SKENARIO RESPIRASI 6

SKENARIO KASUS RESPIRASI 1

Jessica, a fifty-nine year old mother of four, has noticed that she is experiencing shortness of
breath which has worsened over the last six months. For the last week, she has been
coughing and bringing up yellow mucus.
Jessica's family and medical history include a negative history of asthma or allergies, lack of
occupational or home exposure to asbestos, a previous smoking history (one package of
cigarettes per day between the ages of 16 and 52), episodes of bronchitis, treated with
antibiotics on an outpatient basis, and a positive history of heart disease (father at 52 and
brother at 56). Jessica has no history of serious illness, including heart disease, and her weight
is within five pounds of her "desired" weight.
Her nurse practitioner conducts a general physical examination with the following results.
Jessica's skin is normal (no rashes or cyanosis) and her nervous system is functioning
normally. Her body temperature was 98.4°F while her pulse was regular at 95 beats per
minute with an occasional premature beat. Jessica's blood pressure was within normal limits,
however her jugular veins were slightly distended. Her respiratory rate was 28 breaths per
minute; she breathed with pursed lips and used her accessory respiratory muscles more than
would be expected. Jessica presented with a barrel chest and mild dyspnea when climbing
onto the examination table. When listening to her breathing, the nurse practitioner noticed that
Jessica had prolonged expiration accompanied by expiratory wheezes.

Based on these results, the nurse practitioner suspected a pulmonary disorder and, after
consultation with a physician, ordered laboratory tests (blood and sputum), spirometry and
chest x-rays. The results of the laboratory tests were as follows: hematocrit = 49%, white blood
cell count = 9000, pH = 7.38. Analysis of the sputum sample indicated the presence of epithelial
cells, polymorphonucleocytes and gram positive diplococci. Jessica's 1 second forced expiratory
volume (FEV1) was 1.5 L/sec and her forced vital capacity (FVC) was 4 L. These values were
40% and 83% of normal, respectively. Results of the chest x-ray indicated scarring and
hyperinflation of the lungs.The results of these tests coupled with the physical examination and
history lead to a diagnosis of emphysema. Jessica was prescribed antibiotics for the infection
and oxygen by nose as well as a β2-agonist nebulizer as an acute treatment and requested to
stay for observation and stabilization. After Jessica's condition was stabilized she was
discharged and given a prescription for an inhaler containing a β2-agonist to be used as
needed. She was also encouraged to exercise regularly and follow the nutritional guidelines she
was given. Jessica was also informed that if the symptoms either worsened or did not lessen
within the next week, to return and her treatment would be reevaluated and would possibly
include nocturnal oxygen and an inhaler containing corticosteroids.

1) Tentukan gejala dan tanda penyakit pada Jessica

2) Jelaskan faktor risiko Jessica dan pengaruhya pada sistem pernapasan
3) Apa yang dinamakan spirometri dan mengapa Jessica harus melakukan test ini !
4) Apa yang dinamakan emfisema dan pada kasus Jessica mengapa ini bisa terjadi?
5) Apa guna kortikosteroid pada terapi diatas?
SKENARIO KASUS RESPIRASI 2

A 50-year-old man saw his doctor with a case of bronchial asthma. He has around five bad
attacks a year. He started smoking when he was 25. He smokes 15-20 cigarettes a day. His
work is very stressful and he smokes to relieve stress. However, stress worsens his asthma.
The most likely cause is of the man's bronchial asthma is smoking. His doctor recommended he
stop smoking. He also placed the man on medication for his symptoms. Once the man’s lungs
improve, he can start exercise to strengthen them and improve his breathing.

1) Define the difficult terms from the above scenario ?

2) Underline the keywords !
3) Can you explain what triggers asthma?
4) What patological changes that occur in bronkhial asthma according to this image below ?

5) Simply explain how to prevent and treat Asthma?

