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Penyuluhan

OSTEOPOROSIS

dr. Aulia Ayu Hartini

Rumah Sakit Hermina Grand Wisata
21 Maret 2018

Apa itu Osteoporosis?
Suatu kondisi berkurangnya massa tulang yang
berakibat pada rendahnya kepadatan tulang,
sehingga tulang menjadi keropos dan rapuh

Autoanamnesis on July, 29th 2017
Anamnesis
Reason for Seeking Care

Weakness of his right limb since four hours
before hospital admission

29th 2017 Anamnesis Additional Complaining • Dysarthria and trouble understanding speech • Fatigue • Headache on the occipital of head . Autoanamnesis on July.

Autoanamnesis on July. holding the fork in his Day of and should be referred to hand. Decrease admission consciousness. 29th 2017 Anamnesis Present Health History He was taken to the nearest hospital. and the He was eating then doctor said he may be suddenly he can not diagnosed with a stroke. nausea. seizure were Four hours denied. his right body the bigger hospital for admission feel so weak. vomitting. prior to admission . Bogor Medical Center. He also further examination feel his speech weird Patient still feel the cause his wife can not Three hours weakness. fatigue. and understand what he prior to dizziness on the back of spoke clearly the head.

29th 2017 Anamnesis History of previous medication • The patient had a previous treatment in Bogor Medical Center and then reffered to Port Medical Center hospital for further examination . Autoanamnesis on July.

Autoanamnesis on July. 29th 2017 Anamnesis History of previous illness • Patient had Diabetes Mellitus history since more than 10 years. not frequently controlled and medicated • Patient denied history of head trauma • Patient denied history of hypertension disease • Patient denied history of heart disease .

10C .3 kg/m2 • Vital Sign Blood pressure : 180/110 mmHg pulse : 81x/menit RR : 21 x/menit temperature : 36.Physical Examination • General assessment : mild-illness • Conciousness : Composmentis • Weight : 75 kg • Height : 172 cm • IMT : 25.

deformities (-) Eyes : CA -/-. SI -/-.Physical Examination Head : normocephali. direct reflex +/+. pupil isokhor 3mm/3mm. indirect reflex +/+ ENT : abnormalities did not found Mouth : abnormalities did not found Neck : abnormalities did not found .

murmur (-) symmetric. Ronkhi -/-. gallop (. Wheezing -/- . Sonor Percussion +/+. • Right and left BJ I dan II breathing regular.Physical Examination Thorax Cor Pulmo • Cardiomegaly (-). Vesicular +/+. motion were ).

tenderness (-). edema -/-/-/-.Physical Examination • Abdomen : Supel. sianosis (-) . CRT <2 second. hepatosplenomegaly (-) • Ekstremities : warm.BU (+).

Neurogical Examination • Conciousness : Compos mentis • GCS : E4 V5 M6 Rangsangan Meningeal • Kaku kuduk (-) • Test Brudzinski I (-/-) • Test Brudzinski II (-/-) • Kernig Sign (-/-) • Laseque Sign (-/-) .

/ - • Triceps :N / N • Achiles :N / N • Patella :N/ N • Refleks Patologis • Babinski : +/- • Oppenheim : -/- • Chaddock : -/- • Gordon : -/- • Scaeffer : -/- • Hoffman -Trommer : -/- ./ - • Biceps :N / N • Hypertone : .Neurogical Examination Motoric Reflex Muscle tone • Refleks Fisiologis • Hypotone : .

Neurogical Examination Motoric Muscle strength 4444 5555 Ekstremitas Superior Dextra Ekstremitas Superior Sinistra 4444 5555 Ekstremitas Inferior Dextra Ekstremitas Inferior Sinistra Siriraj Stroke Score : -2 .

7 – 1.7 13-17 g/dl Hematokrit 41. 29 th 2017 Pemeriksaan Hasil Nilai Normal Satuan DARAH RUTIN Hemoglobin 13.000 150rb-400rb /uL KIMIA DARAH Glukosa Darah Sewaktu 289 70 – 140 mg/dL Ureum 29.7 10 – 50 mg/dL Creatinin 1.000-10.3 mg/dL SGOT 18 0 – 37 U/L SGPT 17 0 – 49 U/L . Laboratory Examination On July.200 5.37 0.000 /uL Trombosit 316.7 40-52 % Leukosit 10.

59 years old.Resume • A man. History of Diabetes Mellitus more than 10 years. dizziness (+). not frequently controlled and medicated. • Phsycal examination BP : 180/110 mmHg • Neurogical Examination Babinski Test +/- . Dysarthria (+). fatigue (+). suddenly get a weakness of the right limb since four hours before hospital admission.

Working Diagnosis • Non Haemorrhagic Stroke + Diabetes Mellitus .

Therapy • Hospitalized + Consultation to the neurologist and internal medicine • IVF Asering 6 tpm • Citicolin 2 x 500 mg iv • Mecobalamin 3 x 500 mg iv • Amlodipin 1 x 10 mg tab • Clopidogrel 1 x 75 mg • Amaryl 1 x 2 mg • Diet DM 1900 kkal • Sleeding scale • Adviced non contras head CT scan .

Prognosis • Quo ad vitam : Ad bonam • Quo ad functionam : Dubia ad bonam • Quo ad sanationam : Dubia ad bonam .

FOLLOW UP .

