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    1) A 2 year and 5 month old girl presented with a hoarse voice and frequent coughing. Her mother reported she had been suffering from acute pharyngitis a few days prior. 2) On examination, the girl had a heart rate of 122 beats per minute, oxygen saturation of 98%, axillary temperature of 36.1°C, and weight of 13kg. Lung examination found no rales. 3) She was diagnosed with acute rhinopharyngitis (common cold) based on her symptoms and history of recent upper respiratory infections. She was prescribed ibuprofen and loratadine syrups and advised 4 days of rest.

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    1) A 2 year and 5 month old girl presented with a hoarse voice and frequent coughing. Her mother reported she had been suffering from acute pharyngitis a few days prior. 2) On examination, the girl had a heart rate of 122 beats per minute, oxygen saturation of 98%, axillary temperature of 36.1°C, and weight of 13kg. Lung examination found no rales. 3) She was diagnosed with acute rhinopharyngitis (common cold) based on her symptoms and history of recent upper respiratory infections. She was prescribed ibuprofen and loratadine syrups and advised 4 days of rest.

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    11 views3 pages

    Dau C

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    ScribdTranslations
    1) A 2 year and 5 month old girl presented with a hoarse voice and frequent coughing. Her mother reported she had been suffering from acute pharyngitis a few days prior. 2) On examination, the girl had a heart rate of 122 beats per minute, oxygen saturation of 98%, axillary temperature of 36.1°C, and weight of 13kg. Lung examination found no rales. 3) She was diagnosed with acute rhinopharyngitis (common cold) based on her symptoms and history of recent upper respiratory infections. She was prescribed ibuprofen and loratadine syrups and advised 4 days of rest.

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    of 3

    MENTERI KESEHATAN

    H.H coquimbo
    DAU No. 15511691
    Layanan Perawatan Gawat Darurat Primer The DATA URGENT CARE Korelatif 5962
    DATA PASIEN
    Nama: Colomba Bahamondes Bull Tanggal 07-05-2019
    BERLARI: 25.583.125-9 kedatangan
    Tanggal Lahir: 21-11-2016
    21:01:00
    Usia: 2 tahun, 5 bulan, 16 hari Jam
    Alamat: EL SAUCE 101 Kota atau Kota:
    PINTU KONDOMINIUM
    SINDEMPART
    DARI MATAHARI
    Komune: coquimbo
    DATA MASUK PASIEN
    Dikirim oleh:
    Pusat Pengiriman:
    ALASAN UNTUK KONSULTASI
    Jumlah Keripik:

    nomor lama:

    Ramalan: fonasa

    Perjanjian: Fonase B
    Kategorisasi:

    P. 1
    Februari
    TIDA Katego Tanggal jam
    Kategori Alasan Resmi
    K. ri Ibu menunjukkan CONSTANCE
    07-05-2019
    1 C5 bahwa putrinya PAOLA RIOS
    21:32
    memiliki suara serak BASTÍAS
    Ibu menunjukkan bahwa putrinya memiliki suara serak
    dan dan banyak
    banyak batuk.batuk.

    Catatan Tanda Vital:

    saturasi O2 (%)
    (Pulsa/Menit)

    Pengamatan
    Suhu aksila

    Berat (kg)
    Pulsa
    Ibu merujuk
    bahwa
    beberapa
    122 98 36.1 13 hari yang
    lalu dia
    menderita
    faringitis
    akut

    PERHATIAN TANGGAL/WAKTU
    07-05-2019 21:33
    DATA KESEHATAN
    Anamnesa/Evolusi
    Tanggal/Waktu : 07-05-2019 21:35
    Resmi: Christian Vargas Alday

    - Batuk kering, disfonia, tidak demam, riwayat 2 gambar


    pernapasan dalam beberapa hari terakhir. MP (+9, tidak ada rales.
    Mulut. Kongestif tanpa eksudat

    Diagnosis:
    Diagnosis
    ( teks ) : _ _ _ _ _ _ Rinofaringitis akut (common cold)
    Klasifikasi Diagnostik ICD-10: Nasofaringitis akut (flu biasa) - J00 (Utama)

    Relevansi: Ya GES: TIDAK Masalah kesehatan:

    Indikasi Discharge
    Istirahat 4 hari

    Resep Eksternal
    p Resep Pengamatan

    P. 2 dari 2
    MENTERI KESEHATAN
    H.H coquimbo
    DAU No. 15511691
    Layanan Perawatan Gawat Darurat Primer The DATA URGENT CARE Korelatif 5962
    Tanggal 07-05-2019
    kedatangan
    21:01:00
    Jam
    Resep Eksternal
    p Resep Pengamatan
    Ibuprofen 100 mg/5 ml Suspensi Oral, botol 100 ml: 5 Mililiter setiap 8 Jam selama 3
    Hari
    Loratadine 5 Mg/5 Ml Sirup (40 ml): 2,5 Mililiter setiap 12 Jam selama 5 Hari

    Tim Klinis TANGGAL DEBIT: 07-05-2019


    WAKTU TINGGI: 21:36
    Instrumen Nama Resmi
    CONSTANCE PAOLA RIOS Tujuan: Pulang
    perawat BASTÍAS
    Dokter Christian Vargas Alday
    Petugas Pelepasan:

    Christian Vargas Alday (Dokter)


    Fungsi LARI 12.619.648-2
    memulangkan

    P. 2 dari 2

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