TUTORIAL REPORT

SCENARIO A BLOCK 21

Group 3
Supervising Tutor: dr. Ratih Pratiwi Sp.OG
Member's name :
1. Sonia Vanduri Seja 702017002
2. Mini Wulandari 702017006
3. Abu Hanan Hammasin 702017018
4. Fatinah Fairuz Qotinah 702017019
5. Andi Dinda Lady, S Fitri 702015037
6. Anggita Oktaviarni 702017047
7. Erwin Dwitama 702017048
8. Syahid Alhakim Marzali 702017056
9. Safhira Amanda Lee 702017066
10. Arika Shafa Nabila 702017077
11. Ria Salsabilla Ramadhani 702015079

MEDICAL FACULTY
MUHAMMADIYAH UNIVERSITY OF PALEMBANG
ACADEMIC YEAR 2019/2020
 FOREWORDS
We thank God Almighty for all His grace and grace we were able to
complete the tutorial report entitled "Scenario A Tutorial Report 17" as a group
competency task. Salawat together with greetings is always poured out to our lord,
the great prophet Muhammad SAW along with his family, friends, and followers
until the end of time.
We realize that this tutorial report is far from perfect. Therefore we
expect constructive criticism and suggestions to improve in the future. In
completing this tutorial report, the author gets a lot of help, guidance and advice.
On this occasion, the author would like to express respect and thanks to:
1. Allah SWT, who has given life with cool faith.
2. Both parents who always provide material and spiritual support.
3. dr. Ratih Pratiwi Sp.OG as a group 3 tutor.
4. Friends.
5. All parties who help us.
May Allah SWT give a reward for all the charity given to all those who
have supported the author and hopefully this tutorial report will benefit us and the
development of science. May we always be protected by Allah SWT. Aamiin.

Palembang, September
2020

Author

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 TABLE OF CONTENTS

FOREWORDS................................................................................................i
TABLE OF CONTENTS...............................................................................ii
CHAPTER I : INTRODUCTION.................................................................1
1.1 Background.......................................................................................1
1.2 Purpose and Objectives.....................................................................2

CHAPTER II : DISCUSSION.......................................................................3
2.1 Tutorial Data.....................................................................................3
2.2 Scenario.............................................................................................4
2.3 Term Clarifications...........................................................................5
2.4 Problem Identification.......................................................................6
2.5 Problem Analysis..............................................................................7
2.6 Conclusion.........................................................................................
2.7 Conceptual Framework.....................................................................

REFERENCES...............................................................................................

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 CHAPTER I

INTRODUCTION

1.1 Background
Growth and development and geriatricsBlock is block XX-I in semester
7 of the Competency-Based Curriculum (KBK) system for Medical Education,
Faculty of Medicine, Muhammadiyah University of Palembang. One of the
learning strategies for the Competency-Based Curriculum (CBC) system is
Problem Based Learning (PBL). Tutorial is an implementation of the Problem
Based Learning (PBL) method. In the tutorial, students are divided into small
groups and each group is guided by a tutor or lecturer as a facilitator to solve
existing cases.
The tutorial process is also part of the student evaluation in the
formative evaluation section with the aim of helping students achieve learning
goals. The tutorial process is also a requirement for taking the OSOCA (Objective
Structure Oral Case Analysis) exam which is part of the summative evaluation.
Summative evaluation aims to assess the results of student achievement so that the
level of competence that has been achieved can be determined. Summative
assessment is carried out by referring to the learning taxonomy proposed by
Bloom which consists of cognitive, psychomotor, and affective assessments.
On this occasion a case study tutorial was carried out as learning material
to deal with the actual tutorial at a future opportunity. On this occasion I will
explain the case of:
“My poor baby”
A healthy baby boy was delivered spontaneously at PONEK RSMP
Emergency Department, from a G2P0A1, 30 weeks old mother, with head
presentation, and clear amniotic fluid. From anamnesis, it was known that
there was a history of copulation a few hours before the baby was born.
During the pregnancy there was no history of hypertension, diabetes mellitus,
asthma, and heart disease. The baby was born in condition of not crying, pale,
HR 80x/minute, no muscle tone,and RR 30x/minute. APGAR score on minute

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 five was six, and on the tenth minute was nine. Post resusitation the baby was
given nasal oxygen 1 lpm, the cyanosis was reduced, and the patient were
brought to nursery room.
Physical Examination
General Examination
Activity: HR: 150x/minute Cyanosis (-), PB: 42 cm
teroksigenasi
Sucking RR: 70x/minute Dyspneu (+) BW: 1600 g
Reflexes: weak
Cry: weak Temo: 36,6oC Icteric (-) HC : 30 cm

Specific Examination:
Head : Nose: Nasal flaring (+), grunting (+)
Thorax : Chest Retraction (+) epigastrium, suprasternal(+),
intercostal(+)
Heart: Heart sound I and II normal, murmur (-)
Lung: Vesicular (+) normal, ronki (-)
Abdoment : Flat, supple, bowel sound (+)
Ekstremity : Hipotoni, no congenital malformation
Genitalia : No genitalia malformation
Anus : (+), meconium (+)
Downes Score :6

1.2 Purpose and Objectives

The purpose and objectives of this case study tutorial report are:
1. As a tutorial group task report that is part of the KBK learning system in
the Faculty of Medicine, University of Muhammadiyah Palembang.
2. Can resolve the case given in the scenario with the method of analysis and
learning of group discussion.
3. The achievement of the objectives of the tutorial learning method.