Diabetes Mellitus • P: Continue therapy. dizziness (-) • O: BP: 160/80 mmHg. fatigue (+). dysarthria (+). other physical examination is normal.July 30th 2017 • S: Improvement the weakness of limbs. urinary check up . muscle strength 4444/5555/4444/5555 • A: Non Haemorrhagic Stroke.

other physical examination is normal.July 31st 2017 • S: Improvement the weakness of limbs. muscle strength 5555/5555/4444/5555 • A: Non Haemorrhagic Stroke. consul to medical rehabilitation specialist . dizziness (+) • O: BP: 140/80 mmHg. Diabetes Mellitus • P: Continue therapy. Frego 2 x 50 mg.

other physical examination is normal.August 1st 2017 • S: Weakness (+). muscle strength 5555/5555/4444/5555 • Sleeding Scale : • Glucose on 06. forneuro 1 x 1.00 : 204 mg/dL • A: Non Haemorrhagic Stroke. profil lipid check up • Result of medical rehab specialist : should have excersice mobilitation one time a day.00 : 167 mg/dL • Glucose on 11. Frego 2 x 50 mg.00 : 186 mg/dL • Glucose on 16. Target discharge : excercise walk with cane . Dizziness (+) • O: BP: 110/70 mmHg. Diabetes Mellitus • P: Continue therapy.

Diabetes Mellitus • P: Continue therapy. other physical examination is normal. atrovastatin 1 x 20 mg .9 mg/dL • Cholesterol total 246 mg/dL • Cholesterol HDL 40 mg/dL • Cholesterol LDL 172 mg/dL • Trigliserida 169 mg/dL • A: Non Haemorrhagic Stroke. muscle strength 5555/5555/4444/5555 • Laboratoy findings : • Uric acid 5.August 2nd 2017 • S: (-) • O: BP: 120/80 mmHg.

00 : 166 mg/dL • Glucose on 11.5 mg • Citicholin 2 x 500 mg • Mecobalamin 2 x 500 mg • Frego 2 x 5 mg • Amlodipin 1 x 10 mg • Clopidogrel 1 x 75 mg • Metformin 1 x 500 mg • Eclid 3 x 50 mg • Metrix 1 x 2mg • Aminefron 3 x 1 .00 : 315 mg/dL • A: Non Haemorrhagic Stroke.00 : 213 mg/dL • Glucose on 16. Diabetes Mellitus • P: May go home with recommended internal medicine specialist. other physical examination is normal. muscle strength 5555/5555/4444/5555 • Sleeding Scale : • Glucose on 06. with therapy: • Alprazolam 1 x 0.August 3rd 2017 • S: hard to sleep • O: BP: 110/70 mmHg.

ANALISA KASUS .

saat istirahat.Diagnosis Stroke Non Hemoragik Gejala Stroke Non Hemoragik Stroke Hemoragik Onset atau awitan Mendadak Mendadak Saat onset Istirahat Sedang aktif Nyeri kepala +/. muntah. dan penurunan kesadaran . tanpa adanya kejang. + Penurunan Kesadaran . +++ Kejang . +++ Pada anamnesis didapatkan keluhan kelemahan yang mendadak. nyeri kepala. + Muntah .

Diagnosis Stroke Non Hemoragik .

Apatis 1 Apabila score yang didapatkan < 1 Koma 2 maka diagnosisnya stroke non hemroagik.1 x tekanan diastol) – (3 x ateroma) – 12. Diagnosis Stroke Non Hemoragik Variabel Gejala Klinis Skor Siriraj Stroke Score = (2. Diabetes Mellitus Iya 1 Tidak 0 .5 x 0) + (2 x 0) + Tanda-tanda atheroma (2 x 1) + (0. Claudicatio Intermitten hemoragik Iya 1 Tidak 0 3.2  stroke non Tidak 0 2. Tidak 0 Sakit Kepala Iya 1 Tidak 0 Siriraj Stroke Score pada kasus = (2. Angina Pectoris Iya 1 1) – 12 = .1 x 110) – (3 x 1.5 x derajat kesadaran) + (2 x muntah) + (2 x Derajat Kesadaran Sadar 0 sakit kepala) + (0. dan apabila didapatkan skor >1 maka diagnosisnya stroke Muntah Iya 1 perdarahan.

Tatalaksana Stroke di IGD Evaluasi Cepat dan Penatalaksanaan Penatalaksanaan Terapi Umum Diagnosis umum di ruang rawat Medis Lain • Anamnesis • Stabilisasi jalan • Cairan • Pemantauan kadar • Pemeriksaan Fisik napas dan • Nutrisi glukosa darah • Pemeriksaan pernapsan • Analgesik dan neurologis • Stabilisasi antimuntah sesuai hemodinamik indikasi • Pemeriksaan awal • H2 antagonis fisik umum apabila ada indikasi • Pengendalian • Pemeriksaan peninggian tekanan penunjang lanjutan intrakranial • Rehabilitasi • Penanganan • Edukasi transformasi • Disharge planning hemoragik (rencana • Pengendalian kejang pengelolaan pasien • Pengendalian suhu di luar rumah sakit) tubuh • Pemeriksaan penunjang .

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Tatalaksana Hipertensi .

Pemberian obat-obatan oral aksi cepat akan memberi manfaat untuk menurunkan tekanan darah dalam 24 jam awal Mean Arterial Pressure (MAP) dapat diturunkan tidak lebih dari 25%. Pada fase awal standard goal penurunan tekanan darah dapat diturunkan sampai 160/110 mmHg .• Manajenem penurunan tekanan darah pada pasien dengan hipertensi urgensi tidak membutuhkan obat-obatan parenteral.

Diagnosis Diabetes Mellitus .

Konsensus Pengendalian dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia. Jakarta. PERKENI. PB. 2015 . Tatalaksana Diabetes Mellitus Source :Perkumpulan Endokrinologi Indonesia.