weathers change, and were not
followed with wheezing.
2. Mrs. A also complains of productive cough accompanied with pain
while swallowing and fever since one weeks ago, she went to the
Puskesmas and was given an antibiotic but she didnt take it.
3. Her blood sugar level also being checked at the Puskesmas, and the
result was 280 mg/dl, and she also claimed that she often feels thirsty,
famished, and urinate a lot, then she was given an oral anti diabetic but
she didnt take it regularly.
4. According to her family, Mrs. A had a medical history of Diabetes
Mellitus since the age of forty, but she didnt take her medicine
regularly, and seldomly control her condition to the Puskesmas.
5. Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW
40 kg
Vital Sign: BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR:
38x/menit (deep and fast breathing)
Head: Pale conjungtive (-/-), icteric sclera (-/-)
Neck: JVP 5-2 cmH2O
Thorax : Heart and lung within normal limits
Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable
Extremitie: cold extremities (-), edema (-/-). Turgor return slowly.
6. Laboratory Examination:
Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte
250.000/ mm3
BSN 300 mg/dl
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Urinalysis: Keton urin +3, glukose urin +3
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complains of productive cough accompanied with pain while
swallowing and fever menunjukan bahwa adanya infeksi yang terjadi pada
Ny. A, sebagaimana disebutkan oleh WHO manifestasi klinis dari ISPA
adalah timbulnya gejala biasanya cepat, yaitu dalam waktu beberapa jam
sampai beberapa hari. Gejalanya meliputi demam, batuk, dan sering juga
nyeri tenggorok, coryza (pilek), sesak napas, mengi, atau kesulitan
bernapas.
Penggunaan obat(antibiotik) yang tidak rasional/sesuai dapat
menyebabkan kegagalan terapi terutama penggunaan antibiotik yang akan
menimbulkan bahayabahaya lain, misalnya resistensi, supra infeksi dan
efek samping negatif.
3. Her blood sugar level also being checked at the Puskesmas, and the result
was 280 mg/dl, and she also claimed that she often feels thirsty, famished,
and urinate a lot, then she was given an oral anti diabetic but she didnt take
it regularly.
a. What is the meaning of “BSS 280 mg/dl”?
b. What is the blood sugar test?
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c. What is the meaning of “She often feels thirsty, famished and urinate a
lot?
d. What is the relatiton of BSS 280 mg/dl and shortness of breath?
e. What is the impact of Mrs. A didn’t take the oral anti diabetic regulary?
f. How is the pathophysiology of often feels thirsty, fashimed and urinate
a lot?
5. Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW 40 kg
Vital Sign: BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR:
38x/menit (deep and fast breathing)
Head: Pale conjungtive (-/-), icteric sclera (-/-)
Neck: JVP 5-2 cmH2O
Thorax : Heart and lung within normal limits
Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable
Extremitie: cold extremities (-), edema (-/-). Turgor return slowly.
a. What is the interpretation of physical examination results?
b. How is the abnormal mechanism of physical examination?
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6. Laboratory Examination:
Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte
250.000/ mm3
BSN 300 mg/dl
Urinalysis: Keton urin +3, glukose urin +3
a. What is the interpretation of laboratoy examination results?
b. How is the abnormal mechanisme of laboratory examination?
7. How to diagnose?
8. What is the differential diagnose?
9. What is the additional examination of this case?
10. What is the working diagnose of this case?
a. Definition?
b. Epidemiology?
c. Etiology?
d. Pathogenesis?
e. Risk factors?
f. Clinical manifestations?
11. How is the treatment of this case?
12. What is the complication of this case?
13. What is the prognose of this case?
14. What is the medical doctor competences of this case?
15. What is the islamic point of view of this case?
2.6 Hypothesis
Mrs. A, a 48 years old woman, experience shortness of breath,
productive cough accompanied with pain while swallowing and fever,
dehydration, URI, ketoniuria, glukouria because of ketoasidosis diabetic from
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uncontrol DM type 2.
Insulin resistence
DM type 2 uncontrolled
Metabolic disorder
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