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 CHAPTER II
DISCUSSION
2.1 Tutorial Data
Tutor : dr. Ratih Pratiwi, Sp.OG
Moderator : Erwin Dwitama (702017048)
Board secretary : Abu Hanan Hammasin (702017018)
Desk secretary : Arika Shafa Nabila (702017077)
Tutorial Time : Tutorial Session 1
Tuesday, September 29, 2020 (08: 30-10: 30 WIB)
Tutorial Session 2
Thursday, September 2, 2020 (08:0-10.00 WIB)

Regulations:
1.Disable the cellphone or be idle.
2.Raise your hand when submitting an argument.
3.Permission when going out of the room.
4.Relax and pay attention when the tutor gives a briefing.
5.During the tutorial, keep the attitude and words.

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2.2 Scenario
“My poor baby”
A healthy baby boy was delivered spontaneously at PONEK RSMP
Emergency Department, from a G2P0A1, 30 weeks old mother, with head
presentation, and clear amniotic fluid. From anamnesis, it was known that
there was a history of copulation a few hours before the baby was born.
During the pregnancy there was no history of hypertension, diabetes mellitus,
asthma, and heart disease. The baby was born in condition of not crying, pale,
HR 80x/minute, no muscle tone,and RR 30x/minute. APGAR score on minute
five was six, and on the tenth minute was nine. Post resusitation the baby was
given nasal oxygen 1 lpm, the cyanosis was reduced, and the patient were
brought to nursery room.
Physical Examination
General Examination
Activity: HR: 150x/minute Cyanosis (-), PB: 42 cm
teroksigenasi
Sucking RR: 70x/minute Dyspneu (+) BW: 1600 g
Reflexes: weak
Cry: weak Temo: 36,6oC Icteric (-) HC : 30 cm

Specific Examination:
Head : Nose: Nasal flaring (+), grunting (+)
Thorax : Chest Retraction (+) epigastrium, suprasternal(+),
intercostal(+)
Heart: Heart sound I and II normal, murmur (-)
Lung: Vesicular (+) normal, ronki (-)
Abdoment : Flat, supple, bowel sound (+)
Ekstremity : Hipotoni, no congenital malformation
Genitalia : No genitalia malformation
Anus : (+), meconium (+)
Downes Score :6

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2.3 Term Clarifications
1. Downes Score Scale for assessing Respiratory Distress
Syndrome in infant.
2. Apgar Score Activity, pulse, grimmace, appearance,
respiration) is a test given to newborn soon
after birth.
3. Amniotic fluid Protectiove fluid contained by the aminotic
sac of gravid amniote. This fluid serves as
a cushion for the growing fetus, but also
serves to faccilitate the exchange of
nutrients, water, and biochemical products
between mother and fetus.
4. Hypoactive An abnormal decrease in motoric and
cognitive activity.
5. G2P0A1 Gravida 2, Partus 0 and Abortus 1.
6. Meconium Dark green stool comes from the baby’s
intestine.
7. Cyanosis A pathological condition that is
characterized by a bluish discoloration of
the skin or mucous membrane.
8. Recucitation The process of correcting physiological
disorders (such as lack of breathing or
heartbeat) in an acutely ill patient.
9. Grunting An expiratory noise made by neonates with
respiratory problems.
10. Hypotoni A stage of low muscles tone often
involving reduce muscle strength.
11. Dyspneu Breathing difficulties or shortness of
breath.

2.4 Problem Identification

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 1. A healthy baby boy was delivered spontaneously at PONEK RSMP
Emergency Department, from a G2P0A1, 30 weeks old mother, with head
presentation, and clear amniotic fluid. From anamnesis, it was known that
there was a history of copulation a few hours before the baby was born.
During the pregnancy there was no history of hypertension, diabetes
mellitus, asthma, and heart disease.
2. The baby was born in condition of not crying, pale, HR 80x/minute, no
muscle tone,and RR 30x/minute. APGAR score on minute five was six,
and on the tenth minute was nine.
3. Post resusitation the baby was given nasal oxygen 1 lpm, the cyanosis was
reduced, and the patient were brought to nursery room.
4. Physical Examination
General Examination
Activity: HR: 150x/minute Cyanosis (-), PB: 42 cm
teroksigenasi
Sucking RR: 70x/minute Dyspneu (+) BW: 1600 g
Reflexes: weak
Cry: weak Temo: 36,6oC Icteric (-) HC : 30 cm

