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PROGAM STUDI D-III KEPERAWATAN TRENGGALEK

POLITEKNIK KESEHATAN KEMENKES MALANG
TAHUN PELAJARAN 2021/2022
 1. Ahmad Ridani: Emergency Room Doctor ( DINA PANGESTUTI )

2. Desy Aprilia: Radiology doctor ( ANFATA HIKMATUL SISKA )

3. Radiology nurse ( FENTI TRISVIANA)

4. Eka Yulia Rizki Nasution: Lab Officer ( VELLA TIANDANI HARTONO )

5. Muhammad Yasir: ICU Doctor ( RISTA PRASETIANI )

6. Norsida Laili: ICU Nurse ( SINDY PUSPITA PUTRI )

7. Risa Hartati: Emergency Room Nurse ( ROKHMA MISTA FEBRIANAH )

Mrs. N, aged 25, was brought to the hospital by his family with a pale face, somnolence in
consciousness and a thin body, the family said that Mrs. N has a history of shortness of breath.
HIV+testing. Recently, the symptoms of pneumonia have reappeared, such as coughing and
difficulty breathing.

Doctor IGD : How is Mrs. N and her TTV nurse?

Nurse IGD : Mrs. N is not good doc and his BP is 130/80, HR 90x/minute, RR 26x/minute
and the family said Mrs. N has a history of shortness of breath.
Doctor IGD : Have X-rays been taken of the patient’s lung area?
Nurse IGD : Not yet doc, is it recommended to take an X-ray before the examination
continues?
Doctor IGD : Yes, immediately contact a radiologist
Nurse IGD : Okay, I’II tell the doctor about the results later

The emergency room nurse takes the patient to the radiology doctor for an examination

Nurse IGD : Excuse me, here I bring a patient who will have a lung examination that has
been suggested by the ER doctor.
Radiology Doctor : On what basis is the client underwent radiology examination?
Nurse IGD : This is the doctor, the patient complains of shortness of breath and then his
blood pressure is also high. So before doing further examination, the emergency room doctor advised to
do an X-ray first.
Radiology Doctor : Well then I will do an examination later I will give the results to my nurse

Radiologists and nurses perform examinations

Radiology Doctor : Okay nurse, please help prepare the necessary tools for x-rays
Radiology Nurse : Fine, my doctor will prepare the tools

5 minutes later ...............................................................

Radilogy Nurse : Doctor, the tools are ready
Radiology Doctor : Okay, noe let’s do the inspection

After a radiological examination, the results were .....

Radiology Doctor : This nurse is an x-ray, please give the results of the examination to the
emergency room nurse
Radiology Nurse : Ok doctor

The radiology nurse gives the results of the examination to the emergency room nurse
Radiology Nurse : Nurse .... this is the result of the radiology examination of Mrs. N
Nurse IGD : Ok thanks you nurse

Emergency room doctors and emergency room nurses discuss the results of radiological
examinations

Doctor IGD : From the results of the examination, it turned out that Mrs. N has problems in his lungs
Nurse IGD : Yes doc, then what are our next steps?
Doctor IGD : Give 5% dextrose fluid for the patient
Nurse IGD : Good doctor, sorry in advance did the doctor check the condition of Mrs. N
Doctor IGD : Yes nurse, my checked first
 The doctor examined Mrs. N

Doctor IGD : Nurse, so aftre I checked, there were still crackles around the field his lungs so make
preparations immediately and do suction to expedite the airway
Nurse IGD : Ok doc, first I will give informed consent first for the patient’s family Mrs. N agreed to
suction after the action was explained by the nurse. After the action was approved, the nurse
immediately performed suction on Mrs. N.
Doctor IGD : Nurse, I want to confirm the condition of Mrs. N earlier
Nurse IGD : Mrs. N condition the last is still the same, for the last TTV the TD 130/80, HR
80x/minute, RR 26x/minute
Doctor IGD : Has the suction action benn taken?
Nurse IGD : Yes doc, I did it immediately after I got it approval from family
Doctor IGD : So were we go, nurse, let’s do a nasal cannula
Nurse IGD : Wait a minute, doc, I’II take notes first, how do you do it?
Doctor IGD : So do the iv line dextrose 5% and nasal cannula and also ask the lab to do a complete
blood count. The results will be given to me soon, And also a throrax photo, nurse.
Nurse IGD : Yes, doc, I’II confirm again, doc. So Mrs. N was performed with 5% dextrose IV line,
nasal cannula, complete blood count and the chest x-ray. Previously I asked for the doctor’s signature as
proof of delegation, doc.
Nurse IGD : Thankyou doc
Doctor IGD : Yes, let’s go

After the laboratory examination, the laboratory officer submits the results to the nurse
and doctor in change of the ER for discussion.