SKENARIO RESPIRASI 3

Seorang laki-laki berumur 30 tahun dengan kebiasaan merokok, datang ke IGD dengan
keluhan utama batuk darah sebanyak 250 cc sejak 1 hari yang lalu. Penderita mengeluh batuk
dengan dahak sulit keluar sejak 2 bulan yang lalu diikuti demam hilang timbul dan keringat
malam. Penderita 2 hari ini tidak mau makan dan berat badannya menurun 4 kg. Tiga tahun
yang lalu, penderita pernah sakit paru dengan suara serak dan telah mendapat pengobatan
paket dari Puskesmas selama 6 bulan. Saat mendapat pengobatan tersebut, penderita pernah
dirawat di rumah sakit karena muntah-muntah dan mata kuning. Penderita mempunyai 2
anak yang masih balita. Ayah penderita meninggal karena penyakit paru menular dan penyakit
jantung 6 tahun yang lalu. Pada hasil pemeriksaan didapatkan tekanan darah 100/ 60,
konjungtiva pucat, auskultasi suara amforik pada paru kanan dan didapatkan pembesaran
kelenjar leher. Pemeriksaan darah belum ada hasil. Foto torak tampak gambaran fibroinfiltrat
dan kavitas di paru kanan, sedangkan pada apex paru kiri tampak gambaran sarang tawon.
Penderita direncanakan melakukan pemeriksaan sputum, biopsi jarum halus (BJH) pada
kelenjar leher dan bila perlu bronkoskopi. Penderita ditenangkan, diajarkan agar tidak takut
untuk membatukkan. Batuk darah ditampung dan dimonitor volumenya.

1) Define the difficult terms from the above scenario ?

2) Underline the keywords !
3) Can you explain what causes the presence of blood in his cough?
4) What patological changes that occur in his lungs?
5) Simply explain how to prevent and treat TBC?How is the side effect and disadvantages of the
medication?
6) Apa yang dimaksud dengan Pneumonia dan apa bedanya dengan TBC?
SKENARIO RESPIRASI 4

Pasien datang ke poliklinik dengan keluhan pilek kambuh-kambuhan kurang lebih 10 tahun,
memberat 1 bulan ini. Pasien sering bersin-bersin apabila menghirup serbuk bunga salak
(mata pencaharian pasien sebagai petani salak), tetapi dirasakan 1 tahun ini lebih sering dari
sebelum-sebelumnya dan membuat pasien berhenti bekerja. Hidung dirasakan tersumbat, dan
keluar ingus cair. Pasien juga mengeluh di tenggorokan terasa gatal. Mata kadang sampai
nrocos. Bila pagi hari dan udara dingin pilek dirasakan bertambah, bersin-bersin juga
dikeluhkan bertambah. Pasien tidak demam saat datang ke poliklinik, tetapi dalam 1 bulan ini
kadang-kadang muncul demam. Pasien bolak-balik berobat ke puskesmas, tetapi tidak mereda.
Pasien belum pernah melakukan tes alergi, menyangkal mempunyai penyakit asma dan tidak
ada keluarga yang menderita penyakit serupa dengan pasien

1) Define the difficult terms from the above scenario ?

2) Underline the keywords !
3) Can you explain what triggers allergic rhinitis ?
4) What patological changes that occur in allergy ?
5) What causes allergic rhinitis ?
SKENARIO RESPIRASI 5

Seorang bayi laki-laki lahir spontan di puskesmas dari seorang ibu berumur 40 tahun. Berat
lahir 1500 gram, skor Ballard 20. Saat lahir bayi segera menangis, ketuban pecah saat lahir,
jernih dan tidak berbau. Bayi mulai disusui 2 jam setelah lahir, tetapi isapan bayi tampak lemah.
Empat jam setelah lahir bayi tampak sesak, frekuensi napas 70 x per menit, retraksi di
daerah subcostal, tidak tampak biru, dan pada auskultasi terdengar expiratory grunting. Suhu
aksiler 36,3 C. Dua hari kemudian wajah dan daerah dada bayi tampak kuning.

1) Define the difficult terms from the above scenario ?

2) Underline the keywords !
3) Can you explain what happens to that baby ?
4) What patological changes that occur in Hyaline Membrane Disease ?
5) What causes HMD ?