5. Specific Examination:
Head : Nose: Nasal flaring (+), grunting (+)
Thorax : Chest Retraction (+) epigastrium, suprasternal(+),
intercostal(+)
Heart : Heart sound I and II normal, murmur (-)
Lung : Vesicular (+) normal, ronki (-)
Abdoment : Flat, supple, bowel sound (+)
Ekstremity : Hipotoni, no congenital malformation
Genitalia : No genitalia malformation
Anus : (+), meconium (+)
Downes Score : 6
2.5 Problem Analysis

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1. A healthy baby boy was delivered spontaneously at PONEK RSMP
Emergency Department, from a G2P0A1, 30 weeks old mother, with
head presentation, and clear amniotic fluid. From anamnesis, it was
known that there was a history of copulation a few hours before the
baby was born. During the pregnancy there was no history of
hypertension, diabetes mellitus, asthma, and heart disease.
a. What is the definiton of PONEK RSMP Emergency Department?
Answer:
b. What is the purpose of PONEK RSMP Emergency Department?
Answer:
c. How is the development of fetal embryology based on gestational
age?
Answer:
d. What is the meaning of a healthy baby boy was delivered
spontaneously at PONEK RSMP Emergency Department, from a
G2P0A1, 30 weeks old mother, with head presentation, and clear
amniotic fluid.?
Answer:
e. What is the risk factor of preterm birth?
Answer:
f. What is the impact of preterm birth?
Answer:
g. What is the relation of gestational age with the chief complaints?
Answer:
h. What is the relation between the history of copulation before the
baby was born with a chief complaints?
Answer:
i. What is the meaning of during the pregnancy there was no history
of hypertension, diabetes mellitus, asthma, and heart disease?
Answer:

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2. The baby was born in condition of not crying, pale, HR 80x/minute,
no muscle tone,and RR 30x/minute. APGAR score on minute five was
six, and on the tenth minute was nine.
a. What is the meaning of the baby was born in condition of not
crying, pale, HR 80x/minute, no muscle tone,and RR 30x/minute?
Answer:
b. What is the etiology of the baby was born was not crying?
Answer:
c. What is the impact of the baby was born was not crying?
Answer:
d. What is the meaning of the APGAR score on minute five was six,
and on the tenth minute was nine?
Answer:
e. What is the purpose and how is the calculation of the APGAR
score?
Answer:
f. What is the patophysiology of The baby was born in condition of
not crying, pale, HR 80x/minute, no muscle tone,and RR
30x/minute?
Answer:
g. What is the defintion of asphyxia?
Answer:
h. What is the clasfication of asphyxia?
Answer:
3. Post resusitation the baby was given nasal oxygen 1 lpm, the cyanosis
was reduced, and the patient were brought to nursery room.
a. What is the meaning of post resusitation the baby was given nasal
oxygen 1 lpm, the cyanosis was reduced, and the patient were
brought to nursery room?
Answer:
b. How is the procedure of the recucitation?
Answer:

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 c. What is the clasification of oxygenation?
Answer:
4. Physical Examination
General Examination
Activity: HR: Cyanosis (-), PB: 42 cm
150x/minute teroksigenasi
Sucking RR: 70x/minute Dyspneu (+) BW: 1600 g
Reflexes: weak
Cry: weak Temo: 36,6oC Icteric (-) HC : 30 cm

a. What is the interpretation of general examination?

Answer:
b. What is the patophysiology of general examination?
Answer:
c. What is the clasification of baby birth weight?
Answer:
d. What is the impact of low birth weight babies?
Answer:

5. Specific Examination:
Head : Nose: Nasal flaring (+), grunting (+)
Thorax : Chest Retraction (+) epigastrium, suprasternal(+),
intercostal(+)
Heart : Heart sound I and II normal, murmur (-)
Lung : Vesicular (+) normal, ronki (-)
Abdoment : Flat, supple, bowel sound (+)
Ekstremity : Hipotoni, no congenital malformation
Genitalia : No genitalia malformation
Anus : (+), meconium (+)
Downes Score: 6
a. What is the interpretation of specific examination?
Answer:

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 b. What is the patophysiology of specific examination?
Answer:
c. What is the downe score?
Answer:
d. What is the clasification of downe score?
Answer:
e. How to calculate the downe score?
Answer:
6. How to diagnose in this case?
Answer:
7. What is the differential diagnose in this case?
Answer:
8. What is the additional examination in this case?
Answer:
9. what is the working diagnose?
Answer:
10. what is the governance in this case?
Answer:
11. What is the complication in this case?
Answer:
12. What is the prognose in this case?
Answer:
13. What is the islamic view in this case?
Answer:

2.6 Conclusion

A healthy baby boy from a G2P0A1, 30 weeks old mother suffering

asphyxia, low birth weight, and respiratory distress syndrome et cause
immature organ.

2.7 Conceptual Framework

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 History : copulation

Risk Factor : Pre term birth

Immature of fetal organ

Aspyhxia Low birth Acute Respiratory

Distress Syndrome

REFERENCES

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