Doctor IGD : Good morning, Mrs. Desi, I ask for your help to do a complete blood count for Mrs. N
Lab Officer : Ok doc
Doctor IGD : Approximately how long does it take for laboratory results?
Lab Officer : It takes about 2 hours doctor
Doctor IGD : Can’t it be accelerated?
Lab Officer : Ok, I’II try the doctor
 1 hour later .................................................
Lab Officer : This is result of a complete blood test from Mrs. N Hb 10.5g, Ht 30.1%, erythrocytes
3.67, leukocytes 10,000, platelets 235,000, The CD is 22.61% so the patient is declared HIV + doc
Doctor IGD : Thank you ma’am for your help, I will save the lab results first and maybe I will follow
up again. Thank you mom
Nurse IGD : Excuseme doctor, this is the results of the chest x-ray examination of Mrs. N
Doctor IGD : So what about the chest x-ray from Mrs. N?
Nurse IGD : This is a doctor, there is a loss of the costo phreincus angle and there is fluid as much as
500 cc doc. Maybe the doctor can still review
Doctor IGD : Oh yes, after being examined also in this x-ray, it looks right? There was a buildup of
fluid in his lung cavities and his lungs looked swollen. Now maybe this is why Mrs. N has shortness of
breath and pain
Nurse IGD : Doctor, is it better for us to consult with the ICU?
Doctor IGD : Okay, I can, before that, I will first consult with the dr in the ICU. How is the progress
of Mrs. N this nurse?
Nurse IGD : His condition is declining, his last BP is 80/50, HR is 110x/minute, RR 28x/minute. It’s
very concerning, doc, so I propose to get intensive care
Doctor IGD : Has his consciousness decreased?
Nurse IGD : Still somnolent doc
Doctor IGD : Then I will recommend to the ICU for the transfer of Mrs. N to the ICU

The doctor in charge of the ER consulted with the ICU doctor regarding the transfer of
Mrs. N via telephone

Doctor IGD : Assalamualaikum, I am Dani’s doctor as the person in charge of the ER. Here I intend
to consult and submit a transfer recommendation letter for Mrs. N from the ED to the ICU. My patient
Mrs. N is 25 years old with a history of pneumonia and results of HIV + examination. We have done
suction, infusion, and nasal cannula and the results of the chest x-ray are loss of costal phrenic angle and
there is a buildup of fluid in the lungs of about 500cc. Actually we planned to install WSD but the
patients condition was deteriorating so we immediately transferred the patient to another hospital ICU.
ICU Doctor : Okay, wait, I’II ask the nurse if there’s an empty bed. (Doctor asks nurse) It turned out
that there was one empty bed, doc, it could be for Mrs. N, will be soon we prepare
Doctor IGD : Ok, we will immediately transfer the patient to the ICU
Doctor IGD : Excuseme nurse, so Mrs. N will be transferred to the ICU, urgently request consent to
transfer the patient to his family.

The nurse asks for approval from the patient’s family regarding the transfer of the patient
to the ICU.

Nurse IGD : The family doc has approved the transfer of Mrs. N to the ICU
Doctor IGD : All right, nurse, for that, please immediately help the nurse for the transfer patient.
Please check TTV again before the patient is transferred
Nurse IGD : Ok doc, I’II check the TTV ok doc
Doctor IGD : Yes, nurse, and don’t forget to bring the patient’s status and patient files others and
submit to the ICU nurse
Nurse IGD : Ok doc

The nurse moved Mrs. N went to the ICU after doing TTV and brought a referral sheet
and patient status amd files.

Nurse IGD : Good afternoon, I am from the ER taking the patient on behalf of Mrs. N 25 years old.
And here are the patient’s status and files
ICU Nurse : Yes thanks

After the ER nurse has handed over, the ICU nurse will discuss with the ICU doctor for
further treatment.
ICU Nurse : This doctor is Mrs. N is diagnosed with pneumonia and is HIV positive
ICU Doctor : Well, the first action we will take is to monitor the patient’s condition for 1 time 24
hours. If there are no changes, further action will be given.
ICU Nurse : Good doctor, to keep my patient clean, I will take personal hygiene measures
ICU Doctor : Good work.